Consider this . . .

Point to ponder. Take a moment to consider it. Then create your own point to think about, and share back.

Tuesday, March 13, 2007

Humans and their parasites

Epic of Human Migration Is Carved in Parasites’ DNA

Published: March 13, 2007

A human body is not the individual organism its proud owner may suppose but rather a walking zoo of microbes and parasites, each exploiting a special ecological niche in its comfortable, temperature-controlled conveyance. Some of these fellow travelers live so intimately with their hosts, biologists are finding, that they accompany them not just in space but also in time, passing from generation to generation for thousands of years.

The latest organism to be identified as a longtime member of the human biota club is Streptococcus mutans, the bacterium that causes tooth decay. From samples collected around the world, Dr. Page W. Caufield and colleagues at New York University have found that the bacterium can be assigned by its DNA to several distinct lineages. One is found in Africans, one in Asians and a third in Caucasians (the people of Europe, the Near East and India), his team reported in last month’s Journal of Bacteriology.

The geographical distribution of these lineages reflects the pattern of human migration out of the ancestral homeland in Africa. If the tooth decay bacterium spreads easily from person to person, any geographical pattern would soon be blurred. But Streptococcus mutans is transmitted almost entirely from mother to child, preserving its lineages over thousands of years. The bacteria apparently infect the infant during birth, beginning the work that provides the dentistry profession its livelihood. “We’ve never seen father-to-child transmission,” Dr. Caulfield said. Thanks, Mom.

Another faithful member of the human road show is Helicobacter pylori, a bacterium that inhabits half the stomachs in the world. It is a usually well-behaved guest, but gives its hosts ulcers when it acts up. Its pattern of geographic distribution matches that of its host’s migrations, Dr. Mark Achtman of the Max Planck Institute in Berlin and colleagues reported in the journal Nature last month.

There are five ancestral populations of H. pylori — two in Africa, two in Europe and one in East Asia. But all had a common origin, Dr. Achtman said, in a bacterium that started to spread out from East Africa 58,000 years ago, give or take 3,000 years. This is the same time period in which modern humans are thought to have begun their migration out of Africa. The match in dates “implies that H. pylori was present in Africa before the migrations, suggesting that Africa is the source of both H. pylori and humans,” Dr. Achtman and colleagues conclude evenhandedly.

H. pylori seems to be transmitted within families but the exact route — perhaps vomit — is unclear. “It’s amazing that any microbe’s geographical distribution would parallel that of humans as well as pylori’s does,” Dr. Achtman said. “You think of microbes as being easily

transmissible and they are carried all over the world on ships and planes, yet some have not lost these signals of ancient migrations.”

DNA analysis has also shed light on the origin of the tapeworm, one of the 400 or so nonmicrobial parasites that regard the human body as home. The lifecycle of the tapeworm Taenia asiatica alternates between people and pigs, an animal that the religious authorities of both Judaism and Islam agree is unclean. It would be of interest to know just when these filthy animals infected people with their parasites. But the answer is not quite what had been expected.

Eric P. Hoberg, of the U.S.D.A.’s Agricultural Research Service in Beltsville, Md., concluded in 2001 that people contracted tapeworms millions of years ago in Africa, long before the emergence of agriculture and domestic animals. It was humans who infected pigs with tapeworms, not the other way around, Dr. Hoberg and colleagues reported. Indeed, people infected pigs not only with Taenia asiatica but also with a second species of tapeworm, Taenia solium, which humans seem to have acquired either by eating each other or by eating dogs.

If pigs had a religion, it is pretty easy to guess which species they would designate as unclean.



Check Out My Other Blogs (click on blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Monday, March 12, 2007

Night Sight Challenge

Personal Health

Growing Older, and Adjusting to the Dark

Published: March 13, 2007

How well do you see at night? If you’re over 50, probably not as well as you think, no matter how many carrots you eat. The typical 50-year-old driver needs twice as much light to see as well after dark as a 30-year-old. Yet few of us compensate adequately for the reduction in nighttime acuity that occurs in the aging eye.

Changes in driving habits are crucial, and so are adjustments at home to prevent the all-too-common accidents that land older folks in the hospital.

Night and the Aging Eye

In a normal healthy eye, light enters through the pupil and passes through the lens, which focuses it and directs it to the retina on the back of the eye, where images form.

The retina contains two kinds of photoreceptors: cones and rods. Cones enable us to see when it is light. They give us color vision and allow us to see details like the words on this page. Rods are very sensitive, especially to motion. They provide only black-and-white images and thus are critically important for night vision.

If only we had the eyes of a cat.

Compared with the human eye, a cat’s eyes have more rods than cones, which helps the cat see in the dark. Cats also have elliptical pupils that open and close faster and can become larger than our round ones. In addition, cats and some other nocturnal animals have a mirrorlike membrane, the tapetum, on the back of their eyes, which reflects the light passing through the rods back through them in the opposite direction. This “double exposure” allows cats to see well in near darkness.

The human eye changes gradually with age, but the changes are critical, as the Harvard Health Letter described in its March 2006 issue.

In dim light or darkness, eyes adapt by widening the pupils to let in as much light as possible. The iris (the colored part of the eye surrounding the pupil) contains tiny muscles that control the size of the pupil. As you get older, these muscles (like most in the body) weaken and do not respond as well to the need to let in more light. The result is a small pupil when you try to see in poor light. It’s as if your eyes were still young but you were wearing sunglasses at night.

There is also evidence that as we age we lose more rods than cones. In the young eye, rods outnumber cones by nine to one in the part of the retina called the macula. But an autopsy study of older adults found that while the cones remained intact, almost a third of the rods in the macula had been lost.

The less responsive muscles in the iris also affect the eye’s ability to adjust when the intensity of light changes, such as when a car with its headlights on approaches and then passes.

In older eyes, this phenomenon, called dark adaptation, takes longer, which means you see less well in the dark after being in the light, and vice versa. The diminished number of rods may be a factor, but in addition, the light-sensitive pigment in the rods regenerates more slowly in older eyes.

Another common change in older eyes is a gradual clouding of the lens — the formation of cataracts — which makes the lens less transparent and reduces the amount of light reaching the retina. Cloudy lenses also scatter light. This can cause temporarily blinding glare from, for example, the headlights of an approaching vehicle at night.

Behind the Wheel

Traffic deaths are three times greater at night than during the day, though only 20 percent of driving is done after dark. Fatigue and alcohol are two important causes, but experts say the biggest factor is darkness. Ninety percent of a driver’s reaction depends on vision, and we were just not engineered to see very well in the dark.

The American Automobile Association and the National Safety Council, among others, have published critically important suggestions for improving vision when driving at night, however old you are.

The No. 1 recommendation is to protect your eyes during the day by wearing sunglasses (neutral-gray lenses are best) and a hat with a brim when the sun is shining. Bright sunlight bleaches the photoreceptors and lengthens the time it takes for your eyes to adjust to the dark. While it normally takes half an hour for full adaptation to the dark, being in bright sunlight for two or three hours can delay this adaptation by hours.

“The longer you stay in the sun, the worse your night vision gets,” the association warned.

Another recommendation: Clean the windshield of your vehicle, inside and out, at least weekly. As with a cloudy lens, a grimy windshield scatters light and intensifies glare. (You may be surprised by how dirty the inside of the windshield gets.)

Clean the headlights as well; just a thin layer of grime can reduce the light they cast by about 90 percent, which in turn reduces how well a driver can see. And make sure the headlights are properly aligned.

Most new cars these days have rear-view mirrors that adjust automatically at night to eliminate the reflected glare of headlights behind you. If not, make sure to adjust the mirror manually to night setting. But keep in mind that this makes the vehicle behind you appear farther away than it really is.

If you wear glasses, make sure they are clean. Grimy glasses, like a grimy windshield, scatter light. When getting a new prescription, make sure the lenses have an antireflective coating. Though I don’t legally need glasses to drive, my ophthalmologist suggested I wear them, especially when driving at night, to enhance my distance vision.

Avoid looking directly at approaching vehicles at night, even when their lights are dimmed. Instead, direct your eyes about 20 degrees to the right, toward the white line on the right side of the road, and use your peripheral vision to see ahead for those few moments.

Reduce your speed at night and increase the distance between you and the vehicle ahead of you. You should be able to stop inside the area illuminated by your headlights. If you overdrive your headlights, you create a blind crash area in front of your vehicle.

Staying Safe at Home

If I had a dollar for every time someone broke a bone tripping over something in the dark, I’d be rich.

Night lights — the kind that plug into wall outlets — are inexpensive and highly preventive, especially for older people who make nighttime trips to the bathroom.

In unfamiliar surroundings, such as a hotel or friend’s home, leave a light on in the bathroom all night and close the door partway. Or travel with a night light.

Keep paths and stairways clear of objects, including slippers. Loose rugs are accidents waiting to happen. Get rid of them or fasten them securely to the floor with carpet tape.

Finally, have your eyes checked at least once a year. If you have cataracts, have them removed sooner rather than later, and see how much brighter the world can be.



Check Out My Other Blogs (click on blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Sunday, March 11, 2007

Human Evolution

The New Science of Human Evolution
By Sharon Begley
Newsweek

March 19, 2007 issue - Unlike teeth and skulls and other bones, hair is no match for the pitiless ravages of weather, geologic upheaval and time. So although skulls from millions of years ago testify to the increase in brain size as one species of human ancestor evolved into the next, and although the architecture of spine and hips shows when our ancestors first stood erect, the fossil record is silent on when they fully lost their body hair and replaced it with clothing. Which makes it fortunate that Mark Stoneking thought of lice.

Head lice live in the hair on the head. But body lice, a larger variety, are misnamed: they live in clothing. Head lice, as a species, go back millions of years, while body lice are a more recent arrival. Stoneking, an evolutionary anthropologist, had a hunch that he could calculate when body lice evolved from head lice by comparing the two varieties' DNA, which accumulates changes at a regular rate. (It's like calculating how long it took a typist to produce a document if you know he makes six typos per minute.) That fork in the louse's family tree, he and colleagues at Germany's Max Planck Institute for Evolutionary Anthropology concluded, occurred no more than 114,000 years ago. Since new kinds of creatures tend to appear when a new habitat does, that's when human ancestors must have lost their body hair for good—and made up for it with clothing that, besides keeping them warm, provided a home for the newly evolved louse.

If you had asked paleoanthropologists a generation ago what lice DNA might reveal about how we became human, they would have laughed you out of the room. But research into our origins and evolution has come a long way. Starting with the first discovery of a fossil suggesting that a different sort of human once lived on this planet—it was a Neanderthal skull, unearthed in a mine in Germany's Neander Valley in 1856—our species' genealogy was inferred from stones and bones. Fossils and tools testified to our ancestors' origins in Africa, the emergence of their ability to walk upright, the development of toolmaking and more. But now two new storytellers have begun speaking: DNA and brains.

The science of human evolution is undergoing its own revolution. Although we tend to see the march of species down through time as a single-file parade, with descendant succeeding ancestor in a neat line, the emerging science shows that the story of our species is far more complicated than Biblical literalists would have it—but also more complex than secular science suspected. By analyzing the DNA of today's humans as well as chimps and other species (even lice), scientists are zeroing in on turning points in evolution, such as when and how language and speech developed, and when our ancestors left Africa. DNA can even reveal how many pilgrims made that trek. At the new Hall of Human Origins at the American Museum of Natural History in New York, DNA gets equal billing with fossils. And by comparing the impressions that brains left on the inside of skulls, "paleoneurology" is documenting when structures that power the human mind arose, shedding light on how our ancestors lived and thought. Whether or not you believe the hand of God was guiding these changes, the discoveries are overturning longstanding ideas about how we became human.

Not that fossils are passé. new discoveries are pruning and reshaping humankind's family tree as radically as bonsai. The neat traditional model in which one species gave rise to another like Biblical "begats" has been replaced by a profusion of branches, representing species that lived at the same time as our direct ancestors but whose lines died out. It's like discovering that your great-great-grandfather was not an only child as you'd thought, but had a number of siblings who, for unknown reasons, left no descendants. New research also shows that "progress" and "human evolution" are only occasional partners. More than once in human prehistory, evolution created a modern trait such as a face without jutting, apelike brows and jaws, only to let it go extinct, before trying again a few million years later. Our species' travels through time proceeded in fits and starts, with long periods when "nothing much happened," punctuated by bursts of dizzying change, says paleontologist Ian Tattersall, co-curator of the American Museum's new hall.

As its exhibits show, humankind's roots are sunk deep in the East African savanna. There, the last creature ancestral to humans as well as chimps—our closest living cousins—lived, standing at a fork in the family tree as momentous as it is contentious. Fossils never resolved when the lineages split. DNA might. Human DNA and chimp DNA differ by no more than 1.2 percent, and DNA changes at a fairly regular rate. That lets scientists use this rate to calibrate a "molecular clock" whose tick-tocks measure how long ago a genetic change occurred. The fact that the DNA of living chimps and humans differ by about 35 million chemical "letters," for instance, implies that the two lineages split 5 million to 6 million years ago. That fits with the discovery that Earth became cruelly colder and drier 6.5 million years ago, just the sort of climate change that coaxes new species into being. The apes that stayed in the forests hardly changed; they are the ancestors of today's chimps. Those that ventured into the newly formed habitat of dry grasslands had taken the first steps toward becoming human.

Now the contentious part. In 2001, a team digging in Chad unearthed what it claimed was the oldest fossil of an ancestor of humans but not chimps. If so, it must have lived after the two lineages split. Trouble was, Sahelanthropus tchadensis (nicknamed Toumai, the local word for "child") lived close to 7 million years ago. The genetic data, pointing to a human-chimp split at least 1 million years later, suggest that Toumai is not the ur-hominid—the first creature ancestral only to human and not our chimp cousins—after all.

If Toumai is not our ancestor, what is he doing with such a humanlike face and teeth, which look like those of species 5 million years his junior? "A 7 million-year-old hominid should be just starting to look like a hominid, not have a trait you see so much later in the fossil record," says paleoanthropologist Bernard Wood of George Washington University. Even if he is not our ancestor, Toumai is valuable because he undermines the "begat" model of human evolution—that Toumai begat Australopithecus who begat Homo habilis who begat Homo erectus who begat Homo sapiens. That model assumes that each biological innovation, whether bipedality or a large brain or any other, evolved only once and stuck.

Instead, evolution played Mr. Potato Head, putting different combinations of features on ancient hominids then letting them vanish until a later species evolved them. "Similar traits evolved more than once, which means you can't use them as gold-plated evidence that one fossil is descended from another or that having an advanced trait means a fossil was a direct ancestor of modern humans," says Wood. "Lots of branches in the human family tree don't make it to the surface."

In fact, starting 4 million years ago half a dozen hominids belonging to the genus Australopithecus called Africa home. Best-known for the fossil named Lucy, which was discovered in 1974, Australopithecus afarensis had apelike features such as a large jaw and jutting face, and probably scrambled up trees for safety and shelter. But she also strode the grasslands erect, a hallmark of modern humans. Footprints preserved in volcanic ash 3.6 million years old are mute testimony to how one larger afarensis and a smaller companion—woman and mate, or parent and child—walked across a plain in what is now Tanzania.

What triggered this abrupt change—what set us on the road to becoming fully human—has long stumped experts. Where stones and bones were of little help, however, genes and brains have begun to speak. Last summer scientists discovered a gene called HAR1 (for human accelerated region) that is present in animals from chickens to chimps to people. It had changed in only two of its 118 chemical "letters" from 310 million years ago (when the lineages of chickens and chimps split) to 5 million years ago. But 18 letters changed in the (relative) blink of an eye since the human lineage split from chimps', Katherine Pollard of the University of California, Davis, and colleagues reported. That high rate of change is a sign of a gene whose evolution keeps conferring advantages on those who carry it, perhaps starting with Australopithecus.

The brain, more than any other organ, may have reaped those genetic advantages. HAR1 reaches a peak of activity from the seventh to ninth week of gestation in humans, apparently spurring brain growth. And it is plentiful in cells that create the six layers of neurons in the human cortex. "HAR1 is present in neurons that play a role in the geometry and layout of the cortex," says Pollard. It likely helped the cortexes of our ancestors develop the elaborate folds characteristic of a complex brain.

Besides making brain structure more complex, genetic change also advanced the brain's chemistry. In 2005, Matthew Rockman of Duke University and colleagues discovered that a gene called PDYN began accumulating changes 7 million years ago, soon after our oldest direct ancestor appeared. This gene regulates production of a molecule called prodynorphin, which is like the brain's soup stock: depending on what other ingredients are added, it can change into neurochemicals that underlie perception, behavior or memory. "Fossils can tell us a lot, but it is genomes that tell us what was involved in making language possible and in making brains the way they are today," says Rob DeSalle, co-curator of the American Museum's new hall.

It surely took more than prodynorphin's magic to modernize a brain and thus jump-start the creation of new species. To find what else made us human, scientists led by neurogeneticist Daniel Geschwind of UCLA are examining which combinations of genes are active in the cortex, the seat of higher thinking, of chimps and people. Among the genes turned to "high" in people, they reported last year, are those that influence how fast electrical signals jump from neuron to neuron and therefore how fast the brain can process information, those that enhance connections between the cells and thus learning and memory, and those that promote brain growth. This pattern of gene activity, it appears, began emerging when Australo-pithecus species did.

And it helps explain why Lucy's kind were the way they were. Afarensis women and men stood three to five feet tall and weighed 60 to 100 pounds. They had small teeth good for fruits and nuts, but not meat. (The available prey was enough to make one a confirmed vegetarian: hyenas the size of bears, saber-toothed cats and other mega-reptiles and raptors.) That suggests that early humans were more often prey than predators, says anthropologist Robert Sussman of Washington University, coauthor of the 2005 book "Man the Hunted." The evidence is as stark as the many fossil skulls containing holes made by big cats and talon marks from raptors.

The realization that early humans were the hunted and not hunters has upended traditional ideas about what it takes for a species to thrive. For decades the reigning view had been that hunting prowess and the ability to vanquish competitors was the key to our ancestors' evolutionary success (an idea fostered, critics now say, by the male domination of anthropology during most of the 20th century). But prey species do not owe their survival to anything of the sort, argues Sussman. Instead, they rely on their wits and, especially, social skills to survive. Being hunted brought evolutionary pressure on our ancestors to cooperate and live in cohesive groups. That, more than aggression and warfare, is our evolutionary legacy.

Both genetics and paleoneurology back that up. A hormone called oxytocin, best-known for inducing labor and lactation in women, also operates in the brain (of both sexes). There, it promotes trust during interactions with other people, and thus the cooperative behavior that lets groups of people live together for the common good. By comparing the chimp genome with the human, scientists infer that oxytocin existed in the ancestor of both. But it has undergone changes since then, perhaps in how strongly the brain responds to it and in how much is produced. The research is still underway, but one possibility is that the changes occurred around the time our ancestors settled into a system based on enduring bonds between men and women, about 1.7 million years ago.

That was a formula for success, and one that may have also left a mark on the brain. Besides revealing the size of a brain, paleoneurology examines impressions of surface features that the brain leaves on the inside of the skull. That yields clues to its organization. Comparing the shapes of the brains of two hominids that lived 2.5 million years ago, Australopithecus africanus and Paranthropus, scientists find major differences in the shape of the frontal lobe, which controls higher cognition. "Paranthropus has a teardrop shape, whereas africanus is more squared off, and africanus has a swooping down on the bottom where Paranthropus is sort of peaked," says Dean Falk of Florida State University. That configuration suggests that africanus had a better-developed region called area 10, which plays a key role in decision-making, taking initiative and advance planning. It may be why africanus evolved while Paranthropus came to a dead end.

Paleoneurology promises to do what simplistic studies of ancient brains—which asked only how big they were—could not: explain our ancestors' great leaps forward. About 2.5 million years ago a new genus, Homo habilis, appeared in Africa. Discovered by the legendary Louis and Mary Leakey, habilis was the first hominid with a brain bigger than a chimp's, and was the first toolmaker: stone tools—sharp flakes of rock—appeared when habilis did. Their direct descendant, Homo erectus, took an equally momentous step: venturing beyond Africa. In the Republic of Georgia at a site called Dmanisi, scientists have unearthed 1.8 million-year-old fossils of erectus, "the first outpost we know of beyond Africa," says G. Philip Rightmire of Binghamton University. "It looks like these people got out and materialized everywhere in Eurasia," showing up as Java man and Peking man, among others. (None of the original fossils of Peking man survived World War II. Packed for shipment to the United States for safekeeping, they disappeared in transit; only casts remain.) Ancient humans didn't just walk: they reached Australia 60,000 years ago, across miles of open ocean.

Erectus shows that brain size is too crude a measure of a species' talents. At Dmanisi, the brains range from 600 to 770 cubic centimeters, comparable to the more primitive habilis. But while erectus did not distinguish themselves in brain size, brain structure is more telling. They were the first of our ancestors to have an asymmetric brain, as modern humans do; Australopithecus species do not. Asymmetry is a mark of increasing specialization and therefore complex cognitive ability. Erectus used it to, among other things, discover and tame fire. What they did not use it for is technology. Tools found with the Dmanisi fossils include cutting flakes, rock "cores" from which flakes were made and a chopper, all primitive even for their time. "The old idea that you needed a master's degree in stone tools to leave Africa is crazy," says Bernard Wood.

Although erectus spread across Eurasia between 2 million and 1 million years ago, DNA makes clear that the species was almost certainly a dead end and not our ancestor, as some scientists had argued. According to this idea, groups of erectus scattered across the Old World all accrued the same mutations and underwent the same natural selection that led to Homo sapiens. The Y chromosome begs to differ. The Y is passed intact from father to son; in that sense, it's like a last name and so can be used to trace ancestries. But like surnames that got Anglicized at Ellis Island, sometimes a Y changes, with the altered version being passed to all male descendants. Peter Underhill, a molecular anthropologist at Stanford University, tracked 160 such changes in the Y's of 1,062 men from 21 populations across the world. Applying the molecular-clock technique, he concludes that the most recent common ancestor of all men alive today lived 89,000 years ago in Africa. The first modern humans—and therefore, unlike the earlier wave of Homo erectus into Asia a million years ago, the ancestors of everyone today—departed Africa about 66,000 years ago.

These pilgrims were strikingly few. From the amount of variation in Y chromosomes today, population geneticists infer how many individuals were in this "founder" population. The best estimate: 2,000 men. Assuming an equal number of women, only 4,000 brave souls ventured forth from Africa. We are their descendants.

A curious thing about early Homo species is that they looked quite human early on. "By 600,000 years ago everyone had a big brain, and by 200,000 years ago people in Africa looked like modern humans," says archeologist Richard Klein of Stanford. "But there was no representational art, no figurines, no jewelry until 50,000 years ago. Some kind of cognitive advance was required, probably in language or working memory. But since size hardly changed, the brain change that produced behaviorally modern humans must have been in structure."

The source of such structural changes must come, like every aspect of our physiology, from genes. Combing the genome for genes that emerged just when language, art, culture and other products of higher intelligence did, researchers have found three with the right timing.

The first, called FOXP2, plays a role in human speech and language, but it must do something else in other species, because the decidedly nonverbal mouse has a version of it. Using the standard molecular-clock tactic, Svante Paabo and colleagues at the Max Planck Institute estimate that the human version of FOXP2 appeared less than 200,000 years ago—about when anatomically modern humans stepped onto the world stage—and maybe as recently as 50,000. If so, then it is only humans as modern as those in the last diaspora out of Africa who developed advanced, spoken language. Another gene with interesting timing is microcephalin, which affects brain size. It carries a time stamp of 37,000 years ago, again when symbolic thinking was taking hold in our most recent ancestors. The third, called ASPM and also involved in brain size, clocks in at 5,800 years. That was just before people established the first cities in the Near East and is well after Homo sapiens attained their modern form. It therefore suggests that we are still evolving.

The fossils have not finished speaking, of course. These countless postcards from the past surely still lie en-cased in the rocks of the Old World. But now, as ancient DNA and gray matter give up their secrets, they are adding life to the age-old quest to understand where humankind came from and how we got here.

With Mary Carmichael



Check Out My Other Blogs (click on blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Sunday, March 04, 2007

Health Insurance Realities

Without Health Benefits, a Good Life Turns Fragile

Chris Keane for The New York Times

Vicki Readling, a real estate agent, cannot afford health insurance.

Published: March 5, 2007

SALISBURY, N.C. — Vicki H. Readling vividly remembers the start of 2006.

Skip to next paragraph

The Uninsured

Middle Class Not Exempt

Articles in this series will explore the growing ranks of Americans without health insurance.

“Everybody was saying, ‘Happy new year,’ ” Ms. Readling recalled. “But I remember going straight to bed and lying down scared to death because I knew that at that very minute, after midnight, I was without insurance. I was kissing away a bad year of cancer. But I was getting ready to open up to a door of hell.”

Ms. Readling, a 50-year-old real estate agent, is one of nearly 47 million people in America with no health insurance.

Increasingly, the problem affects middle-class people like Ms. Readling, who said she made about $60,000 last year. As an independent contractor, like many real estate agents, Ms. Readling does not receive health benefits from an employer. She tried to buy a policy in the individual insurance market, but — having had cancer — could not obtain coverage, except at a price exceeding $27,000 a year, which was more than she could pay.

“I don’t know which was worse, being told that I had cancer or finding that I could not get insurance,” Ms. Readling (pronounced RED-ling) said in an interview in her office, near the tree-lined streets and stately old homes of this city in the Piedmont region of North Carolina.

It is well known that the ranks of the uninsured have been swelling; federal figures show an increase of 6.8 million since 2000.

But the surprise is that the uninsured are not necessarily the poor, the unemployed and the undocumented. Solidly middle-class people like Ms. Readling are one of the fastest growing subgroups.

And that is one reason, according to a recent New York Times/CBS News poll, that the problems of the uninsured have jumped to the top of the domestic political agenda in Washington and on the campaign trail.

Today, more than one-third of the uninsured — 17 million of the nearly 47 million — have family incomes of $40,000 or more, according to the Employee Benefit Research Institute, a nonpartisan organization. More than two-thirds of the uninsured are in households with at least one full-time worker.

Ms. Readling’s experience is typical; people who have had serious illnesses often have difficulty obtaining insurance. If coverage is available, the premiums are often more than they can afford.

While the government does not have an official definition of “middle class,” one commonly used point of reference is the median household income, which was $46,326 in 2005.

Katherine Swartz, a professor of health policy and economics at Harvard, said the soaring cost of health care was a major reason for the increase in the number of uninsured. She said it also reflected long-term changes in the economy, like the decline in manufacturing jobs and the growth in the share of workers in service industries and small businesses, which are less likely to provide health benefits.

Moreover, Ms. Swartz said, “Companies have become more aggressive in hiring people as temporary or contract workers with no fringe benefits.”

The National Association of Realtors says 28 percent of its 1.3 million members are without health insurance.

“Because real estate agents are independent contractors, they are forced into the individual insurance market, where there is no negotiating or leverage,” said Pat V. Combs, president of the association.

As an independent contractor with a Century 21 real estate brokerage, Ms. Readling had bought insurance on her own, a temporary extension of coverage from a prior job. But she was unable to renew it after she had surgery for breast cancer in 2005. Most insurers would not offer her coverage, she said, and one carrier quoted a price of $2,300 a month for coverage with a deductible of $5,000 a year.

Concerns about health insurance permeate her life.

To save money, Ms. Readling said, she defers visits to the doctor and stretches out her cancer medication, which costs her about $300 a month. She takes the tiny pills three or four times a week, rather than seven days a week as prescribed.

“I really try to stay away from the doctor because I am so scared of what everything will cost,” said Ms. Readling, who is divorced and has twin 18-year-old sons. Before every doctor’s visit and test, she asks, “How much are you going to charge me?” She says she tries to arrange “the best deals I can.” But in many cases, the price is still unaffordable, and “I have to do without.”

Even those with insurance have reason to be concerned, economists say, because they end up paying for the uninsured in various ways. Some of the costs are also passed on to taxpayers and employers. To help cover the cost of treating the uninsured, hospitals often increase charges to other patients. Insurers then increase premiums for companies that provide health benefits, and they in turn shift some costs to employees.

Ms. Readling is engaged to be married in June, to another real estate agent. But she said she may postpone the wedding because she would not want her husband to be legally responsible for her medical bills.

“I am scared to get married because I don’t have insurance,” Ms. Readling said. “If I have to go to the hospital and I can’t pay my hospital bills, what happens? Do they go after him? Can they take your home?”

To collect unpaid medical bills, health care providers often obtain judgments against a patient’s spouse, as well as the patient, and file liens against their homes. Ms. Readling says she does not own a house, but her fiancé does.

The idea of universal coverage, in the form proposed by President Bill Clinton, proved politically untenable. Since the Clinton plan collapsed in 1994, the politics of health care have changed because of the steady rise in health costs, the increase in the number of uninsured and the erosion of employer-sponsored insurance. Politicians are once again speaking about universal coverage as a goal, though opinion polls show that many voters still oppose the idea of a government-run health care system.

Ms. Readling said it was stressful enough visiting doctors every few months for her cancer follow-ups. Without coverage, she said, the experience is even more stressful.

“When you go to any medical person and they ask for your insurance card, you are so ashamed because you have to say, ‘I don’t have insurance,’ ” Ms. Readling said. “You just feel like you are dirt.”

Ms. Readling said she often woke up at night, terrified of the cost of getting sick without insurance.

“Anything that goes wrong with my health could destroy me financially,” Ms. Readling said. “I could be ruined.”

She said she had never voluntarily allowed her insurance to lapse and could not understand why she was being blackballed.

“What did I do wrong?” Ms. Read-ling asked. “Why am I being punished? I just don’t understand how I could have fallen through this horrible, horrible crack.”

Knowing her health benefits from her prior job would expire in January 2006, she began shopping for a new policy in May 2005. But in June 2005, she learned she had cancer.

“At that point,” Ms. Readling said, “I called everybody I could think of, begging for help. But no insurer would touch me.”

Barbara Morales Burke, the chief deputy insurance commissioner of North Carolina, said state law did not guarantee the availability of health insurance for individuals. “Most insurers decline to issue policies to those individuals whom they deem to be too risky because of their medical history,” Ms. Morales Burke said.

Blue Cross and Blue Shield of North Carolina will sell to anyone, regardless of the person’s medical condition, she added, but the premiums may be very high for people who have had serious illnesses.

Heidi Deja, a spokeswoman for Blue Cross and Blue Shield of North Carolina, said, “Rates are based on the anticipated cost of providing care.” For people who have had serious illnesses, she said, monthly premiums “can run into the thousands of dollars.”

A 1996 federal law limited the ability of insurers to discriminate against people because of pre-existing conditions. But consumer protections are much more extensive in the group health insurance market.

“In the individual market, the federal protections provide precious little help to people seeking coverage,” said Karen L. Pollitz, a research professor at the Georgetown University Health Policy Institute.

When Ms. Readling was shopping for insurance, she found two responses particularly galling. One insurer, she said, suggested she return to her prior job, at a furniture company, so she could participate in its group health plan, though she loved her work as a real estate agent. Another insurer suggested she remarry her former husband to get back on his insurance plan.

Working with her doctors, Ms. Readling raced to get as many tests as possible before her coverage expired. She recalled her anxiety in the final months: “It’s like a freight train coming at you, and it’s going to get you. And there was nothing I could do.”

Ms. Readling said she was mystified by the inability of real estate agents to band together and buy health insurance as a group.

“Why can’t Realtors in North Carolina, or a few counties, have coverage under one umbrella?” she asked. “You would think that some insurance company would want our business.”

Janet S. Trautwein, executive vice president of the National Association of Health Underwriters, which represents insurance agents and brokers, said employee groups were more attractive to insurers for several reasons.

“In a group health plan,” Ms. Trautwein said, “the employer typically pays a large share of the premium, so most employees sign up as soon as they are eligible, regardless of their health status.”

“The health plan covers a mix of sick and healthy workers,” she said. “By contrast, individuals and independent contractors are more likely to defer coverage until they need it, so the pool of people insured is, over all, less healthy. Sick people consume more health care. As a result, the cost to insure them is higher.”

Though satisfied with her care, Ms. Readling continually wonders if doctors and nurses treat her differently because she is uninsured.

“Are they going to turn their nose up at you because you don’t have insurance?” Ms. Readling asked. “Will they take care of other people first? They can make more money on patients with insurance. What am I? I am just a financial loss to them.”



Check Out My Other Blogs (click on blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/