Category: Today’ News Headlines

How to Take Charge of Your Medical Care

Screen Shot 2018-11-13 at 4.34.13 AMWalking into a doctor’s office or hospital can be intimidating. But when you go armed with the right tools and frame of mind, you can walk out of that appointment or hospital stay feeling more confident and satisfied. Learn how to ask your questions, either for yourself or a loved one, figure out your various medical options and determine the best course of action. Just having that knowledge in your pocket can help you feel better.

When You’re Healthy

It can be hard to think about dealing with a medical emergency when you are well, but the things you do now can really pay off later.

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Get Your Paperwork in Order

As much as we don’t want to think about the end of our own lives, it’s a good idea to get a head start while you’re still relatively young and in good health. Don’t just assume your partner or family can read your mind about whether or not you’d want to be put on a feeding tube or be resuscitated if something went wrong. Yes, that means having an advance care directive on hand. This also means appointing a proxy granting him or her power-of-attorney to make your medical decisions if you’re not able to do so.

If you are fortunate enough to have some form of health insurance, always have your current policy information handy and organized in case you need it. In fact, keep it in an easily accessible folder, along with an updated list of all the medications you’re taking — prescribed, over-the-counter and supplements — and a record of your personal and family medical history. Regardless of whether you’re going to see your general practitioner about a viral infection or end up in the E.R. with a broken foot, you’re going to be asked about your medical history, so it’s best to come with as much detail as possible.

Know Your Rights

In the United States, we have various sources setting forth our rights as patients. HIPAA, for example, guarantees on a federal level a patient’s right to get a copy of his medical records, as well as the right to keep them private. There is also the Patient’s Bill of Rights that is part of the Affordable Care Act, though it primarily deals with insurance-specific rights, rather than general health care. Some states, like New York, do have a Patients’ Bill of Rights which grants additional protections, like receiving an itemized bill and explanation of all charges, as well as a right to get emergency care if you need it, meaning that hospitals are not permitted  to turn away a patient requiring emergency care, regardless of where they live and regardless of whether they can pay the bill. In addition, some organizations, like the American Hospital Association, have their own guidelines outlining the rights of patients.

All patients also have the right of informed consent, meaning that if you require any sort of treatment or procedure, your physician should explain what will happen to you in a way you understand, which allows you to make an educated decision. Being familiar with informed consent before needing medical treatment can help you achieve the best outcome possible.

Schedule Regular Appointments

It’s important to stay on top of your health, so schedule regular check-ups to ensure everything is in working order. If you live somewhere with numerous options for medical care, you’ll have the task of finding and then selecting a doctor who best serves your needs. This is true when dealing with your physical as well as a mental health. Once you’re at the appointment, make the most of your time with your doctor, by asking any questions you may have about your body and health, and requesting a full blood test workup.

WeWork’s Rise: How a Sublet Start-Up Is Taking Over

Screen Shot 2018-11-13 at 4.30.28 AMCritics have derided WeWork as overvalued and vulnerable to the next downturn. But the company holds so many leases in so many cities, it might hold more power than its landlords.

Real estate titans have long scoffed at WeWork, which in eight short years has managed to attain a $20 billion valuation by selling short-term leases for shared office space with a mixture of stylish design and free-flowing alcohol.

Derided by some as a real estate company masquerading as a technology company, it has been called everything from a “$20 billion house of cards” to a “Ponzi scheme.”

The naysayers argue that WeWork’s business model looks brilliant only in a rising economy that has allowed it to lock in long-term leases and then re-rent that space to other businesses at a premium. The enormous valuation it has obtained is higher than that of Boston Properties and Vornado, two of the country’s biggest office-space landlords — companies that actually own the kind of space that WeWork usually rents.

Now, with interest rates creeping higher, residential real estate prices flattening and fears of an economic slowdown coming, real estate insiders are gleeful at the notion that a downturn could be an existential threat for the company.

But a funny thing happened as WeWork has scaled up all over the globe: It may have become too big to fail.

WeWork has gobbled up leases for so much space in so many cities, there’s a compelling case to be made that its landlords wouldn’t be able to afford for it to go under.

Because of WeWork’s size, “they have more power in a down market,” said Thomas J. Barrack Jr., the longtime real estate investor and founder of Colony Capital.

The company is scheduled to release third-quarter financial results on Tuesday. A WeWork spokesman, citing the coming report, declined to comment.

The conventional wisdom is that when the economy turns south, WeWork’s customers — many of which are start-ups and may be the most vulnerable — will simply walk away. The flexibility of WeWork’s short-term leases is part of its appeal, after all.

READ MORE: https://www.nytimes.com/2018/11/13/business/dealbook/wework-office-space-real-estate.html?action=click&module=Editors%20Picks&pgtype=Homepage

The scripted chaos of Stephen Curry

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Like a seasoned yogi realizing he can deepen his stretch, there is a zen-like quality to Stephen Curry’s exacting hunt for the perfect shot.

On Sunday against the Nets, he continued his streak of making at least five threes in the first seven games of the season, breaking the record George McLoud set in 1995. Curry is on pace to shatter the single-season record in three-pointers made, which he set at 402 in 2015-2016, which shattered his own the previous record of 286 in 2014-15, which shattered his own previous record of 272 in 2012-13.

In the offseason, he told the Wall Street Journal, “I might be delusional, but I feel like I can get better at putting the ball in the basket.” His personal trainer, Brandon Payne, added that “he’s not even close” to his peak. Together, to hear it from Pablo Torre on ESPN’s High Noon, Curry and Payne devised a drill in which Curry had to hit 20 sets of shots, differing in spot and style, from the perimeter, and swish six of 10 free throws. It was called “Perfection.”

Up against the Warriors’ decadence, tried-and-true theories about the professional athlete’s insatiable drive fall away. It’s hard not to wonder why they’re not satisfied when they’re already deemed unbeatable. What an extravagance. And what do they have left to improve?

But the difficulty of Curry’s shots aren’t mere theatre. If he wants to actually shoot the ball, defenses are going to force the world’s best decoy to chase perfection and master chaos.

Consider: Opponents would rather allow Kevin Durant to play one-on-one against mismatches and let Jordan Bell throw down alley-oops than allow Curry to shoot threes. Hell, they’d rather let him get lay ups: the Warriors often free Curry up by running him off screens as he cuts to the rim, usually as a fake-out before he sprints to the corner pocket. Against the Jazz on Oct. 19, Curry was aggressively chased off the three-point line by Dante Exum and hounded on pick and rolls by Ricky Rubio and Rudy Gobert, whose 7’9 wingspan gave Curry pause. They tugged at his jersey and laid him out with hard screens. Royce O’Neale even gave him a nosebleed. Curry didn’t hit a three until more than halfway through the second quarter, on a uniquely unguardable play illustrated by NBA analyst Jared Dubin.

Curry tried to push the game to devolve into chaos, his high-risk way of forcing the issue: boxing out for offensive rebounds, throwing dangerous outlets, whipping rainbow passes across the floor. But the Jazz’s length, athleticism, and discipline tipped the scales in their balance, up until Jonas Jerebko’s game-winning putback for the Warriors.

As though he took note, Curry had, to put it lightly, more success against the Wizards on Oct. 24, scoring 51 points and drilling 11 threes. The Wizards tried to switch and trap Curry mercilessly, forcing the ball out of his hands. The only problem: he got rid of it by flinging it into the basket.

READ MORE: https://www.sbnation.com/2018/10/31/18047242/stephen-curry-highlights-golden-state-warriors-mvp

California Tenants Take Rent Control Fight to the Ballot Box

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LOS ANGELES — From pulpits across Los Angeles, Pastor Kelvin Sauls has spent the past few months delivering sermons on the spiritual benefits of fasting. The food in the sermon is rent, and landlords need less of it. “My role is to bring a moral perspective to what we are dealing with around the housing crisis,” Pastor Sauls explained.

In addition to a Sunday lesson, this is an Election Day pitch. Pastor Sauls is part of the campaign for Proposition 10, a ballot initiative that would loosen state restraints on local rent control laws. The effort has stoked a battle that has already consumed close to $60 million in political spending, a sizable figure even in a state known for heavily funded campaigns.

Depending on which side is talking, Proposition 10 is either a much-needed tool to help cities solve a housing crisis or a radically misguided idea that will only make things worse. Specifically, it would repeal the Costa-Hawkins Rental Housing Act, which prevents cities from applying rent control laws to single-family homes and apartments built after 1995.

The initiative drive builds on the growing momentum of local efforts to expand tenant protections. “In the midst of the worst housing and homeless crisis that our country has ever seen, how does a bill that restricts local government’s ability to address it go untouched?” asked Damien Goodmon, director of the Yes on 10 campaign, which is primarily funded by the AIDS Healthcare Foundation in Los Angeles.

Proposition 10 has won prominent endorsements from backers including the California Democratic Party and The Los Angeles Times. But opponents have also amassed editorials and broad support, mainly from a coalition of construction unions, nonprofit housing developers and local chambers of commerce.

Among those fighting the initiative is a relatively recent class of landlords — private equity firms like Blackstone Group, which accumulated a vast residential real estate portfolio after the housing market collapse a decade ago. Landlords warn that repealing the Costa-Hawkins law would create deep uncertainty among developers, making California’s housing shortage worse by discouraging construction.

“This is a serious problem, but the solution to that problem should not land solely on the rental housing industry,” said Tom Bannon, president of the California Apartment Association, a landlords’ group.

The California fight reflects a renters’ rights movement that is bubbling up in churches and community centers across the country, a semi-coordinated stand of low-income tenants against the gentrifying American city. Last month in the Roxbury section of Boston, about 300 people gathered for an afternoon assembly on how to blunt evictions and economic displacement. The event offered free child care and had organizers speaking English, Spanish and Cantonese.

‘Transgender’ Could Be Defined Out of Existence Under Trump Administration

Screen Shot 2018-10-21 at 6.25.10 PMWASHINGTON — The Trump administration is considering narrowly defining gender as a biological, immutable condition determined by genitalia at birth, the most drastic move yet in a governmentwide effort to roll back recognition and protections of transgender people under federal civil rights law.
A series of decisions by the Obama administration loosened the legal concept of gender in federal programs, including in education and health care, recognizing gender largely as an individual’s choice and not determined by the sex assigned at birth. The policy prompted fights over bathrooms, dormitories, single-sex programs and other arenas where gender was once seen as a simple concept. Conservatives, especially evangelical Christians, were incensed.

Now the Department of Health and Human Services is spearheading an effort to establish a legal definition of sex under Title IX, the federal civil rights law that bans gender discrimination in education programs that receive government financial assistance, according to a memo obtained by The New York Times.
The department argued in its memo that key government agencies needed to adopt an explicit and uniform definition of gender as determined “on a biological basis that is clear, grounded in science, objective and administrable.” The agency’s proposed definition would define sex as either male or female, unchangeable, and determined by the genitals that a person is born with, according to a draft reviewed by The Times. Any dispute about one’s sex would have to be clarified using genetic testing.

“Sex means a person’s status as male or female based on immutable biological traits identifiable by or before birth,” the department proposed in the memo, which was drafted and has been circulating since last spring. “The sex listed on a person’s birth certificate, as originally issued, shall constitute definitive proof of a person’s sex unless rebutted by reliable genetic evidence.”

The new definition would essentially eradicate federal recognition of the estimated 1.4 million Americans who have opted to recognize themselves — surgically or otherwise — as a gender other than the one they were born into.
“This takes a position that what the medical community understands about their patients — what people understand about themselves — is irrelevant because the government disagrees,” said Catherine E. Lhamon, who led the Education Department’s Office for Civil Rights in the Obama administration and helped write transgender guidance that is being undone.

The move would be the most significant of a series of maneuvers, large and small, to exclude the population from civil rights protections and roll back the Obama administration’s more fluid recognition of gender identity. The Trump administration has sought to bar transgender people from serving in the military and has legally challenged civil rights protections for the group embedded in the nation’s health care law.

MORE ON THIS STORY: https://apple.news/AApI1C7vASruuUKqJyd5nEA

This is the front line of Saudi Arabia’s invisible war

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A battlewagon roarsthrough the gates of a beach villa on Yemen’s Red Sea coast, a luxury property with a 20-foot chandelier and indoor pool, now repurposed as a busy field hospital. Young fighters, drenched in the sweat of the battle, leap from the pickup and hoist a wounded comrade, blood streaming down his face, into the emergency ward.

A piece of shrapnel had sliced his nose and lodged in his right eye. The fighter, a portly young man named Ibrahim Awad, groans. “Please, Hameed” he calls to a fellow fighter, a glint of panic in his one good eye. “My head feels heavy.”

The Saudi-led war in Yemen has ground on for more than three years, killing thousands of civilians and creating what the United Nations calls the world’s worst humanitarian crisis. But it took the crisis over the apparent murder of the dissident Jamal Khashoggi in a Saudi consulate two weeks ago for the world to take notice.

Saudi Arabia’s brash young crown prince, Mohammed bin Salman, under scrutiny over the Khashoggi case, now faces a fresh reckoning for his ruthless prosecution of the war in Yemen — yet another foreign policy debacle for Saudi Arabia, and a catastrophe for the Arab world’s poorest country.

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Outside Yemen, the catastrophic war has been largely overlooked.

The Saudis barred foreign journalists from northern Yemen, scene of the biggest airstrike atrocities and the deepest hunger. The conflict is mostly unknown to Americans, whose military has backed the Saudi-led coalition’s campaign with intelligence, bombs and refueling, leading to accusations of complicity in possible war crimes.

Since June, the war has centered on the Red Sea port of Hudaydah. After a tense journey along a coastal highway prone to bombs and ambushes, we made a rare visit this month to the chaotic battlefield at the city gates. There we saw what Prince Mohammed’s war looks like up close, from one side, among those Yemenis who are fighting and dying in it.

READ MORE: https://www.nytimes.com/interactive/2018/10/20/world/middleeast/saudi-arabia-invisible-war-yemen.html

Mammograms, CT scans, X-rays: Assessing the risk of all that radiation

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An X-ray for knee pain. A CT scan for a head injury. Mammograms every other year, starting at age 50. Over a typical lifetime of radiation exposure from medical tests, a person can start to wonder: How much is too much?

There’s no formula for answering that, experts say, in part because the health effects of radiation don’t add up in a linear way. And while massive doses of radiation are known to be harmful, the small doses used in routine tests are usually safe, especially compared with other health-care choices people make without thinking twice.

“Radiation does have some risk,” says Russ Ritenour, a medical physicist at the Medical University of South Carolina in Charleston. “But it is important for medicine. And in most cases, the risk is quite small compared to the risk of taking too much Advil over your life and other things like that.”

Ionizing radiation – the type that can damage cells – is a daily fact of life even for people who never go to the doctor. Rocks and soil contain radioactive materials, which also appear in our food, our bones and the air we breathe. Cosmic rays barrage us with radiation from space, with higher doses at altitude and on airplanes.

Overall, a person in the United States gets an annual average of about 3 millisieverts (mSv) of background radiation. (Millisieverts are units that measure radiation absorbed by our bodies.)

Added exposure, totaling another 3 mSV each year for the average American, comes from such man-made sources as power plants that run on coal and nuclear fuel, and consumer products including TVs and computer screens. But most of the extra radiation we get comes from X-rays and CT scans, Ritenour says.

Most routine diagnostic tests emit extremely small amounts of radiation. A patient will get about 0.001 mSv from an arm X-ray, 0.01 mSv from a from a panoramic dental X-ray, 0.1 mSv from a chest X-ray and 0.4 mSv from a mammogram, according to Harvard Medical School. (Those estimates vary somewhat, depending on the source and on the specific device used, the size of the patient and other factors.)

CT scans, which take multiple X-rays to create cross-sectional images, deliver higher doses: 7 mSv for a chest CT, and 12 mSV for a full-body scan, according to the National Cancer Institute. Studies have found doses of 25 mSv or more from a PET/CT, an imaging test that requires ingesting a radioactive substance.

With the increasing availability and affordability of imaging technologies, people are getting more tests than they used to. Today, Americans receive more than 85 million CT scans each year, compared with 3 million per year in the 1980s.

Many of those tests may be excessive, argue some researchers, who have been trying to quantify the risks of our increasing use of ionizing radiation in medical imaging. A 2009 study by scientists at the National Cancer Institute estimated that 2 percent – or about 29,000 – of the 1.7 million cancers diagnosed in the United States in 2007 were caused by CT scans. In a 2004 study, researchers estimated that a 45-year-old who planned to get 30 annual full-body CT exams would have a nearly 2 percent lifetime risk of dying of cancer. Other studies are underway to clarify risks, including in children.

But evaluating an individual’s chances of experiencing a bad outcome from any given test or a combination of tests is tricky. Some of the most definitive data on radiation’s health effects come from long-term studies of tens of thousands of people who survived the atomic bombings of Hiroshima and Nagasaki in 1945. Sudden exposure to 1,000 mSv, those studies have found, increased the risk of getting cancer by 42 percent and increased the risk of dying of cancer by 5 percent.

Risks of secondary cancers also rise with the high doses of radiation used in some cancer treatment – a trade-off that often makes sense because doing nothing would be even riskier.

Evidence is murkier about health consequences from lower doses. The Food and Drug Administration estimates that 10 mSv of radiation, an amount typical for a CT of the abdomen, increases lifetime cancer risk by 1 in 2,000. But that calculation assumes that risks are proportional to dose, which has not been proved. Below 10 mSv, there is not enough good data to draw clear conclusions.

There is also no absolute number of scans that constitute a tipping point for health, Ritenour says, in part because our bodies have repair mechanisms that can fix cells damaged by radiation. So while every scan adds to the chances that a problem will occur, radiation doesn’t build up in the body. And damage doesn’t accumulate like water poured into a glass. Theoretically, he adds, 10 mammograms in one day would be riskier than one mammogram a year for 10 years.

“All you can really say is that there’s very little chance a problem can happen” at low doses, says Ritenour, who often consults with patients who have questions about radiation. “It is very unsatisfying in a way. You can’t say, ‘You will definitely have no problems.’ ”

Although health risks from most imaging tests are extremely small, fear can be hard for people to rationalize away. There is a one-in-a-million chance of getting cancer from a chest X-ray, Ritenour says, the same tiny chance of getting cancer from toxins in peanut butter.

Making decisions about diagnostic tests ultimately requires comparing their potential benefits with their potential harms. That balance can be easy to measure if someone has a broken leg or a bullet fragment lodged in their body. But decisions become more nuanced for tests such as mammograms, which catch breast cancers in some women but also produce false alarms that cause unnecessary anxiety and follow-up testing that entails even more radiation. Given the trade-offs, the U.S. Preventive Services Task Force offers evidenced-based advice about many screening tests, and those guidelines can be helpful starting points for conversations with your doctor.

Online calculators can also offer food for thought. When I entered my location, estimated miles traveled by airplane and other information into a tool maintained by the Nuclear Regulatory Commission , I learned that I absorb an estimated 318 millirems, or 3.18 mSv, of radiation each year. Each millirem, according to this government agency, equates to a 1.2-minute reduction in life span, the same accrued from eating 10 extra calories (assuming I’m overweight) or crossing the street three times. In other words, I am likely to die 4 1/2 hours sooner than I would if I could avoid radiation altogether.

While some researchers work to better understand and communicate the risks of radiation, others are refining technologies and procedures, adds Louis Wagner, a diagnostic medical physicist at McGovern Medical School at the University of Texas Health Science Center at Houston. And the field has come a long way.

For example, after studies found an elevated risk of breast cancer among women who had received X-rays for childhood scoliosis, experts say, many health centers switched from taking images from the front of the body to taking images from behind to reduce the cancer risk.

Technicians have made mistakes, such as using higher doses of radiation than needed during scans, and some mistakes have led to expensive legal cases, Wagner says. But those cases are rare. And most machines are now equipped with safety features to avoid overexposure.

“The profession has sought to make use of radiation very, very beneficial to patients with minimal and, I believe, unrecognizable risks,” Wagner says. “I want patients to know the medical profession is avidly pursuing better ways to use radiation to increase the benefits-to-risks ratio. I think good progress is being made.”