Category: Health

Updated at 3:30 p.m. ET on October 17, 2022

In the fall of 1988, Matthew Farrow, a 5-year-old boy with a rare blood disorder, received the world’s first transplant of umbilical-cord blood from a newborn sibling. It worked: Farrow was cured. This miraculous outcome broke open a whole new field in medicine—and, not long after, a whole new industry aimed at getting expecting parents to bank their baby’s umbilical-cord blood, just in case.

These days, in fact, being pregnant means being bombarded at the doctor’s office and on Instagram with ads touting cord blood as too precious to waste. For several hundred dollars upfront, plus a storage fee of $100 to $200 every year, the banks’ ads proclaim, you could save your child’s life. Cord-blood banking has been likened to a “biological insurance policy.”

In the U.S., the two biggest private cord blood banks are Cord Blood Registry and ViaCord. Together, they have collected more than 1 million units. But only a few hundred units of this privately banked cord blood have ever been used in transplants, the great majority by families who chose to bank because they already had a child with a specific and rare disorder treatable with a transplant. For everyone else, the odds of using privately banked cord blood are minuscule—so minuscule that the American Academy of Pediatrics (AAP) recommends against private banking. It does make an exception for families with that disease history. “But that’s a rare circumstance,” says Steve Joffe, a pediatric oncologist and ethicist at the University of Pennsylvania, “and not one that anybody is going to build a successful business model around.”

ViaCord and Cord Blood Registry do offer free services for families in which someone has already been diagnosed with a condition treatable with cord blood. In general, the companies reiterated to me, cord blood does save lives and they are simply providing an option for families who want it.

But the marketing also gives the impression of much more expansive uses for cord blood. The private banks’ websites list nearly 80 diseases treatable with transplantation—an impressive number, though many are extremely uncommon or closely related to one another. (For example: refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation.) They have also recently taken to highlighting the promise of still-unproven treatments: Temporary infusions of cord blood, they say, could eventually treat more common conditions such as cerebral palsy and autism. Video testimonials feature parents talking excitedly about the potential of cord blood for their children. But the evidence isn’t there yet—and may never appear. Nonetheless, says Paul Knoepfler, a stem-cell scientist at UC Davis, “the cord-blood companies seem to be trying to expand their base of potential customers.”

The initial exuberance around cord blood came from a real place. The blood left over in umbilical cords is replete with cells that have the special ability to turn into any kind of blood, including red blood cells, which carry oxygen, and white blood cells, which make up the immune system. Adults have stem cells in their bone marrow and blood—which can also be used for a transplant—but those in a baby’s umbilical cord are more immunologically naive. That means they are less likely to go awry and attack a recipient’s body. “They don’t cause as much havoc,” says Karen Ballen, an oncologist at the University of Virginia. This allows doctors to use cord blood that matches only four out of six immunological markers.

Because cord blood is so valuable, publicly run banks have been collecting donations since the 1990s. Despite amassing fewer units overall, public banks worldwide have provided 30 times as many units of blood for treatment—and saved more lives—than private ones, because they are accessible by any patient in need. Although the AAP recommends against private banking, it does recommend donating to public banks.

One appeal of private banking, though, as the companies highlight, is that the cells in a baby’s umbilical cord are a perfect match for them in later childhood or adulthood. But this is usually irrelevant: In most of the diseases that can be cured by a cord-blood transplant, doctors would, for medical reasons, not use the patient’s own cells. In cases of inherited disorders such as sickle cell anemia, for example, a child’s own cord-blood stems have the same problematic mutation. For children with one of many types of leukemia, the concern is that cord blood could contain leukemia-precursor cells that cause the cancer to reappear; in addition, donor blood-stem cells are better because they can mop up remaining leukemia cells. Doctors would “never” use banked cord blood from a child with these types of leukemia, says Joanne Kurtzberg, a pediatrician and cord-blood pioneer at Duke University, who helped treat Farrow when he was a young boy.

When privately banked cord blood is used in transplants, it is more likely to go to a sibling. Genetically, siblings have about a 25 percent chance of being perfect matches for each other. The chances of finding a suitable match among unrelated bone-marrow or cord-blood donors from a public bank, on the other hand, range from 29 to 79 percent, depending on one’s ethnic background. (The majority of donors are white, so it’s highest for white patients.) In any case, not banking a matched sibling’s cord blood doesn’t foreclose the possibility of a transplant, because that sibling can still donate bone marrow. “I often encounter families who have some guilt around not storing the cord blood, and I will point out, ‘Well, your donor child that matches our patient is still here,’” says Ann Haight, a pediatric hematologist and oncologist at Emory University.

Even if a baby’s cord blood is banked, there’s no guarantee that it will contain enough cells for a transplant. In fact, most may not: Public banks only keep 5 to 40 percent of their donations, as the rest don’t meet their standards. Private banks will save much smaller samples, which they argue serve a different purpose. Whereas public banks are looking for large samples that are mostly likely to be used for transplants, says Kate Girard, the director of medical and scientific affairs at ViaCord, “when families are banking with us, this is that child’s only cord, so our threshold is way lower.”

Another reason to bank these smaller samples, a spokesperson for Cord Blood Registry pointed out, is that they can still be used for experimental infusions treating conditions such as cerebral palsy and autism. (About 80 percent of units released by CBR have been used this way, as have about half from ViaCord.) The private banks partner with researchers, such as Kurtzberg at Duke, who are running clinical trials to test these treatments. The theory goes that cells from cord blood can make it to the brain, where they might have some neuroprotective role—but the mechanism remains unknown, and the effects are not entirely clear. As Kurtzberg told me, “The therapy is not proven.”

The current state of cord-blood science might be summed up thus: Proven uses are very uncommon, and unproven uses are, well, unproven. Of course, a future discovery could lead to a real breakthrough in the use of stem cells from cord blood—an idea private banks trade on. Who knows what might be in store for cord blood later, when your baby is 30, 50, 70 years old? In a recent Cord Blood Registry survey of new parents, a spokesperson told me by email, 45 percent named “belief in future treatments” as the primary reason for banking their child’s cord blood and tissue. Knoepfler, the stem-cell scientist, notes that scientists have been excited for decades about the promise of stem cells. But translating interesting results in the lab to a doctor’s office, he says, “​​is really much harder than many of us realized. I include myself in that.”

Medical discoveries have actually changed the ways cord blood is used over years, but they have so far resulted in less use of cord blood. In the past several years, doctors have refined a protocol to use half-matched donors in transplants. Doctors generally get more cells from these donors than from an infant’s banked cord blood, which means the transplants “take” more quickly and the patient spends less time in the hospital. For this reason, cord blood has been falling out of favor. Public banks have started scaling down their collections; the New York Blood Center, which had launched the world’s first public bank, recently stopped collecting new donations. How cord blood gets used in the future is still unknown.

More than 30 years ago after Kurtzberg first treated Farrow, she is still in touch with him. He’s 39 now, and doing well. Having watched cord banking grow and evolve over the years, she remains a proponent of public banking and the possibilities ahead. When it comes to private banks, however, she says, “I don’t think it’s a necessity. I think it’s nice to have if you can do it.” There isn’t much harm in private banking, after all, as long as parents can afford the several thousand dollars over their child’s lifetime.

Afford might be the key word here. The ads for cord-blood banking feel a lot like those for any number of “nice to have” baby products aimed at anxious parents, be they organic diapers or BPA-free wooden toys tailored to your child’s age and cognitive development. If anything, the stakes of cord-blood banking are higher than anything else you might choose to buy. The opportunity only comes around “once in a lifetime,” and it could literally save your child’s life—even if the chances of that are very, very small. “It’s playing to parental guilt and the desire for parents to have healthy children and do whatever they can for their kids,” says Timothy Caulfield, a health-law professor at the University of Alberta who has studied cord-blood banks. “There’s a huge market based on exactly that.”

It’s telling, perhaps, that Cord Blood Registry ran a giveaway of $20,000 worth of baby products this summer. The curated package of luxury “baby essentials” resembled the registry of parents who want the best for their kid, and can afford it. Included were a Snoo smart bassinet ($1,695), an Uppababy stroller and car seat ($1,400), Coterie diapers ($100 for a month’s supply, guaranteed to be “free of fragrance, lotion, latex, rubber, dyes, alcohol, heavy metals, parabens, phthalates, chlorine bleaching, VOCs, and optical brighteners”), and, of course, a lifetime of cord-blood and tissue banking ($11,860).

This article originally misspelled Kate Girard’s last name.

It is a truth universally acknowledged among health experts that official COVID-19 data are a mess right now. Since the Omicron surge last winter, case counts from public-health agencies have become less reliable. PCR tests have become harder to access and at-home tests are typically not counted.

Official case numbers now represent “the tip of the iceberg” of actual infections, Denis Nash, an epidemiologist at the City University of New York, told me. Although case rates may seem low now, true infections may be up to 20 times higher. And even those case numbers are no longer available on a daily basis in many places, as the CDC and most state agencies have switched to updating their data once a week instead of every day.

How, then, is anyone supposed to actually keep track of the COVID-19 risk in their area—especially when cases are expected to increase this fall and winter? Using newer data sources, such as wastewater surveillance and population surveys, experts have already noticed potential signals of a fall surge: Official case counts are trending down across the U.S., but Northeast cities such as Boston are seeing more coronavirus in their wastewater, and the CDC reports that this region is a hot spot for further-mutated versions of the Omicron variant. Even if you’re not an expert, you can still get a clearer picture of how COVID-19 is hitting your community in the weeks ahead. You’ll simply need to understand how to interpret these alternate data sources.

The problem with case data goes right to the source. Investment in COVID-19 tracking at the state and local levels has been in free fall, says Sam Scarpino, a surveillance expert at the Rockefeller Foundation’s Pandemic Prevention Initiative. “More recently, we’ve started to see lots of states sunsetting their reporting,” Scarpino told me. Since the Pandemic Prevention Initiative and the Pandemic Tracking Collective started publishing a state-by-state scorecard of breakthrough-case reporting in December 2021, the number of states with a failing grade has doubled. Scarpino considers this trend a “harbinger of what’s coming” as departments continue to shift resources away from COVID-19 reporting.

Read: Warning signs about the first post-pandemic winter

Hospitalization data don’t suffer from the same reporting problems, because the federal government collects information directly from thousands of facilities across the country. But “hospitalizations often lag behind cases by a matter of weeks,” says Caroline Hugh, an epidemiologist and volunteer with the People’s CDC, an organization providing COVID-19 data and guidance while advocating for improved safety measures. Hospitalizations also don’t necessarily reflect transmission rates, which still matter if you want to stay safe. Some studies suggest, for example, that long COVID might now be more likely than hospitalization after an infection.

For a better sense of how much the coronavirus is circulating, many experts are turning to wastewater surveillance. Samples from our sewage can provide an advanced warning of increased COVID-19 spread because everyone in a public-sewer system contributes data; the biases that hinder PCR test results don’t apply. As a result, Hugh and her colleagues at the People’s CDC consider wastewater trends to be more “consistent” than constantly fluctuating case numbers.

When Omicron first began to wreak havoc in December 2021, “the wastewater data started to rise very steeply, almost two weeks before we saw the same rise” in case counts, Newsha Ghaeli, the president and a co-founder of the wastewater-surveillance company Biobot Analytics, told me. Biobot is now working with hundreds of sewage-sampling sites in all 50 states, Ghaeli said. The company’s national and regional dashboard incorporates data from every location in its network, but for more local data, you might need to go to a separate dashboard run by the CDC or by your state health department. Some states have wastewater surveillance in every county, while others have just a handful of sites. If your location is not represented, Ghaeli said, “the wastewater data from communities nearby is still very applicable.” And even if your county does have tracking, checking up on neighboring communities might be good practice. “A surge in a state next door … could very quickly turn into a surge locally,” Ghaeli explained.

Read: The BA.5 wave is what COVID normal looks like

Ghaeli recommends watching how coronavirus levels in wastewater shift over time, rather than homing in on individual data points. Look at both “directionality” and “magnitude”: Are viral levels increasing or decreasing, and how do these levels compare with earlier points in the pandemic? A 10 percent uptick when levels are low is less concerning than a 10 percent uptick when the virus is already spreading widely.

Researchers are still working to understand how wastewater data correlate with actual infections, because every community has unique waste patterns. For example, big cities differ from rural areas, and in some places, environmental factors such as rainfall or nearby agriculture may interfere with coronavirus tracking. Still, long-term-trend data are generally thought to be a good tool that can help sound the alarm on new surges.

Wastewater data can help you figure out how much COVID-19 is spreading in a community and can even track all the variants circulating locally, but they can’t tell you who’s getting sick. To answer the latter question, epidemiologists turn to what Nash calls “active surveillance”: Rather than relying on the COVID-19 test results that happen to get reported to a public-health agency, actively seek out and ask people whether they recently got sick or tested positive.

Nash and his team at CUNY have conducted population surveys in New York City and at the national level. The team’s most recent survey (which hasn’t yet been peer-reviewed), conducted from late June to early July, included questions about at-home test results and COVID-like symptoms. From a nationally representative survey of about 3,000 people, Nash and his team found that more than 17 percent of U.S. adults had COVID-19 during the two-week period—about 24 times higher than the CDC’s case counts at that time.

Studies like these “capture people who might not be counted by the health system,” Nash told me. His team found that Black and Hispanic Americans and those with low incomes were more likely to get sick during the survey period, compared with the national estimate. The CDC and Census Bureau take a similar approach through the ongoing Household Pulse Survey.

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These surveys are “a gold mine of data,” though they need to be “carefully designed,” Maria Pyra, an epidemiologist and volunteer with the People’s CDC, told me. By showing the gap between true infections and officially reported cases, surveys like Nash’s can allow researchers to approximate how much COVID-19 is really spreading.

Survey results may be delayed by weeks or months, however, and are typically published in preprints or news reports rather than on a health agency’s dashboard. They might also be biased by who chooses to respond or how questions are worded. Scarpino suggested a more timely option: data collected from cellphone locations or social media. The Delphi Group at Carnegie Mellon University, for example, provides data on how many people are Googling coldlike symptoms or seeking COVID-related doctor visits. While such trends aren’t a perfect proxy for case rates, they can be a helpful warning that transmission patterns are changing.

Readers seeking to monitor COVID-19 this fall should “look as local as you can,” Scarpino recommended. That means examining county- or zip-code-level data, depending on what’s available for you. Nash suggested checking multiple data sources and attempting to “triangulate” between them. For example, if case data suggest that transmission is down, do wastewater data say the same thing? And how do the data match with local behavior? If a popular community event or holiday happened recently, low case numbers might need to be taken with a grain of salt.

“We’re heading into a period where it’s going to be increasingly harder to know what’s going on with the virus,” Nash told me. Case numbers will continue to be undercounted, and dashboards may be updated less frequently. Pundits on Twitter are turning to Yankee Candle reviews for signs of surges. Helpful sources still exist, but piecing together the disparate data can be exhausting—after all, data reporting and interpretation should be a job for our public-health agencies, not for concerned individuals.

Read: The plan to stop every respiratory virus at once

Rather than accept this fragmented data status quo, experts would like to see improved public-health systems for COVID-19 and other diseases, such as monkeypox and polio. “If we get better at collecting and making available local, relevant infectious-disease data for decision making, we’re going to lead healthier, happier lives,” Scarpino said.

There’s nothing better than enjoying a fresh scone with your morning coffee or tea. Since fall is now in full swing it’s only appropriate that even morning scones have a hint of pumpkin. Not only does pumpkin mix well with spices such as cinnamon, ginger, cardamon but there are also numerous health benefits to pumpkin. Plus, this recipe for pumpkin scones calls for almond flour, making it gluten-free. If you’re looking for more texture, add chopped nuts to the scone dough like pecans or walnuts.

How to make gluten-free pumpkin scones

First, preheat your oven to 375 degrees Fahrenheit. Next, combine the milk and vinegar and let rest for about 5 minutes. While you’re waiting combine the almond flour, 5.5 tablespoons of tapioca, sugar, coconut flour, baking powder, spices and salt in a bowl. Add the cold butter to the bowl and cut the butter into the flour mixture using a fork or pastry cutter. In the end, the butter should be in very tiny pieces incorporated into the flour and the resulting flour should look like crumbly sand.

Add the milk mixture, pumpkin and vanilla to the bowl and mix together with a spatula or spoon until just combined. Let the dough rest for 2-3 minutes. Place a piece of parchment or a silicone mat on a sheet pan and sprinkle the remaining tapioca starch on it. Scoop the dough out on the pan and form it into a ball. Form the dough into a flattened round disk about an inch or so thick. Use a large knife to cut the disk into 6 or 8 sections.

Place the pan in the oven at 375 degrees for about 20 minutes. Remove the pan from the oven and use a knife to cut deeper into the slices. Place the pan back in the oven for 10 more minutes. Remove the pan from the oven again and use the knife to carefully separate the cut sections so each scone is a separate triangle so each side of the scone can be exposed to the heat in the oven. Reduce the heat to 350 degrees and continue baking for about 10-15 minutes, or until the undersides of the scones are slightly golden. Let the scones cool before handling them.

Enjoy the scones as is, or drizzle them with your choice of melted coconut butter mixed with stevia or monkfruit drops, or an icing made from powdered sugar or sugar substitute like powdered erythritol and milk.

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About the Author

A food blogger, recipe developer, and personal chef based in Missouri, Priscilla specializes in low-carb, Paleo, gluten-free, keto, vegetarian, and low FODMAP cooking. See what she’s cooking on Priscilla Cooks, and follow her food adventures on Instagram and Pinterest.

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On Oct. 17, hearing aids approved by the U.S. Food and Drug Administration (FDA) became available over the counter for the first time, for potentially thousands of dollars less than prescription hearing aids. Many experts are hopeful that opening the market up will spur the creation of innovative new devices, bring down costs, and encourage hearing-aid use in a country where only a fraction of older adults who are hard of hearing use hearing aids.

What do these expanded options mean for people who are thinking about buying a hearing aid? For now, experts say there’s still a lot we don’t know—including which devices will be announced in the coming months and how much prices may fluctuate on the new market. However, over-the-counter hearing aids could make a big difference in your life if you have mild or moderate hearing loss. Here’s what you need to know.

When will over-the-counter hearing aids be available at stores?

The first over-the-counter hearing aids are available online and in-person at some stores, including pharmacies like Walgreens, beginning this week.

Walmart announced on Oct. 17 that hearing aids will be available at its website, at Walmart Vision Centers in certain states (although the company plans to eventually offer these services nationwide) and at more than 400 Sam’s Club Hearing Aid Center locations.

More stores are expected to announce that they’ll be carrying over-the-counter hearing aids in the coming weeks. Best Buy, for instance, announced on Oct. 17 that it will open hearing centers in 300 stores by the end of the month. Best Buy customers can also use an online hearing assessment tool and buy their products online.

Should I buy an over-the-counter hearing aid?

Over-the-counter hearing aids are intended for people with mild to moderate hearing loss, so the first step is determining whether you are eligible for one.

People with mild or moderate hearing loss tend to have difficulty hearing when talking with people in a group or when there’s background noise, according to the Hearing Loss Association of America. Another sign is needing to turn the volume up on the television or phone. A signal of more severe hearing loss is finding it difficult to hear when you’re having a one-on-one conversation with someone in a quiet environment. For more guidance, the Hearing Loss Association of America has a helpful checklist of potential signs.

An audiologist can help you to determine your level of hearing loss, says Nicholas Reed, an audiologist at Johns Hopkins University. These tests, unlike hearing-aid fittings, are also typically covered by insurance. Other tests are available through apps, including SonicCloud. Reed says hearing tests can be helpful, as people tend to be bad at sensing how much their hearing has changed. “Hearing loss happens really slowly, really insidiously,” he says. “And the truth is, your brain is good at not picking up those kinds of changes.”

People who are more tech-savvy may also be better equipped to buy an over-the-counter hearing aid, since the devices require tinkering to get the fit and levels right, says Dr. Catherine Palmer, director of audiology at the University of Pittsburgh Medical Center.

If you’re not, Reed suggests considering bringing your over-the-counter device to an audiologist to get some help using it. “It’s easy to set yourself on the wrong path,” says Reed. “If you’re at all confused or not super tech savvy, an audiologist could help.”

How much do over-the-counter hearing aids cost? What about prescription hearing aids?

The cost of hearing aids can vary dramatically. Over-the-counter hearing aids can cost anywhere from a few hundred dollars to thousands.

Hearing aids that require a prescription typically cost a few thousand dollars on average for a pair, according to the FDA, although that price is often bundled with other services, including the cost of having the device fitted by an audiologist.

Are over-the-counter hearing aids covered by insurance?

Medicare does not cover hearing aids or hearing aid fittings, although some Medicare Advantage plans offer some coverage. Some private insurance companies cover hearing aids, but not all. Check with your insurance provider to see if you’re covered under your individual plan.

Are more expensive hearing aids always better than cheaper ones?

More expensive hearing aids may come with specialized features, such as being smaller in size and having a smoother user experience, says Reed. However, now that over-the-counter hearing aids have been FDA approved, Reed says that buyers can feel reassured that the products are held to a standard, and less-expensive hearing aids should be able to fit your basic needs if you have moderate or mild hearing loss. If you’re not that comfortable with technology, Reed says, you might even be happier with a simpler (and less pricey) device. “There’s almost no evidence that cost is related to outcomes,” says Reed.

How should I choose an over-the-counter hearing aid?

Hearing is a bit like a “fingerprint,” says Reed. That means hearing loss is a little bit different for everyone—and that hearing aids won’t work the same for everyone.

Over-the-counter hearing aids come in two main types, says Palmer. The first is a self-fitting device, which users typically modify by connecting the device to an application on their smartphone, and then tuning it by listening to sounds. To operate the other type—called a simple modifier—users can manually control volume and sometimes the bass and treble of sounds.

It’s important to buy a device with a warranty so that you can return it if the device doesn’t work for you or your lifestyle, Palmer says. “Until the person uses the device, they will not know if it will meet their needs,” she says. Under the FDA regulation, the packaging must state if your device can be returned. Reed also suggests checking whether the device comes with robust customer support, which can help you learn to use the device and address any problems.

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