The cost of coping with the disease — currently estimated at $215 billion — is projected to rise to half a trillion dollars by 2050. That amount will likely tax our overburdened health care system, the economy and the families of those affected.

Amy Goyer realized her 84-year-old father Robert’s health was deteriorating one night while watching a movie with him.

“He asked me the name of the movie like 20 times within a half-hour, and I thought, ‘This is not normal for him,’ ” Goyer tells NPR’s Jacki Lyden.

It wasn’t normal; it was Alzheimer’s. As her father’s condition worsened, Goyer made the decision to return home to Phoenix to take care of him.

“As time progressed, he was having trouble managing the finances; the paperwork was overwhelming,” she says. “He would get incredibly stressed out … [and] little things about his memory kept getting worse and worse.”

Goyer is no stranger to caregiving; she’s worked at AARP for 19 years giving advice as a home and family expert. When she first began taking care of her dad, she decided to start a blog, which then turned into a web video series.

In the series, Goyer offers advice to caregivers like herself, who are struggling to take care of their loved ones.

“It’s very challenging, and there are times I get very exhausted,” she says. “And I just feel like the biggest enemy of caregivers is sleep deprivation because you just do not have the energy to deal with the emotional aspects of it and … just doing, doing, doing.”

Because her mother is at home, too, recovering from a stroke, Goyer often has to help both parents get up in the morning and go to the bathroom, do all of their personal grooming and put on their pajamas at night. She also must make sure they have all their medications throughout the day.

Goyer does have some help, but caring for someone with Alzheimer’s can be staggering. She says one of the most difficult aspects of the disease is what’s been described as “the long goodbye.”

“Over time, it’s like he’s being robbed of who he is,” she says. “And my dad is probably the most optimistic person you’d ever know, and he still has that, which is wonderful for us. But there are times when he gets very cranky because he doesn’t know what’s going on.”

Given her family history of Alzheimer’s — her grandmother had it as well — Goyer says she fears getting the disease herself.

“I think about it all the time, but it’s hard when I’m focusing on caring for my parents to think about that for myself,” she says. “All I can do is anything that will prevent the onset of the disease. But I sure would like to have a lot more tools in my toolkit to fight it.”

A Search For Answers

Alzheimer’s is a disease that can last a really long time and cost a lot of money — so much money, in fact, that the U.S. government is paying attention with new legislation.

In 2011, Obama signed the National Alzheimer’s Project Act into law. Currently, about $500 million per year goes to Alzheimer’s research, and the new law includes an additional $100 million toward treatment, research, medicine and diagnostic tools.

Dr. Dorene Rentz, a neuropsychologist and co-director of Harvard Medical School’s Center for Alzheimer’s Research and Treatment, has been studying Alzheimer’s patients for three decades. In 2005, the breakthrough was the discovery of something called amyloid plaque in the brains of patients with Alzheimer’s. Not all people with the plaque go on to develop the disease, however.

“Unfortunately, we’ve come to discover that many older individuals who are still normal have these changes of amyloid plaque,” Rentz tells Lyden.

She says doctors believe an abundance of what’s called fibular amyloid may trigger Alzheimer’s, but that’s not always the case. Some people can walk around with a “head full of fibular amyloid,” she says, and live normal lives.

In patients already diagnosed with Alzheimer’s, even if amyloid plaque is removed, the neurons may be too damaged for memory loss to be reversed. If diagnosed earlier, there might be some hope.

Rentz and a colleague at Harvard are launching a nationwide clinical trial this fall to see what happens in the brains of people who have amyloid plaque, but not Alzheimer’s. The object of the study is to see if doctors can remove the amyloid and prevent them from getting symptoms of Alzheimer’s.

Living With Alzheimer’s

In 40 years, there will be 13.8 million people in the U.S. alone living with Alzheimer’s.

Over her 30-year career working with the disease, Rentz says, people she had diagnosed with Alzheimer’s were devastated because there wasn’t much that could be done. Things have changed, however, as technology and awareness has improved.

“People are more educated and many people are coming earlier to get tested because they are experiencing memory loss,” she says.

Even when a patient’s clinical profile indicates early signs of a neurodegenerative disease like Alzheimer’s, Rentz says, she gives them hope because there are things that can be done.

“Because they’re not yet fully devastated in this disease, we can actually give them some FDA-approved medications that are good in keeping people stable for a while,” she says.

Rentz says she also encourages a healthy diet and intellectual stimulation, what’s called “optimal aging.” She says this helps people with early signs of Alzheimer’s — who often tend to withdraw — to stay engaged and active.

Goyer won’t let her parents withdraw. She’s providing a happy, nurturing environment, getting her parents as engaged as possible and having fun.

“I’m not just trying to keep my parents alive; I’m trying to have a good life with them and live my life at the same time,” she says. “There’s still a lot of fun and a lot of surprises and just a lot of love. My parents are just very sweet individuals and I’m very lucky in that way.”

There might not be a cure for Alzheimer’s, but that doesn’t mean there isn’t hope. [Copyright 2013 NPR]

Men don’t live as long, and they’re more likely to engage in risky behaviors, like smoking and drinking.

But in the past decade, global health funding has focused heavily on women.

Programs and policies for men have been “notably absent,” says Sarah Hawkes, from the University of London’s Institute of Global Health.

She and a colleague published a commentary in The Lancet Friday calling for more gender equality in global health funding.

“If you look at the top 10 health problems around the world, they are much more common in men,” she tells Shots. “But the current focus is predominatly on women’s health. “

Take for instance, the United Nations’s Millennium Development Goals. In 2000, global leaders agreed on eight ways to improve the lives of the poorest people around the world.

The fifth goal is specifically aimed at maternal health. And all of the other goals “touch on essential aspects of women’s well-being, and in turn, women’s empowerment is critical for achieving the goals,” the U.N. Women’s website says.

There isn’t a specific goal targeted at men.

Hawkes agrees that maternal health is important and should be funded. “We don’t want to see this money diverted away from women’s health,” she says. “But focusing on maternal health means you miss the biggest burdens of disease.”

Hawkes says that when you look at recent data, men lose three times more years of healthy living than women because of tobacco, alcohol and unsafe driving.

“It’s cool to be a man that smokes and drinks — who drives a fast motorbike, or fast cars,” she says. “If you were really serious about saving lives, you would spend money tackling unhealthy gender norms,” that promote these risky behaviors.

Health economist Karen Grepin, of New York University, agrees that more focus should go to stopping tobacco and alcohol use. But she doesn’t think there should be specific policies for men versus women. “If we focus on closing inequality, we’ll miss the boat,” she says. “The goal is to reduce mortality, not to reduce inequalities in the measure of mortality.”

Grepin, who wasn’t involved with the commentary, also doesn’t think that the recent focus on women’s health is a bad thing.

“Women are politically, economically disadvantaged around the world,” she tells Shots. “There are really important consequences for women’s health. They play a large role in taking care of children. When they get sick, there’s a spillover effect in the house — for the next generation.”

Grepin thinks that maternal health may have been undervalued and underfunded in the past. “In many places, women still have a high risk of dying during childbirth, which is completely avoidable,” she says. “The fact that this still happens is appalling. It’s a blight on society that needs to be addressed.”

With the recent emphasis on maternal health, she says, the world is making progress on this front. The risk of a mother dying during childbirth has declined by nearly half worldwide since 1990.

“Has that necessarily driven up mortality in men?” she asks. “Probably not.” [Copyright 2013 NPR]

Even people with insurance can face steep copayments for drugs, a sizable share of hospital bills and significant incidental expenses. These side effects of cancer care are sometimes even called “financial toxicity.”

So wouldn’t it make sense for doctors and patients to talk over the financial strain that cancer treatment might bring and what might be done to manage it?

Well, it’s not always easy for patients to bring it up, says S. Yousuf Zafar, a gastrointestinal cancer specialist at Duke Cancer Institute. He and his colleagues recently asked hundreds of insured cancer patients at Duke and three affiliated rural cancer centers about their financial concerns.

Median household income for the people in study was about $60,000 a year, and the median out-of-pocket costs for their care were nearly $600 a month .

“The bottom line was that patients want to talk about the cost but only a minority actually do,” Zafar tells Shots.

The people who did talk about financial issues told the researchers it was helpful to do so. “They said it helped decrease their expenses,” Zafar says. Unfortunately, in this study the researchers didn’t get into the details of how that happened.

But he drew one possible way from his own practice. “I treat colon cancer, and I have the option of giving a drug as an IV or an oral pill,” he says. “If I give the pill form, the patient faces a copay even if they have insurance, and that copay goes away if I give the intravenous version.”

The two forms of the drug are pretty much the same when it comes to effectiveness, though the side effects differ a little. “For the most part, it doesn’t matter to me,” he says. “It comes down to patient preference and cost.”

Why don’t most patients ask about costs?

“Many said they didn’t think their financial problems were bad enough to bring it up,” he says. “Many said they wanted the best care regardless of costs.” And they may have been worried that doctors might cut corners on care after a cost discussion.

Some patients said it’s not their doctor’s job to think about the costs, Zafar says, and others figured the doctor wouldn’t know what to do about them anyway.

Patients might have a point there. “I don’t think the majority of oncologists are prepared to have a discussion about cost,” he says. “Quite honestly, we haven’t received the training to do so.”

In the meantime, doctors can direct patients to social workers and financial counselors to lend a hand. “Any help is likely better than none,” Zafar says.

Doctor need to get with it, though. “We can’t necessarily give the best care to patients unless we address cost,” Zafar says.

The research hasn’t been published yet. Zafar will present the findings to cancer specialists at the American Society of Clinical Oncology annual meeting in Chicago in a few weeks. [Copyright 2013 NPR]

Psychiatry’s new manual, DSM-5, has been nearly 20 years in the making. During that time, scientists have learned a lot about the brain. Yet despite some tweaks to categories such as autism and mood disorders, DSM-5 is remarkably similar to the version issued in 1994.

“There are lots of changes throughout the manual that reflect the research in the last 20 years,” says Michael First, a clinical psychiatrist at Columbia University who was involved in creating both DSM-IV and DSM-5. (The APA abandoned Roman numerals for the new manual.) “But because that kind of research hasn’t allowed for a paradigm shift, the DSM is not a paradigm shift either,” First says.

Specifically, DSM-5 will continue to use symptoms as the primary way to decide whether a person has a particular disorder. That may not sound odd until you consider what’s happened in other fields of medicine, like cardiology.

If you go to a hospital with chest pain these days, chances are you’ll get a diagnosis based on tests of the electrical activity in your heart, the enzymes in your blood, and the blood flow through your arteries. But if your problem is emotional pain, your diagnosis will probably be based on a conversation.

So why is psychiatry still so last-century? Scientists say it has to do with the nature of the brain itself.

The Hippo Problem

When psychiatrists began work on DSM-5, they expected to come up with a document that would signal a new era in mental health care, First says.

“We were hoping and imagining that research would advance at a pace that laboratory tests would have come out,” he says. “And here we are 20 years later and we still unfortunately rely primarily on symptoms to make our diagnoses.”

That’s not ideal, First says. Not for doctors. Not for patients. Not for scientists.

The problem is that the new DSM is still classifying mental disorders based on their surface appearance, not their underlying biology. And the history of science shows that appearances can be deceiving.

Take hippos, for example. Early naturalists thought hippos must be related to pigs. After all they look somewhat alike and have similar teeth. But fossils and genetic studies showed that hippos’ closest living relatives are actually dolphins and whales.

So to avoid the hippo problem, many areas of medicine have begun to look beneath the superficial appearance of an illness.

A New Kind Of Medicine

“For literally centuries, doctors have looked at diseases using signs and symptoms,” says Susan Desmond-Hellman, an oncologist who is chancellor of the University of California, San Francisco. So, she says, doctors would ask questions like, “Do you have a lump somewhere?”

But now, many scientists are concerned that this emphasis on the signs and symptoms of a disease “could be seen as holding us back,” Desmond-Hellman says. Instead, she’s been advocating something called “precision medicine,” which tries to classify diseases in a way that indicates what’s truly causing the problem.

A good example of this new approach is breast cancer, Desmond-Hellman says. “I’m a cancer doctor and had the incredible opportunity to work on revolutionizing how we treat breast cancer based on what’s in your DNA that’s signaling the breast cancer to grow,” she says. “And it’s a wonderful opportunity because if a patient has a breast cancer that’s driven by something in the genome, we can turn it off.”

This revolution happened in part because cancer researchers looked beyond the old way of classifying tumors according to simply what body part they appeared in, Desmond-Hellman says. And something similar needs to happen in mental health because, she says, “everything from autism to Alzheimer’s is classified in ways that clearly don’t work today.”

Desmond-Hellman adds that she’s not criticizing psychiatrists or psychologists for using the DSM. It’s still the best option because there still aren’t genetic tests or brain scans that offer a better way to classify patients with mental disorders.

Brain Research Looks Ahead

So why haven’t researchers developed simple lab tests for mental disorders?

“We’ve tried,” says Thomas Insel, director of the National Institute of Mental Health. “You know we’ve actually looked — using brain imaging, using various endocrine tests, looking at a range of other kinds of biomarkers. So far that has been found wanting.”

For example, researchers tried for many years to find a genetic test or a brain-scanning technique that could identify people with depression. That approach would make sense if scientists knew that all depression can be linked to the same underlying problem. But what if it can’t, Insel says. What if depression is like a fever?

“Some people who have a fever have a bacterial infection, some a viral infection, some an endocrine problem,” Insel says, “a whole range of reasons why that would be your presenting symptom and a whole range of different treatments that you need for each of those causes.”

So a few years ago, the NIMH began moving away from research based on categories defined only by symptoms. Instead, it’s pushing an approach it calls Research Domain Criteria that emphasizes basic functions in the brain. Researchers might get money to study circuits involved in fear, or so-called working memory.

This sort of research has the potential to uncover problems in the brain that will change the way mental disorders are classified, Insel says. “A biological thing that presents with depression in some people might present with psychosis or anxiety in others,” he says. “And so maybe what you’ll find is a problem that cuts across the current diagnostic categories.”

Insel says findings like that are years off. Maybe they’ll get here in time for the next version of the DSM. Maybe.

A Better Future?

Michael First, the psychiatrist who spent much of his career working on the DSM, says he’s learned to be cautious about anticipating major advances in any problem that affects the brain.

Back in the 1990s, when he was writing a guidebook to DSM-IV, First says, he made an unfortunate prediction about Alzheimer’s. “I stuck my neck out,” he says. “We said that by the time DSM-5 comes out, Alzheimer’s will be the first diagnosis that has a laboratory test.”

That hasn’t happened. Even though scientists have learned a huge amount about the plaques and tangles associated with Alzheimer’s and even though high-tech scans can reveal ever more subtle changes in the brains of people with the disease, there’s still no lab test that’s good enough to diagnose Alzheimer’s.

First says migraine headaches are another brain problem still waiting for a lab test. “If you have a headache and you go to a neurologist, even though they might run some blood tests, the actual diagnosis of a migraine vs. a cluster headache depends on the description of the symptoms,” he says. “So psychiatry is not unique.”

In fact, almost every specialty that deals with the brain has run into the same roadblocks facing psychiatrists. “The brain is very, very complicated and it really hasn’t yielded its secrets yet,” First says.

And that, he says, is the primary reason mental health isn’t more like cardiology or oncology, why psychiatrists and psychologists still rely on symptoms, rather than lab tests. The human brain is the most complicated thing in the universe. It has nearly 100 billion neurons and many trillions of connections, and its complex wiring changes all the time.

But the daunting complexity of the brain is no reason to give up on the DSM or the ability of mental health professionals to treat mental disorders, First says. “When people walk into our offices they come for help, not some explanation of the neurobiology of what’s going on,” he says. “They want some relief of suffering and the DSM remains the most valuable tool for psychiatrists to be able to do that.” [Copyright 2013 NPR]

That’s right, you have to go way back to the Bush administration to find Dr. Mark McClellan, the last person to be officially put in the post.

Tavenner, who has been running the agency in an acting capacity since late 2011, has a big job. CMS oversees Medicare, Medicaid, and the Children’s Health Insurance Plan, which together serve north of 100 million Americans and have a combined budget larger than the Defense Department’s.

CMS is also playing a major role in the implementation of the Affordable Care Act. The agency is in charge of the Medicare changes in the law, the creation of health exchanges and a significant expansion in Medicaid.

She comes to the agency with a reservoir of good will that eluded two previous nominees for the job, Obama appointee Donald Berwick and Bush appointee Kerry Weems.

Tavenner, a nurse, hospital executive, and one-time Virginia health secretary won the backing of House Majority Leader Eric Cantor, which made it safe for many Senate Republicans to support her.

She also benefited from auspicious timing. Weems’ nomination got caught up in the politics of the Children’s Health Insurance Program renewal; Berwick’s in the furious fight over the Affordable Care Act. Even McClellan’s nomination was held up briefly because then Sen. Byron Dorgan, D-N.D., was irritated because McClellan, in his previous position as commissioner of the Food and Drug Administration, had opposed Dorgan’s legislation allowing easier importation of cheaper prescription drugs from Canada and other industrialized nations.

Tavenner also takes over just as the agency is getting some good news from the Congressional Budget Office.

It seems that CBO is among the agencies now predicting a slowdown in health spending. The latest 10-year spending estimates for Medicare and Medicaid, according to CBO, are down some $225 billion ($138 billion for Medicare and $89 for Medicaid) from where they were in March 2010.

Finally, of course, Tavenner takes the reins officially with a groundswell of goodwill from those whose economic future she now controls. Within moments of her confirmation, reporters’ inboxes were flooded with congratulations and praise.

“Her leadership, extensive experience and strong knowledge of the healthcare system are huge assets in tackling our nation’s healthcare challenges moving forward,” said Scott Serota, president and CEO of the Blue Cross/Blue Shield Association.

Agreed Rich Umbdenstock, president and CEO of the American Hospital Association, “As acting administrator, Marilyn has demonstrated her willingness to listen to, learn from and work in partnership with the nation’s health care providers.”

She better enjoy it now. It only gets harder from here. [Copyright 2013 NPR]

The Centers for Disease Control and Prevention has the answer for you: no.

Last summer, researchers at the federal public health agency collected 161 filter samples from public swimming pools in the Atlanta area. More than half of those samples, 58 percent, were contaminated with E. coli.

That, the CDC reported today, “signifies that swimmers introduced fecal matter into pool water.”

Toddlers who aren’t toilet trained are just one source of the problem, according to the study, which was published in the latest Morbidity and Mortality Weekly Report.

People who don’t shower with soap before swimming bring E. coli on their backsides, the CDC reports. And people who swim while sick with diarrhea are much more likely to introduce E. coli, Cryptosporidium, and other yucky germs into the water.

That takes some of the shine off the opening of summer pool season, doesn’t it?

Fortunately, a properly chlorinated pool can kill E. coli quickly. So if your local pool is doing a good job maintaining chlorine and pH levels, that takes care of that problem.

The testing method used in this study couldn’t tell if the E. coli was alive or had already been killed. And no outbreaks of pool-related disease were reported last summer in Atlanta.

Wondering why the lifeguards kick you out of the pool for 30 minutes after a “fecal incident”? That’s the amount of time the CDC recommends to make sure that E. coli, by far the most common fecal pathogen, has been killed.

Other bugs are a lot harder to kill, unfortunately. It can take 45 minutes to kill Giardia, which causes diarrhea, in a pool chlorinated with 1 part per million of free chlorine. But it can take more than a day to kill Cryptosporidium, even with 10 times as much chlorine.

The CDC wants you to do your part by showering before you get in the pool. Children should be taken to the bathroom every hour, and diapers should be checked and changed at least that often. Most important, stay out of the pool when suffering from diarrhea.

Oh, and the CDC knows you pee in the pool, too. The nitrogen in urine depletes free chlorine in pool water, making it harder to kill germs. Nitrogen also converts the chlorine into a form that irritates the eyes and lungs. So stop doing that.

But this subject isn’t a complete bummer. It’s given us here at Shots an excuse to revisit the classic Baby Ruth in the pool scene from the 1980 movie “Caddyshack.” Enjoy! [Copyright 2013 NPR]

Jolie, whose mother died at 56 from ovarian cancer, has a genetic variant that puts her at high risk for ovarian and breast cancer. She made public her thinking and ultimate decision in an op-ed in Tuesday’s New York Times. The disclosure has sparked discussion about breast cancer risk and prevention.

Orenstein recently wrote about her own experience and the downsides of cancer awareness in a much talked about cover story for the Times’ Sunday Magazine called “Our Feel-Good War on Breast Cancer.”

Orenstein tells Greene that Jolie’s op-ed resonates with her, but she has some concerns about Jolie going public:

“I feel that it’s really really important that women recognize that Angelina Jolie is in this very particular group of women that has this genetic mutation. She’s not a woman of average risk, and to take her experience and generalize it either to ordinary women of average risk or even women with a family history, that concerns me.”

Orenstein says the high volume of messages about breast cancer creates problems, too.

“Women are bombarded with breast cancer pretty much everywhere they go now. there’s something pink that’s reminding you of breast cancer. And the unfortunate result, and this is an unintended consequence, is that even as we have an epidemic of breast cancer, the average woman has an exaggerated sense of her own personal risk, so that we make decisions that are not in our own best interest.”

Heart disease remains the No. 1 killer for women in the U.S. Cancers of all kinds come in second.

Orenstein had a recurrence of breast cancer 15 years after her first diagnosis and faced fresh set of decisions about her care:

“We live with risk. And breast cancer is one of those risks. When your risk is not particularly elevated, removing a body part has its own risks. I’ve had a mastectomy; it’s pretty tough. And the reconstruction, while it looks really good and Angelina Jolie’s probably looks better, it doesn’t have sensation. So you’re going to lose that as well.”

On Jolie’s risk factors and how they compare with those that are more common, Orenstein says:

“She had to make a decision about a very elevated risk in a family where there’s been significant death from cancer. That’s a different situation from where you have not a particularly elevated risk in your other breast. So what my doctors said to me was, if you make a decision to remove your other breast that’s a psychological decision having to do with your risk tolerance — not a medical decision.”

[Copyright 2013 NPR]

So, how low should we go? Currently, the government recommends that Americans should aim for 2,300 milligrams per day. And people older than 50, as well as those with high blood pressure, diabetes or kidney disease are advised to reduce sodium even further, down to 1,500 mg per day.

But a panel of experts convened by the Institute of Medicine concludes in a new report that “the evidence on direct health outcomes does not support recommendations to lower sodium intake … to or even below 1,500 mg per day.”

Why? We asked the committee chairman, Brian Strom, a dean and professor of public health at the University of Pennsylvania, to summarize the panel’s findings for us. “The net conclusion is that people who are eating too much sodium should lower their sodium, but it is possible that if you lower it too much you may do harm.”

Strom says a lot more research is needed to better understand how ultra-low-sodium diets may be beneficial or harmful. Strom pointed to an Italian study of people with congestive heart failure as an example of research that has hinted that diets too low in sodium may be problematic for certain people.

“The people on the low-sodium diet actually did worse [compared to those on medium-sodium diets],” says Strom. “They had more hospital re-admissions and they had a higher mortality rate.” He says it’s unclear if the results would be the same for Americans with congestive heart failure, since treatments here are different than they are in Italy. But, he says, the findings raise questions.

The American Heart Association, which recommends a low-sodium (1,500 mg) diet for all Americans, released a statement stating that it disagrees with the key findings of the new report.

And some preventive health experts are critical, too. The World Health Organization has concluded that elevated blood pressure is the leading cause of preventable death, which suggests that staving off high blood pressure with low-sodium diets is an important strategy.

“Sodium reduction remains a critically important component of public health efforts designed to … prevent cardiovascular disease,” Lawrence Appel of Johns Hopkins University writes in an email.

Appel points out that many of the studies that suggest that low-sodium diets are harmful focus on “sick populations in which illness leads to low sodium intake rather than the reverse.”

Some groups of Americans, including older adults and African-Americans, are especially sensitive to the blood-pressure lowering effects of cutting sodium, Appel says. So the strategy of aiming for low-salt diets has “tremendous potential to reduce racial disparities in blood pressure-related cardiovascular disease.”

The bottom line, according to Bonnie Liebman, director of nutrition for the Center for Science in the Public Interest, is that Americans are eating way too much salt, on average about 3,400 milligrams a day.

“And we know that much is harmful,” she says. “It increases blood pressure, which increases the risk of heart attack and stroke.”

And she says focusing on the potential risks of a very-low-sodium diet distracts from the more important conversation about how to get Americans to start consuming less.

To better understand just how much salt is found in the typical lunch out, I met Liebman at a food court. Our first stop was McDonalds, where it turns out burgers have about twice as much salt as the fries: 1,000 mg, and up to 2,000 if you get the Angus bacon burger, Liebman says.

Put the burger and fries together and you’ve already reached the recommended daily sodium intake. Liebman says it’s a similar story at every chain, from Subway to Chipotle to Pizzeria Uno. (McDonalds has pledged to reduce sodium 15 percent across its menu by 2015.)

So even though the new study raises questions about potential harms of ultra-low-sodium diets, with a food supply like ours, most of us consume way too much salt. [Copyright 2013 NPR]

Brown is chief of family medicine at Florida International University’s medical school. The RV is the school’s mobile health clinic.

Every Monday it’s parked at the Royal Country Mobile Home Park in northwest Miami-Dade County. “It’s a beautiful place right here,” he says. “But this is not a wealthy community.”

Brown helps direct FIU’s Neighborhood HELP program. It’s part of the school’s curriculum that connects medical students with families in neighborhoods where medical care is scarce.

Students visit families in their homes where they conduct examinations and provide basic care. But some things are better done in a clinic. So the medical school bought its own RV. “We’re able to bring free basic primary care to our households relatively close to their community,” Brown says.

In one of the RV’s exam rooms, third-year medical student Veronica Alvarez met recently with patient Maritza Flores. Flores has diabetes and high blood pressure. With help from the school’s faculty, Alvarez has been treating her since January.

Flores says with Alvarez’s encouragement, she’s begun exercising more and has improved her diet. And, thanks to FIU’s doctors, she’s begun taking medication for her diabetes and high blood pressure. In just a few months, Alvarez says, she’s seen a big improvement. “The high blood pressure and the diabetes together is what you worry about,” Alvarez says. “And now, her diabetes is well-controlled and her hypertension is well-controlled as well.”

Over the last decade, a pressing need for new doctors has led many universities to open medical schools. Seventeen new schools have been accredited since 2005, and several are looking at new ways to train doctors.

When it was founded just four years ago, Florida International University took on a mission — to improve the health of nearby communities. Another focus for the school is to train more doctors in primary care.

Nationally, there’s a shortage of primary care doctors — one that’s expected to worsen as millions more Americans get access to health care under the Affordable Care Act.

But Dr. John Rock, the medical school’s dean, says the two missions go together. Sending students out to treat patients in their communities teaches them the art of primary care.

FIU just graduated its first class from the medical school. Nearly half of the students, Rock says, are doing residencies in primary care.

Several other new medical schools are also developing programs that allow students to develop ongoing relationships with patients. And there are others that, like FIU also have a social mission — to improve the quality of life in medically-underserved communities.

In Miami, that includes places like Miami Gardens, where med student Danny Castellanos got to know a family that has 10 members, including a great-grandmother and five children.

Castellanos saw the family as part of a team that included a faculty advisor, a nursing student and a social worker. One of the first things they did was get all of the children qualified for Medicaid, which paid for their coverage.

Over the three years, Castellanos became involved in the healthcare of the entire family, including most recently the great-grandmother. She’s now taking part in a telemedicine pilot program.

Castellanos says the school installed an electronic unit in the household. “It has a screen,” he says. “It has a camera. It has a blood pressure cuff on it, a stethoscope which allows us to hear the heart sounds. We just ask her to place it in certain areas on her chest, ask her to put the blood pressure cuff on. And we get those kind of readings electronically.”

The telemedicine pilot will be evaluated for its cost-effectiveness.

But, overall, FIU’s Rock says the school’s focus on improving the health of targeted communities already is a success.

And for families in the program, the benefits are even more tangible. They’re much more likely now to receive regular checkups and less likely to use emergency rooms. “We also have increased health literacy, so they have a keen understanding of what some of the issues are,” Rock says. [Copyright 2013 NPR]

The threshold now for drunken driving is a blood alcohol concentration of 0.08. (The BAC equals alcohol divided by the volume of blood it’s in.)

The NTSB would push for it to be lowered to 0.05, in line with the limits in countries such as Denmark, the Philippines and Switzerland.

How many drinks would it take to run afoul of the new limit? The answer depends on weight, gender and how long a person has been drinking.

A man weighing 180 pounds who drank three beers in an hour would have a BAC of 0.052, according to a calculator on the Wisconsin Dept. of Transportation website. A 120-pound woman would hit the same level drinking two beers over 60 minutes.

At 0.05 BAC, drivers have worse coordination and can’t keep track of moving objects all that well, the National Highway Traffic Safety Administration says.

“We need as much attention today on impaired driving as we saw in the early 1980s when organizations like MADD were founded and the drinking age became 21,” said the text of a speech to be given by Deborah A.P. Hersman, chairman of the NTSB, at the start of a two-day meeting on impaired driving. “Over that decade, real progress was achieved in the United States.”

More than 10,000 highway deaths in 2010 involved an alcohol-impaired driver, according to the NTSB. While that’s down from more than 18,000 in 1988, the NTSB says it could be reduced further still with strichter alcohol limits.

But it looks like a tough sell. “When the limit was .10, it was very difficult to get it lowered to .08,” Jonathan Adkins, a spokesman for Governors Highway Safety Association told USA Today. “We don’t expect any state to go to .05.” [Copyright 2013 NPR]