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The Health 202: Trump will propose executing drug dealers. But only in some already legal cases.


President Trump has admired Philippine President Rodrigo Duterte as a model for cracking down on drug crimes. (AP Photo/Bullit Marquez, File)

President Trump today will emphasize that the death penalty can be extended to drug dealers. But compared to his tough talk about executing a class of people he seems to view as street thugs, the president’s proposal aimed at curbing the opioid epidemic is a little less than it seems.

On a visit to New Hampshire, one of the states hardest-hit by opioid addiction and overdose, Trump will officially propose that his Justice Department pursue stiffer penalties — including capital punishment — for traffickers when appropriate under the law.

That last part is important as the administration had been considering making trafficking in even small doses of fentanyl — a deadly synthetic opioid — a capital offense. But instead, Trump is urging more aggressive prosecution of drug dealers, and only seeking the death penalty when it’s already available.

U.S. law allows for the death penalty to be applied in four types of drug-related cases, according to the Death Penalty Information Center: murder committed during a drug-related drive-by shooting, murder committed with the use of a firearm during a drug-trafficking crime, murder related to drug trafficking and murder of a law-enforcement officer that relates to drugs.

The measures are part of a three-pronged approach to fighting opioid abuse and overdose the White House rolled out last night. It’s aimed at reducing the demand for opioids by slowing overprescribing, cutting off the supply of illicit drugs and helping those who are addicted, my colleague Katie Zezima reports.

“The opioid crisis is viewed by us at the White House as a nonpartisan problem searching for a bipartisan solution,” White House counselor Kellyanne Conway told reporters.

For weeks, whenever the president mentioned opioid abuse, he has praised the leaders of countries where people are executed for drug crimes, or even shot in cold blood. Exhibit A: Philippines President Rodrigo Duterte, whose brutal campaign to crack down on illicit drug has resulted in the deaths of more than 12,000 people without due process, as police and hired guns have slaughtered suspected users and distributors on the streets and in their homes.

Trump applauded Duterte last spring for doing an “unbelievable job” in combating the illegal drug trade, and after meeting with Duterte in November he said the two have a “great relationship.” Last month, Axios’s Jonathan Swan reported that Trump often compares drug dealers to serial killers and advocates they get the death sentence, as in the Philippines and a handful of other countries mostly in Asia and the Middle East.

And a week ago, at a political rally in Pennsylvania, the president again suggested the United States should join the handful of other countries in allowing capital punishment for drug crimes.

“You kill 5,000 people with drugs because you’re smuggling them in, and you are making a lot of money and people are dying,” Trump said, prompting cheers from the gathered crowd. “And they don’t even put you in jail. That’s why we have a problem, folks. I don’t think we should play games.”

Trump’s “tough guy” stance stood in stark contrast to the more measured approach preferred by some of his top administrators, such as Health and Human Services Secretary Alex Azar. Azar has gone out of his way to stress better treatment as key to quashing the epidemic.

The United States is one of 32 countries with death penalty laws for drug offenses, but only seven nations actually conduct executions routinely, according to a March report from Harm Reduction International. They include Iran, Saudi Arabia, Vietnam and Malaysia, as well as China and Singapore, two countries Trump also referred to as examples of ways he thinks the United States should approach the issue.

(The Philippines doesn’t actually allow the death penalty for drug crimes, but executions are being carried out ad hoc under Duterte as noted above.)

Ashok Kumar, Singapore’s U.S. ambassador, argued in a recent letter to The Washington Post that his country is one of the few that have kept drug abuse under control through its “clearheaded approach,” which includes education, rehab programs — and stiff penalties.

But experts in drug law say there’s no evidence that capital punishment on its own reduces dealing or drug use – and it could even worsen the behavior. The most likely scenario is that lower-level operators, such as drug runners, would be caught and executed while organized criminal leaders remained free to carry on their activities, Georgetown Law professor Larry Gostin told me.

“In the case of trafficking, the economic rewards are so lucrative and the supply networks so sophisticated that, in my view, it would provide no deterrent to organized crime,” Gostin said.

Iran, for example, has one of the highest addiction rates in the world. According to the United Nations Office of Drugs and Crime, 2.2 million people — nearly 3 percent of the population — are hooked on drugs. Yet Iran also carries out more executions per capita for drug offenses than any other country, with 242 people executed last year, according to HRI.

Columbia University law professor Jeffrey Fagan also said he sees no scientific evidence that executing drug dealers deters dealing or drug use. “It’s not a smart policy, even if it has some emotional appeal,” Fagan told me.

But it’s well known that Trump acts — and speaks — from his gut, not necessarily because he believes there’s evidence to support his views. From his own blunt rhetoric, he has made clear he admires the same trait in other world leaders, even leaders such as Duterte who show a blatant disregard for human rights.

Duterte announced Wednesday that he’s withdrawing the Philippines from the Rome Statute, the treaty that established the International Criminal Court, which is looking into his violent campaign to determine whether it justifies an official investigation into charges of crimes against humanity. Duterte said the decision to withdraw was because of “baseless, unprecedented and outrageous attacks” by U.N. officials and an attempt by the ICC prosecutor to seek jurisdiction “in violation of due process and presumption of innocence.”

And last year, Duterte said this: “Hitler massacred 3 million Jews. There are 3 million drug addicts. I’d be happy to slaughter them … You destroy my country, I kill you. It’s a legitimate thing. If you destroy our young children, I will kill you.” (AP Photo/Andrew Harnik, File)

AHH: Many Obamacare insurers turned a profit for the first time last year after three years of pretty heavy losses. Politico’s Paul Demko writes premium spikes led to the profitable year, citing analysis of financial filings of 29 regional Blue Cross Blue Shield plans. Steven Udvarhelyi, CEO of Blue Cross and Blue Shield of Louisiana, told Paul that 2017 “was the first year we got our head above water in the individual market since the ACA passed.”

“The healthier balance sheets are a welcome development for insurers after three years of major Obamacare losses, estimated at more than $15 billion by McKinsey,” Paul writes. “That led many national insurers, including UnitedHealth Group and Aetna, to flee the law’s marketplaces, in some cases leaving Blue Cross Blue Shield plans as the only option for customers.”

But one profitable year doesn’t totally rescue insurers from potential instability moving ahead. The Trump administration is expected to finalize a rule making it easier to buy cheaper plans that are exempt from parts of the health-care law, following Congress’s repeal of the law’s individual mandate. These big changes to the law are weighing on insurers as they decide what to do for 2019.

This file photo shows a Centers for Disease Control and Prevention logo at the agency’s federal headquarters in Atlanta. (AP Photo/David Goldman, File)

OOF: The leading candidate to head the Centers for Disease Control and Prevention is Robert Redfield, a longtime AIDS researcher who is well-respected for his work but once expressed a controversial position on HIV testing, our colleague Lena H. Sun reports.

Redfield was previously floated as a candidate for the top post at the CDC as well as at the National Institutes of Health under other GOP admnistrations, Lena writes. He would fill the role left vacant by Brenda Fitzgerald, who stepped down in January amid reports that she had investments in tobacco, drug and food stocks while heading the CDC.

Redfield is a former Army physician, and currently the director of clinical care and research at the Institute of Human Virology at the University of Maryland School of Medicine. He oversees a major clinical program providing HIV care and treatment to more than 6,000 patients in the Baltimore-Washington region and a care program that is part of the President’s Emergency Plan for AIDS Relief, known as PEPFAR. He has also served as a member of the Presidential Advisory Council on HIV/AIDS.

In the early 1990s, while he was an AIDS researcher in the Army, Redfield stirred controversy over an experimental AIDS vaccine that ultimately failed. “He had been known as a strong supporter of mandatory patient testing for HIV during the 1980s, at a time before effective treatments were available and intense stigma surrounded people infected with the virus,” Lena writes. Some felt the policies he advocated weren’t embracing sound public health approaches to the AIDS epidemic and were stigmatizing of those who were infected.

Trump speaks during an opioids event at the White House in October. (AP Photo/Evan Vucci, File)

OUCH: Watch out, opioid epidemic. Six months after Trump declared opioid abuse a public health emergency, his administration has a detailed plan for how it plans to counter the abuse and overdose crisis. We wrote extensively above about the penalties it’s proposing, but the plan officials released yesterday also calls for a slew of other policies to limit access to opioids and improve education. Here are some of the White House’s goals and strategies, per Katie:

  • Sharply reduce the number of painkillers that are prescribed nationwide, aiming to slash opioid prescriptions by one-third over three years.
  • Tighten the number of opioid prescriptions that can be reimbursed by Medicaid as a way to curb overprescribing.
  • Create a national prescription-drug monitoring system so suspicious prescriptions can be flagged. Right now, each state operates its own, and a few states have data-sharing agreements.
  • Test all federal inmates for opioid addiction and provide options for treatment when inmates complete their sentences and reenter society.

  • Put more naloxone, a drug that can reverse opioid overdoses, in the hands of more first responders. 

The Supreme Court is set to hear a major free-speech case on Tuesday related to information about abortion services. (AP Photo/J. Scott Applewhite, File)

— Tomorrow, the Supreme Court is set to hear oral arguments in a major case on free-speech rights for antiabortion “crisis” pregnancy centers, a hearing The Health 202 wrote about in November. The Post’s Robert Barnes reports from Gilroy, Calif., about clinics that are challenging a new state law requiring them to publicly post a notice informing clients about the availability of free or low-cost access to family-planning services, including abortion.

These centers say they’re being forced to deliver a message antithetical to their mission: encouraging women to carry out their pregnancies rather than end them. But California cites Supreme Court precedent upholding those abortion language requirements in contending it is requiring the clinic to deliver only a neutral and factual message, Bob reports. The message “doesn’t move in one direction or another on the political spectrum,” either in encouraging abortion or discouraging it, California Attorney General Xavier Becerra told Bob.

“We were trying to figure out the way to best get information to people about their health-care options and their rights,” Becerra said. “And this is a pretty straightforward way — neutral way — of getting that information to women.”

Abortion-rights advocates could ironically benefit in other ways, even if they lose this particular case. “If the court rules broadly against the government’s ability to have centers deliver its message, some abortion rights supporters wonder whether the same reasoning could work in their favor in other cases,” Robert writes. “They might challenge dozens of state laws that require doctors and others to deliver certain information to women about the alleged dangers that accompany abortion.”

Abortion rights supporters and opponents rally in the Texas state capitol. (AP Photo/Tamir Kalifa)

— On Friday, the National Academy of Sciences released the first in-depth report in more than 40 years about the state of science on abortion safety and quality in the United States. The work — conducted with support from six private foundations — found that abortions done in a clinic or with drugs appear to be safe in the vast majority of cases, The Post’s Ariana Eunjung Cha reports. Among the study’s interesting takeaways:

  • Legal abortions in the United States, whether by medication or the three major surgical methods, “are safe and effective.”
  • The quality of abortion care depends on where a woman lives.
  • Ninety-five percent of abortions are at clinics or other office-based settings.
  • Despite much speculation about abortion’s impact on future childbearing, the science shows that the procedure does not appear to increase the risk of secondary infertility, pregnancy-related hypertensive disorders, abnormal placentation, preterm birth or breast cancer.
  • Having an abortion does not appear to be linked to such mental-health consequences as depression, anxiety, and/or post-traumatic stress disorder.

House Speaker Paul Ryan (R-Wis.). (Andrew Harrer/Bloomberg)

—Four former FDA commissioners say the “Right to Try” legislation the GOP-led House is teeing up for another vote would put vulnerable patients in danger, our colleague Laurie McGinley reports. Robert Califf and Margaret Hamburg, who led the FDA under the Obama administration, and Mark McClellan and Andrew von Eschenbach, who served under George W. Bush, sent a statement to lawmakers provided to The Post. “There is no evidence that either bill would meaningfully improve access for patients, but both would remove the FDA from the process and create a dangerous precedent that would erode protections for vulnerable patients,” they warned.

“Right to Try” would allow seriously ill patients to bypass the FDA in order to get access to experimental drugs. A Senate version of the bill passed over the summer. The House version failed to pass last week 259-140, seven votes short of the two-thirds threshold needed to pass a bill under suspension of the rules, a procedure typically reserved only for non-controversial legislation. Afterwards, House Majority Leader Kevin McCarthy (R-Calif.) said lawmakers would try again to pass the legislation with only a majority vote.

–A few more good reads from The Post and beyond:

Coming Up

  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on the DEA’s role in combating the opioid crisis on Tuesday.
  • The Senate Finance Committee holds a hearing on the nominations of “John J. Bartrum, of Indiana, to be an Assistant Secretary of Health and Human Services and Lynn A. Johnson, of Colorado, to be Assistant Secretary for Family Support, Department of Health and Human Services” on Tuesday.
  • The House Ways and Means Subcommittee on Health holds a hearing on “Implementation of MACRA’s Physician Payment Policies” on Wednesday.
  • The Atlantic holds an event on “The State of Care” on Wednesday.
  • Politico holds an event on “How to Improve Health Care in Nursing Homes and Bend the Cost Curve” on Wednesday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on the opioid crisis on Wednesday.
  • The Alliance for Health Policy, the Association of Health Care Journalists and the National Institute for Health Care Management hold a webinar on Thursday.

On Saturday Night Live, Anderson Cooper interviews members of a White House in turmoil: 

And on Weekend Update, SNL interviews Kate McKinnon as Education Secretary Betsy Devos: 

Watch the moment a family was reunited with a German shepherd that United Airlines mistakenly shipped to Japan:

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Why The World Needs Health Care Innovation Now


The health care industry can be difficult for innovation. There are a whole host of challenges that make it difficult to drive change — and many who try quickly get discouraged. Some of these challenges result from necessary features of the industry, such as regulation, research and ethical standards. Others — like policy debates, outdated systems and an overwhelming amount of red tape — are problems that need to be solved as soon as possible.

While some of these issues are difficult to resolve quickly, innovators in all corners of the health care industry are working to try and make improvements for patients, practitioners and companies alike. And since health care spending increased by $3.3 trillion in 2016, the opportunities for growth are replete. The following are some of the top reasons that we need health care innovation now.

Faster Development Of Treatments

It takes far too long for new drugs to make it to market. Data from research firm PhRMA identified that it takes 10 years, on average, for a new drug to be available for use. About 60-70% of that time is taken up in clinical trials, but frequently, the remainder is due to outdated regulatory systems. 

Fortunately, through the use of technology, we can significantly speed up that process. Sophisticated AI can increase the effectiveness of researchers, helping them find useful compounds or relevant data that might have been too difficult to find without contextual search features. Pharmaceutical companies are beginning to appreciate the powerful ways in which AI can augment drug research and development. For example, Genentech and GNS Healthcare announced a partnership last year aimed at using AI technology to analyze massive amounts of cancer patient data in order to identify novel cancer therapies. 

Additionally, cloud platforms can help digitize many of the regulatory processes that are still on paper. Some people have even argued that the development process itself should be more customizable and that current FDA regulations are too one-size-fits-all for certain treatments.

Increased Access To Care

Health care systems are different all around the world, and unfortunately, in many regions, it can be difficult to connect people with care. Access is frequently tied to economic status. A CDC report detailed that in the U.S., over 23% of near-poor adults ages 18-64 don’t have access to health insurance, and that number rises to 26% within the poor category. This isn’t just a challenge in the U.S., either — even in countries with universal insurance, access to care can be limited by geography. Smaller communities may not be able to find the services they need locally.

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Why Process Is US Health Care’s Biggest Problem

ilbusca/Getty Images

A lot of money has been spent on information technology in health care with little to show for it. To understand why we must pay a visit to the hospital.

It only takes 10 minutes of direct observation of a nurse in a hospital to understand care-delivery processes are not standardized and are dependent on individuals, not systems. This lack of reproducibility leads to errors. Since every caregiver does it his or her own way, it’s difficult to improve anything. Stable systems that are reproducible are required to deliver consistently high quality. Industrial companies figured this out 50 years ago. The writings of manufacturing gurus Imai and Shingo provide insight into how quality is built into processes. A process must first be stabilized then standardized before being improved. Because few standardized processes exist in care delivery there are many possibilities for error. That’s why simply making a poor process electronic by implementing an electronic health record (EHR) doesn’t lead to better quality or cost.

When it comes to change, the technology is the easiest part. Most health systems in America have or are implementing the EHR. And the vendor processes for implementation have become very good. The hard part is to get the doctors, nurses, and administrators to agree on what is the best way to deliver the care. Since the doctors control most care decisions, the rest of the provider team follows the doctors’ lead. If the doctor wants to do things a certain way, that’s what is done. The problem is the next doctor wants it his way and so on. Eventually, we end up with a hopeless mess in which no one knows how anything should be done on any given day. And good luck to a new nurse or technician coming into the system who must learn a multitude of work processes and remember the doctor-dependent differences.

Health care technology is very effective when it is used to support a well-designed care process. The design of new standard care processes need to be owned and driven by the people doing the work, not by some outside consulting firm that brings a 100-page playbook as the answer. As the frontline workers create new designs, they need certain systems that can help them deliver the improved care. Examples of these systems include electronic alerts for medication interactions and reminders to ensure all steps in the care process for the pneumonia patient are followed.

Insight Center

There are two types of improvement systems needed to create a well-designed care process. One is a improvement approach that brings members of an existing clinical team members together to improve an existing care process. They use proven improvement methods such as the principles, systems, and tools of the Toyota Production System (TPS). The second is an innovation process aimed at radically redesigning care. It’s associated with TPS and employs design thinking.

In both cases, the initial effort where rapid experimentation occurs might be an ambulatory clinic or an ER. It becomes a place for others in the organization to learn. It is an inch-wide, mile-deep change in practice that incorporates new processes not only for care delivery but also management. It should result in the systems necessary for sustaining improvement over time. As the model line achieves 50% to 80% improvement over baseline performance, the learning should be spread to other parts of the organization. This new way becomes the new best-known way to deliver care.

One example of a radical innovation is the attempt of HealthEast (now part of Fairview Health Services), which serves the Minneapolis-Saint Paul area, to create the clinic of the future. The leaders brought the vendors in their extended supply chain to the table to help in the design process. This included Epic, an EHR company; Herman Miller, an office furniture company; Boldt, a construction company; and HGA, an architectural firm. Together, the team began redesigning the care-delivery model. Each vendor had the opportunity to deeply understand the needs of the HealthEast providers. By the end of the design phase a new process supported by electronic records, architecture, furniture, and building was integrated to create a unique patient experience.

Before HealthEast formed the model clinic, a group of 11 clinicians had over 11 preferred ways for “their” clinic assistant to do just about everything. One key process, screening the patient for health risks such as cancer and hypertension, resulted in over seven places in the EMR for the provider to look for relevant information. Not only is that time-consuming (contributing to physician burnout), but it also greatly increases the chances of missing important information.

The multi-disciplinary team created a single screening process. Now, clinicians have just two places to look in the EMR for information on whether patients have had screens like mammograms and colonoscopies for cancer, staff can remind patients about what screening tests they need, and leaders are able to support the development of standardized clinical processes. The leader’s standard work is to audit the process and monitor the data. If the process stops being followed or the data shows deteriorating results, leaders will know that immediately.

In the first three months after its introduction, the redesigned process reduced provider search time per patient by 23 minutes. The overall screening rate went from 60% compliance to 72% compliance, meaning over 500 more individuals were appropriately screened over baseline. Perhaps more telling are the changes in patient comments. They went from comments such as “I do not feel my medication list was reviewed,” to “My doctor and medical assistant are always timely, thorough, and reassuring.” These results would not have happened unless all parties were working to build a better process.

Technology now exists to support disruptive innovation in health care. It is an important enabler, but the process must precede the technology. For example, Hospital at Home is an innovation that may well cut the cost of care significantly by reducing the need for inpatient beds. It couldn’t happen without the technology, which allows 24-hour monitoring of patients, real-time electronic communication between providers, and complex equipment to be rapidly set up in the patient home. But it still requires a nurse and a doctor.

What that nurse and doctor do and how they do it are still what will determine successful outcomes of care. Building the care process through careful understanding of what each process step delivers is critical. The medical team can then leverage the technology for data and communication and other needs that support the steps in the process.

Again, this requires standardized work. Every nurse and doctor does not get to do it his or her own way. Standards are established about how the work is performed, and those standards are followed by all until a better way is determined collectively by the team. New innovative care models such as Hospital at Home are based on clear and reproducible standards and will obsolete the old ways of the non-standardized care delivered in most hospitals.


It takes more design time to create a care model that builds in quality and efficiency, but without that work upfront, the technology doesn’t matter and, in fact, only increases costs. This thinking is not new. Many industries from aviation to automotive to nuclear power have been applying this concept of “process before technology” for a long time. The safety and quality results in those industries is second to none. It’s about time health care catches up. Our lives may depend on it.

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Crain’s 2018 Health Care Heroes never quit

What makes a Crain’s Health Care Hero?

For one, they never quit. When they see a problem, an unmet need, a crisis, they don’t form a commission or draft a memo. They don’t pass the buck. They take action.

Now in its 17th year, Health Care Heroes recognizes outstanding and beyond-the-ordinary achievements in health care in Michigan. Each Hero has either directly saved lives or significantly contributed to alleviating human pain and suffering. All have improved the quality of lives of the people or patients they touch.

Competition for our Heroes is stiff, and many worthy candidates who have changed lives in their own right have been left out. Out of the 80 nominees we received this year, we could have easily selected 25 for recognition in the eight categories: physician, allied practitioner, corporate achievement, board member, administrator, heart, cancer and other researcher.

Our judges vigorously debated the nominees. Our judges included former Heroes Rob Casalou, CEO of St. Joseph Mercy Health System; Lisa Newman, M.D., an oncologist with Henry Ford Health System; pharmacist Ghada Abdallah; and Crain’s senior reporter Jay Greene.

In the end, we decided that two categories required co-winners. One of those was a new category the judges decided we needed to create on the spot — lifetime achievement.

One of the never-quit co-winners in lifetime achievement is George Mogill, M.D., a 100-year-old family medicine doctor from Detroit who took care of soldiers and others during the Normandy invasion in World War II and helped break the color barrier in Detroit in the mid-1940s.

At 95 years old, Jean Kantrowitz continues to promote and support cardiac medical device research with two Michigan-based companies. For years, she collaborated and assisted her late husband, Adrian Kantrowitz, M.D., whose team attempted the world’s first pediatric heart transplant at Maimonides Medical Center in Brooklyn in 1967.

The other category with co-winners was administrator. Sharing the honor are Chris Allen, CEO of Authority Health, who for years has worked to expand access to health care in Detroit; and James Fahner, M.D., division chief of the hematoloy/oncology department at Helen DeVos Children’s Hospital in Grand Rapids, who also is involved with the Make-A-Wish Foundation.

The physician Hero award went to Tolulope Sonuyi, M.D., an emergency physician at DMC Sinai-Grace, who founded DLIVE, the first hospital-based violence intervention program in Michigan. More than 65 people have participated in the program with a 100 percent success rate.

Corporate achievement went to Molly MacDonald, founder of The Pink Fund, which provides short-term financial support to women who are in active cancer treatment. A breast cancer survivor herself, MacDonald’s own story is worthy of a television special.

Allied practitioner went to Najah Bazzy, R.N., CEO of Zaman International, an Inkster-based nonprofit that helps women and children pull themselves out of poverty with job training, food, furniture and emotional support.

The heart and vascular care research Hero is William O’Neill, M.D., medical director of the Henry Ford Center for Structural Heart Disease, who has pioneered multiple balloon angioplasty and valve replacement innovations over the years.

Our oncology care and research Hero is Jeffery Taub, M.D., a Children’s Hospital of Michigan pediatrician who also has been involved in multiple research projects, including a study on children with Down Syndrome, acute lymphoblastic leukemia and acute myeloid leukemia and using zebrafish to identify genetic and environmental factors that may lead to childhood leukemia.

In the other health services research category, Gregory Auner, a medical engineering researcher at Wayne State University, won for conducting some of the most cutting-edge research in the nation on cancer detection, pathogen and infection detection and traumatic brain injuries.

The board member Hero selected was Jody Burton Slowins, co-founder of Partners in Personal Assistance, an Ann Arbor-based nonprofit that provides patient-directed care to clients and also competitive wages and benefits to caregivers.

Crain’s Health Care Heroes will be honored at Crain’s Health Care NEXT event, to be held in June. Stay tuned for further information.

Read about all the winners here.

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Yemen: Diphtheria outbreak ‘symptoms of collapsed health system’

The World Health Organization (WHO) is racing to vaccinate people in Yemen against a rapidly spreading outbreak of diphtheria.

Around 1,300 people have been infected and more than 70 have died since the disease was first detected six months ago.

Al Jazeera’s Hannah Hoexter reports.

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Soaring health costs prompt employer-hospital surgery deals

Medicare and Medicaid first led the push for bundled payments, and now large employers like General Electric, Walmart and Boeing are increasingly looking at fixed price deals as an option for controlling the high cost of health care. In 2014, Lowe’s even struck a deal to fly employees for free to the Cleveland Clinic for a fixed price surgery deal, rather than pay unbundled costs at other hospitals.

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Health Fair pushes the importance of mental wellness

Today was the last day of the ISU health fair, which was busy with people not only getting their physical health checked out, but also their mental health.

We talked to members of the ISU’s counseling department, to find out the importance of keeping your mental health in tip-top shape.

When thinking of staying in shape mental health isn’t the first thing that comes to mind, but it’s just as important as everything else.

Elizabeth Macklin, a master’s student in counseling, said “Mental health is very important because it affects our physical health… Lot of the time what’s going on in our head will manifest in other ways… Like physically…”

The Psychology Clinic for ISU was at the health fair screening for depression and anxiety, while the Counseling Department was screening for general mental wellness.

They say knowing about your mental wellness is just like knowing numbers like cholesterol in your body. It helps you decide what changes to make moving forward.

Carol Kirkpatrick, the Chair of Health Fair Planning Committee, said “It’s the same thing of knowing what your mental health is… If you do an anxiety or depression screen if gives you that information to say… You know maybe this isn’t just a low mood… Maybe it’s a sign that I have something I want to speak to someone about…”

Mental health concerns are relatively common.

18 percent of the population deals with an anxiety disorder, but it’s not something you should ignore.

Nearly 37 percent of people who have an anxiety disorder go untreated, meaning many should get screened to see how that is affecting their life.

Jeremy Torgesen, a counseling student, said “One in four people will struggle with mental health concerns in their life time so whether it’s you or a loved one there is got to be someone you know that could benefit”

The ISU counseling center holds counseling sessions priced at 15 dollars for an individual and 20 dollars for couples.

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This Study May Find That Moderate Drinking Is Healthy. The Alcohol Industry Was Asked to Pay for It.

“This must have seemed like a dream come true for industry. Of course they would pay for it,” he said. “They’re admitting the trial is designed to provide a justification for moderate drinking. That’s not objective science.”

Asked about the meetings, Dr. Mukamal did not deny he had participated, but said the slides did not convey the full complexity of his presentation.

Last year, Dr. Mukamal told The New York Times that he had had “literally no contact with anyone in the alcohol industry in the planning of this.” He defended that statement saying the presentations took place long before the N.I.H. announced the funding grant in late 2015.

The description of the trial that he gave at the meetings was just a “boilerplate,” he said.

“My job there wasn’t to raise money,” Dr. Mukamal added. “It was to educate.”

A Vexing Question

The N.I.H. awards most research funds on a competitive basis, and grant applications undergo a two-tier review of the scientific merit and public import of a project, as well as the scientific integrity.


Continue reading the main story

At a cost of $100 million, the new trial aims to resolve a persistent medical conundrum. Though excessive drinking is harmful and problem drinking is on the rise in the United States, many observational studies have found that moderate drinkers outlive abstainers and have less heart disease.

These studies don’t prove that moderate drinking is the reason these people live longer, however. The new trial, called the Moderate Alcohol and Cardiovascular Health Trial (M.A.C.H.), is intended to answer that question.

In January, Dr. Mukamal and his colleagues started recruiting volunteers ages 50 and older who are at high risk for heart disease; eventually there are to be 7,800 participants at 16 sites worldwide. Half will be told to abstain from alcohol. The rest, including both men and women, will be told to have one serving of alcohol a day.

No other long-term trial has ever asked participants to drink, much less drink every day. Scientists will track the two groups for six years on average to see whether daily drinkers have fewer heart attacks and strokes, and lower odds of diabetes and death.

The research will attempt to track the risks of drinking, but critics say it may not fully capture the harms. For one thing, the study will be too short to detect an increase in cancers linked to alcohol consumption, which may take decades to develop.

In addition, two servings has long been considered moderate drinking for men. Lowering the threshold may reduce falls, car accidents and alcohol abuse among the subjects; but one drink daily also may not reflect real-life habits.

Moreover, many people whose health might be compromised by light drinking — anyone with a history of addiction, psychiatric, liver or kidney problems, certain cancers or a family history of breast cancer — will not be allowed to participate. People who have never drunk alcohol also are excluded.

“You’re picking off the people who are most likely to have the harms,” said Dr. Richard Saitz, chair of the Department of Community Health Sciences at Boston University School of Public Health, after reviewing the parameters of the study.


Continue reading the main story

But if the study finds even a modest cardiovascular benefit to light drinking, he added, “You can be sure that the way it will be understood by the general public is that this applies to everybody.”

Despite its shortcomings, M.A.C.H. may well be the last word on the subject of moderate drinking, since trials like these are both expensive and logistically complicated to carry out.


No other long-term trial has ever asked participants to drink, much less drink every day, or encouraged participants to drink whatever they like.

Edu Bayer for The New York Times

Dr. Mukamal, who has published nearly a hundred scientific papers on the relationship between moderate drinking and cardiovascular disease. emphasized in an interview that he was committed to reporting the results accurately based on the data.

“If anyone has any doubt whatsoever that our intent is to provide the most accurate and precise description of our findings, they are sorely mistaken,” he said.

‘They’d Be Happy’

Private contributions for the study from the alcohol industry are being channeled through the Foundation for the N.I.H., a nongovernmental entity that raises money for N.I.H. research and manages the partnerships established to direct private donations.

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In this case, the industry donors were expected to be held at “arm’s length” and not to play any role in the research or to communicate with the scientists, said Julie Wolf-Rodda, director of development for the foundation.

George Koob, the current director of the National Institute on Alcohol Abuse and Alcoholism, said the foundation constitutes an impregnable “firewall” that prevents donors from interfering with research.

In an interview, he said he was unaware of the meetings between N.I.H. officials and industry officials to rally support for the study, most of which took place before he took the helm of the institute in late January 2014. He denied that the institute had solicited funding.

Raising his voice during an interview, Dr. Koob insisted the industry’s sponsorship would not compromise the study and said that the study protocol went through several rigorous reviews. “We do things right at N.I.H.,” he said.


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But his predecessor, Dr. Ken Warren, who helped organize and participated in some of the meetings as acting director of the alcohol abuse institute, acknowledged in an interview that the scientists’ presentations were meant to both “demonstrate to the industry that the study was feasible” and “to determine if they had interest in taking part” as funders.

Questions about moderate drinking and heart disease are important public health questions, Dr. Warren said, and a government trial would be more credible than research “directly funded by an entity such as the alcoholic beverage industry, which could be considered biased.”

Most of the cost of this government trial, however, is being picked up by five of the world’s largest alcoholic beverage makers — Anheuser-Busch InBev, Heineken, Diageo, Pernod Ricard and Carlsberg.

In an interview, Dr. Lorraine Gunzerath, a retired senior adviser to Dr. Warren, took credit for coming up with the idea of reaching out to the alcohol industry for funding.

Clinical trials like this one don’t fall neatly under the mission of the alcohol abuse institute, she said. “We were supposed to be preventing alcoholism, so to spend that kind of money on research for a possible good use of alcohol was something that would never fly,” she said.

But, referring to the alcohol industry, Dr. Gunzerath said, “If we had a clinical trial, and it was a positive result — which we thought it might be, you sort of think you know where it’s going — they’d be happy.”

All the N.I.H. had to do was “make a business case to the industry that it would be to their benefit, even if they couldn’t actually control the trial’s outcome,” Dr. Gunzerath said.

She arranged for the university scientists to address executives at alcohol industry meetings. “If they didn’t like the research team, they would have said no,” she said.


The study was designed not to differentiate between types of alcohol, expecting to find that one serving of beer, liquor or wine each day would be beneficial.

Edu Bayer for The New York Times

It was no secret at the time that Dr. Mukamal and his collaborators “already believed that moderate alcohol is a good thing,” she said. He already had published papers suggesting as much.


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After the scientists’ presentations, which were provided to The Times by Dr. Gunzerath, she would speak briefly to say that “it would be nice if we could get money from the industry,” but explain that funds would have to flow through the foundation.

On Sept. 30, 2013, Dr. Gunzerath sent an email headed “URGENT! Response needed ASAP!” to Dr. Mukamal, inviting him to Philadelphia to address the annual meeting of the Worldwide Brewing Alliance, to get the brewers’ “buy in” and “extra overall funding potential as well.”

“I can make it,” Dr. Mukamal responded. “I could do any version or part or the whole day, night before or drive down that day etc. whatever works best for you.”

Dr. Gunzerath and Dr. Warren also arranged meetings between the scientists and industry representatives at the Distilled Spirits Council’s Washington headquarters on Nov. 21, 2013, and Jan. 28, 2014.

A spokesman for the Distilled Spirits Council said that after the N.I.A.A.A. approached the trade group in 2013, the council “provided them with a forum to present the initial outline of their study.”

Representatives of Anheuser-Busch InBev, Heineken and Diageo confirmed that the scientists’ presentations played a role in the companies’ decisions to underwrite the trial.

“When Heineken was invited by the N.I.H. to partially fund the N.I.A.A.A. trial for a duration of ten years, as part of our decision making process, the scientists presented the research project to us so we would have a sound understanding of the trial,” Michael Fuchs, a company spokesman, said in an email.


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Growing Trend

These days, it is not unusual for the N.I.H. to look to business to participate in public-private partnerships to fund medical research. When an N.I.H. center is seeking outside funding from the private sector, it starts by submitting a “request for collaboration” to a steering committee of the N.I.H. and the foundation based in the office of the director of the N.I.H., Dr. Francis Collins.

For the moderate drinking trial, the alcohol abuse institute signed an agreement with the foundation that said, “Under no circumstances shall N.I.A.A.A. or its representatives communicate directly with any Donor in order to raise funds for the project or to disclose to any Donor any information” about “the name and affiliation of the awardee” or “details and information relevant to the award.”

But by the time the institute submitted the request for outside funding in early 2015, its officials and outside scientists had already met with alcohol industry executives. Representatives of beer and liquor companies had already heard directly from Dr. Mukamal.

The alcohol abuse institute took an extra step to secure Dr. Mukamal’s position as top contender for the grant. While N.I.H. grants are supposed to be awarded on a competitive basis, the institute’s request for outside funding said the award would be restricted to applicants with “unique” resources and backgrounds — and specifically mentioned Dr. Mukamal, who had helped persuade the alcohol industry to fund the research.

Whether scientists studying alcohol should accept money from the industry has long been controversial. Many scientists and policymakers have publicly said that any engagement with the alcohol industry undermines the credibility of the research.

In 2016, a group representing hundreds of scientists and policymakers published a statement saying researchers should never accept direct or indirect industry funding, and that “any form of engagement with the alcohol industry may influence the independence, objectivity, integrity and credibility” of the research.

“We know that industry funding not only affects the results of studies but affects the questions that are asked, how the results are analyzed and what the answers are,” said Dr. Adriane Fugh-Berman, a professor of pharmacology at Georgetown University and director of Pharmed Out, a group that researches drug marketing.

If the health effects of moderate drinking are a priority for the N.I.H., she added, “they should fund it themselves.”

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Veterans hospital killings spotlight problem of violence against health care workers

The man’s complaint seemed straightforward: He had come to the emergency room last June at Harrington Hospital in Southbridge, Massachusetts, for wrist pain that wouldn’t quit.

The 24-year-old patient seemed anxious. But he didn’t present any signs of being dangerous — red flags that nurse Elise Wilson had come to recognize over the course of her four-decade career. She had spent 35 years in the ER, where nurses encounter violence from patients or patients’ relatives “almost on a daily basis,” she said.

Wilson started entering the patient’s vital information into a computer in a triage room. When she turned around, he was looming over her with a knife.

“The first thing he did was punch me in the head,” Wilson, 66, said.

From there, a normal day at work turned into a fight for survival as Wilson got stabbed in her neck, then nearly a dozen times in her arm. With the other arm, Wilson grabbed her nurses’ clogs and banged them on the floor to catch other hospital employees’ attention and screamed.

Image: RN Elise Wilson, a nurse at Harrington Hospital

Image: RN Elise Wilson, a nurse at Harrington Hospital

Nearly 10 months later, Wilson still hasn’t recovered from the stabbing and cannot return to work. (The man accused of stabbing her, Conor O’Regan, has schizophrenia, has been deemed unfit for trial and is in a psychiatric facility.)

But her resolve to protect other health care workers is stronger than ever — especially after the killing last week of three staff members at a Yountville, California, treatment facility by a troubled veteran.

Health care workers face an alarmingly high rate of serious workplace violence, which is on average four times more common in health care than in other private industries, according to the Occupational Safety and Health Administration.

The World Health Organization estimates that up to 38 percent of health workers throughout the globe suffer physical violence at some point in their careers. And the American Nurses Association, which represents 3 million nurses in the U.S., reports that 1 in 4 nurses has been assaulted at work.

There have been high-profile incidents in recent years: the Utah nurse whose rough arrest after she refused to draw an unconscious patient’s blood was caught on video; a Boston surgeon who was fatally shot by a patient’s son.

But health care workers say they deal with other violence on a regular basis, like being kicked, pushed, hit, spit on, and verbally abused.

“We work with people with histories of violence who may be delirious, have dementia, be under the influence of drugs, and we also work very close to them, almost intimately, and often we’re alone when we’re working with our patients,” said Seun Ross, the director of nursing practice and work environment at the American Nurses Association. “I think that all of those aid in the profession’s propensity to being exposed by violence.”

Yet despite the frequency with which the incidents happen, there are no federal regulations that protect health care professionals from workplace violence — only some scattered state laws. While OSHA has offered voluntary guidelines for keeping health care workers safe for more than two decades, they don’t require that hospitals or other health care centers implement them.

Image: Vanessa Flores, Fernando Juarez

Image: Vanessa Flores, Fernando Juarez

Advocates hope to change that. Last week, just two days before 36-year-old veteran Albert Wong slipped into the Pathway Home in Yountville and held three staffers hostage before killing them and then himself, a congressman from California introduced a bill called the Health Care Workplace Violence Prevention Act.

It calls for OSHA to require health care employers to adopt a comprehensive workplace violence prevention plan.

“Every hospital needs to have a plan to deal with workplace violence and reduce it,” said Rep. Ro Khanna, D-Calif., who introduced the bill. “You may want to make sure that the tables and lamps are locked down so that people can’t throw objects at health care workers, you may want to make sure that there’s a safe exit, enough security, that people aren’t bringing weapons of any kind into a medical facility. What the bill does is require that hospitals comply with an OSHA standard.”

Those in the medical profession say that not only are such precautions necessary, but better responses from supervisors and managers in response to violence are needed, too.

One woman, a 26-year-old nurse from Tennessee who asked to remain anonymous out of fear of job repercussions, recalled a time last year while working in the ER when a patient, frustrated that he wasn’t allowed to get out of his bed, bit her so hard on her arm that it left a large bruise. She told management, but nothing happened.

“They ask if we want to report it, and then we fill out an occurrence report sheet, and then after that, that’s really it. I never get a follow-up,” she said, adding that in other venues, that type of aggression would be unacceptable. “I can’t go to Target and bite somebody over their prices.”

Still, many in health care are quick to dismiss violence as part of their jobs. Dr. Kayla Behbahani, a chief resident in psychiatry at the University of Massachusetts Medical Center in Worcester, hopes to change that.

Behbahani has been shoved by a patient. And when she was in her third year of residency, a mentally ill patient in an outpatient clinic became agitated when Behbahani wanted to admit her to the hospital.

“She told me that the last person who admitted her to the hospital received 57 stitches, and at that point she reached for her cane,” Behbahani said.

Behbahani was shaken up, but wasn’t hurt by the encounter. She’s now on a workplace violence prevention committee at her hospital and urges residents to report any threatening behavior.

“It turns out a lot of health care providers don’t report verbal aggression. They only report physical. We’re trying to change that behavior,” she said.

It’s not just mentally ill patients who lash out: According to a 2014 study in the Journal of Emergency Nursing, patients with dementia or Alzheimer’s and patients on drugs were the most likely to hurt nurses.

Khanna, the California representative, hopes that his bill will get bipartisan support so there can be a federal standard on de-escalating and preventing violence.

In Massachusetts, there’s pending legislation called “Elise’s Law,” named after Wilson, the ER nurse who was stabbed. It would require all health care providers to do an assessment of the risk for workplace violence and then require them to develop a plan to prevent it, which could mean increasing security staff or putting metal detectors in parts of the hospital.

“I don’t care who passes the law, so long as something passes,” Wilson said. “They need to make it a standard that all states have to follow.”

“It’s just so risky out there now,” she added. “It’s not like we’re police officers with bulletproof vests.”

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What are the best teas for health?

It’s likely that we all enjoy a hot cup of tea — or herbal infusion — at least from time to time, if not on a daily basis. But what are the most important health benefits that some of these soothing teas can bring us? Read on to learn more about the top teas for our health.

Some teas and herbal infusions have long been appreciated for their alleged health benefits, but what does research have to say?

“Tea began as a medicine and grew into a beverage,” writes 19th-century Japanese scholar Okakura Kakuzo in his infamous publication The Book of Tea.

In it, he speaks at length about the history of tea and the philosophy of the traditional Japanese tea ceremony.

Kakuzo was correct: modern research about the history of tea-drinking in the world confirms that this beverage was originally consumed less for pleasure or as a mindfulness aid, calling for the drinker to take slow sips and be in the moment.

Instead, as shown by Prof. Victor Henry Mair — from the University of Pennsylvania in Philadelphia — in The True History of Tea, early in its history, the tea plant (Camellia sinensis) became popular for its medicinal properties.

The tea plant’s main varieties — Camellia sinensis sinensis and Camellia sinensis assamica — are responsible for most of the tea brews that we are accustomed to: black tea, green tea, white tea, and oolong tea.

There are many other types of teas and infusions using various other plants, such as Aspalathus linearis, which is better known as “rooibos” or “redbush.” In this Spotlight, we’ll give you an overview of the top five teas that can benefit your health.

1. Green tea

A favorite with tea drinkers everywhere, green tea has been praised for its medicinal properties for years. Some recent studies have now confirmed some of these benefits, suggesting that green tea may protect various aspects of our health.

Green tea can increase cognitive functioning.

To begin with, this beverage has been found to enhance cognitive functioning, with one study connecting it to better working memory, the type of we use on a day-to-day basis.

Researchers from the University Hospital of Basel in Switzerland found that healthy people who agreed to consume a soft drink containing 27.5 grams of green tea extract exhibited more intense activity in brain areas linked to working memory.

Therefore, participants who had ingested the green tea extract had better connectivity between the frontal and parietal lobes of the brain, which are two regions involved in aspects of learning, memory processes, and decision-making.

The health benefits brought about by green tea have been linked with their content of polyphenols, which are micronutrients with antioxidant properties. As antioxidants, these substances can protect against the action of free radicals, which induce the type of cellular damage consistent with aging.

A 2017 study that was published in the Journal of the American Chemical Society found that one such polyphenol found in green tea — called epigallocatechin gallate — may lower the risk of Alzheimer’s disease by interacting with the “building blocks” that form beta-amyloid plaques.

A buildup of these plaques in the brain is typical of this condition and impairs brain cell signaling. Epigallocatechin gallate, this study suggests, could stop beta-amyloid from forming into plaques, potentially helping to keep Alzheimer’s at bay.

This same green tea polyphenol has also been said to slow down the growth of tumor cells of certain types of cancer, such as pancreatic cancer.

Research that was led by the Los Angeles Biomedical Research Institute in California has shown that epigallocatechin gallate can disrupt the metabolism of pancreatic cancer cells, thereby impairing their growth.

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2. Jasmine tea

What we refer to as “jasmine tea” is a type of beverage that usually has green tea at its base, to which jasmine flowers are added for an enriched aroma.

Jasmine tea is an important component of the diet of one of the longest-living populations in the world.

But the benefits of jasmine tea aren’t solely due to the antioxidant effects of the tea plant, since jasmine blooms also bring their own medicinal properties to the mix.

In the book Ikigai: The Japanese Secret to a Long and Happy Life, authors Héctor García and Francesc Miralles note that the inhabitants of a healthy, long-lived community in the Okinawa Prefecture of Japan are avid drinkers of Sanpin-cha, a special blend of green tea and jasmine.

“Okinawans drink more Sanpin-cha — a mix of green tea and jasmine flowers — than any other kind of tea,” they write, suggesting that this blend may play a role in keeping the inhabitants of Okinawa healthy and mentally agile well into old age. This may be because, like the tea plant, jasmine flowers contain antioxidants — which may protect cells from age-related damage.

Jasmine itself has been linked with improved physical well-being and is said to reduce the impact of stress. That is why some researchers have experimented with compounds derived from this plant in the search of better therapies.

For instance, Prof. Eliezer Flescher — from Tel Aviv University in Israel — noticed that methyl jasmonate, which is a compound obtained from jasmonic acid, found in the jasmine plant, induces the death of cervical cancer cells.

And, if you happen to enjoy drinking jasmine tea simply because you love the way it smells, there’s actually a good reason for that. Research that was published in the European Journal of Applied Physiology explained that the smell of jasmine tea is soothing, able to calm nerves, and able to help regulate mood.

3. Rooibos tea

Another type of tea with antioxidant properties is rooibos, or “redbush tea,” which is prepared from the Aspalathus linearis plant native to South Africa.

Rooibos tea may protect liver health.

Research has suggested that the antioxidant effects of rooibos are similar to, if not quite as strong as, those of green tea.

A recent study on the rat model has suggested that the antioxidants in rooibos tea may protect the liver from oxidative stress, helping to render this organ more resilient to induced damage.

The researchers who conducted the study noted that their findings suggest that rooibos tea or rooibos-derived dietary supplements may offer a useful health boost.

Results from this study suggest that the daily intake of unfermented rooibos herbal tea or a derived commercial rooibos supplement may benefit human health by providing the liver with an enhanced antioxidant capacity to reduce damage induced by toxicants.”

Moreover, rooibos has also been cited as helpful in lowering blood pressure and relaxing tense muscles, suggesting that the active ingredient in this instance might be one of the flavonoids (pigments) that it contains: chrysoeriol.

Unlike green or black tea, rooibos does not contain any caffeine, so it won’t have the same stimulating effects. This makes it safe to drink well into the evening.

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4. Hibiscus tea

Those of you who enjoy the refreshing taste of a more sour brew may also be familiar with herbal infusions of hibiscus, a plant whose flowers can be used not just to make invigorating beverages, but also to give a subtle “punch” to salads, or as an elegant garnish for sophisticated dishes.

Hibiscus tea is an antioxidant and may bring cardiovascular benefits.

The most commonly used variety is Hibiscus sabdariffa, also known as the “roselle.”

For the tea — or, more correctly “tisane” (herbal tea) — its calyces are typically used, although other parts of the plant, such as the leaves, seeds, and roots, are safe for consumption.

Studies have suggested that extracts from the hibiscus calyx and hibiscus leaves have antioxidant and antitumoral effects.

Therefore, they may protect against the aging action of free radicals at a cellular level, as well as fight certain types of leukemia cells.

Hibiscus tea has also been tied to cardiovascular benefits, helping to regulate systolic and diastolic blood pressure — that is, blood pressure during and in-between heart beats, respectively.

Though not so commonly used to brew tea, hibiscus leaves have also been linked repeatedly to a wide array of health benefits. Thus, the polyphenols in hibiscus leaves may help to induce tumor cell death in skin cancer, according to a 2015 study.

Another study from the same year also argued that hibiscus leaf extracts could inhibit the action of prostate cancer cells.

5. Lemon verbena tea

Another herbal tea whose medicinal properties are getting increasingly recognized is that made out of lemon verbena, scientifically dubbed Aloysia citrodora.

Infusions with lemon verbena are said to help with weight management.

It is the citrus-flavored cousin of a better-known plant that has been used in herbal infusions for years: verbena, or vervain (Verbena officinalis).

Infusions made with lemon verbena are great for those who, like me, prefer a subtler citrusy aroma in their hot drinks, rather than the strong, lemony flavor of commonly commercialized citrus tea blends.

The first time that I came upon this plant sold as a tisane herb was in a local organic shop that was selling it as “weight loss tea.”

In fact, studies have shown that the polyphenols in this plant can decrease the formation of fatty acids, marking its potential use in the treatment of obesity-related health issues.

Researchers have also suggested that lemon verbena extracts may help to lower inflammatory markers’ levels in the blood of some people with multiple sclerosis.

“Results demonstrate that supplementation with lemon verbena extracts may affect the cytokine [inflammation markers] profile depending on the clinical subtype,” the study authors conclude.

Having a cup of your tea — or tisane — of choice may be a pleasant way to carve out some self-indulgence time and stimulate your bodily and mental well-being in a subtle way.

But always keep in mind that, as the saying goes, “one swallow does not a summer make,” and the most potent health benefits are best reaped by leading a healthful, wholesome lifestyle.

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