Date: 2/11/2009
By SETH BORENSTEIN
AP Science Writer
WASHINGTON (AP) — Like any young woman in love, Bianca Acevedo has exchanged valentine hearts with her fiance.
But the New York neuroscientist knows better. The source of love is in the head, not the heart.
She’s one of the researchers in a relatively new field focused on explaining the biology of romantic love. And the unpoetic explanation is that love mostly can be understood through brain images, hormones and genetics.
That seems to be the case for the newly in love, the long in love and the brokenhearted.
“It has a biological basis. We know some of the key players,” said Larry Young of the Yerkes National Primate Research Center at Emory University in Atlanta. There, he studies the brains of an unusual monogamous rodent to get a better clue about what goes on in the minds of people in love.
In humans, there are four tiny areas of the brain that some researchers say form a circuit of love. Acevedo, who works at the Albert Einstein College of Medicine in New York, is part of a team that has isolated those regions with the unromantic names of ventral tegmental area (VTA), the nucleus accumbens, the ventral pallidum and raphe nucleus.
The hot spot is the teardrop-shaped VTA. When people newly in love were put in a functional magnetic resonance imaging machine and shown pictures of their beloved, the VTA lit up. Same for people still madly in love after 20 years.
The VTA is part of a key reward system in the brain.
“These are cells that make dopamine and send it to different brain regions,” said Helen Fisher, a researcher and professor at Rutgers University. “This part of the system becomes activated because you’re trying to win life’s greatest prize — a mating partner.”
One of the research findings isn’t so complimentary: Love works chemically in the brain like a drug addiction.
“Romantic love is an addiction; a wonderful addiction when it is going well, a horrible one when it is going poorly,” Fisher said. “People kill for love. They die for love.”
The connection to addiction “sounds terrible,” Acevedo acknowledged. “Love is supposed to be something wonderful and grand, but it has its reasons. The reason I think is to keep us together.”
But sometimes love doesn’t keep us together. So the scientists studied the brains of the recently heartbroken and found additional activity in the nucleus accumbens, which is even more strongly associated with addiction.
“The brokenhearted show more evidence of what I’ll call craving,” said Lucy Brown, a neuroscientist also at Einstein medical college. “Similar to craving the drug cocaine.”
The team’s most recent brain scans were aimed at people married about 20 years who say they are still holding hands, lovey-dovey as newlyweds, a group that is a minority of married people. In these men and women, two more areas of the brain lit up, along with the VTA: the ventral pallidum and raphe nucleus.
The ventral pallidum is associated with attachment and hormones that decrease stress; the raphe nucleus pumps out serotonin, which “gives you a sense of calm,” Fisher said.
Those areas produce “a feeling of nothing wrong. It’s a lower-level happiness and it’s certainly rewarding,” Brown said.
The scientists say they study the brain in love just to understand how it works, as well as for more potentially practical uses.
The research could eventually lead to pills based on the brain hormones which, with therapy, might help troubled relationships, although there are ethical issues, Young said. His bonding research is primarily part of a larger effort aimed at understanding and possibly treating social-interaction conditions such as autism. And Fisher is studying brain chemistry that could explain why certain people are attracted to each other. She’s using it as part of a popular Internet matchmaking service for which she is the scientific adviser.
While the recent brain research is promising, University of Hawaii psychology professor Elaine Hatfield cautions that too much can be made of these studies alone. She said they need to be meshed with other work from traditional psychologists.
Brain researchers are limited because there is only so much they can do to humans without hurting them. That’s where the prairie vole — a chubby, short-tailed mouselike creature — comes in handy. Only 5 percent of mammals more or less bond for life, but prairie voles do, Young said.
Scientists studied voles to figure out what makes bonding possible. In females, the key bonding hormone is oxytocin, also produced in both voles and humans during childbirth, Young said. When scientists blocked oxytocin receptors, the female prairie voles didn’t bond.
In males, it’s vasopressin. Young put vasopressin receptors into the brains of meadow voles — a promiscuous cousin of the prairie voles — and “those guys who should never, ever bond with a female, bonded with a female.”
Researchers also uncovered a genetic variation in a few male prairie voles that are not monogamous — and found it in some human males, too.
Those men with the variation ranked lower on an emotional bonding scale, reported more marital problems, and their wives had more concerns about their level of attachment, said Hasse Walum, a biology researcher in Sweden. It was a small but noticeable difference, Walum said.
Scientists figure they now know better how to keep those love circuits lit and the chemicals flowing.
Young said that romantic love theoretically can be simulated with chemicals, but “if you really want, you know, to get the relationship spark back, then engage in the behavior that stimulates the release of these molecules and allow them to stimulate the emotions,” he said. That would be hugging, kissing, intimate contact.
“My wife tells me that flowers work as well. I don’t know for sure,” Young said. “As a scientist it’s hard to see how it stimulates the circuits, but I do know they seem to have an effect. And the absence of them seems to have an effect as well.”
Copyright 2009 The Associated Press.
How to manage the maze of medical debt
Date: 2/10/2009
By TOM MURPHY
AP Business Writer
Prostate cancer hospitalized Ernest Patton for only a few days in 2007, but that was long enough to push the North Carolina man toward financial ruin.
His radiation treatment cost $65,000. The total bill topped $100,000, and almost none of it was covered by the insurance he received through his fast-food restaurant job.
But thanks to his sister, who quickly learned the ropes of debt reduction, most of that debt has been forgiven.
“If it hadn’t been for family, I wouldn’t have survived,” Patton said.
A recovery like this is not unusual, but people swamped with medical debt often don’t know how to find relief, according to debt experts. They say both insured and uninsured patients have more leverage than they think to lighten the sometimes crushing weight of medical bills.
And more people are feeling that weight. The nonprofit Commonwealth Fund estimated that a third of all working-age Americans were struggling to pay medical bills in late 2007, the latest figures available. The New York-based private foundation supports independent research and offers grants on health care issues and policy.
Researchers say that percentage likely has risen, given the growing number of people who have since lost jobs and insurance coverage in the recession. About 46 million Americans are uninsured, according to recent estimates.
Medical bills can skyrocket quickly for the uninsured, who often face larger charges because they don’t have insurers negotiating prices for them.
But even people with insurance can get pinched if they chose a plan that provides limited coverage. More employers also are reducing insurance offerings or asking their employees to pay a greater amount.
Medical providers also have become more aggressive in collecting because fewer patients are paying, said Kevin Flynn, president of Philadelphia-based Health Care Advocates Inc., a for-profit business that works with patients on debt resolution and insurance disputes.
Flynn said he started noticing the trend about four months ago, and it will grow worse as the economy weakens.
Still, he estimates that the average patient can shave as much as 15 percent off a bill even before seeking help from a company like his.
NAVIGATING THE PROCESS
Patton’s debt recovery began when his sister, who helped manage his bills after he became sick, asked for help. Leatha Tripp, 70, knew her 56-year-old brother’s insurance wouldn’t dent his bills.
She applied for charity help and offered proof of Patton’s wages. The hospital wrote off the cost of his stay, and the cost of the radiation treatment was eventually forgiven as well.
“I was really shocked that these places would work with you,” said Tripp, who received help from the nonprofit Patient Advocate Foundation.
A patient’s first step should be to learn about public aid programs or hospital discounts, said Carol Pryor, policy director for The Access Project, a Boston-based nonprofit that works to improve health care access.
Patients also should ask for a bill copy that shows every item of care delivered. Scrutinize it and question anything suspicious. Negotiate that $10 charge for Tylenol.
Look for errors too. Flynn frequently sees overcharges for operating room time. They may list six hours when a procedure took four.
Some mistakes really stick out. Flynn once saw a hysterectomy listed on a man’s bill.
Ask about payment options, too. Hospitals frequently offer steep discounts if a bill can be paid all at once. Some may set up no-interest payment plans.
Patients with insurance also should be wary of balance billing. That’s the difference between the amount billed by a provider and the amount paid by the insurer after patients pay copays, coinsurance or deductibles.
Patients should not be balance billed if they use providers in their insurance network. They should check with their insurer if they’re billed for anything beyond standard payments like co-pays or deductibles.
Insurance also can be scrutinized. Most insurers offer a toll-free phone number people can use to ask questions or request a review of their coverage.
Many state governments provide independent panels of experts that examine claims if that review fails to resolve problems.
ENLIST AN ADVOCATE
Sometimes a patient advocate makes a huge difference. It did for Domenico Pelliccione. The 62-year-old suburban Denver resident lost his wife of 21 years, Donna, to colon cancer last July.
Donna had no insurance, and bills totaled more than $300,000 after she started treatment in July 2007.
Meanwhile, Pelliccione was working 12-hour days as a truck driver and then heading to the hospital immediately afterward.
Nasty phone calls and letters started coming from the hospital, Pelliccione said. “I was getting so tired by the end that I didn’t really care about it,” he said. “All I needed to do was be there for her.”
Then someone told him about Patient Advocate Foundation, a nonprofit that helps people with life-threatening or debilitating illnesses negotiate their debt.
The foundation helped whittle his bills down to $190,000 and then to only $5,000 over several months.
The foundation’s services are free, but some for-profit advocates do charge. Potential customers should ask what fees or percentage of savings a company may charge. Other nonprofit agencies like the American Cancer Society can provide referrals to these advocates.
OTHER AVENUES
Even after exhausting these resources, many patients can still wind up with large bills. That’s where friends and family and word of mouth can help.
The North Carolina brother and sister, Leatha Tripp and Ernest Patton, held a yard sale to help with remaining debt. They also rallied their eight siblings and raised about $5,000.
That topped Patton’s insurance contribution, which covered only a few hundred dollars, Tripp said. Her brother had signed up for the least expensive insurance option at work because it was all he could afford.
Community support has helped the Summerlin family of Avon, Ind., as their 8-year-old son, Tommy, fights leukemia.
His parents, Linda and Tom Summerlin, both work full-time, and they have insurance. But they still face daunting costs. Doctors plan to give Tommy a bone marrow transplant, which runs at least $250,000 without complications.
Linda Summerlin noted that even if insurance covers 80 percent of that bill, $50,000 remains.
“I remember when he got the diagnosis,” Summerlin said. “I was like, ‘I’d sell my house, I’d sell my car, I’d sell the shirt off my back to pay for it, if that’s what it took for him to live.'”
So far, she hasn’t had to do any of that. Several local restaurants helped raise money. A woman the Summerlins had never met organized a golf outing that brought in several thousand dollars.
“If we hadn’t had the fundraising, our Christmas would have been very meek,” Linda Summerlin said.
Copyright 2009 The Associated Press.
By TOM MURPHY
AP Business Writer
Prostate cancer hospitalized Ernest Patton for only a few days in 2007, but that was long enough to push the North Carolina man toward financial ruin.
His radiation treatment cost $65,000. The total bill topped $100,000, and almost none of it was covered by the insurance he received through his fast-food restaurant job.
But thanks to his sister, who quickly learned the ropes of debt reduction, most of that debt has been forgiven.
“If it hadn’t been for family, I wouldn’t have survived,” Patton said.
A recovery like this is not unusual, but people swamped with medical debt often don’t know how to find relief, according to debt experts. They say both insured and uninsured patients have more leverage than they think to lighten the sometimes crushing weight of medical bills.
And more people are feeling that weight. The nonprofit Commonwealth Fund estimated that a third of all working-age Americans were struggling to pay medical bills in late 2007, the latest figures available. The New York-based private foundation supports independent research and offers grants on health care issues and policy.
Researchers say that percentage likely has risen, given the growing number of people who have since lost jobs and insurance coverage in the recession. About 46 million Americans are uninsured, according to recent estimates.
Medical bills can skyrocket quickly for the uninsured, who often face larger charges because they don’t have insurers negotiating prices for them.
But even people with insurance can get pinched if they chose a plan that provides limited coverage. More employers also are reducing insurance offerings or asking their employees to pay a greater amount.
Medical providers also have become more aggressive in collecting because fewer patients are paying, said Kevin Flynn, president of Philadelphia-based Health Care Advocates Inc., a for-profit business that works with patients on debt resolution and insurance disputes.
Flynn said he started noticing the trend about four months ago, and it will grow worse as the economy weakens.
Still, he estimates that the average patient can shave as much as 15 percent off a bill even before seeking help from a company like his.
NAVIGATING THE PROCESS
Patton’s debt recovery began when his sister, who helped manage his bills after he became sick, asked for help. Leatha Tripp, 70, knew her 56-year-old brother’s insurance wouldn’t dent his bills.
She applied for charity help and offered proof of Patton’s wages. The hospital wrote off the cost of his stay, and the cost of the radiation treatment was eventually forgiven as well.
“I was really shocked that these places would work with you,” said Tripp, who received help from the nonprofit Patient Advocate Foundation.
A patient’s first step should be to learn about public aid programs or hospital discounts, said Carol Pryor, policy director for The Access Project, a Boston-based nonprofit that works to improve health care access.
Patients also should ask for a bill copy that shows every item of care delivered. Scrutinize it and question anything suspicious. Negotiate that $10 charge for Tylenol.
Look for errors too. Flynn frequently sees overcharges for operating room time. They may list six hours when a procedure took four.
Some mistakes really stick out. Flynn once saw a hysterectomy listed on a man’s bill.
Ask about payment options, too. Hospitals frequently offer steep discounts if a bill can be paid all at once. Some may set up no-interest payment plans.
Patients with insurance also should be wary of balance billing. That’s the difference between the amount billed by a provider and the amount paid by the insurer after patients pay copays, coinsurance or deductibles.
Patients should not be balance billed if they use providers in their insurance network. They should check with their insurer if they’re billed for anything beyond standard payments like co-pays or deductibles.
Insurance also can be scrutinized. Most insurers offer a toll-free phone number people can use to ask questions or request a review of their coverage.
Many state governments provide independent panels of experts that examine claims if that review fails to resolve problems.
ENLIST AN ADVOCATE
Sometimes a patient advocate makes a huge difference. It did for Domenico Pelliccione. The 62-year-old suburban Denver resident lost his wife of 21 years, Donna, to colon cancer last July.
Donna had no insurance, and bills totaled more than $300,000 after she started treatment in July 2007.
Meanwhile, Pelliccione was working 12-hour days as a truck driver and then heading to the hospital immediately afterward.
Nasty phone calls and letters started coming from the hospital, Pelliccione said. “I was getting so tired by the end that I didn’t really care about it,” he said. “All I needed to do was be there for her.”
Then someone told him about Patient Advocate Foundation, a nonprofit that helps people with life-threatening or debilitating illnesses negotiate their debt.
The foundation helped whittle his bills down to $190,000 and then to only $5,000 over several months.
The foundation’s services are free, but some for-profit advocates do charge. Potential customers should ask what fees or percentage of savings a company may charge. Other nonprofit agencies like the American Cancer Society can provide referrals to these advocates.
OTHER AVENUES
Even after exhausting these resources, many patients can still wind up with large bills. That’s where friends and family and word of mouth can help.
The North Carolina brother and sister, Leatha Tripp and Ernest Patton, held a yard sale to help with remaining debt. They also rallied their eight siblings and raised about $5,000.
That topped Patton’s insurance contribution, which covered only a few hundred dollars, Tripp said. Her brother had signed up for the least expensive insurance option at work because it was all he could afford.
Community support has helped the Summerlin family of Avon, Ind., as their 8-year-old son, Tommy, fights leukemia.
His parents, Linda and Tom Summerlin, both work full-time, and they have insurance. But they still face daunting costs. Doctors plan to give Tommy a bone marrow transplant, which runs at least $250,000 without complications.
Linda Summerlin noted that even if insurance covers 80 percent of that bill, $50,000 remains.
“I remember when he got the diagnosis,” Summerlin said. “I was like, ‘I’d sell my house, I’d sell my car, I’d sell the shirt off my back to pay for it, if that’s what it took for him to live.'”
So far, she hasn’t had to do any of that. Several local restaurants helped raise money. A woman the Summerlins had never met organized a golf outing that brought in several thousand dollars.
“If we hadn’t had the fundraising, our Christmas would have been very meek,” Linda Summerlin said.
Copyright 2009 The Associated Press.
Italian woman moved to hospital where she can die
Date: 2/3/2009
ROME (AP) — A woman at the center of Italy’s right-to-die debate was transferred Tuesday to a hospital where she is to be allowed to die after 17 years in a vegetative state.
Eluana Englaro was moved to the northeastern city of Udine overnight, said family lawyer Vittorio Angiolini.
A small crowd of anti-euthanasia activists gathered outside the clinic in Lecco, where she had been cared for, seeking to prevent the ambulance from leaving, TV footage showed. Some were shouting “Eluana, Wake Up!”
Englaro has been in a vegetative state since a car accident in 1992, when she was 20. Her father has led a protracted court battle to disconnect her feeding tube, insisting it was her wish.
An Italian court in the summer granted his request, setting off a political storm in the Roman Catholic country.
Her father then sought to have her removed from the Catholic clinic in Lecco to Udine, in the region where the family is from. But the government issued a decree last month telling state hospitals that they must guarantee care for people in vegetative states, leading at least one hospital in Udine to refuse to take Englaro.
She was moved overnight to La Quiete, a private clinic.
Welfare Minister Maurizio Sacconi said the government is looking into the situation.
Italy does not allow euthanasia. Patients have a right to refuse treatment but there is no law that allows them to give advance directions on what treatment they wish to receive if they become unconscious.
The case has provoked the strong reaction of the Vatican, which is opposed to euthanasia. Pope Benedict XVI said this weekend that euthanasia is a “false solution” to suffering.
Cardinal Javier Lozano Barragan, the pope’s health minister, told La Repubblica that removing Englaro’s feeding tube “is tantamount to an abominable assassination and the church will always say that out loud.”
Copyright 2009 The Associated Press.
ROME (AP) — A woman at the center of Italy’s right-to-die debate was transferred Tuesday to a hospital where she is to be allowed to die after 17 years in a vegetative state.
Eluana Englaro was moved to the northeastern city of Udine overnight, said family lawyer Vittorio Angiolini.
A small crowd of anti-euthanasia activists gathered outside the clinic in Lecco, where she had been cared for, seeking to prevent the ambulance from leaving, TV footage showed. Some were shouting “Eluana, Wake Up!”
Englaro has been in a vegetative state since a car accident in 1992, when she was 20. Her father has led a protracted court battle to disconnect her feeding tube, insisting it was her wish.
An Italian court in the summer granted his request, setting off a political storm in the Roman Catholic country.
Her father then sought to have her removed from the Catholic clinic in Lecco to Udine, in the region where the family is from. But the government issued a decree last month telling state hospitals that they must guarantee care for people in vegetative states, leading at least one hospital in Udine to refuse to take Englaro.
She was moved overnight to La Quiete, a private clinic.
Welfare Minister Maurizio Sacconi said the government is looking into the situation.
Italy does not allow euthanasia. Patients have a right to refuse treatment but there is no law that allows them to give advance directions on what treatment they wish to receive if they become unconscious.
The case has provoked the strong reaction of the Vatican, which is opposed to euthanasia. Pope Benedict XVI said this weekend that euthanasia is a “false solution” to suffering.
Cardinal Javier Lozano Barragan, the pope’s health minister, told La Repubblica that removing Englaro’s feeding tube “is tantamount to an abominable assassination and the church will always say that out loud.”
Copyright 2009 The Associated Press.