Awareness about optimizing gut health has become more mainstream over the past few years, leading to a rise in at-home test kits for analyzing your gut microbiome.
One of the more well-known companies creating these tests is Viome, which offers at-home tests for gut health and other health markers.
While many people are curious about their gut health — particularly as research emerges about gut health’s connections to the immune system, mood, mental health, autoimmune diseases, and skin conditions — science does not yet support the use of at-home gut microbiome tests.
Commonly, a gastroenterologist will diagnose gut health issues and may order tests or procedures to determine the cause of symptoms. However, many people see at-home testing as a convenient way to get more information about their health without working with a doctor.
This article discusses the science behind at-home microbiome testing and explains why Healthline does not recommend Viome’s tests or supplements.
While Viome is quickly becoming known for its gut health testing, the company failed Healthline’s rigorous vetting process and is not a company we would recommend, for a number of reasons.
Further, while the company’s lab in Bothell, Washington, is third-party certified by the Clinical Laboratory Improvement Amendments, third-party validation for Viome’s supplement products is not publicly available to confirm purity and potency.
Another potential safety concern is the lack of transparency around the ingredients in the supplements.
While customers can access dosage information for active ingredients in their personalized formulas using the company’s app, a full list of inactive ingredients is not publicly available.
Without this information, people with food allergies or intolerances cannot assess whether Viome products are safe for them to take.
Finally, Viome states that it offers consults from clinicians as part of its CancerDetect test, but the company does not provide further information regarding who the clinicians are or their qualifications.
Throughout this article, we discuss the scope of gut microbiome tests and Viome and explain why we do not recommend the brand.
Your gut microbiome includes the bacteria, viruses, fungi, and other microbes that live in your intestines. These microorganisms are essential for moderating digestion, the central nervous system, and the immune system (5, 6).
A gut microbiome test can determine the composition of different types of microbes within your gut. These tests are performed by analyzing stool samples.
Typically, a gut microbiome test detects the types of microbes in your gut and any signs of inflammation, yeast overgrowth, bacterial overgrowth, or parasites. It also identifies markers for common issues, such as calprotectin, which is associated with inflammatory bowel disease (IBD) (1, 7).
Several available types of gut microbiome test kits claim that they can help people understand their gut flora. Some tests detect bacteria, fungi, parasites, and other organisms, while others focus on just fungi and bacteria or just bacteria.
These tests require an at-home fecal trial that you mail back to the test provider. Some tests also offer a companion blood or saliva test to provide further insight.
Viome is a company that offers at-home microbiome testing kits for people who want to learn more about their gut health. Your gut microbiome is the collection of microorganisms living in your intestines — some of which are harmful to health and some of which are beneficial.
Using a platform powered by artificial intelligence (AI), Viome collects blood, stool, and saliva samples from users to analyze their microbiome (gut bacteria) and human gene expression (proteins that dictate cell function).
The company then provides diet and lifestyle recommendations to help Boost gut conditions and overall health. In some cases, the company suggests that users take its branded supplement blends.
With the increasing popularity of probiotics and the consumption of more whole foods, interest in balancing one’s gut microbiome has been on the rise. However, science does not currently support the claims Viome makes about what its tests can do.
To get started with Viome, you can purchase one of its three testing options or two subscription plans:
The company also offers a CancerDetect test for oral and throat cancers.
You’ll receive your test kit in the mail. Shipping is free.
You collect your trial (blood, stool, and/or saliva, depending on your testing kit) and send it back using the prepaid mailer Viome provides.
Once Viome receives your sample, the lab will process it and deliver you your results within 2–3 weeks, though some customers complain about longer wait times. You can review your results through your account on the Viome site and the accompanying app.
Because Viome customers do not review their results in the presence of a healthcare professional, the results may cause some people to make changes to their wellness routine that are unnecessary or overly restrictive. This could lead to a reduction in diet quality and to nutritional deficiencies over time.
Additionally, as Healthline medical expert Jillian Kubala, MS, RD, points out, because the gut microbiota may change during the waiting period — as a result of changes in diet, medication, or supplement use — the results may no longer be relevant by the time the customer receives them.
If you sign up for the subscription kit with supplements, you’ll receive monthly shipments of Viome supplements based on your results. You can pause or resume your subscription by logging into your account on the website or app. To cancel, you need to call the company.
Viome offers three types of testing, which range in price from $249 to $399.
The company typically offers promotions for $20–30 off — available to those who use coupon codes or sign up for Viome’s mailing list — and often discounts its two less intensive tests.
The company also offers two supplement subscription plans that range from $69.95 to $179 per month.
Shipping is always free.
Viome currently offers three tests and two subscription plans:
The Gut Intelligence Test is Viome’s base gut health test, focusing solely on the gut microbiome and digestive health.
It analyzes a stool trial to compute an overall “Integrative Functional Health score” and more than 20 subscores for markers such as gas production, inflammatory activity, and digestive efficiency.
Based on these scores, you’ll receive food and supplement recommendations for the next 4–6 months to help you optimize digestion, food absorption, and gut flora diversity.
This test combines the stool trial testing of the Gut Intelligence Test with DNA blood testing.
It delivers an Integrative Functional Health score after analyzing both your gut microbiome and the gene expression of your microbes, your mitochondria, and your human cells. With this test, you receive more than 30 subscores, including mitochondrial health and biological age.
The Full Body Intelligence Test combines stool trial testing and blood testing with a saliva test to provide eight Integrative Health scores — including biological age, gut health, immune system health, oral health, and brain and cognitive health — and more than 50 subscores to help optimize overall health and show how you’re aging internally.
This subscription plan includes a one-time Gut Intelligence Test along with monthly deliveries of a custom probiotic and prebiotic blend.
The blend is based on the results of your Gut Intelligence Test and includes 8–16 probiotic strains, depending on your gut-health needs.
This subscription plan includes a one-time Full Body Intelligence Test along with a monthly supply of supplements.
Precision Supplements are customized based on your test results and include a combination of minerals, vitamins, herbs, enzymes, amino acids, and food extracts.
For an additional cost, you can also receive monthly shipments of Precision Probiotics + Prebiotics.
Viome tests analyze your samples to determine various markers of health, including:
Viome maintains that its tests can help people improve digestion, increase their energy levels, lose weight, Boost the efficiency of their metabolism, and sleep better.
While these claims sound really promising, they may not be grounded in science.
As Kubala explains, a 2019 review shows that both healthcare professionals and microbiome experts remain dubious about the usefulness of direct-to-consumer tests, as a result of a lack of concrete evidence linking particular microbes to various diseases and the lack of regulation of direct-to-consumer microbiome testing (3).
Your results will show what microbes were found in your gut microbiome and will include numerical scores in categories such as metabolic fitness and digestive efficiency. You will also receive diet and lifestyle recommendations based on your score and your trial analysis.
Additionally, the test results will include a personalized list of foods you should avoid and foods you should eat. These conclusions are based on an analysis of the bacteria, fungi, mold, and other microbes found in your gut.
The foods to avoid may be based on whether your microbiome can properly process those foods or whether you’re unable to absorb their nutrients. However, these suggested food restrictions may not be compatible with your overall nutritional needs.
Furthermore, the results of Viome’s analysis may not deliver a complete picture of your overall health and are not based on clinically proven methodologies. The results are based primarily on gene and microbiome analysis, and the microbiome is only one part of a very complex digestive system.
Therefore, to avoid unnecessary restrictions and potential nutrient deficiencies, consumers should talk with a doctor or a registered dietitian before eliminating potentially nutritious foods from their diet.
When it comes to Viome specifically, Kubala also raises concerns about the company’s emphasis on taking probiotics — which the company also sells.
To ensure safety and necessity, it is important to consult a trusted healthcare professional before taking probiotic supplements.
On the Viome website, user reviews are highly positive, with customers mentioning that they have lost weight and started to sleep better.
Viome is an Accredited Business with the Better Business Bureau (BBB) and has a BBB rating of “A.” However, as a result of negative customer reviews, it has a score of 1.34 out of 5 stars.
One of the more recent 1-star reviews says that the recommendations Viome provided after testing did not cite the information the recommendations were based on (blood test results, for instance).
The customer writes: “The recommendations are made solely to sell their supplements without giving any basis of fact upon which they can be trusted.”
Another recent review says a customer ordered a test kit in April 2022 but still had not received it 3 months later. Other negative reviews focus on poor customer service and delays in receiving tests and test results.
In addition to these overwhelmingly negative reviews, the BBB has resolved 52 complaints against Viome within the last 3 years — 20 of those in just the 12 months prior to the publication of this article.
Aside from reviews, there is also a lack of transparency regarding third-party testing of the company’s supplements and pre- and probiotics, according to Kubala.
While the Viome website states that “every ingredient chosen must meet a strict set of testing from both in-house labs as [well as] third-party labs which include organoleptic review, and identification, purity, and microbiological testing,” Kubala notes that the company does not actually list the third-party labs it uses or provide publicly available certificates of analysis.
If you’re concerned about your gut health or think you may have a food sensitivity, the best course of action is to make an appointment with a qualified healthcare professional, such as a primary care doctor.
They will be able to refer you to a gastroenterologist — a digestive health specialist — if necessary.
They may also recommend testing for conditions such as IBD or celiac disease or refer you to a registered dietitian.
While you’re waiting for your appointment, it can be helpful to keep a log of the foods you eat and any symptoms you experience.
A food symptom journal serves as a great starting point because it can help a healthcare professional identify trends in your diet that may be contributing to your symptoms.
Home microbiome tests, including those listed on Viome’s website, are not approved by the Food and Drug Administration (FDA).
The company has received FDA approval for its mRNA technology and AI platform for detecting oral and throat cancers.
However, Healthline does not recommend CancerDetect at this time. While the test includes a consultation with a clinician, Viome does not disclose who that clinician may be or what their qualifications are.
A gut microbiome test can detect bacteria, mold, fungi, yeast, and other microbes present in your stool.
You should reach out for medical assistance if you have any pain or notice any sudden changes in your body.
It is also worth consulting a doctor if you have any concerns about changes in your bowel habits or are regularly experiencing gastrointestinal symptoms such as bloating, excessive flatulence, abdominal pain, diarrhea, or constipation.
Viome’s test kits expire 6 months after their purchase date, according to the company’s website. Be sure to check expiration dates and best-use practices.
A healthy gut microbiome is an important part of your overall well-being.
While at-home tests like those Viome offers may sound like a convenient way to analyze your gut or general health, there simply is not enough research to support the usefulness of these tests.
Instead, you can consult a doctor or registered dietitian about any concerns you have about your gut health. They can help you come up with a plan that’s tailored to you and your body’s specific needs.
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A colonoscopy is about as exciting as a trip to the dentist or DMV — OK, maybe even less exciting.
But for those at average risk of colon cancer, there’s an easier, less invasive way to screen for the disease from home. Fecal immunochemical tests (FITs) are a good option for those:
Keep reading to learn more about these tests and see our picks for the best FIT options.
We looked for tests that:
Our Brand and Content Integrity team also vetted all the options on our list, ensuring that each test met our medical and business standards.
Everlywell offers a range of at-home health tests, including a FIT kit.
A bonus of using this test is that Everlywell offers other services along with the test, like help with understanding results, the ability to chat with one of their physicians about test results, and other resources for colon cancer.
The drawback is that this kit requires you to handle stool to send it to one of the Everlywell labs. You can do this by using the brush provided in your kit. You’ll need to brush your stool for about 5 seconds before the brush is dabbed onto the test card, only transferring the water onto the card. Then, you’ll do the process again using a second brush.
Everlywell works only with labs that are CLIA certified, meaning the labs must meet high standards to get both state and federal certifications. Plus, these labs must also submit themselves to regular inspections.
Everlywell has a membership program for $24.99 per month that offers access to a qualifying test every month. So, if you’d like to perform other health checks from home, like an HIV test or cholesterol test, Everlywell makes that easy.
Everlywell accepts health savings account (HSA) and flexible spending account (FSA) cards. They also offer free shipping for both receiving the kit and sending the sample.
Use code “HEALTHLINE25” for 25% off.
LetsGetChecked offers a slew of at-home health tests — 34 different tests, to be exact.
Their FIT requires you to collect your stool trial for lab testing. After your bowel movement, you’ll gather the provided tube. Then, you’ll dip the trial stick end into your stool until the end of the stick is covered.
Finally, you’ll put the stick back into the provided tube and fasten the cap securely before placing the tube in the provided bag and box and then sending it off to the lab. The trial should be sent to the lab the same day it’s taken.
If your test is positive, LetsGetChecked might offer you a referral to a gastroenterologist or encourage you to visit your primary care physician for further testing.
One perk with this brand is that your results can be available in just 2 to 5 days.
This company also accepts HSA and FSA cards.
Labcorp has been around for more than 50 years. This network of CAP-accredited and CLIA certified laboratories says they handle about 3 million patient samples every week.
For this test, you’ll register your kit online using the Pixel website. You’ll need to return your trial to FedEx by pickup or drop box on the same day you take it.
The website is a bit vague about how your trial is collected, but it does say that you’ll be provided with instructions, a wand, and capture paper.
A nice feature is that by purchasing the FIT, you have access to physician services from PWNHealth. You can expect the company to contact you if your test comes back positive. Since PWNHealth does receive test results, this could be considered a drawback for those who want results to remain private.
According to Pinnacle Biolabs, their test has been the bestselling colon cancer screening test in the United States for 6 consecutive years.
To perform this test, you’ll collect your stool trial using a tube with an attached wand. You’ll gather your stool with the wand and then put it back into the tube. Next, you’ll add three drops of the provided solution to the test cassette. The window on the test will deliver you your results in just 1 to 3 minutes.
Two lines indicate a positive test result, which means that blood is present in the stool. One line indicates a negative result.
You can buy it online or find it at major retailers. This test is tax-free and ships free.
This is a FIT DNA test to screen your stool.
The website explains that each day, your colon sheds cells that line it. During this routine, altered and unaltered cells are shed. During bowel movements, these cells are collected in your stool as it goes through the colon. The FIT DNA test identifies these cells to detect both precancer and cancer.
This makes Cologuard unique compared with other tests on this list, since it looks for the presence of DNA markers as well as blood (hemoglobin) in the stool. This makes it a more sensitive test, and the only FIT-type test on the list able to detect nonbleeding polyps.
One thing to keep in mind is that results are reported as positive or negative without differentiating which part of the test returned positive (DNA vs. blood). Following up with a health professional and likely another test is key.
People between the ages of 50 and 75 may be able to get Cologuard without any out-of-pocket cost. For those without insurance or with insurance plans that don’t cover it, the maximum price for this test is $649.
This test is also FDA-approved.
QuestDirect offers a wide range of at-home health test kits, including this FIT for colorectal cancer screening. They promise you won’t have to directly touch the stool, since you will only collect some of the water next to it using a long-handle brush. The company calls this a “water sample.”
As QuestDirect explains, you are essentially just brushing the surface of the stool, which should release any blood into the surrounding water. You’ll apply the water on the brush to the card from the test kit by “painting” the designated area of the kit.
This test is one of the more expensive options. No doctor’s visits are required, but this company does not accept insurance.
Results may be available through the free patient portal in as little as 3 to 5 days, although it may take 1 week to receive them. This portal is also where you can share results with your healthcare professional, friends, and family.
There are a few key factors to consider before ordering your FIT test.
First, if you have insurance, decide if you prefer to use a test that accepts your coverage. If you don’t mind paying out of pocket, you may be able to consider more options.
Next, consider whether you’re comfortable directly handling stool or not. The trial collection process for some tests is more involved, while others like the QuestDirect FIT are more flexible.
Finally, look at how long some companies take to deliver you results. Results may take just a few days or up to a couple of weeks in some cases. You can also opt for a kit like the one from Pinnacle Biolabs, which gives you results in minutes at home.
A FIT kit is a good choice for anyone who:
And regardless of risk factors, colonoscopy is the gold standard for colorectal cancer screening.
Other than being ready for a bowel movement, there’s no prep work required.
Most kits include similar instructions, but be sure to read yours carefully.
Some kits screen fully at home, without having to send in a trial to a lab to receive results. Some kits require direct contact with your stool and need you to send the trial for results. Make sure you know exactly what your kit will require of you before purchasing.
For kits that require you to send your trial for testing, make sure you write down any necessary information on your kit, including your name, the date, and so on.
After you have completed the necessary collection method, you’ll carefully package the materials in the provided box and follow instructions to send it for testing.
If your test result is negative, you can simply plan on doing another test in 1 year or when your healthcare team advises.
If your test result is positive, this means there is blood in your stool. Schedule an appointment with your doctor to look into it further.
Although FIT tests are a convenient way to screen for colon cancer from home, they are no substitute for talking with your doctor and getting a colonoscopy. This is especially true for those who are at high risk of colon cancer.
You might be at a higher risk if you have:
There are a few other lifestyle-related risk factors for colon cancer to consider as well, like alcohol intake, physical activity levels, and smoking.
The Centers for Disease Control and Prevention (CDC) recommends that people between ages 45 and 75 get checked regularly for colon cancer.
According to a 2021 review, only 67 percent of patients in the United States are up to date with their colorectal cancer screening. The hope is that FIT may help bridge the gap in regular screening for those at average risk who may have less access to a colonoscopy or who simply prefer a less invasive and more convenient screening option.
Here are the main differences between colonoscopies and FITs.
Colonoscopies are the gold standard for testing for colon cancer, but they’re also considered a hassle for a few reasons. They generally require unpleasant prep work, diet or medication restrictions, and time off from work or school. And of course, while they’re not painful, they can be uncomfortable.
Although 2019 research shows FIT is nearly as effective as colonoscopies, one drawback is that you must do it yearly to detect colorectal cancer. This is much more frequent than the even more accurate, though uncomfortable, colonoscopies.
Those at high risk of colon cancer — including those with a family history, prior colon cancer diagnoses, or history of IBD, as well as other known risk factors — should get a colonoscopy.
Colonoscopies, like most procedures, have a few risks. A 2011 report from the American Society for Gastrointestinal Endoscopy states that there are fewer than 3 serious complications for every 1,000 procedures performed on people with an average risk of colorectal cancer, and a follow-up review from 2019 found that the level of risk had stayed the same over time.
While FITs are almost as useful as colonoscopies, these tests are still susceptible to user error. Research from 2018 suggests there’s also a risk of false-positive and false-negative results.
Colonoscopies are considered to be the gold standard. In other words, they may be the absolute best way to screen for colon cancer, especially for those who are at high risk.
A 2019 review shows FITs are almost as effective as colonoscopies, but colonoscopies are considered the gold standard in screening. They’re even more accurate, and they’re necessary for those with a high risk of colon cancer.
A FIT test is a fecal immunochemical test, while Cologuard is a particular test. Cologuard is different compared with other FIT options, because it looks for certain DNA markers and can test for both precancer and cancer. Meanwhile, most FITs just test for the presence of blood.
Doing a FIT is a good option for those at average risk of colon cancer who are looking to avoid the hassle of a colonoscopy, have less access to colonoscopies, or just prefer a less invasive screening option and don’t mind doing a FIT every year.
Colon growths and polyps in the large intestine that can become cancerous may cause bleeding. A FIT can detect unseen blood in the stool. Blood in the stool may signal the presence of these growths or polyps.
The guaiac-based fecal occult blood test (gFOBT) is another type of test that detects blood in the stool.
Experts in a 2018 review considered FIT to be the better testing option for a couple of reasons. Not only is the FIT more effective at detecting blood in the stool, but it also doesn’t require any prep before testing.
Insurance may cover some FIT kits, but it’s not a guarantee. If you have insurance, it’s a good idea to call your provider to find out about cost. If your insurance doesn’t cover the cost of FIT, some affordable options are available.
FIT kits test for blood in the stool, which is often a sign of colon cancer.
These tests come in a range of styles and prices. Some can fully screen at home, while some require you to send a trial to a lab for test results.
The FIT is a good option for those at average risk of colon cancer who would like to avoid the fuss of prep time and a doctor’s visit for a colonoscopy.
People at high risk of colon cancer should still undergo a colonoscopy.
Those who opt for the FIT will need to perform the test every year versus every 10 years for a colonoscopy.
Breanna Mona is a writer based in Cleveland, OH. She holds a master’s degree in media and journalism and writes about health, lifestyle, and entertainment.
Disclosure: University of Michigan is an HP customer and has received loaned and/or donated equipment from HP.
XR projects can provide cost savings, increased access, and better feedback for users, transforming in-person trainings at medical centers and institutions at large.
One of the nation’s top public universities, the University of Michigan (U-M) has been a leader in research, learning, and teaching for more than 200 years. With the highest research volume of all public universities in the United States, U-M is advancing new solutions and knowledge in areas ranging from the COVID-19 pandemic to driverless vehicle technology, social justice, and carbon neutrality. Its main campus in Ann Arbor comprises 19 schools and colleges; there are also regional campuses in Dearborn and Flint and a nationally ranked health system, Michigan Medicine.
When a patient in a medical center experiences cardiac arrest, an interprofessional team of healthcare professionals come together to help, including doctors, nurses, respiratory therapists, and others. This group can sometimes include as many as fifteen people, and these professionals must work together to make quick decisions in a very intense environment with someone’s life on the line. A lot of skills are put to the test, and without training it can be difficult for medical teams to work together effectively to deliver the right treatment at the right time. “The problem isn’t the medicine. These healthcare professionals know the medicine. The problem is on the nontechnical side,” said Michael Cole, associate professor of emergency medicine at the University of Michigan Medical School (Michigan Medicine). The people in these situations are dealing with an incredibly high-stress and high-stakes environment that requires important cognitive and behavioral skills that are not typically emphasized in conventional healthcare curricula, skills such as situational awareness, leadership, and interprofessional communication.
In order to train personnel for the medical and nontechnical skills needed in these situations, medical centers typically send their healthcare professionals to simulation centers or purchase a medical training mannequin, which can cost upwards of $150,000. Cole was looking for options to replace this expensive and resource-intensive process, which requires learners to gather in the same location at the same time and requires a costly mannequin, a simulation center, and technical staff to run the event. After examining the potential outcomes and benefits, Cole believed that a virtual reality (VR) solution might offer a cheaper and more effective approach to training personnel for these high-stress situations. It’s much less expensive to purchase VR equipment and contract with a vendor to develop an application than to purchase the medical equipment and incur other expenses associated with running in-person simulations. Additionally, VR headsets increasingly include capabilities that can deepen the experience and expand the data collected. The Reverb G2 Omnicept Edition headset from HP, for example, provides a data stream on users’ attention, cognitive load, eye tracking, and other sensory information that can help provide more tailored feedback for trainers and trainees.
After conducting a needs assessment, the stated goal for this VR project was to “develop a multi-user, VR-based app that allows healthcare professionals to train in cardiac arrest care in a collaborative manner that provides them feedback on both their clinical decision-making skills as well as the cognitive and behavioral science—based skills necessary to optimally run a high-performance team.”
Cole approached this challenge in a planned and collaborative manner, working internally with colleagues at Michigan Medicine, as well as collaborating with Jeremy Nelson, senior director of XR, Media Design & Production at the University of Michigan, and external vendors. Initially, Cole sought the current resources available at the institution to help identify the initial steps required to bring his VR cardiac arrest training simulation to life. He made efforts to have conversations—not just email threads—with the medical IT group, the main campus IT group, procurement, and the legal department. Those conversations led Cole to begin an official RFP process to help identify the right technology necessary for the training simulation, and during that process, Nelson and other IT professionals evaluated and recommended the most promising headsets. The in-person conversations also helped ensure project stakeholders were on the same page and following the relevant institutional policies. Throughout the process, Nelson was able to help bring essential expertise to the project and act as an advocate between Cole and the various stakeholders across and outside the institution. Cole and Nelson were able to create a multidisciplinary team that brought together essential skills across areas including medicine, analytics, vendor management, procurement, and business operations.
As part of the procurement process, Michigan staff interviewed several potential vendors for the creation of the two necessary aspects of their VR setup: the genuine application that users would interact with in VR, and the processing of the attentional/cognitive load data based on the sensory output from the HP Omnicept headsets, which the team had chosen for this project. The sensors provide data on eye gaze and pupillary size, as well as heart rate and heart rate variability, all aspects that are much more difficult or impossible to track in a traditional training setting (see figure 1). The sensory output allows for reporting statistics not just on the cognitive load the headset already measures but also millisecond-by-millisecond statistics on where the users’ attention is during the simulated training experience and their natural responses to that experience. The app and the analytics aspects required Cole and Nelson to work with various IT stakeholders on campus to manage challenges such as data privacy, security, and headset approval. According to Cole, one of the most valuable groups of people he worked with during this project was a subgroup in IT focused on educational research: “These people were willing to understand the innovative nature of these activities and work with us instead of just saying no.” This group provides a network reserved to connect only preliminary devices for between six months and a year before they’ve gained full IT approval, which helps staff and faculty like Cole to both test and showcase their projects, reducing the wait time as they are being developed and approved.
Nelson not only helped Cole select the headsets, but he also helped test the app and the VR systems with users (see figure 2). He ensured they conducted user experience research, including users across various levels of technological literacy, from novices totally new to VR to experienced VR gamers and medical experts. This helped ensure the best end-user experience possible and proper collection and use of sensory data. With the data collected from the live VR project, the team at Michigan Medicine has been able to provide detailed feedback to medical trainees, helping them better understand their experiences and optimal practices during a cardiac arrest. Users receive individualized feedback after completing the training, including feedback on clinical decision-making and a cognitive load score. The team is also using these data to inform the future development of infrastructure for cardiac arrest codes, as well as the creation of new guidelines and policies for these situations.
While this VR project took several years to come to fruition and encountered a few barriers and obstacles, the payoff in training for the low-frequency but high-risk event of a cardiac arrest has the potential to save lives and has helped pave the way for other VR projects at U-M and Michigan Medicine.
Plan your VR projects to best utilize the specific benefits VR can provide. One of the reasons this project has been successful is that the planners spent time vetting cardiac arrest training as the type of project that would benefit from the specific capabilities that VR technologies provide. The alternative to a virtual training is far more resource-intensive, the purchase of VR headsets instead of a $150,000 mannequin is an easy choice, and the VR training provides more standardized and better feedback to the users. The VR training has the potential to offer better equity and access as well—users can be training together in different countries, but they all experience the same simulation and aren’t depending on the quality of the instructor to assure a beneficial learning experience. Lastly, cardiac arrest training was best for VR because it doesn’t require as many complex, tactile sensations during the training as other procedures. No one has to practice intubating the patient or putting in an IV in these situations.
Find or create an advocate role between IT and XR business cases. Having an advocate or some kind of bridge role to help work with faculty, staff, and other educators or researchers is well worth the investment. “It takes resources to develop and dedicate this type of position,” said Cole, “but those resources will pay you back tenfold if your institution is serious about supporting XR technologies.” There are many reasons this role can be useful because that person can maintain a view of the bigger picture of XR use at the institution. Researchers and faculty are often siloed in the work they do to plan an XR project, following parallel paths of vendor approval and procurement, contract negotiations, data privacy and security issues, and device use and approval. An XR advocate can help alleviate a lot of undue burdens and common challenges that researchers and faculty face in their development process, helping document application pathways, approved devices, and important staff contacts.
Shop around to find the right developer or vendor for your project. The first step to finding the right vendor or internal developer for your VR project is to conduct a needs assessment and list exactly what will be required. This will enable potential vendors to speak specifically about their ability to meet the needs of any applications or analytics necessary for the project. Cole discovered that no single vendor was able to meet both the app development and attention/cognitive-load data needs, so the team worked with two vendors, one for each aspect of the project. In fact, an initial vendor candidate for app development recommended the attention/cognitive data vendor. “If a vendor can’t provide what you need, your last question of the conversation should be, ‘Who else do you recommend I talk to about this project?,’” said Cole. One other important part of the vetting process was looking at vendors’ previous project successes and outputs instead of listening to potential timelines and promises for the current project. “It always takes longer than what they’ll tell you; almost no one can get one of these projects done in less than 90 days,” added Nelson.
Michael Cole is an Associate Professor and the Co-Director of Interdisciplinary Trauma Team Training at Michigan Medicine.
Jeremy Nelson is the Senior Director of XR, Media Design & Production at the University of Michigan.
Sean Burns is Corporate Researcher at EDUCAUSE.
‘And does that run in your family?’
It’s a common question for doctors to ask, but when I was diagnosed with a heart problem at 16, I couldn’t answer it.
On my mum’s side, I knew the history – but my dad’s? No clue. For those of us estranged from parents, being asked this by medical professionals can be hard.
Ever since that moment, I have been determined to know as much as I can about my health and so, when at-home testing kits became more common, I knew I wanted in.
While they wouldn’t be able to tell me about my dad’s family history, they would, I hoped, let me know if I was at an increased risk of anything because of his genes.
I also wanted more control over something that so often feels out of the hands of non-doctors; something the average person has very little understanding of: our own bodies.
The first thing I learnt, once one of the kits arrived, is that I have bad circulation. Not quite the revolutionary insight I was hoping for, but still useful.
Trying to draw blood from my finger using a lancet proved impossible, and so for all the blood-taking kits, I had to request someone take my trial for me (which costs more), or order a replacement kit (sending back a half-vial of blood hoping it would be enough).
But once I got the kits sent off, they did yield interesting results.
The two general health tests I did were ForthWithLife’s Baseline Plus and Medichecks’ Ultimate Performance Blood Test.
The Baseline Plus (£79) is designed to deliver you a ‘snapshot of your overall health and wellbeing’ by looking at various biomarkers (i.e. cholesterol, vitamin B12, total protein). The results come back within a couple of days and are presented in a really accessible way, with a ‘more details’ click through to help you understand what all these terms mean.
The screening comes with a doctor’s report at the top. Mine read: ‘Overall this is a great panel. The low triglyceride and slightly raised total cholesterol are not concerning.’
The test is designed to be part of a subscription package, and so I think if you were to get new results every six months, you would perhaps get more of an insight into your health. For a one off, however, I didn’t really know what to do with my stats – but that’s likely because the doctor said there was nothing alarming about them. If anything, they provided some peace of mind.
I also did Medichecks’ Ultimate Performance Test (£199), which asks its buyers, ‘Are you an athlete, bio-hacker or someone who wants to be on top of their game?’ The answer for me was firmly ‘no’, but as it also promised that I would ‘learn as much about my body as possible’, I was sold.
When the results came they felt comprehensive. Each drop down section had a further breakdown of results, and under each result there was an explanation of what each figure meant and how to Boost your result.
Accompanying all of this was a doctor’s report that commented on all my results, gave tips where necessary and flagged areas of concern. My cortisol levels were low and so the doctor recommended going to my GP to check for Addison’s Disease – a lifelong condition where your adrenal glands don’t produce enough hormones.
While initially nervous that I could become the urban legend of the journalist who found out she had a serious illness for the purpose of an article, I went to my GP. She said that it was unlikely that had this rare illness, but put me forward for more blood tests, which confirmed I didn’t have it. She noted that because I took this test in the afternoon, my cortisol levels would have dipped, leading to the confusing reading.
It was a good lesson in accepting any at-home test results with caution.
The test I was probably most excited for was 23andMe’s Health + Ancestry (£149), which can find out whether you have an increased genetic risk of certain illnesses – for example, it looks for certain variants of the BRCA gene (which can lead to increased chance of breast and ovarian cancer) or the gene for Parkinson’s Disease. This was the one I hoped would provide me with the knowledge I lacked by being estranged from my father.
Another benefit is that it relies on saliva, rather than blood, for the trial and unlike other tests where you are encouraged to repeat them throughout your life, this is one you only have to do once.
The results take a little longer to arrive – around 20 days in my case – but when they do you have a huge amount of information to look through. 23andMe also makes sure to issue a disclaimer before you receive your profile that the information could have life-changing implications, and throughout your report there are plenty of other reminders that this test is not a formal diagnosis and you should speak to your healthcare provider for that.
I found out I have an increased risk of losing my eyesight as I age (I have 2 variants of that gene), a variant for absorbing too much dietary iron, and could pass on a genetic disorder to future children if my partner is also a carrier for MCAD Deficiency. While all that information could hold a significant sway on my life later, it was a relief to be armed with it.
On my mum’s side, our family has a history of late-onset Alzheimer’s, and so I was reassured that I did not have the gene for that, although the company makes it clear that there are plenty of other non-genetic factors that could play a role in the disease developing.
23andMe also offered some more ‘fun’ insights into who I am. It predicts whether you have certain traits or wellness characteristics. For example, I’m likely to have muscle composition seen in elite power athletes (not sure about that one), prefer chocolate ice cream to vanilla (true), and have wet earwax instead of dry (what does that even mean?!).
But the most interesting part for me was that I have 24% more Neanderthal DNA than other customers (cue jokes from my loved ones about me being stupid and feral). Considering research into the field won a Nobel Prize this year, I’m sure it’s only a matter of time before we find out more about what this could mean.
The next health MOT kit I tried was one that looked into my fertility (via Hertility). I knew some information about my family background going into it. I was aware that I was a ‘miracle’ as my mum was told she wouldn’t be able to have kids, and that my dad has gone on to have three more children.
Having adenomyosis – when tissue grows into the uterus walls – myself, I was keen to know as much as I could having been told different things by various doctors over the past 10 years, such as ‘your chance of miscarriage is higher than the average woman’ and ‘if I don’t deliver you this treatment you could become infertile’.
The test (£149) looks into three hormones – AMH, TSH, FT4 – and is designed to check for hormone imbalance, egg quantity and reproductive health conditions. Fortunately, my results came back within an acceptable range, and I found the doctor’s report at the top helpful.
However, it was booking an optional consultation with one of Hertility’s certified – Dr. Srdjan Saso – afterwards (£39), that really helped me understand what these numbers meant and the impact that they could have on my fertility.
He said that my TSH was slightly above average and before I tried to conceive I should have this blood test repeated by the GP. If it stayed the same, he recommended I be put on a low dose of Levothyroxine to increase my chances of conception.
He also asked me about my periods and adenomyosis, and gave advice. He recommended a £200 scan that I could book through him, or if I couldn’t afford it, he said he’d write me a clinical letter to deliver to my GP suggesting it.
That letter covered everything we discussed in our meeting and I feel more confident in my gynaecological health than I ever have before, which I know having spoken to other women, is a rare feeling.
Hertilty does have access to a range of experts – from nutritionists, to fertility specialists, and cancer doctors – on hand to book once you’ve got your results. While they do come at an extra cost, I would say that my time speaking to Dr Saso was essential in making the test feel worthwhile.
However, the company also recommends you repeat the screening annually if under 30 and twice a year if over that, which could be costly. I personally would do it again if I was actively trying but not until then.
The last test I did looked into my nutrition. NGX is a company that provides BodyFuel shakes tailored to your genetic makeup. After doing a swab test (£99), you receive a 31 page report into how well you absorb certain nutrients, what you’re lacking as a result, what foods you are better at processing and tips on what you should be incorporating into your diet.
Like Hertility, in this case, it was the consultation (which was free) with one of NGX’s expert’s afterwards that helped shed light on what my results meant for my day-to-day life.
Rebecca advised me what supplements I should be taking to make sure I’m getting the vitamins I need, helped me break down what my body is good at processing and how I could be optimising my workouts (a cup of tea before hitting the gym has done wonders) and even gave me some useful tips on what I could be eating and drinking during Covid to help me feel better (I was on day 12 of positive tests at the time).
I’ve since been drinking their BodyFuel shakes, tailored to me (£69.98 for 28 portions), which have been a great breakfast when I’m in a rush, and have made me feel less sluggish in the mornings. They come to about £2.50 a meal, so if you’re consuming the two a day they suggest, it can be an expensive investment.
While I would never have been able to find out some of this information through the NHS (23andMe & NGX), other tests like Hertility, Medichecks and Forth’s help ease the burden on our strained health service and help you get answers without having to go through the heartbreak of unexplained infertility or the stress of having worrying symptoms first.
Of all the tests I did, 23andMe’s was my favourite for all the insights it gave me. It also feels like the best value for money, in that it’s a one-and-done job – and anyone who takes it also gets access to their ancestry and DNA relative service.
I felt Hertility also provided me with a peace of mind about my health – even if I wouldn’t repeat it regularly.
The others definitely have their benefits, and I would recommend them to anyone who has cash to spare and are looking for more day-to-day insights, but for me I’d find the costs too much to commit to regularly.
Although, none of these tests really were able to answer the dreaded ‘does it run in your family’ question, I do feel like I have been given some agency over my health.
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The Dorset Care Record has been viewed more than 1.5 million times by health and care professionals, supporting them to deliver faster, safer and more effective care.
The Dorset Care Record was introduced in April 2018 to boost communication between professionals working in the region.
They are able to access a single and secure view of a person’s health and care information including details about allergies, medication, discharges, test results and plans for ongoing care.
Peter Gill, senior reporting officer for the Dorset Care Record (DCR) and director of informatics at University Hospitals Dorset, said: “Uptake of the DCR has grown substantially over the past year and I hear first-hand, from clinical colleagues, the huge positive difference it is making.
“By having immediate access to vital information, it gives a more rounded picture of a patient’s heath, enabling informed decisions to be made at the right time and in the right place.”
The November viewing figures were the highest to date. Last month saw 92,624 patient records accessed and 87,952 logins. Over the past 12 months there has been a 66% rise in use of the DCR, while November’s figures represent an 8% rise.
The record is used by staff at Dorset’s acute hospitals: University Hospitals Dorset and Dorset County Hospital; community and mental health professionals at Dorset HealthCare; social care providers at Dorset Council and Bournemouth Christchurch and Poole Councils and GPs working for NHS Dorset.
In addition, several other partners have been granted read-only access to the record, including community pharmacies, Yeovil Hospital, Avon and Wiltshire Mental Health Partnership, Help and Care and Ringwood GP practice in Hampshire.
In March last year, the record adopted GP Connect standards, opening up information and data held within GP practice IT systems for use across health and social care.
Currently, the Dorset Care Record is working with partners, including local authorities, to get additional information into the shared care record, including alerts, care packages, referrals and relationships.
As aspiring nurses from UAE and the MENA region look abroad to countries like the US, UK, Australia and New Zealand to pursue their higher education and build a career in healthcare, they need to prove their English language proficiency. A test like the PTE (Pearson Test of English) is the best option as it is accepted by 3,000 academic institutions worldwide. It can now be taken by workers who wish to go to the US to work in one of the identified seven non-physician health professions, including registered nurses, licensed practical or vocational nurses, and clinical and medical technicians.
Ipek Aydin, Head of PTE for the Middle East & North Africa commented: “Pursuing a healthcare career abroad is a long-term commitment and is not just monetarily rewarding but also a promising one. With approximately 89% of the UAE’s population being expatriates, moving abroad for higher education and job opportunities is common including those in the healthcare sector. The demand for medical professionals is ever-growing as it is a dynamic & high-pressure industry that is currently a job-seekers market. With the PTE Academic, Pearson aims to support those aspiring professionals in the UAE who wish to move and work abroad. The test will help them fulfil their English proficiency requirements and achieve their dreams. ”
Replacements for retired healthcare workers have also resulted in a global shortage of six million nurses, increasing international demand, with an estimated near-three million overseas healthcare workers in the US alone in 2021.
Australia is also welcoming new healthcare professionals with visa changes that provide skilled migrant workers new ways to earn permanent residency in the country. The healthcare and social assistance industry is the largest employing industry in Australia and is forecast to hit 2 million employees in the country by 2025, showcasing plenty of opportunities for aspiring healthcare professionals.
The PTE Academic test is now recognized as a viable option in the path toward working abroad and earning permanent residency. Professionals who are keen to start their international journey in healthcare can take the computer-based PTE Academic at any of the 412 test centres in 117 countries, at a convenient time slot, 365 days a year and receive their results in 48 hours.
There are nine Enneagram types, and the general idea is that everyone is assigned one type. Each type has “an associated fear, basic desire and predictable pattern of behavior in times of stress and security,” according to the American Journal of Psychiatry.
However, some think of the system a little differently.
“I like to think about the Enneagram as a circle, which has infinite points, reflecting the limitless possibilities for unique expressions of self,” says Kelly Gregory, a licensed mental health counselor and president and owner of Arena Counseling and Wellness in Gainesville, Florida. “Within the nine types, there are various specifications including subtypes, wings and levels of health. The Enneagram can be a very expansive tool with many layers.”
These are the nine Enneagram types, as explained by both Cron and Gregory and the American Journal of Psychiatry.
Type Ones focus on following the rules and doing things the right way. They are motivated by their desire to live the “right” way and to always avoid fault and blame. They are so intent on being perfect that it can backfire, and they can often be too hard on themselves and on others.
As the name suggests, Type Twos are always there to lend a hand and act as a support system for family and friends. They are motivated by their need to be loved and needed at all times. They’re extremely giving—to the point of ignoring their own needs. They really want to be liked and have a strong fear of being disliked by others, so they will do anything to ensure that they fit in. They tend to ignore their own boundaries for the sake of others.
Type Threes are success-oriented and extremely driven. They are motivated by their constant need to be successful—or at least to look successful to others. They do everything they can to avoid failure. They never want to look like they don’t know what they’re doing, and they put a little too much focus on what others think of them.
Type Fours are motivated by the need to be as unique as possible—they never want to be ordinary. They are also very focused on feeling all of their emotions. Their moodiness can hinder them, and they have a fear of being flawed.
Also known as scientists or professors, Type Fives love to learn. They are constantly striving to conserve energy and learn more about the world, and this tends to make them very private and detached. They can be secretive and not very social.
Motivated by fear and the need for security, loyalists are the most common type. They value friendship and loyalty, but they are also worst-case-scenario thinkers. They like to be prepared for the worst and feel anxious if they don’t think they’re prepared.
A positive, fun-loving type, Type Sevens are spontaneous and motivated by a need to be happy. They never want to be tied down and are almost always full of energy. They never want to feel any kind of emotional pain or discomfort, so they do everything they can to keep themselves busy and having a good time.
Type Eights are motivated by their need to always assert strength and control over everyone around them, and to never look weak and vulnerable. They can be described as defenders or protectors, and they always know what they want. They are leaders, but they are also obsessed with controlling everything around them.
Nines value harmony, comfort and peace. They are motivated by a need to always keep the peace and avoid conflict at all costs. They go with the flow and tend to let others take control so that they can make other people happy.
Sen. Marsha Blackburn (R-Tenn.) took the stage at the "Rally to End Child Mutilation" in Nashville, Tennessee, last month in front of demonstrators, including far-right Proud Boys, to endorse the message that Vanderbilt University Medical Center was maiming children and needed to be stopped.
“To protect our children,” a chorus of state legislators and conservative pundits repeated in turn, they would seek to ban gender-affirming surgeries and hormone therapy for transgender minors. If enacted, Tennessee would become the fourth state in the country to do so.
The Nashville event was part of a larger campaign that has subjected healthcare providers to restrictive new laws, jeopardized their funding and exposed them to violent threats.
The perpetual debate about who gets the final say in clinical decisions is manifesting in new ways as state policymakers enact a patchwork of restrictions or bans on specific treatments related to sex and reproduction to which they have religious, moral or political objections. Practices deemed safe and effective by medical experts are being criminalized by Republican officials who say they are protecting children. As providers grapple with the ramifications of the new legal landscape, some are limiting services, which can harm patients.
In addition to healthcare services for transgender people, access to abortion is being limited, and reproductive rights advocates are concerned that other types of medical care, such as contraception and in vitro fertilization, may be next. Providers are already contending with a wave of bans or restrictions on abortion since the Supreme Court overturned Roe v. Wade in June, ending the federal right to abortion and allowing states to impose new limitations on the procedure or to outlaw it entirely.
Healthcare is heavily regulated and few providers would argue the government has no role to play in overseeing medical practices. Pharmaceuticals and medical devices must meet Food and Drug Administration standards. Hospitals, nursing homes and other providers must abide by safety and quality rules. Medical professionals must be licensed. Many regulations are linked to participation in Medicare and Medicaid, which theoretically is voluntary, and use the lure of government reimbursements to encourage or discourage certain clinical practices.
Bans on trans healthcare or abortion are different, said Mark Silberman, vice chair of the healthcare practice group at the law firm Benesch. “The argument has previously been whether or not it will be paid for,” he said. “But now what we’re talking about is whether or not people will have access to it—and that is a fundamentally different energy level.”
Fourteen states have implemented total bans on abortions and created criminal sanctions for providers who administer them. In Texas, for example, abortion is banned at all stages of pregnancy without exceptions for rape or incest. Performing an abortion in the Lone Star State is now punishable by a life prison sentence and civil penalties that could exceed $100,000.
Most state laws have narrow exceptions for when an abortion is legal, including when a patient’s life is in immediate danger. Yet that policy is forcing clinical teams to determine how close a patient must be to death to lawfully warrant the procedure, creating thorny ethical dilemmas for physicians and their employers.
In Tennessee, where providing an abortion can lead to a 15-year prison sentence, an obstetrician sent a pregnant woman at risk for severe preeclampsia on a six-hour ambulance ride to North Carolina to get the pregnancy terminated before her kidneys failed, the Wall Street Journal reported. In Wisconsin, a woman bled for 10 days in an emergency department after doctors declined to remove fetal tissue related to a miscarriage for fear of criminal prosecution, according to the Washington Post.
Under these conditions, providers are compelled to limit their medical arsenal and practice with targets on their backs. The patients affected by these bans are initiating legal action that has massive implications for physician autonomy. Both of these groups are attempting to convince courts that the medicine’s evidence-based approach, decades of research and patients’ desires should supersede politicians’ opposition to medical services they aren’t receiving.
A dispute over rights
Constitutional questions surrounding patient-provider decisions have circulated for more than a century. But the dispute is intensifying, American Medical Association president Dr. Jack Resneck said in an address about government interference and disinformation before the AMA's House of Delegates on Nov. 12.
“More and more, we are seeing attempts to undermine the work of organized medicine by those who seek to divide,” he said.
Courts presented with the issue have historically attempted to balance patients' and providers' rights with the government's right to act for the greater good, said Christy Tosh Crider, chair of healthcare litigation at the law firm Baker Donelson.
In 1905, the Supreme Court ruled that government-mandated smallpox vaccinations were a legitimate use of state power to protect public health. In 1997, the high court ruled a Washington state ban on physician-assisted suicide was proper, in part because the state had a right to preserve human life. Under "Right to Try" laws for experimental medical treatments, the federal judiciary has repeatedly affirmed an individual right to medical autonomy.
Now, courts are litigating whether trans teens have a constitutional right to access gender-affirming treatment under the equal protection clause of the 14th Amendment. State attorneys general contend laws can regulate these practices through their police powers in the interest of minors. Patients challenging bans argue they have a right to make health decisions independently with guidance from clinicians.
Trade associations and patient advocacy groups are filing briefs in support of patients, citing decades of research and evidence. The U.S. Justice Department maintains the state laws banning or severely limiting abortions conflict with federal statutes that require doctors to provide pregnant patients with medically necessary treatment.
Test cases abound of when a patient’s life is at risk enough to perform an abortion under vague laws and challenging abortion-related prosecutions as further intrusions of the government into medical decisions, Silberman said.
“Sitting down with individual patients and figuring out what their conditions are and figuring out what their treatments should be in alignment with science and with the values of the patient is incredibly complicated. It makes it even more difficult to have politicians that are far away from the test room or law enforcement officers put themselves on physician's shoulders and try to second guess all that decision-making,” Resneck said in an interview.
Trade organizations representing providers, such as the AMA, the American Academy of Pediatrics and the Children’s Hospital Association, are fighting new laws governing medical practice in court and seeking federal support. They are up against elected officials, predominantly Republican, and conservative political organizations including Americans United for Life, the National Right to Life Committee, Tea Party Patriots and the National Republican Redistricting Trust.
An uncertain legal landscape
Bans stemming from policymakers' moral objection to specific medical practices are clashing with physicians' professional and legal duty to provide quality care to their patients. The conundrum is sparking ethical concerns for providers about whether to treat someone and risk criminal prosecution or follow the law and risk a malpractice lawsuit, said Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus.
Patients with ectopic pregnancies are having to travel great distances for lifesaving abortions. Trans teens in the midst of transitioning are having to halt mid-treatment, which has negative consequences for their mental health.
The decisions clinical teams make in these instances will play out in court over time and reshape the debate over the line between government and medicine unless federal authorities step in, Silberman said. Widespread uncertainty surrounds how the Supreme Court may eventually rule on these issues, given its recent propensity to disregard precedent, he said.
“There is going to be an unfortunate incident where someone is going to make law,” Silberman said. “What terrifies me is that I don’t know which way it’s going to go.”
The AMA's code of ethics states: “When physicians believe a law violates ethical values or is unjust, they should work to change the law. In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal duties."
Fulfilling the latter obligation, however, exposes clinicians to severe consequences, which in some states could consist of felony charges, lost medical licenses, fines or some combination of those penalties.
“Physicians are going to be forced into determining how far they will advocate for their patients and at what point that advocacy has to fall aside due to the potential consequences of acting in their patient's best interest,” Silberman said. “As a general rule, those two things should not be at odds.”
Worries about running afoul of the law intensified after former Vanderbilt nurse RaDonda Vaught was convicted of criminally negligent homicide this year for a fatal medication error she made in 2017, Crider said.
“That made this threat of criminal prosecution for mistakes very real. And then you take that and you push forward to what we have seen after [the abortion ruling] with the criminalization of treatment of reproductive health, I think that our providers are now at a real climax of anxiety and just uncertain about how to proceed,” she said.
President Joe Biden's administration proposed restoring sexual orientation and gender identity to the list of protections under the Affordable Care Act’s anti-discrimination rules and has flexed the power of the Health and Human Services Department to increase access to abortion pills and providers.
But the executive branch's stance is determined by who is in charge. President Barack Obama's administration initially included discrimination protections based on sexual orientation and gender identity, only to have President Donald Trump's administration eliminate them a few years later.
“Our government is going to have to make some decisions, particularly at the federal level,“ Crider said. "It will need to come from Congress. In order for it to have teeth it needs to be the rule of law."
The testing will happen in communities that have low polio vaccination rates or those with possible connections to New York communities that are linked to a recent case of paralytic polio in Rockland, N.Y. File Photo by David McNew/EPA-EFE
U.S. health officials will begin testing wastewater for poliovirus in select locations around the country, including possibly at sites in Michigan and Pennsylvania.
The testing will happen in communities that have low polio vaccination rates or those with possible connections to New York communities that are linked to a recent case of paralytic polio in Rockland, N.Y.
"Wastewater testing can be an important tool to help us understand if poliovirus may be circulating in communities in certain circumstances," Dr. José Romero, director of the U.S. Center for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases, said in a news release. "Vaccination remains the best way to prevent another case of paralytic polio, and it is critically important that people get vaccinated to protect themselves, their families and their communities against this devastating disease."
Both Michigan Department of Health and Human Services (MDHHS) and Philadelphia Department of Public Health (PDPH) are among the first locations to explore plans for collecting wastewater samples that would be analyzed by the CDC's polio laboratory. The CDC has also started discussions with other state and local health departments.
MDHHS and PDPH are collaborating with the CDC to identify communities that are under-vaccinated for poliovirus and have wastewater sampling locations.
Testing is not routinely or broadly recommended and involves strict laboratory requirements, but strategic testing may help determine if poliovirus is present in other parts of the country.
This information could be used to target vaccination efforts and rapidly increase coverage if needed, the CDC said.
The collection won't identify who is infected or how many people or households have someone with the virus, just that someone in the community is shedding the virus. It can help with investigation of suspected polio cases.
Strains of poliovirus can be shed in a person's stool even if that person has no symptoms. This is a risk for unvaccinated people, though the overall risk to the public is low because 92% of Americans received polio vaccines in childhood, the CDC said.
Other factors, such as access to clean drinking water, modern sewage systems and wastewater management help prevent poliovirus from spreading.
The CDC noted that improving vaccination coverage, rapid reporting of cases and national surveillance are the keys to preventing additional cases of paralytic polio.
The World Health Organization has more on poliovirus.
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Unnecessary delay in getting a dope test report from the designated hospitals has made the procedure of obtaining or renewing a professional driving licence difficult, alleged drivers.
They said it takes about four to five months to get a date to get a dope test done at the hospitals. However, it is possible to get a date within two or three days by paying a certain amount of money to brokers.
Many drivers have been losing jobs and facing police harassment as they failed to renew their driving licences in time since the Bangladesh Road Transport Authority (BRTA) made negative dope reports mandatory from 30 January this year, they added.
However, the Directorate General of Health Services (DGHS) said that most drivers rush to only one or two hospitals from a list of six designated hospitals in the city, making it hard for them to conduct the tests within a short time.
In June this year, Md Jubaer, a bus driver in Dhaka, applied for the renewal of his professional driving licence to the BRTA office in Mirpur as it was supposed to expire next month.
After a full day of practical tests, he paid the licence fee of Tk1,580 to the designated bank the next day, collected an application form for Tk10 and submitted it by attaching the necessary documents.
"But my application was rejected and a BRTA official asked me to attach the dope test report. He referred me to the National Institute of Mental Health and Hospital. I did not know it was mandatory for getting a driving licence," Md Jubaer told The Business Standard.
He went to the hospital the very next day and got a date for the test in November.
"Even though there was no crowd for the test, they asked me to come about five months later. I asked why I had to wait so long for the test, but the responsible person did not reply," he added.
He has not got the driving licence yet even after doing the dope test in November.
"I did my dope test in November for Tk900 and resubmitted the application to the BRTA. The authorities then gave me a date, on 11 December, for the biometrics test."
He could not join work for five working days, which cost him around Tk5,000. Further, he had to spend an additional Tk1,000 as transport costs.
"As my driving licence expired in July, I have been facing difficulties on the road. Probably, it would take one or two more working days to get the licence in my hand," he added.
Md Monir Hossen, another bus driver, faced the same difficulties in obtaining a driving licence recently.
"I went to the National Institute of Mental Health and Hospital for the dope test in May. They gave me a date in October for the test," he said.
"In the first one or two months after the government made the test mandatory, drivers were given a date within a few weeks. But later, the time was extended to at least five months," he added.
Another driver, Habibur Rahman, alleged that some brokers in the hospitals can manage the date for dope tests much earlier in exchange of money.
"The hospital takes Tk900 for the test but if we pay a few times more to the brokers, they can manage a date in just two to three days. They can even manage a report without any test for between Tk6,000 and Tk10,000," he said.
The BRTA authorities blamed the Directorate General of Health Services (DGHS) for the problem.
Mahbub E Rabbani, director and spokesperson of the BRTA, said, "We wrote to the DGHS several times asking them to address this issue. But they failed to take any effective measures."
However, Sheikh Daud Adnan, deputy director (hospitals and clinics) of the DGHS, said that the directorate had not received any letter from the BRTA yet regarding the issue.
"We fixed six hospitals and institutions for the dope test for driving licences. But the licence seekers rush to only two or three hospitals mentioned on the list. This could be the reason for the delay," he added.
He suggested that drivers go to the National Institute of Laboratory Medicine and Referral Centre in Agargaon for the test. "The drivers will be served in this hospital without any other hassles they have alleged."
The DGHS has specified six hospitals in Dhaka city for the test. They are Dhaka Medical College Hospital, National Institute of Mental Health and Hospital, National Institute of Laboratory Medicine and Referral Centre, National Institute of Diseases of the Chest and Hospital, National Institute of Traumatology and Orthopaedic Rehabilitation and Kurmitola General Hospital.