California Gov. Jerry Brown Signs Right-to-Die Bill Into Law

By Dennis Thompson
HealthDay Reporter

MONDAY, Oct. 5, 2015 (HealthDay News) — California Gov. Jerry Brown on Monday signed “right-to-die” legislation that would allow the terminally ill to legally end their lives.

A lifelong Catholic and former Jesuit seminarian, Brown’s decision to support the bill passed by state legislators last month could have a significant impact on the right-to-die debate in the United States. Given the size of its population — nearly 40 million people — and its influence, California often sets the tone for potentially groundbreaking issues.

“I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill,” the governor wrote in a signing statement that accompanied his signature, the Associated Press reported.

In September, state senators voted 23-14 to let doctors prescribe life-ending medications to patients expected to die within six months. The California Assembly approved the bill earlier in a 43-34 vote.

Supporters believe that California’s approval of the measure could add momentum to the adoption of right-to-die laws across the country.

Opponents of the bill include religious groups such as the Catholic Church and advocates for the disabled.

California becomes the fifth state in which people are allowed to legally end their lives. Oregon, Vermont and Washington already have passed laws allowing the practice, and Montana’s courts have authorized it.

“I think lawmakers will be more comfortable voting for aid-in-dying, knowing that a big jurisdiction like California has already done so,” said Barbara Coombs Lee, president of Compassion & Choices, a national organization that supports the practice. “It’s hard for lawmakers sometimes to think about being the pioneers in a social change movement. It will be easier for them to feel that they are one more state coming along in the assimilation of a new medical practice.”

The California legislation is modeled after the Death With Dignity law passed by Oregon voters in 1994, which made that state the first in the nation to allow some terminally ill patients to choose the time of their own death.

The effort to pass the legislation in California was prompted, in part, by the death last year of Brittany Maynard, a 29-year-old California woman diagnosed with terminal brain cancer. Maynard moved to Oregon so she could end her own life when the time was right, and became a prominent activist in the “death with dignity” movement through online videos and well-read news articles about her choice.

Under both the Oregon law and the California law, two physicians must see the patient, review the prognosis and agree that the person has an illness that will be fatal in six months, Coombs Lee said.

The doctors also must attest that the patient has no mental illness or mood disorder that impairs judgment, and that the person is not being coerced or forced into the decision, she said. The person must receive counseling about hospice and palliative care, and be told that they are under no obligation to either fill the prescription for the life-ending drugs or to take them.

“The control resides with the patient, from beginning to end,” Coombs Lee said.

The California law places additional safeguards on the Oregon model, including a statement that the patient must sign within 48 hours of their self-inflicted death indicating that they are still of sound mind and remain capable of taking the medication on their own, Coombs Lee said.

However, opponents believe the Oregon law is flawed and allows abuses that will also occur in California.

Marilyn Golden, a senior policy analyst with the Disability Rights Education and Defense Fund, said that assisted suicide laws could potentially let insurance companies coerce vulnerable people into a cheap and quick death.

“If insurers deny or even delay a person’s life-sustaining treatment, they are being steered toward hastening their death,” she said. “Do we really think insurers will do the right thing or the cheapest thing?”

Golden also questioned whether the safeguards cited by Coombs Lee are truly effective, noting that people who are depressed or being pressured to take their own lives can “doctor shop” until they find a physician willing to sign off on their lethal prescription.

“It’s common knowledge in Oregon that if your doctor says no, you can call Compassion & Choices to find a doctor who says yes,” Golden said.

These are troubling concerns that have kept legislators in other states from acting on assisted suicide legislation, she said.

“No one pays attention to the fact that 12 other states this year have rejected the Oregon model,” Golden said. “As the legislators became aware of these problems, they chose not to move forward.”

Coombs Lee believes many other states will come around, encouraged by Maynard’s story and the example set by California.

“It takes a long time for lawmakers to educate themselves, and to start to feel comfortable voting yes,” Coombs Lee said. “It’s very unlikely a bill would pass a legislature the first time. California has been considering this in one way or another since 1991, when the first ballot initiative occurred.”

More information

For more on Oregon’s Death With Dignity Act, visit the Oregon Health Authority.

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Is Butter Bad For You? What You Should Know

Photo: Getty Images

Is butter really artery-clogging enemy No. 1? For the past few years, a fierce debate has raged on among experts about saturated fat—is it bad or not? A new study from Journal of the American College of Cardiology offers some key insights.

After following close to 85,000 women and nearly 43,000 men, Harvard researchers found that what you eat instead of saturated fat, found in whole milk, cheese, and meat as well as butter, matters just as much for your heart as the total amount of saturated fat in your diet.

RELATED: 13 Best (and Worst) Ways to Measure Body Fat

To reach their findings, the researchers checked in with participants every four years over three decades to evaluate their diets and signs of disease. (Everyone was free of diabetes, heart disease, and cancer at the start of the study.) In the end, they found that when men and women replaced 5% of their saturated fat calories with polyunsaturated fats, like those in nuts, their risk for heart disease dropped by 25%. Replacing that same amount of saturated fat with monounsaturated fat (also found in nuts as well as olive oil) reduced participants’ heart risk by 15%. Meanwhile, trading “sat fat” for whole grain carbohydrates resulted in a 9% reduction in risk.

Finally, and this is the important part, the researchers found that swapping saturated fat for processed carbs, like white bread and white rice, had zero effect on heart disease risk.

In other words if you trade ice cream for cookies, or swap in white rice in lieu of extra cheese, you won’t do your heart any favors. But there might be some benefit to replacing a portion of the saturated fat in your diet with other plant-based fats and whole grains.

What about your beloved butter?

While I don’t think butter is your best fat option, I do think organic grass-fed butter is far better than margarine, which is processed and loaded with trans fats, which we know for sure are bad. Previous studies also seem to show that overall saturated fats may be neutral, and some, like those found in coconut and cocoa butter, are actually beneficial.

What this really shows, however, is that your health depends on your whole diet. So go ahead and eat a little saturated fat, but make sure you have it with lots of produce, as well as lean protein, whole grains, and other good fats, too.

RELATED: 10 Best Foods for Your Heart

To simplify things further, check out these 5 simple swaps. Each is designed to keep your diet balanced and best protect your ticker.

Choose spreads and substitutes wisely

If you have to choose between organic, grass-fed butter on whole wheat toast versus a donut, I say pick the toast! But even better, try using ripe avocado or almond butter as spreads.

In a similar vein, instead of adding bacon and cheese to a burger, slather it with olive tapenade, guacamole, or tahini.

Eat meat with veggies

When using ground meat in loaves, meatballs, or casseroles, cut the portion in half, and fill it in with a combo of minced or shredded veggies, and either a whole grain, like quinoa or oats, or mashed beans. Sadly, the latest study didn’t look at replacing your saturated fat with veggies, but with everything we know about the health benefits of produce, I’m willing to bet this move can pay major health dividends.

RELATED: Best Snacks for Weight Loss

Think beyond cheese

In a burrito, tacos, or a taco salad, replace cheese and sour cream with veggies, like spinach, mushrooms, bell peppers, and onions, along with brown rice, beans, and guacamole.

Snack smart

In place of cheese and crackers as an appetizer or snack, reach for nuts, olives, and popcorn (it’s a whole grain).

Tweak your treats

Cut your ice cream portion in half and top it with toasted oats and chopped nuts.

What’s your take on this topic? Chat with us on Twitter by mentioning @goodhealth and @CynthiaSass.

Cynthia Sass is a nutritionist and registered dietitian with master’s degrees in both nutrition science and public health. Frequently seen on national TV, she’s Health’s contributing nutrition editor, and privately counsels clients in New York, Los Angeles, and long distance. Cynthia is currently the sports nutrition consultant to the New York Yankees, previously consulted for three other professional sports team, and is board certified as a specialist in sports dietetics. Cynthia is a three-time New York Times best-selling author, and her brand new book is Slim Down Now: Shed Pounds and Inches with Real Food, Real Fast. Connect with her on Facebook, Twitter and Pinterest.

 

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Making Sense of the Email Avalanche

MONDAY, Oct. 5, 2015 (HealthDay News) — That seemingly interminable delayed response to your email doesn’t mean you’re being ignored: it could be due to a host of other factors.

Then again, you might be being ignored, researchers report.

The University of Southern California School of Engineering researchers assessed how the volume of incoming emails affects recipients’ behavior and the length of time it takes them to reply.

Email response depends on a variety of factors, including age, type of electronic device, the amount of email and timing, the researchers found.

Ninety percent of people respond within a day or two to emails they intend to respond to. But, half will respond in under an hour, and the most likely reply time is two minutes, according to the study authors.

Younger people respond faster but with shorter replies. Teens are the quickest to reply, with an average response time of 13 minutes, compared to 16 minutes for young adults ages 20 to 35. Adults 35 to 50 take 24 minutes and those older than 51 take 47 minutes, the investigators found.

Email responses from women typically take about four minutes longer than from men.

The type of technology used by recipients also matters. People working on a laptop will take nearly twice as long to reply as those using a mobile phone, the study authors said.

And if you receive a curt email reply, don’t fret. Most email replies contain just five words, more than half have less than 43 words, and only 30 percent have more than 100 words, the findings showed.

The researchers also found that when users first initiate an email conversation, they tend to exchange messages of similar length. But as the email chain continues, this similarity starts to disappear. And a long delay in the final response means the conversation is likely over, the researchers said.

And in a finding that will surprise no one, younger people are better able to cope with a large number of emails than older people. When overloaded with messages, younger people tend to send shorter and faster replies, while older people reply to a smaller percentage of emails, the study found.

In general, people have difficulty keeping up with the growing number of emails. As that load rises, people reply to fewer of their emails.

The researchers also found that people are more active emailers during the day than at night, and weekend emails get shorter replies than weekday ones.

Finally, emails sent in the morning tend to get longer replies than those sent in the afternoon.

The study findings were presented earlier this year at the World Wide Web Conference in Florence, Italy. Until published in a peer-reviewed journal, research presented at meetings is considered preliminary.

More information

To read about the psychology behind emails, visit the American Psychological Association.

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Parents Can Take Steps to Help Make Homework Less Stressful

MONDAY, Oct. 5, 2015 (HealthDay News) — Homework may be stressful for kids and parents alike, and it can be especially difficult for children with learning and behavior challenges, experts say.

Parents can take steps, however, to make homework less of a burden for the entire family, said education specialist Barbara Resnick, of the Family Institute at Northwestern University in Evanston, Ill.

“Establish a routine for homework, and dedicate a set time for it to get done,” she suggested in a university news release. “Check the nightly planner with your child when they come home, and clarify assignment expectations by reading and highlighting instructions.”

Parents should also monitor the amount of time younger kids need to complete their assignments, Resnick added. If homework time seems excessive or if children clearly don’t understand their homework and need total supervision to complete it, parents should share these concerns with their child’s teacher.

“Although most parents are not formally trained as educators, the homework time spent together can be used to teach a variety of learning strategies,” said Resnick. “For instance, teach prioritization of assignments or how to break a larger assignment into more manageable pieces.”

When homework gets tough, it’s important for parents to help children remain confident and understand that learning is a process. “Acknowledge efforts that your child makes to complete an assignment, and not just the result,” Resnick said. “Remind your child that everyone makes mistakes and that nobody is perfect.”

More information

The American Academy of Pediatrics provides more tips to help children develop good homework habits.

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As HIV Patients Live Longer, Certain Cancer Risks Rise: Study

By Alan Mozes
HealthDay Reporter

MONDAY, Oct. 5, 2015 (HealthDay News) — Antiretroviral therapy has extended the lives of people with HIV, but living longer may increase these patients’ risk for certain cancers.

A study of nearly 90,000 HIV patients revealed a rise in three types of cancer as the AIDS-causing virus has evolved from a probable death sentence into a manageable chronic condition.

“We found that the risk of some cancers, such as anal, colorectal and liver cancers, are increasing over time mainly because HIV patients are living longer,” said study lead author Michael Silverberg, of the Kaiser Permanente division of research in Oakland, Calif. Kaiser Permanente is one of the nation’s largest health plans.

According to the U.S. National Cancer Institute, HIV patients have always faced a significantly higher cancer risk, most notably for Kaposi sarcoma, non-Hodgkin lymphoma and cervical cancer. That’s because of a generally weakened immune system and a higher rate of infection with cancer-related viruses.

HIV antiretroviral therapy, launched in 1996, has curbed some of that elevated risk. Now, the study team explained, HIV patients receiving antiretroviral therapy can look forward to a life span of roughly 75 years.

However, cancer risk has not been brought down to general population levels. And some cancer risk has actually risen since the advent of antiretroviral therapy, the researchers said.

Results of the study are published in the Oct. 6 issue of Annals of Internal Medicine.

The researchers focused on roughly 87,000 HIV patients and almost 197,000 non-HIV adults who participated in the North American AIDS Cohort Collaboration on Research and Design study between 1996 and 2009.

Investigators tracked the rate of nine types of cancer, including Kaposi sarcoma, non-Hodgkin lymphoma, Hodgkin lymphoma, lung cancer, anal cancer, colon/rectal cancer, liver cancer, oral cavity/pharyngeal cancer and melanoma. They also tallied each group’s total cancer risk until age 75.

The team determined that compared with non-HIV participants, cancer rates for HIV patients were higher across all nine cancers in every year examined.

In particular, by 2009, HIV patients were identified as having a one in 25 lifetime risk for developing Kaposi sarcoma, non-Hodgkin lymphoma or lung cancer, the findings showed.

However, declines were seen in the rate of Kaposi sarcoma — by 6 percent a year — and non-Hodgkin lymphoma, which fell by 8 percent a year, the study authors reported.

No change was noted for lung cancer, Hodgkin lymphoma and melanoma, the researchers said.

“This is because the increased risk of developing certain cancers that comes with living longer has been compensated by improvements in care, such as reduced smoking, increased awareness of the harmful effects of sun exposure, and improved immune function,” said Silverberg.

But anal cancer and liver cancer incidence each went up by 6 percent a year, while colon cancer rose by 5 percent annually, the study found.

Why? A declining early death rate among HIV patients — about 9 percent a year — which provides greater opportunity for other diagnoses, the researchers said.

By contrast, no notable increase in cancer risk of any kind was observed among the non-HIV group.

“Knowing what the cancer risks actually are for today’s HIV patients as they live longer is useful clinically, because it can help us prioritize which cancers we need to focus on for this group in terms of prevention,” Silverberg said.

Cancer is only one aspect of a changing risk profile confronting today’s HIV patients, said Dr. Jeffrey Laurence, senior scientific consultant for programs at amfAR, the Foundation for AIDS Research.

“It’s also heart disease, accelerated cardiovascular disease, osteoporosis and kidney disease, all of which are now more common among HIV patients,” Laurence said.

Most likely, a longer life span is contributing to the increase in cancer and these other chronic conditions, he said. “In general, we need to be more aware of each patient’s particular health profile, so we can perhaps modify or change treatment as needed to deal with the risks at hand,” he said.

Study co-author Dr. Michael Horberg, immediate past chair of the HIV Medicine Association, agreed.

As HIV has become a long-term chronic condition, “all sorts of health issues that patients and their doctors didn’t think they had to worry about are now something they have to worry about,” said Horberg, who is Kaiser Permanente’s director of HIV/AIDS.

“It’s no longer enough just to survive,” he added. “You want to survive well.”

More information

There’s more on HIV and cancer risk at the U.S. National Cancer Institute.

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Demi Lovato Poses Nude, Makeup-Free to Celebrate Confidence

“What’s wrong with being confident?”—That’s the question Demi Lovato asks in her latest single. And after stripping down and rocking nothing but confidence in a recent photo shoot, she proved she practices exactly what she preaches.

The pop star bared it all in front of the camera in a raw and candid shoot for Vanity Fair to promote her upcoming new album, Confident, and also opened up about her journey to achieving a whole new level of self-love and acceptance.

“When I think of confidence, I think of many things. But one thing in particular is feeling comfortable in your own skin,” Lovato said in a video from the Vanity Fair shoot.

For the photo series, the singer-songwriter asked photographer Patrick Ecclesine if they could do away with any magazine gimmicks, including retouching and makeup. Oh, and she wanted to truly bare it all by skipping clothes, too.

RELATED: How Demi Lovato Conquers Everyday Negativity

“I thought there was something incredible about the idea of no makeup whatsoever, no clothes, and no retouching. I would have never thought I would have ever gotten to a place in my life where I could feel comfortable doing that,” the 23-year-old said. “It’s empowering, and it shows other women that you can get to a place where you can overcome obstacles of body image issues. You can feel comfortable and confident in your skin.”

Lovato, who recently launched a mental health awareness campaign, also spoke candidly about her struggle with eating disorders in the past. She explained that she went from “hating every single inch of my body” to loving herself the way she is.

“I learned after working very hard on my spirituality and my soul—and my body—I learned that you can get to a place where you love the skin you’re in. And I’m excited to share that with the world,” she said.

Lovato lovers everywhere appreciated the star’s brave act, taking to Twitter to praise the sexy photos and build a viral hashtag surrounding the artist. The singer expressed gratitude on social media to tell her supporters just how much the positive response means to her.

This means everything to me… You have no idea…. Thank you so much… 🙏🙏🙏 #CONFIDENT http://pic.twitter.com/oiW2Ovf4iB

— Demi Lovato (@ddlovato) October 3, 2015

Add her new single to your favorite workout playlist below:

RELATED: Demi Lovato Opens Up About Mental Health, Addiction: ‘Recovery Is Possible’

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Move More to Prevent Heart Failure

MONDAY, Oct. 5, 2015 (HealthDay News) — When it comes to preventing heart failure, the more exercise, the better.

How much more? A new study suggests maybe as much as two to four times the U.S. minimum recommended levels of 150 minutes of moderate physical activity a week.

The researchers reviewed 12 studies from the United States and Europe that included more than 370,000 people who were followed for an average of 15 years.

People who did two to four times more exercise than the U.S. minimum activity recommendations lowered their risk of heart failure by 20 percent and 35 percent, respectively, the researchers found.

The U.S. recommended minimum levels of exercise were associated with only a slight decrease in heart failure risk, the researchers found.

The study was published Oct. 5 in the journal Circulation.

“Walking 30 minutes a day as recommended in the U.S. physical activity guidelines may not be good enough — significantly more physical activity may be necessary to reduce the risk of heart failure,” said senior study author Dr. Jarett Berry. He is an associate professor of internal medicine and clinical sciences at the University of Texas Southwestern Medical School in Dallas.

Overall, the more people exercised, the lower their risk of heart failure.

“Future physical activity guidelines should take these findings into consideration, and potentially provide stronger recommendations regarding the value of higher amounts of physical activity for the prevention of heart failure,” study lead author Dr. Ambarish Pandey, a cardiology fellow at University of Texas Southwestern Medical School, said in a journal news release.

Berry added: “If you look at the general population, we’ve had tremendous success in reducing coronary heart disease over the last 30 years. But heart failure rates have not declined enough. The findings from the present study suggest that higher levels of physical activity may help combat this growing burden of heart failure.”

In heart failure, the heart cannot supply adequate amounts of blood to the rest of body, resulting in shortness of breath and reduced ability to exercise, the researchers explained.

More information

The U.S. National Heart, Lung, and Blood Institute has more about heart failure prevention.

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Poor, Minorities Spend More Time Waiting for Medical Care

By Dennis Thompson
HealthDay Reporter

MONDAY, Oct. 5, 2015 (HealthDay News) — While almost everyone complains about the time it takes to see their doctor, the problem is even worse for minorities and poor people, according to new research.

Blacks and Hispanics spend approximately 25 percent more time seeking health care than whites. People also spend more time in a doc’s waiting room if they’re unemployed, in a low-paying job or never attended college, the study found.

Researchers suspect some people have to wait longer because their circumstances force them to use a “safety net” option for health care, such as emergency rooms or low-cost community health centers, said study senior author Dr. Ateev Mehrotra, an associate professor of health care policy and medicine at Harvard Medical School in Boston.

“They don’t have the same level of staffing that a private office will have, and they’ll be a less efficient because of that,” Mehrotra said. “They’ll have to work harder to move patients through.”

One bright spot the study found is that everyone gets the same average amount of face-to-face time with doctors, around 20 minutes. That held true regardless of income or background, the researchers said.

Findings from the study are in the Oct. 5 JAMA Internal Medicine.

In the study, researchers analyzed data gathered by the annual American Time Use Survey between 2005 and 2013. The survey, conducted by the Bureau of Labor Statistics, measures the amount of time people spend at various activities.

The study authors then compared the time estimates with data on time spent with a physician collected from 2006 to 2010 by the National Ambulatory Medical Care Survey.

Whites only had to cool their heels for about 80 minutes on average in a doctor’s waiting room. By comparison, blacks had to wait an average 99 minutes, and Hispanic wait times averaged around 105 minutes, the study found.

Unemployed people spent 94 minutes in the waiting room, versus 72 minutes for people making the most money. Low-income folks waited an average 80 minutes, the researchers said.

Education also made a difference. People with graduate degrees waited an average 76 minutes, as opposed to 91 minutes for those with a high school education or less, the study noted.

The Institute of Medicine has identified timeliness of care as a key aspect of quality health care, and it hasn’t received the attention it deserves, said Dr. Joseph Ross, an associate editor of JAMA Internal Medicine who co-wrote an accompanying editorial.

“There hasn’t been nearly enough work to evaluate the time it takes for a patient to receive care in the United States,” said Ross, who’s also a primary care physician and associate professor of medicine at Yale University School of Medicine in New Haven, Conn. “I would say at this time, the system is designed around how physicians want to practice medicine, for the most part, and not around the patient’s needs.”

Mehrotra provided a personal example from a time he had to see an orthopedic surgeon to discuss a broken bone in his leg.

“The way that orthopedic surgeon worked was he scheduled 30 appointments at 8 a.m.,” he said. “Thirty people showed up at 8 a.m., and then he saw them as he saw fit. Some people waited up to four hours to see him.”

The racial, ethnic and economic disparities observed in this study are more likely due to the underfunded “safety net” clinics and emergency rooms that see people who are uninsured or have lousy insurance, said lead author Dr. Kristin Ray, an assistant professor of pediatrics at the University of Pittsburgh School of Medicine.

Because they have less money and less staff, these settings struggle to keep patients flowing through. “One potential solution is that we can make sure we are adequately funding and supporting these clinics and community health centers,” she said.

The Affordable Care Act won’t necessarily drive down wait times, because more people will seek more care as they gain access to insurance. “Simply giving people insurance may not give them access to efficient care,” Ray said.

Instead, doctors need to look at different ways to run their offices. For example, physicians can cut down on repeat visits from some patients by having them phone in their blood pressure or glucose levels after self-checking them at home, Mehrotra said.

Telemedicine and e-medicine are two other options through which people can receive prompt care without having to travel or wait, Ray said.

Clinics also can consider innovative models such as open-access scheduling, where most patients can pop into the office without scheduling their visit in advance, Ross said.

It all comes down to treating the patient as a customer and making their experience better, Mehrotra said.

“I do believe that there are ways that, if we made it a more patient-centric system, we can get patients in and out of an in-person visit much faster,” he said.

More information

For more on access to health care, visit the U.S. Centers for Disease Control and Prevention.

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FDA Orders Studies on Contaminated Endoscopes Tied to Illness Outbreaks

MONDAY, Oct. 5, 2015 (HealthDay News) — Recent outbreaks of life-threatening infections linked to endoscopic devices called duodenoscopes led the U.S. Food and Drug Administration on Monday to order manufacturers to conduct postmarket studies of the devices in health care facilities.

The goal is to learn more about how the scopes are cleaned and prepared for reuse in actual health care settings, the FDA said. Duodenoscopes are flexible, lighted tubes threaded through the mouth, throat and stomach to the small intestine, and used to diagnose and treat problems in the liver, pancreas and gallbladder.

Last February, the FDA issued a warning that duodenoscopes are hard to clean even when health care workers follow manufacturers’ directions. In March, the FDA issued final recommendations for the cleaning and sterilization of duodenoscopes.

That action came shortly after reports that duodenoscopes contaminated with a “superbug” (drug-resistant bacteria) caused seven serious infections and two deaths at Ronald Reagan UCLA Medical Center in Los Angeles. Shortly after that, similar infections linked to the scopes were reported at Cedars Sinai Hospital in Los Angeles.

Since that time, the FDA has been working with the three manufacturers of duodenoscopes to improve the safety of the devices, including reviewing the companies’ cleaning instructions, looking at ways to improve the disinfection process and considering design changes to make the scopes easier to clean.

The findings from the postmarket surveillance studies may help identify additional ways to reduce risks associated with the scopes, such as new labeling with different cleaning/sterilization instructions or new regulations to protect patient safety, the FDA said in a news release.

“These studies will provide critical information about the effectiveness of current reprocessing instructions and practices that may provide additional information to inform the FDA’s actions to protect the public health and help reduce the risk of infections,” said Dr. William Maisel. He is deputy director for science and chief scientist at the FDA’s Center for Devices and Radiological Health.

The three companies that sell duodenoscopes in the United States — Olympus America Inc., Fujifilm Medical Systems USA, Inc., and Hoya Corp. (Pentax Life Care Division) — have 30 days to submit postmarket surveillance plans to the FDA, the agency said.

The plans must outline how the companies will conduct the studies in order to find out how well health care workers follow instructions to clean and disinfect the scopes between use in different patients, and to learn more about the rate of contamination associated with the devices.

More information

Read more about duodenoscope cleaning from the U.S. Food and Drug Administration.

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10 Things You Never Knew About the Clitoris

Brace yourselves ladies, there’s a whole lot to know about the clitoris that they didn’t teach us in health class. While you’ve probably heard the many unfortunate nicknames for this body part (including “the bean”— who came up with that?), and you definitely know a thing or two about the ahem, functions, of the clitoris, you might not know that it actually gets erect, for example.

Yep, “lady boners” (another very unfortunate nickname, sorry) are real.

To help you become a bit more “cliterate,” here are 10 facts about this amazing part of your anatomy.

RELATED: 14 Fascinating Things All Women Should Know About Orgasms

It’s truly unique

When it comes to climaxing, “the clitoris is really, really crucial,” says Jim Pfaus, PhD, professor and sex researcher at Concordia University in Montreal. But that’s not the only thing that makes it special: the clitoris is actually the only organ in the body with the sole function of providing pleasure.

It’s long been a mystery

Until 1998 most textbooks only illustrated the external glans. That’s when Helen O’Connell, an Australian urologist, revealed through a series of MRI studies that the clitoris is actually a complex, powerful organ system composed of a total of eighteen parts, two thirds of which are interior.

It’s much more than meets the eye

“When people talk about the clitoris, they’re usually just talking about the glans—the very sensitive outside part,” says Rebecca Chalker, PhD, Professor of Sexology at Pace University and author of The Clitoral Truth ($12, amazon.com). But the bump you can see on the vulva is only the tip of an iceberg.

The internal part is connected to the glans by the corpora cavernosa, two spongey areas of erectile tissue. Farther down, the corpora cavernosa branches off into a pair of wings known as the crura which extend into the body and around the vaginal canal like a wishbone. Then, underneath the crura are the clitoral vestibules, or vestibular bulbs. Like much of the clitoris, these sac-like structures of tissue become engorged with blood when you get aroused.

RELATED: 4 Yoga Moves for Better Sex

It’s got a lot of nerve

The clitoris is the most nerve-rich part of the vulva, says Debra Herbenick, PhD, a sexual health educator from The Kinsey Institute. The glans contains about 8,000 nerve endings, making it the powerhouse of pleasure. To get some perspective, that’s twice as many nerve endings as the penis. And its potential doesn’t end there. This tiny erogenous zone spreads the feeling to 15,000 other nerves in the pelvis, which explains why it feels like your whole body is being taken over by your O-M-G moment.

Every woman’s is different

Women are all unique, so why would clitorises be any different? Every woman needs a different kind of stimulation to feel satisfied, depending on her unique biology. “Just because it’s sensitive doesn’t mean everyone wants it to be stimulated directly,” Herbenick says. “Some women prefer touching near the clitoris but not on it.” Pfaus agrees: “If she’s too sensitive with direct stimulation, more of that may make her want to kill you.”

It’s the real G-spot

We’ve all heard about the infamous G-spot: Does it exist? Do all women have one? Yes and yes. That’s because the G-spot is actually the clitoris. This notorious pleasure zone became sensationalized back in the 80s which, as Chalker explains, “created this idea that if you could only access the G-spot inside the vagina, it would promote female orgasm.” But we’ve since learned that some women may feel more sensation via the internal shafts of the clitoral complex (hence why some women might like vaginal penetration more than others), while others prefer external touch. One way is not better than another way, Pfaus adds; it’s really about exploring the possibilities to find out what you like best.

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It’s very similar to the penis…

“The clitoris and the penis are somewhat mirror images of each other, just organized differently,” Chalker explains. “In fact, up until two weeks of pregnancy, all embryos appear to be female.” It’s not until week eight of gestation that testosterone kicks in and the penis starts to form. “None of these parts disappear, they just get rearranged,” Chalker says. For example the internal part of the clitoris, also made of erectile tissue, becomes the frame of the penis. With this concept in mind, Chalker points out: “If you consider the clitoris only consisting of the glans, then that’s like saying the only part of a penis is the tip.”

…It even gets erect

“When we talk about erection, we can’t just talk about the penis,” Pfaus says. “We have to talk about the clitoris.” Sure, it might be less noticeable for women, but it can definitely be observed and felt. This occurs when the vestibular bulbs become engorged with blood during arousal. The blood is then trapped here until released via orgasmic spasms.

Size doesn’t matter

Like men, women can get self-conscious about their sexy parts. But guess what? Just like penises, clits come in all shapes and sizes. And size doesn’t matter for either, Chalker explains.  Think of it this way: since the brain is your main sex organ, the genitals are simply the receptors of pleasure. “It has to do with visual, tactile, and oral stimulation,” Chalker says, “rather that the actual size of the clit. So while glans may vary from woman to woman, this shouldn’t affect the pleasure-potential.” Also worth noting: chances are size doesn’t (or, at least, shouldn’t) matter to your partner.

It can grow with age

Although the size of your clitoris doesn’t impact your sex life, don’t be surprised if it changes dimensions over your lifetime. According to Chalker, due to a change in hormone levels after menopause, the clit may enlarge for many women. So if you notice some differences in the size of your lady parts over time, don’t be alarmed.

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