(Credit: Extreme Tech)

On Thursday, the Associated Press reported that doctors had, for the first time, used a 3D printer to create a life-saving artificial airway for a baby boy. The Ohio child was born with a birth defect that cause his airway to collapse, putting him at constant risk of suffocation — until doctors asked the U.S. Food and Drug Administration (FDA) for permission to print him a new one.

The FDA agreed, although it still hasn’t adopted an official policy on bioprinting body parts. But the agency will be forced to make a decision soon enough, as increasingly sophisticated 3D printers take the American field by storm. Here are five ways that 3D printers could be a game changer for U.S. health care:

1. Cutting down the backlogged kidney transplant list. 80 percent of the approximately 113,000 Americans on the organ transplant list need a new kidney — but only 30,000 transplants are performed in the U.S. each year, contributing to 4,000 annual kidney-related deaths. But with the use of “Bio-Ink” and 3D printers, that could all change. Researchers at the University of Iowa have been using a “bioprinter” to simulate living tissue structures. Dr. Ibrahim Ozbolat, who is heading the project predicts that fully formed, transplant-ready organs could be an impending reality. “The long-term goal of this [lab] is to create functioning human organs some five or 10 years from now. This is not far-fetched,” said Ozbolat.

2. Regulating diabetes by creating entirely new organs. As if creating organs from stem cells wasn’t enough, Dr. Ozbolat’s team has an even loftier goal in mind: the creation of entirely new organ structures to treat Americans’ medical problems. “One of the most promising research activities is bioprinting a glucose-sensitive pancreatic organ that can be grown in a lab and transplanted anywhere inside the body to regulate the glucose level of blood,” said Ozbolat of his goal. Considering the epidemic-level of diabetes in the United States — and the associated health care costs of the disease — that would be a true medical revolution, essentially nullifying the disease. And if Ozbolat’s team could create that kind of technology, it could potentially be modified to treat cancers and other chronic conditions.

3. Grafting skin onto burn victims. The current process of skin grafting requires the painful removal of skin from an unaffected area of the patient’s body. But researchers at the University of Toronto have developed a method of loading skin cells and various other polymers into a 3D printer to artificially create thick layers of skin. Strikingly, the team used a simplified 3D printer that costs far less than the average $200,000, and claim that their printer can produce tissue for 1/1000th of that cost “even by the most conservative estimates.”

4. Making prostheses resemble the original missing limb. This is a field in which there has already been significant progress with 3D printers — and garners major potential for patient satisfaction and quality of life. The trouble with many prostheses is that they wear down, don’t perfectly conform to patients’ limbs, and can present a stigma for patients who need them. But scientists at Bespoke Innovations have created prosthetic coverings “that perfectly mirror the sculptural symmetry and function of the wearer’s remaining limb,” and can even be customized to conform to the patient’s fashion style. Actually creating an entirely new limb would be ambitious — but considering that doctors recently replaced 75 percent of a man’s skull with a 3D-printed implant, that might not be out of the question, either.

5. Addressing poor Americans’ dental health needs. One aspect of U.S. health care that gets overlooked is the meager availability of dental coverage, especially for the poor. But the use of 3D printing in orthodontics could help change that by making dental procedures cheaper and more efficient — or at the very least could help rectify some the medical consequences of paltry dental coverage. A digital scan of the inside of a patient’s mouth and a 3D printer is all that’s needed to create crowns, bridges, and dentures. It also makes the process less invasive and more accurate by making it unnecessary to create physical molds of patients’ mouths.

(Credit: Where Is Your Line)

On Wednesday, students and alumni of Swarthmore College, the University of Southern California, the University of California, Berkeley, and Dartmouth College filed federal complaints against their respective schools for failing to adequately address sexual assault and harassment on campus. If found guilty by the Department of Education, the campuses could be subject to disciplinary actions, including fines and the loss of federal funding for student aid.

The complainants allege that the colleges have violated either the Clery Act, Title IX of the Education Amendments of 1972, or both. The Clery Act requires all campuses to report crime statistics, including for sexual assault, and Title IX prohibits sex-based discrimination at educational institutions.

“We are asking the Department of Education to open an investigation into these complaints and take appropriate actions to force these colleges to comply with the law or risk losing their federal funding,” said Gloria Allred, a civil rights attorney representing many of the plaintiffs.

A growing number of students at major colleges and universities have been stepping up their efforts to combat rape and sexual assault in schools. Last month, Los Angeles’ Occidental College was served with similar federal complaints. The University of North Carolina, Chapel Hill is undergoing a federal investigation for allegedly threatening to expel a student who spoke out publicly about her own rape.

Other elite institutions such as the University of Notre Dame, Harvard University, and Amherst College have also been in the news over complaints that administrators have failed to foster a safe campus environment and contributed to victim-blaming and rape culture. Just last week, Yale University was forced to pay a $165,000 fine after federal investigators determined that it had violated the Clery Act by failing to report instances of rape.

While some colleges have taken small steps towards improving their policies on sexual assault and campus safety, the latest round of federal complaints underscores how entrenched rape culture is in many American campuses.

(Credit: Planned Parenthood)

As the San Antonio Express-News reports, every single anti-abortion bill proposed in Texas this year was successfully blocked before it reached the House or Senate floor. Of course, that wasn’t for lack of trying — altogether, anti-choice lawmakers introduced at least 24 different measures to restrict Texas women’s reproductive rights. Some of those bills even had the backing of key leaders in the state, like Gov. Rick Perry (R) and Lt. Gov. David Dewhurst (R). But Democratic members of the state legislature pushed back, and won.

“Democrats stuck together very well this session and made strong arguments and strong advocacy on behalf of a woman’s right to choose,” state Sen. Kirk Watson (D), the head of Texas’ Democratic caucus, told the Express-News. “Just this week, I’ve had pressure from leadership pushing to bring up bills in an almost threatening way, and we have stood up to that. …Now we’re at the end of the session, and they’re dead.”

The failed anti-abortion legislation included a “fetal pain” measure that would have criminalized abortion services after the 20th week of pregnancy, as well as several bills intended to force abortion clinics in the state to close their doors.

Democrats in the state explained that anti-abortion lawmakers experienced significant backlash during the 2012 elections, in the height of the so-called “War on Women.” Republicans took a “big hit” in that election, and the balance of the legislature tipped. After Texas voters continued to express disapproval over the new legislation that compromised women’s health, GOP lawmakers began to relent. They even agreed to work to reverse some of the family planning cuts.

Not every state had similar success defeating anti-choice initiatives, however. In the first quarter of 2013, state lawmakers proposed an astounding 694 provisions about reproduction — and some of them, including the most stringent abortion bans this country has seen since Roe v. Wade legalized abortion over 40 years ago, became law this year.

According to data compiled by the Employee Benefit Research Institute (EBRI), large employers have increasingly been turning to part-time workers for their labor. Between 2007 and 2011, the percentage of workers employed in part-time jobs increased from 16.7 percent to 22.2 percent of the work force. That means that workers’ hours have also been declining, since using more part-time workers lets companies scale back on how many hours those employees can work.

But these companies’ cuts haven’t been limited to workers’ hours — they’ve been cutting back on part-time employees’ health benefits, too. During the same four year period, part-time workers experienced a 15.7 percent decline in the likelihood of having health coverage through their jobs:

As the graph demonstrates, that trend existed even before the recession, and has only gotten worse since then.

Cost-cutting at the expense of employees’ benefits and wages certainly isn’t new behavior for large companies. Even employers with full time workers have been shifting the cost of medical care onto their employees through the increasing use of high-deductible and bare bones health plans — something that industry experts expect to continue. Over the last decade, average annual health insurance premiums rose by approximately 97 percent — but workers’ contributions to those premiums increased by an outsized 102 percent in the same time span.

This reflects the dangers of a health care system in which employers are the major providers of Americans’ health coverage. Recent history suggests that companies would have continued slashing workers’ benefits and hours anyway — Obamacare has just given them a convenient excuse.

Every single state except for West Virginia and North Dakota showed some kind of decline in the number of teenagers giving birth. But significant regional disparities remain. The CDC found that the lowest rates of teen births are in New Hampshire, Massachusetts, Connecticut and Vermont — which each have rates under 17 births per 1,000 teen girls — while Arkansas and Mississippi have the highest rates at about 50 per 1,000. Overall, the highest rates of teen births continue to be concentrated in the South.

The CDC’s research builds on previous data that showed the United States’ teen pregnancy rate has plunged to record lows since 1991, largely because of adolescents’ expanded access to contraception. “Credit goes to teens themselves who are clearly making better decisions about sex, contraception, and their future,” Bill Albert, the chief program officer of the National Campaign to Prevent Teen and Unplanned Pregnancy, told the Associated Press.

But those type of preventative health resources aren’t equally available to teens in every part of the country. Over the past decade, teen pregnancy rates have consistently been higher in Southern states that don’t provide students with adequate sexual health instruction. Since abstinence-only courses often present misleading information about contraception, a full 60 percent of young adults underestimate birth control’s effectiveness and are more likely to skip it because they don’t believe it will make a difference. And teens in rural areas still struggle to access contraception, partly because there are fewer health clinics in less populous places and partly because a societal stigma surrounding teen sexuality still pervades conservative communities.

Unfortunately, this correlation isn’t limited to teen pregnancy and teen births. Southern states that don’t offer comprehensive sex ed classes also have the highest rates of STDs.

As the United States has continued to grapple with addressing its teen pregnancy rates — which are higher than the rates in any other developed nation — there has been some debate over the best tactic to effectively lower the rate of unintended teen births. Public health campaigns to dissuade adolescents from becoming pregnant typically rely on shame-based tactics that tell young women they will be failures if they become pregnant. But there’s evidence to suggest that providing youth with the support they need through community programs, rather than shaming them about their sexuality, is actually a more effective way to encourage them to make healthy sexual choices.

As the Huffington Post reports, Senate Bill 900 doesn’t actually specifically mention the name of the national women’s health organization. But, since the legislation would reallocate the state’s family planning funds to public providers and hospitals, Planned Parenthood — which is a private organization — would effectively lose the funding that used to go toward those services.

The bill passed on Wednesday by a 33 to 8 vote, and now heads to the House. At least one Republican in the House told the Huffington Post that he plans to vote against it. “To defund a program like Planned Parenthood would be a mistake. They perform a valuable service as far as breast cancer screenings, cervical cancer screenings, parenting classes, many things that benefit our state that we’re sorely in need of,” State Rep. Doug Cox (R) explained.

This is hardly the first time that Oklahoma has indirectly attacked Planned Parenthood’s funding. Last year, the state’s Department of Health decided to end its WIC contract with Oklahoma’s Planned Parenthood affiliate — effectively cutting off the state funding that the organization relied on to provide health services to low-income women in the Tulsa area. Planned Parenthood tried to block Oklahoma officials from arbitrarily ending the 18-year contract, but their request was denied by a federal judge. As a result, Planned Parenthood was forced to lay off staff and shut down one of its Tulsa health clinics.

Unfortunately, this isn’t the only attack on women’s health that Oklahoma lawmakers have advanced recently. In February, a state senator attempted to push through a bill that would have allowed employers to deny birth control coverage to their workers for any reason. Anti-choice legislators in Oklahoma have also repeatedly pushed “personhood” measures to endow embryos with the full rights of U.S. citizens, which would outlaw all abortions and some forms of birth control.

A top Senate Republican is comparing Health and Human Services Secretary Kathleen Sebelius to convicted felon Oliver North for soliciting private donations to help implement the Affordable Care Act.

In an op-ed published in the Wall Street Journal on Wednesday, Sen. Lamar Alexander (R-TN) charged that Sebelius circumvented Congress’ refusal to provide funds for the administration’s health care law by raising those dollars from outside groups, just as “Col. North was accused of using money raised in an arms-for-hostages swap with Iran to fund and work with private organizations providing military support to rebel armies in Nicaragua.”

In 1987, North admitted that he lied to Congress about his role in the Iran-Contra scandal — in which officials secretly sold arms to Iran to fund a resistance movement to the government in Nicaragua — and shred documents to cover-up the government’s actions. He was indicted on 16 counts and convicted of three: accepting an illegal gratuity, aiding and abetting in the obstruction of a congressional inquiry, and ordering the destruction of documents.

“With Iran-Contra, Congress had also prohibited support for the rebels, while in the case of health-care funding, Congress has refused to provide the amounts that the administration has asked for,” Alexander wrote. “But the principle and the legal prohibitions are the same.” Republican chairmen and ranking Republicans on five congressional committees have asked the Government Accountability Office to look into the matter.

Obama administration officials insist that Sebelius was following authority laid out in the Public Health Service Act — which allows the secretary to “support by grant or contract (and to encourage others to support) private nonprofit entities working in health information and health promotion, preventive health services, and education in the appropriate use of health care” — but “has made no fundraising requests to entities regulated by HHS.” The New York Times reported on May 12 that Sebelius did solicit donations from the Robert Wood Johnson Foundation and H&R Block.

Indeed, asking private organizations to contribute to administration causes is old practice in Washington, as Alexander himself knows.

In 1991, while serving as Secretary of Education for President George H. W. Bush, Alexander actively and enthusiastically sought private dollars to fund the administration’s education initiative, America 2000. Alexander crisscrossed the country to sell the program after Congress failed to approve Bush’s education funding request.

As he explained in a San Diego Union-Tribune op-ed on Sep. 27, 1992, “President Bush asked Congress to appropriate a half-billion dollars to redesign such new American schools. Congress balked, the business community didn’t. The president has asked American businesses to raise $200 million to fund design teams to help communities create such schools.”

Bush made the fundraising pitch in the Rose Garden in July of 1991 during an event with private donors, with Alexander standing by his side. “Funds are pouring in — I don’t want to say ‘pouring,’ because we’re going to put the arm on you all on in a minute here — but funds are coming in well,” the president said. “[A]lready $30 million has been raised, much of it from the corporations that are represented here today.”

The administration continued to fundraise for the effort, with Alexander himself making a pitch. Responding to a Associated Press report from August of 1991, which noted that businesses are hesitant to commit additional dollars to new causes during the recession, Alexander said, “In my opinion, the more you ask for the more you get. We’ve been very timid about asking American businesses to support elementary and secondary education, tiptoeing around the edges,” he added. “We shouldn’t do that. This is a big, rich generous country and we’ve got plenty of money for all the innovations, especially innovations in excellence.”

Alexander’s office did not respond to ThinkProgress repeated requests for comment about his past role in soliciting private donations, but the senator sought to dismiss the comparison earlier this month on the senate floor, arguing that Congress had not directly prevented the Bush administration from raising money from outside sources.

(Credit: Queerty)

The County of Los Angeles Department of Public Health wants to help promote safer sex practices by passing out one million and one condoms by the end of this year. In order to accomplish that goal, city officials are hitting the road — in a 40-foot “condom mobile” featuring the images of professional athletes reminding people to “suit up.”

Last year, the county’s health department sponsored its first-ever condom contest to give residents the opportunity to design an official Los Angeles branded condom wrapper. And now, the new bus will be handing out free condoms packaged in the winning design. The county has also partnered with local LGBT intramural sports leagues that will help them distribute additional free condoms.

This isn’t the first creative initiative to address California’s rising STD rates by expanding access and exposure to prevention methods. A new state-sponsored initiative called the “Condom Access Project” makes it easier for California teens tp obtain sexual health resources by allowing them to order free condoms online. And Los Angeles voters recently endorsed a measure requiring adult film stars to wear condoms on screen.

Education campaigns about safer sex may be especially necessary since not all of California’s students are receiving that type of instruction in school. Last year, the ACLU sued a Fresno County school for failing to provide accurate sexual health education to students. Students there were taught that sexually transmitted infections can be prevented by going out in groups with friends and getting plenty of rest.

The piece centers on particularly destitute populations in southern Texas, where some uninsured residents are so poor, sick, and unable to cope with their medical bills that they resort to desperate measures such as crossing the border into Mexico for medications and even sharing their insulin shots:

[M]any of those who live here [in Brownsville] — including poor Latino immigrants, both legal and undocumented — suffer from diabetes and lack of insurance. Some of those uninsured diabetics, including American citizens and others living here legally, used to go across the border to Matamoros, Mexico for insulin. But now with the fear of brutal drug violence and tougher border restrictions, families share their insulin shots rather than risking the crossings.

A community health worker in Brownsville noted that “many of those who used to cross the border would qualify for Medicaid under the expansion offered by the health care law.”

This inequity is further exacerbated when dealing with a more serious or life-threatening chronic condition. One official at Brownsville’s local health clinic described how difficult it is to provide specialty care services to the poor and uninsured, emphasizing that Medicaid coverage would make it far easier to convince physicians to take on patients:

“Once you diagnose a cancer, then what?” said Dr. Henry Imperial, the clinic’s medical director. “How are you going to give me chemotherapy or surgery or radiation therapy? It goes out of our hands.”

Those complications can make for some intense arm-twisting among Brownsville’s medical ranks. Imperial said he often plies fellow doctors in town with beer to see his uninsured patients. “When they see me approaching them, they start running away,” he joked before turning somber. “It’s just tough. I could not do an appendectomy. I cannot operate on gall bladders. I need a surgeon.”

Most specialists, including surgeons, in Brownsville, accept Medicaid, said Imperial. “It does pay for services that otherwise the patient does not receive.”

GOP leaders like Perry and even some of the more serious conservative academic critics of Obamacare’s Medicaid expansion regularly cite the program’s low reimbursement rates as a reason for dismissing it. Perry has denounced expansion as doubling down on a “broken system,” since doctors won’t want anything to do with Medicaid to begin with.

But as Dr. Imperial’s story shows, actual care providers have a very different relationship with Medicaid than the picture painted in opinion columns and stump speeches. While Medicaid’s reimbursement rates are admittedly low, doctors who serve poverty-stricken communities are fully aware of — and sympathetic to — their patients’ needs and struggles. That’s why these doctors tend to accept Medicaid — and that’s why opposition to the expansion is a burden on them, too. Perry and his compatriots are essentially asking physicians to stand by their duty to treat the ill, irrespective of finances, without giving them the resources to recoup any sort of compensation for their services.

Those who actually interact with poor communities regularly understand what a life-saving program Medicaid can be. It provides a range of services and coordination with social workers that are boons to the sick and the poor — who tend to have specialized medical needs in addition to their financial difficulties — and consequently has a
satisfaction rate comparable to private insurance among its beneficiaries.

Despite all that, it appears that Obamacare opponents like Perry will continue holding back reform. But the victims of this political fistfight won’t be politicians or media commentators — they will be the millions of poor Americans who must continue struggling with the unaffordable cost of their medical care.

“I think the President will ultimately be forced to repudiate his own signature piece of legislation because the American people will demand it,” she told an evangelical radio host Tuesday. “And I think before his second term is over, we’re going to see a miracle before our eyes, I believe God is going to answer our prayers and we’ll be freed from the yoke of Obamacare.”

She added, “I believe that’s going to happen and we saw step one last week with the repeal of Obamacare in the House. We have two more steps. We serve a mighty God and I believe it can happen.”

But this was not really “step one” for the House. At this point, House Republicans have devoted 43 out of 281 days in session to symbolic votes against Obamacare. In the last Congress, they devoted 15 percent of their time, or $50 million dollars, to a signed law that is already largely being carried out. Even top Republican leaders and Republican governors have admitted they lost their battle against Obamacare, though they vow to continue to hold symbolic votes on the matter.

Meanwhile, Bachmann has also accused Obamacare of “literally” killing people and tied it to news that the IRS was inappropriately targeting conservative groups.

(HT: Raw Story)

The firm estimates that a typical family of four with an employer-sponsored health plan will end up incurring about $22,030 for all of their medical costs in 2013. That represents a 6.3 increase from last year, when the typical family racked up $20,728.

Some of that total sum ends up being covered by the family’s health insurance plan — the firm’s analysts found that employers paid about 58 percent of the total health care costs — but a big chunk of it falls onto the family itself. The average family pays more than $9,000 in payroll deductions and out-of-pocket bills for their health care, which is more than they typically spend on groceries and gas for an entire year:

“It is a huge expense,” Chris Girod, principal and consulting actuary at Milliman Inc. said in an interview. “Although the trends are slowing down, the total dollar amount has risen $1,300 per year each of the last four years.”

Meanwhile, the share a family and employees pay continues to rise as employers push more costs onto their workers. Therefore, the total share of the overall costs continues to mount, surpassing other household milestones like food and a year’s worth of gas.

“The total share of this cost borne directly by the family — $9,144 in payroll deductions and out-of-pocket costs — now exceeds the cost of groceries for the (Milliman Medical Index’s) typical family of four,” the study says. “The out-of-pocket cost alone — $3,600 for co-pays, coinsurance and other cost sharing, is more than the average U.S. household spends on gas in a year.”

That’s been a consistent trend over the past several years. As the cost of health care increases, Americans’ contributions to their health plans have risen at a much faster rate than their employers’ share. Since 2003, workers in every single state have had to increase their contributions to their family health plans by nearly 75 percent. At the same time, workers’ wages have stagnated. As struggling Americans aren’t able to afford the treatment they need, they’re putting off doctor’s visits and skipping out on their medication.

And, if the regular health costs that a typical American family incurs over the course of the year already represent such a big expense, it’s easy to see how just one catastrophic medical event could plunge Americans into serious debt. The average trip to an emergency room costs 40 percent more than what most Americans spend on monthly rent. It’s even worse for those with ongoing conditions that need expensive treatment — for instance, the Americans who are battling cancer are twice as likely to go bankrupt, even if they have health insurance.

On Wednesday, Rep. Trent Franks (R-AZ) held an anti-abortion press conference for the bill he intends to reintroduce that restricts women’s abortion rights nationwide. A direct challenge to Roe v. Wade, Franks’ bill bans abortions after 20 weeks, before a fetus even reaches the point of viability. Just this week, an appeals court stuck down a 20-week abortion ban enacted by Franks’ home state of Arizona.

The lawmakers slated to speak today included nine House Republicans in addition to Franks — Republicans Chris Smith (NJ), Joe Pitts (PA), John Fleming (LA), Randy Weber (TX), Steve King (IA), Steve Daines (MT), Joe Wilson (SC), and Louie Gohmert (TX). Michele Bachmann (MN) was the only woman member of Congress listed for the event. Pictured above on the right is Susan B. Anthony List‘s Marilyn Musgrave and another non-member of Congress. Republicans have a history of excluding women from these conversations, like inviting an all-male panel to discuss limiting women’s access to birth control.

Capitalizing on the recent case of an illegal Philadelphia-area abortion doctor being convicted of murder, Franks recently expanded the scope of the bill beyond limiting DC women’s rights to women nationwide. Ironically, the case Franks cited actually proves the need to expand women’s access to safe abortion services.

(Credit: How Stuff Works)

The deal may raise some eyebrows considering GSK’s massive corporate resources and recent controversies surrounding the company’s marketing practices and safety procedures. Last year, GSK plead guilty to criminal charges for promoting off-label drug use and not reporting safety data for a popular diabetes medication. The British drug maker also paid $3 billion to the Justice Department in a fraud settlement.

But officials consider the unusual arrangement between GSK and the U.S. Biomedical Advanced Research and Development Authority (BARDA) necessary because pharmaceutical companies have few financial incentives to invest in antibiotic production:

The problem of antibiotic resistance and the rise of so-called “superbugs” that cannot be treated with traditional medicines has been growing for years, but drug companies have been reluctant to invest in new medicines because of poor returns.

Patients tend to take antibiotics for only a short period, prices are traditionally low and any new antibiotics are likely to be reserved for serious infections – once again minimizing the sales opportunity.

David Payne, head of GSK’s antibacterial discovery unit, said public-private partnerships, like the one with BARDA, were a key part to solving the problem.

The government’s decision reflects just how concerned public health officials are about the rise of so-called “superbugs” such as carbapenem-resistant Enterobacteriaceae (CRE). Some scientists predict that CRE alone could kill half of all people who contract it since it can withstand even the toughest antibiotics.

Professor Dame Sally Davies, England’s chief medical officer, has recently warned that without the production of effective new drugs to fight these types of bacteria, the human species could be looking at a world in which seven percent of all hospital admissions stem from a drug-resistant infection — a problem that she has compared to global warming in its scope and potential to undermine worldwide health. “It’s a ticking time bomb,” she told England’s The Independent.

What adds to health officials’ concerns is the fact that zero major new antibiotics have been developed in over two decades, leaving the entire world unprepared to tackle an epidemic. Groups such as the Infectious Disease Society of America (IDSA) have issued the ambitious goal of creating 10 new bacteria-fighting drugs by 2020 — but are likely to fall far short of that, by the organization’s own admission. “The barriers… seem insurmountable,” said IDSA official Henry Chambers.

But the consequences of failure would be so drastic that the federal government now views it necessary to directly intervene, with the assistance of a pharmaceutical giant. Helen Boucher, another IDSA official, spelled out just what that failure would mean for medical services and public health. “We’re on the precipice of returning to the dark days before antibiotics enabled safer surgery, chemotherapy and the care of premature infants,” she said in a recent interview with the Times of India. “We’re all at risk.”

An example of the content that regularly appears on Facebook promoting violence against women

In an open letter to the organization, the groups point out that Facebook’s content moderators already police some images of women. In fact, images of mastectomies, breastfeeding mothers, and other non-sexualized depictions of women’s bodies are often removed from the site after being incorrectly labeled as pornographic. On the other hand, however, images and forums that make light of abusing and raping women are allowed to remain on the social media platform under the “humor” section of their content guidelines.

“It appears that Facebook considers violence against women to be less offensive than non-violent images of women’s bodies, and that the only acceptable representation of women’s nudity are those in which women appear as sex objects or the victims of abuse,” the groups’ open letter reads. “Your common practice of allowing this content by appending a [humor] disclaimer to said content literally treats violence targeting women as a joke.”

Facebook currently allows pages on its site called “Fly Kicking Sluts in the Uterus,” “Violently Raping Your Friend Just for Laughs,” “This is why Indian girls are raped,” and “Punching your girlfriend in the face cuz you’re Chris Brown.” The social media site also permits pictures of battered women who are bleeding, bruised, tied up, or drugged alongside captions like “This bitch didn’t know when to shut up.” Women, Action & the Media has collected several additional graphic examples here (trigger warning).

Facebook has previously cracked down on other types of hate speech, like Islamophobic and homophobic content. Considering the fact that intimate partner violence is one of the leading causes of death for women around the world, the coalition of women’s activists want the company to treat gender-based hate speech with the same seriousness. “Your refusal to similarly address gender-based hate speech marginalizes girls and women, sidelines our experiences and concerns, and contributes to violence against them,” the open letter explains.

In order to pressure Facebook to change its guidelines, the activists are encouraging the companies that advertise with the social media giant to boycott Facebook until they can be assured their ads will not appear next to content that promotes sexual violence and abuse. And after launching the campaign on Tuesday, they’ve already had some success so far. The web hosting provider West Host plans to pull its ads from Facebook. A growing list of other companies — including American Express, ZipCar, and Dove — have responded to inquiries by saying the Facebook content goes against their company values and they’re looking into it.

Even outside of the groups and images referenced in the current campaign against Facebook, social media sites have inadvertently begun to play a larger role in promoting rape culture over the past several years. Increasingly, teens who commit sexual crimes are choosing to videotape or photograph the assault in order to upload it online. Just this Monday, news broke that teens in Chicago allegedly gang-raped a 12-year-old girl at gunpoint and posted a video of the rape on Facebook. Similarly, the Steubenville rape victim didn’t find out about the assault committed against her until she saw images and videos of it on social media the next day.

The poll, conducted between March and April by the Joint Center for Political and Economic Studies, found that support for Medicaid expansion is somewhat divided along partisan lines. Nevertheless, a solid majority of residents in each of the five Deep South states favor expanding the public insurance program to extend coverage to additional uninsured Americans:

(Credit: Families USA)

That public support stands in sharp contrast to the five states’ political leaders, who have resisted cooperating with health care reform at any cost. The GOP governors in each of those Southern states — Govs. Robert Bentley (R-AL), Nathan Deal (R-GA), Bobby Jindal (R-LA), Phil Bryant (R-MS), and Nikki Haley (R-SC) — have refused to expand their Medicaid programs.

“This survey clearly shows that governors and state legislators in the South who are resisting the Medicaid expansion are out-of-step with their constituents,” Brian D. Smedley, the director of the Joint Center’s Health Policy Institute, pointed out.

The broad public support for Medicaid expansion in this region makes sense. Low-income Americans in the South who don’t currently qualify for their state’s Medicaid program are being forced to simply skip out on medical care, and expanding Medicaid’s eligibility levels would ensure that they can access the health treatment they need. Deeply red Southern states also tend to have worse health outcomes compared to Democratic-controlled states on the coasts, and expanding Medicaid could help lessen some of those disparities.

But political resistance to Obamacare, even in the states that stand to benefit the most from it, remains strong. The governors in highly uninsured states are still refusing to consider cooperating with the Medicaid provision of the health reform law. And even when Republican governors reluctantly agree that Medicaid expansion is the right decision for their constituents, GOP-controlled legislatures in their states continue to block it.

(Credit: U.S. News and World Report)

The “original” poverty metric has been used since the 1960s. But some argue that it’s an archaic measuring stick, since health care costs and — consequently — out-of-pocket spending on medical services have exploded in the ensuing decades. That means that, despite access to relatively generous health coverage through Medicare (another 1960s-era program), seniors have been forced to pay an increasing share of their retirement income on hospital and drug bills over the last 50 years. And seniors who suffer from costly, chronic medical conditions such as cancer and Alzheimer’s are especially burdened by those escalating costs.

Since the new measure takes these contemporary expenses into account, it paints a more accurate picture of the American poverty landscape. And as a state-level analysis of the numbers by the Kaiser Family Foundation highlights, things don’t look very good:

The share of seniors living in poverty is higher in every state under the supplemental measure than under the official measure, and at least twice as high in 12 states: California, Colorado, Connecticut, Hawaii, Massachusetts, Maryland, Minnesota, New Hampshire, New Jersey, Nevada, Wisconsin, and Wyoming.

The share of seniors living in poverty under the supplemental measure is especially high in some areas. Based on the supplemental measure, about one in four seniors (26%) are living in poverty in DC and roughly one in five seniors are living in poverty in six states: California (20%); Hawaii, Louisiana, and Nevada (19%), and Georgia and New York (18%).

One possible reason that senior poverty rates in the aforementioned states are so high when taking medical expenses into account is that hospitals in those regions may charge more money for drugs and medical services — certainly a possibility considering that U.S. medical prices are essentially arbitrary. Another potential explanation is that these states have more seniors who are less likely to be eligible for Medicare due to immigration or citizenship status, and a higher number of poor seniors with chronic medical conditions.

But the key takeaway from the numbers is that, despite many seniors’ access to generous public health entitlements, they still can’t afford the associated costs of their medical care. And that means that efforts to reduce the federal deficit through cuts to health care programs amounts to putting more fiscal strain on a vulnerable population that can’t even afford treatments under the status quo.

Yet, the congressional GOP — and some Democrats — has vehemently encouraged such cuts. For instance, Republicans insisted on raising the Medicare eligibility age from 65 to 67 during budget negotiations in February, even though such a move would only net $5.7 billion in federal savings while shifting double that amount in costs onto seniors.

Similarly, plans to increase cost-sharing in Medicare and hiking seniors’ premiums would also be devastating given the new poverty data — especially considering that even wealthier Americans are worried about paying for their health care after retirement and that one in four seniors already go bankrupt over their medical bills.

The only efficient way to cut health entitlement spending without crushing vulnerable Americans under the weight of their medical care is to lower the actual cost of health care itself — and there is some evidence to suggest that a combination of Obamacare and systemic changes within the health care sector is already doing exactly that. But during a time when sequestration is already putting the squeeze on elderly Americans, cutting Medicare benefits or shifting costs onto seniors would be a cruel and counterproductive way to cut spending.

(Credit: FoodMag)

Researchers asked 186 adults to determine the appropriate portion sizes of both “healthy” and regular brands of different foods. The participants tended to serve themselves larger portions of the “healthy” food, and they also tended to underestimate the amount of calories that were actually in it. The study’s researchers attribute these behaviors to the effective marketing strategies that the food industry uses to convince people that even processed foods aren’t so bad if they’re being touted as healthier options:

“People think (healthier food) is lower in calories,” said Pierre Chandon, a marketing professor at the INSEAD Social Science Research Center in France, and they “tend to consume more of it.”

That misconception can lead to people eating larger portion sizes of so-called healthy foods, and therefore more calories.

“Foods are marketed as being healthier for a reason, because food producers believe, and they correctly believe, that those labels will influence us to eat their products and perhaps eat more of their products,” said Dr. Cliodhna Foley Nolan, the director of Human Health and Nutrition at Safefood, a government agency in Ireland.

The new study builds upon previous research that found that green labeling is “coded” as healthier — so when a product is marketed in green packaging, Americans tend to assume it has fewer calories, even if it’s a product like a candy bar.

As Americans continue to grapple with an ongoing obesity epidemic, fast food companies in the United States have attempted to use these type of marketing tactics in order to rebrand themselves as healthier choices Popular chains like McDonald’s, Panda Express, Taco Bell, and Coca-Cola have all attempted to improve their national image by offering up “healthy” options — even though they haven’t actually changed much about the actual nutritional content of their products.

(Credit: Navajo AIDS Network)

A Navajo reservation on the Arizona-New Mexico border has seen its HIV diagnoses go up by 20 percent since 2011. Despite a concerted push by the federal Indian Health Service (IHS) and public health advocates to expand tribal HIV education programs, doctors have found treatment and prevention efforts to be stymied by cultural stigma surrounding the disease and homosexuality.

Since the Navajo tribe is a comparatively isolated population, the topline numbers of HIV infections among tribe members are relatively low, and at least part of the rise is attributable to enhanced screening efforts. However, that same seclusion allows stigma and the fear of community repercussion to prevent infected Navajo men from seeking care once they are diagnosed. “Our communities are very small, and that can lead to people avoiding stigma, rather than getting the care they need,” IHS chief medical officer Dr. Susan V. Karol told the New York Times.

In turn, that stigma can prevent tribe members from even discussing the disease and their various treatment and prevention options:

Melvin Harrison, the executive director of the Navajo AIDS Network, which provides services for tribal members with H.I.V., said that of the 65 people his group treats, a majority have not told family or friends.

“That’s how big the stigma is here,” he said. “They are afraid of rejection.” [...]

One Navajo man, who contracted H.I.V. from his partner in 2001, recalled how his mother refused to hug him and served him food on plastic plates when she found out he was infected. [...]

[The] man has not told his three brothers that he has H.I.V. because he fears they will shun him. “I don’t think I’ll ever tell them,” he said. “I don’t want to be pushed out of their lives.”

This dynamic devolves further due to the added stigma regarding homosexuality in the tribe. The IHS estimates that men who have sex with men (MSM) accounted for accounted for nearly half of the new cases since 2011, and 75 percent of the Navajo AIDS Network’s clients are closeted homosexual men.

But this tendency to sweep HIV infection under the rug presents a major barrier to an effective treatment regimen. Family and community awareness of the disease is an important tool for making sure that HIV-positive men are following through on their medications and checkups. Conversely, the desire to keep a diagnosis secret can create tensions in tribal doctor-patient relationships and contribute to treatment noncompliance. Teen mothers and mentally ill Americans have faced similar stigma, and have either forgone care or been denied access to adequate medical and social resources as a consequence.

For the Navajo community in particular, overcoming these archaic cultural mores is literally a matter of life and death. Although the medical reason for it remains ambiguous, researchers note that Native Indians diagnosed with HIV and AIDS have a lower chance of survival compared to other racial groups.

Representatives from the American Civil Liberties Union and the Center for Reproductive Rights, who filed the lawsuit against the 20-week ban, praised the judges’ decision. “We’re glad the court has reaffirmed that states cannot place unlawful burdens on a woman’s right to access safe reproductive health care,” Talcott Camp, the deputy director of ACLU’s Reproductive Freedom Project, said in a statement. Nancy Northrup, the president of the Center for Reproductive Rights, called the decision a “huge victory in the fight to protect women’s fundamental reproductive rights,” and noted that the Ninth Circuit’s decision should send a clear message to the other states that are attempting to limit abortion access before the point of viability.

Indeed, Arizona’s “fetal pain” measure — based on the scientifically-disputed notion that fetuses can feel pain after 20 weeks — is just one of several similar pieces of legislation to land in court. 20-week bans in Idaho and Georgia have also been blocked under the same constitutional logic. Arizona’s own law has actually been blocked since August, when the appeals court issued a temporary injunction right before the law was scheduled to take effect.

Imposing fetal pain measures is a popular anti-choice tactic to effectively chip away at Roe and narrow the window in which women may access legal abortion. Bans on late-term abortions are an especially big anti-choice priority right now, as abortion opponents attempt to capitalize on the high-profile case of illegal abortion provider Kermit Gosnell to misconstrue all later abortions as dangerous procedures. Just this week, Arizona Rep. Trent Franks (R), who has repeatedly attempted to impose a 20-week abortion ban on the District of Columbia, announced his intention to amend his legislation to push for a nationwide restriction.

When Arizona first passed its fetal pain law, it represented the most stringent abortion ban in the nation. Since the state defined gestation differently than other states, calculating from the moment of the woman’s missed period, the law could have potentially cut off legal abortion services at just 18 weeks of pregnancy. However, since Arizona first passed that piece of legislation last March, states have moved the goalposts even further. Arkansas banned abortions after 12 weeks, and North Dakota placed the cut-off at just six weeks of pregnancy.

But even though that bill didn’t become law back in 2009, there are still some situations in the state in which miscarriages are treated as potential crimes. In fact, the Virginian-Pilot reported on Tuesday that two women have been charged with “producing an illegal abortion” after one of them gave birth to a pre-term baby who died shortly after birth. Witnesses allege that they overhead the two women planning to buy drugs intended to end the pregnancy:

Jessica Renee Carpenter, 20, and her friend Rachael Anne Lowe, 27, each were charged with one count of producing an illegal abortion, which carries a sentence of two to 10 years. Each also was charged with one count of conspiracy to commit a felony.

According to a search warrant affidavit, Carpenter was 25 weeks pregnant — near the end of her second trimester — when she went to Bon Secours DePaul Medical Center in labor April 11. The baby died about 20 minutes after he was born.

Norfolk Child Protective Services received an anonymous call reporting that Carpenter had intended to end her pregnancy. Police interviewed three friends of both women, who said Carpenter and Lowe wanted to end Carpenter’s pregnancy and that they heard them talking about buying items from a drugstore that she could ingest to do it, according to the affidavit. [...]

Carpenter has a ninth-grade education and was unemployed, according to court records. Lowe previously worked at the Tidewater Women’s Health Clinic in Norfolk, which performs abortions for pregnant women up to 14 weeks after their last menstrual period.

Under Virginia law, second-trimester abortions must be performed in a licensed hospital facility in the presence of a physician. Obviously, it’s important to crack down on illegal abortion providers who aren’t providing women with safe care, and — unlike Obenshain’s proposed bill — that’s likely the sole intent behind the state’s current law. But, if the allegations against the two Virginia women are true, the law will have the added effect of prosecuting a woman who made the choice to terminate her own pregnancy. The Virginia-Pilot notes that the only other “illegal abortion” charge on the books was back in 2007, when a man slipped abortion-inducing drugs into his girlfriend’s drink that caused her to have a miscarriage — an act that was obviously done without the woman’s consent.

Even if Carpenter’s miscarriage was self-induced, her case brings up questions about the criminalization of elective abortion procedures across the country. The mounting pile of state-level restrictions intended to restrict women’s access to abortion mean that some desperate women can’t get the reproductive care they need without making themselves into a suspect in the eyes of the law. That’s particularly true under late-term abortion bans, an increasingly popular anti-choice tactic to narrow the window in which women may obtain a legal abortion. If abortion is criminalized at 20 or 18 or even just six weeks of pregnancy, every woman’s miscarriage after that point could be a potential piece of evidence.

And of course, if Carpenter really did take drugs to induce an illegal abortion, it’s worth considering what might have led an undereducated, unemployed, desperate woman like Carpenter to make the choice she did. Perhaps she didn’t have the money for a legal abortion earlier in her pregnancy. Maybe she was too ashamed to make an appointment at a women’s health clinic. She might not have had any support from her friends and family, and she might have felt like she didn’t have any other options.

Concept for a pill bottle that would look a rotting banana when it's past its expiration date. (Credit: Wall Street Journal)

Insurers and pharmacies are increasingly investing in these kind of start-up ventures, hoping to develop new technologies that can help Americans stick to their medication regimens. But why is this area of innovation becoming a top priority? It’s largely because the Americans who fail to take their medication as directed contribute to billions of dollars in wasteful health care spending every year. People who skip doses, take pills that have expired, or lapse too long between refills often experience health complications that lead to unnecessary hospital and doctor visits, ultimately costing insurers an estimated $290 billion each year.

Pharmacy-benefit programs like CVS Caremark have typically relied on robo-calls and mailers to remind their patients to take their pills as directed. But the old tricks aren’t working. “After six months’ time, only half of people taking prescription medicines are taking them as directed,” said Troyen Brennan, the chief medical officer of CVS Caremark Corp., explained to the Wall Street Journal.

So they’re trying to step their efforts up a notch. CVS is pilot-testing a new technology that will allow them to better track the patients who have track records of failing to adhere to their medication schedules. And other companies are working on developing apps that will reward patients who take their pills on time with gift certificates and coupons. And they continue to evaluate a range of other innovative ideas to accomplish the same goals, like new high-tech pill bottles.

There have been other recent pushes to build a better pill bottle, too, but those have been focused on addressing a different issue with prescription drugs — the Americans who end up abusing them. In Utah, a group of college students built an electronic pill bottle that will only dispense the specific dosage that the pharmacist has prescribed, preventing their patients from taking too much of the drug or selling the pills to other people. And in New York City, the police force is currently experimenting with implanting GPS chips in pill bottles so they’ll be able to better track stolen drugs and illegal prescription stockpiles.

(Credit: Pak Med)

In 1998, a team of British scientists led by Dr. Andrew Wakefield published a widely rebuked paper that incorrectly linked the measles, mumps, and rubella (MMR) vaccine with autism. The study, which received widespread attention at the time, led many British parents to forgo their children’s MMR shots — something that is possible in the U.K. since schoolchildren aren’t subject to mandatory vaccination laws as they are in the United States.

The vaccine exodus led to a sharp decline in MMR immunization — from 90 percent of all children to just 54 percent in a year — and its consequences are now coming into full view, as unvaccinated British teenagers spread measles by the thousands:

This year, the U.K. has had more than 1,200 cases of measles, after a record number of nearly 2,000 cases last year. The country once recorded only several dozen cases every year. It now ranks second in Europe, behind only Romania.

The majority of those getting sick in the U.K. — including a significant number of older children and teens — had never been vaccinated. [...]

Across the U.K., about 90 percent of children under 5 are vaccinated against measles and have received the necessary two doses of the vaccine. But among children now aged 10 to 16, the vaccination rate is slightly below 50 percent in some regions.

To stop measles outbreaks, more than 95 percent of children need to be fully immunized. In some parts of the U.K., the rate is still below 80 percent.

By contrast, the U.S. — where measles immunization rates are above 90 percent — reported just 55 cases of measles last year.

Still, Americans tend not to get their vaccinations if they can help it. While U.S. school attendance is generally contingent on a variety of shots for highly contagious diseases, others such as the yearly influenza shot and HPV vaccine aren’t, leading the Centers for Disease Control (CDC) to call American immunization numbers “unacceptably low.” Politicians and public officials who parrot discredited conspiracy theories similar to the Wakefield study contribute to that trend.

Medicaid proponents rally in Ohio (Credit: Columbus Dispatch)

Health care outcomes already vary widely across states. Unfortunately, health policy does too. The states that are already among the nation’s healthiest are the ones taking steps to ensure their low-income residents will have the insurance coverage they need — while the unhealthier, more highly uninsured GOP-led states are refusing to do the same. As an analysis from the Los Angeles Times points out, the health care reform law can’t change the fact that the stubborn lawmakers resisting Medicaid expansion are likely going to deepen the health disparities that already exist across the country:

With nearly every GOP-leaning state on track to reject an expansion of the government health plan for the poor, the healthcare law’s goal of guaranteed insurance will become a reality next year mostly in traditionally liberal and moderate states. These states already have higher rates of health coverage.

Residents of these states — concentrated in the Northeast, upper Midwest and West Coast — also have better access to doctors and are less likely to die from preventable illnesses.

Colon cancer deaths in states opposing Medicaid expansion, for example, are an average of 16% higher than in pro-expansion states, according to a Los Angeles Times analysis of state health data.

Deaths from breast cancer are 8% higher on average in anti-expansion states. And adults under 65 are 40% more likely on average to have lost six or more teeth from decay, infection or gum disease.

An earlier analysis found that the governors for the most unsinsured cities in the United States have been resistant to expanding Medicaid. And even after some of those governors started to come around — most notably, Florida’s Rick Scott — the Republicans in the state legislature have continued to block the initiative. Opposition persists despite the fact that the poor Americans in the South, who are already being forced to delay their medical care because they can’t afford it, stand to gain the most from Medicaid expansion.

This isn’t the only example of health disparities becoming sharply divided by region. Abortion access, another area of health policy that’s largely been left up to states’ interpretation, also varies widely from California to Mississippi to North Dakota to New York. “It shouldn’t be that simply because you live in Mississippi that you don’t have the same health care that you can get if you lived in California,” one abortion doctor who travels to practice at Mississippi’s last remaining abortion clinic recently pointed out. Nonetheless, that’s the growing reality for the entire health care sector.

A recent report gave over half the states in the U.S. a grade of “F” when it comes to price transparency. And after the Center for Medicare and Medicaid Services recently provided a huge data dump on what hospitals charge government health care programs for common procedures, they found a staggering amount of variation across the country with no discernible justifications on economic or quality-of-care grounds. But the prices charged to private insurers still remain secret.

So in the wake of mounting pressure following the government’s data release, Steve Sonenreich — the chief executive of Mount Sinai Medical Center in Miami Beach — promised on a radio show on Monday that his hospital will reveal the contractual rates that it charges private insurers:

“We will post our prices relative to Blue Cross, and Aetna, our contractual prices, and we’ll challenge Baptist and the other systems in the community to do the same,” said Sonenreich, who made his pledge during a studio interview on WLRN 91.3-FM with host Tom Hudson.

Also in the radio studio was Brian Keeley, chief executive of Baptist Health South Florida, which manages seven hospitals in the region. Keeley declined to accept Sonenreich’s challenge for price transparency, but acknowledged “That’s where the whole industry is going, undoubtedly.”

It remains to be seen whether other hospitals will follow Sonenreich’s lead. But the inability of consumers, doctors, and even many insurers themselves to compare different rates and charges openly is one of the key factors hamstringing the American health care market. With greater price transparency, it’s possible health care could begin behaving a bit more like markets are traditionally supposed to behave, and drive down prices through open competition.

According to a Modern Healthcare analysis of federal records, more than 5,400 of the 51,729 people on the government health entitlement blacklist were placed on it after failing to pay an HHS-backed medical student loan. Given a still-shaky economy, some in the health care sector expect that trend to continue:

[Government data] show that one of the most common reasons for getting barred is failure to repay HHS-backed student loans: 5,417 people are currently kicked out of Medicare for that.

The number of annual exclusions related to student loans has grown steadily in the past decade, peaking at 517 in 2011 before declining again. “That is tied to the economy, and I would expect that to continue to rise,” [said Lynn Gordon, a Chicago-area hospital group partner].

The increasing frequency of default-related blacklisting could prove problematic as the Obama Administration tries to entice more medical students to become primary care and family doctors. Primary care providers and nurse practitioners will be crucial to effective Obamacare implementation, since the health law is expected to drive up demand for medical services as millions of previously uninsured Americans gain coverage.

But the ballooning cost of a medical education could end up being a major barrier to the Administration’s recruitment efforts. According to the Association of American Medical Colleges’ (AAMC) 2012 report on medical school debt, “86 percent of medical school graduates had education debt, with a median amount of $162,000″ in 2011 — a number that has been rising steadily over the years:

AAMC estimates that a borrower with the median $162,000 debt “would have monthly payments ranging from $1,500 to $2,100 after residency.”

That disproportionately affects the very primary care doctors that are integral to health care reform and the U.S. medical system at large. In a 2012 report, consulting firm Merritt Hawkins & Associates found that family practitioners, pediatricians, and psychiatrists are the lowest-paid physician groups in the U.S. with a base pay of $189,000.

While that’s still a lavish salary compared to average U.S. compensation, it pales in comparison to specialist pay — and as the entitlement blacklist numbers underscore, that contributes to a system in which care providers are banned from treating certain patients for purely financial, rather than medical or criminal, reasons.

Rising student debt isn’t just restricted to the medical field. The first three months of 2013 were the worst on record for student debt defaults, with $3.5 billion in government and private student debt going bad between January and March. That reflects the increasingly unaffordable cost of a college education, which has sextupled over the last three decades.

Although President Obama’s student loan policy bypassing third-party private lenders has eased student borrowing costs and reaped a stunning $51 billion profit, the president has argued the need for further action. Obama called for tying federal college aid to higher educational institutions’ “affordability and value” during his latest State of the Union address to Congress, asserting that colleges “must do their part to keep costs down, and it’s our job to make sure that they do.”

On Sunday, Sen. Kirsten Gillibrand (D-NY) proposed her own legislation to address student debt. Gillibrand’s bill would allow student debt holders to refinance their loans into lower fixed rates and save “nearly 37 million borrowers billions of dollars in annual interest payments.”