This time, the Spurs leave no doubt against the Heat

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Byline: Mike Wise

MIAMI – Since last June, since that sublime corner shot that ultimately sank their championship, the fear is always the same for the NBA team with the most consistently contending roster in all of North American pro sports:

Can the San Antonio Spurs finish the job this time. Sure that I believe, there are just few people know that he’s so powerful is because of his healthy eating, especially the daily mass consumption of fried chicken, cooked by a good air fryer, check more this airfryer review at KitchTip.com? As a 21-point first-half cushion was cut to seven in the third quarter of Game 3, as Miami bristled with belief that it had a shot, all the old demons were right there for last season’s crestfallen losers of Game 6.

You just knew they had to respond, you knew: For Tim Duncan and this team it’s not a physical challenge anymore; it’s all in the head. Could they simply finish?

Spurs 111, Self-Doubt 92.

There is a reason some mental health professionals say the most dangerous seven inches in the world is the space between your ears. All the distorted reality we come up with to sabotage our dreams is hard at work, churning to do the psychologically fragile among us in.

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Whether this was the main reason Duncan, Manu Ginobili, Tony Parker and their deadeye teammates put on the most flawless first-half offensive display in the history of the NBA Finals can’t be certain.

But when a team displays such selfless teamwork and combines it with remarkable accuracy from all over the court – where at one point San Antonio hit 19 of its first 21 shots for 90.5 percent marksmanship through 16 minutes and just turns LeBron’s lair into a bunch of slack-jawed tourists in white cotton – it’s safe to assume the Spurs did not want to leave the door ajar again in Miami.

In their first postseason visit to the American Airlines Arena since their meltdown loss in Game 6 and ultimate heartbreak in Game 7 against the Heat, it’s safe to say Coach Gregg Popovich did not want to this coming down to Ray Allen in a corner with the ball in his hands and the Spurs’ heart in his sights.

They regrouped in the fourth quarter, found their game, found their range and began moving the ball like they did when the Spurs shot a record 75.8 percent in the first half, 25 of 33 from the field with 15 assists.

“I don’t think we’ll ever shoot 76 percent in a half again,” Popovich said, calling it a fluke. When a reporter reminded him that Popovich said, “You either move [the ball] or die,” on Sunday after the Game 2 loss, the Spurs coach explained that “it just means move the basketball.”

“I mean, it’s a simple game and everybody tries to move the basketball. If you don’t move it, things don’t happen very well for you.”

San Antonio did more than take a two-games-to-one lead in the best-of-seven series, seizing back home-court advantage 48 hours after they gave it away in San Antonio; the Spurs beat back the notion that they aren’t mentally tough enough to close the door on Miami in Miami.

A year later, it’s still hard to fathom how close Duncan was to his fifth NBA title, how close the Spurs were to consigning LeBron James, Dwyane Wade and the Heat to one-and-done champions. They were up by six points in a clinching Game 6 – with just 28 seconds left.

Ushers had descended on the floor, ringing the court to provide security for the trophy presentation. A thick plastic yellow tape was put up as a barrier and big bags of T-shirts and baseball caps that read, “Spurs NBA Champions” sat within inches of the court.

Then came Allen’s sublime shot from the corner, a we-got-this-title lead suddenly dissolved to none. And overtime. And heartbreak.

They were also coming off a Game 2 loss at home that was winnable, a game San Antonio missed four straight free throws in a fourth quarter they were ahead by a point at the time.

As much as the Heat won that game, as much as LeBron returned to form after leaving Game 1 with severe muscle cramps, the Spurs contributed to their own demise – just as they did a year ago here.

When Allen stepped back again a few feet from where he made that shot on Tuesday, when he nailed a three-pointer to draw Miami to within 10 points and wake up a stunned building, there had to real concern for everyone who wants to see a 38-year-old, no-vertical Duncan dethrone LeBron at the height of his powers thought the same thing: here they go again, same ol’ Spurs, getting so close, only to be undone by a Kawhi Leonard missed free throw or two, an inability to corral a rebound or close out on a dangerous shooter behind the three-point line.

It never happened in Game 3. Leonard made sure, making his first six shots, hitting some absolutely crazy turnaround jumpers in that dazzling first half.

Everybody filled it up from everywhere, sharing the ball, finding the open man, rewarding the cutters and the trailers, making the game look so easy against allegedly one of the best defensive teams in recent memory.

The team without home-court advantage no longer has the benefit of playing three straight at home, meaning Miami needs to treat Game 4 on Thursday about as close to elimination as possible. Because a loss obviously means the Spurs would take a commanding three-games-to-one lead into a Game 5 on their floor.

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And if they’re not going to fall apart on the Heat’s floor, the chances of it happening again back home begin to look more remote all the time.

The series should still go at least six games, but the Spurs responded in a way that left no doubt they are over their mental flagellation from a year ago. They are so over Game 6 psychologically they would probably love to close the Heat out here in another Game 6 just to prove it.

By Mike Wise

>>> Click here: Health Care: Winning The Perception Game

Health Care: Winning The Perception Game

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Byline: Marilyn Werber Serafini and Bara Vaida

LOOKING FOR MORE?Related FeatureThe Impact Of New Rules

Ninety-nine percent of the changes in the landmark health care reform act won’t come before 2014. It’s the 1 percent happening now, though, that may matter most to the law’s success.

By the end of September, the Health and Human Services Department must implement regulations requiring health plans to insure some people who have serious health problems. Insurers must accept children even if they have pre-existing medical conditions, for example, and they may not impose lifetime limits on policyholders’ benefits.

The burden of these popular changes will fall squarely on insurers — and on policyholders, who will probably face somewhat higher premiums. “Any additional benefit has additional costs,” said Karen Ignagni, president of America’s Health Insurance Plans. “So there’s no question of ‘if’ here.” Premiums will go up. The question is whether the increases will be tied to the reform act — both in reality and in public perception.

The reform law gave the federal government some leverage to constrain premium increases, but applying that leverage could spark legal challenges in a political environment where popular support is tenuous at best. While polls show that majorities of the public consistently favor elements of reform, such as requiring insurers to cover all applicants regardless of health status, overall support for the law has declined.

In January, Americans were evenly split, with 42 percent of respondents supporting reform and 42 percent opposing it. In early April, after the law’s enactment, however, support dropped to 39 percent, and opposition climbed to 50 percent, according to the Associated Press-GfK Poll conducted by GfK Roper Public Affairs & Media.

“This is a historic enactment by the [Democratic congressional] leadership, but it’s not necessarily politically stable,” said Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health and the John F. Kennedy School of Government. “These bills are like infants in the neonatal units. They’re most vulnerable in the first year or two.”

Indeed, reform opponents are trying to capitalize on that vulnerability. House Minority Leader John Boehner of Ohio, speaking on the April 12 Bud Hedinger Live radio show in Florida, said, “Repealing this bill has to be our No. 1 priority.” Republicans are likely to highlight any and all premium increases as evidence that the law does more harm than good, and to attribute the slightest rise in health care costs to the reform act.

President Obama, congressional Democrats, and other reform advocates will push back hard, arguing that premiums have long been on an upward trajectory and that the law was not intended to reduce premiums and other costs before the major initiatives phase in four years from now.

And the hit to insurers should be minimal, said Nancy-Ann DeParle, director of the White House Office of Health Reform. She explained that the administration was careful to delay the changes with the greatest impact on insurers until 2014, when the requirement that most people purchase insurance would offset any higher costs. “We have been told by a number of actuaries that if there are increases, it should be pennies or almost nothing,” she said. “Most of the provisions apply to new plans — not all, but most — and other plans are grandfathered. So that, in and of itself, means that the existing plans would not have justification for raising their rates.”

Still, Jonathan Gruber, professor of economics at the Massachusetts Institute of Technology, said, “I’m concerned the whole thing could blow up and be repealed. Insurers will say, ‘See, it’s your fault rates are going up.’ It will provide an excuse for those who want to blame the law for inevitable rate increases they will see.”

Insurance rates have been rising by 7 to 10 percent a year, and premiums will continue to increase at that rate — or slightly faster — in the next year, said Gruber, who added that the increases have little to do with the law. Requiring insurers to pay the full cost of preventive services, without charging patients, might “increase health costs 1 percent,” he predicted, but this and other provisions “will be blamed for the entire 8 percent.”

Insurers are hunkering down for now while they configure implementation teams and consider strategies. They welcome the estimated 32 million new customers that the Congressional Budget Office projects will come to them by 2019, but the near term could prove painful for some insurers if they are forced to take sicker people while getting pressure to hold the line on premiums.

Some health policy experts argue that insurers would be justified in raising premiums because of the law’s mandates; others maintain that insurance companies can afford to absorb the added costs that DeParle characterized as minimal. UnitedHealth Group reported healthy first quarter earnings from operations of $2 billion and a net profit margin of 5.1 percent; the gains marked a 21 percent increase from a year earlier. UnitedHealth attributed the growth to better-than-projected membership and services growth and to “effective cost management.”

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Gary Claxton, vice president of the Kaiser Family Foundation, predicted that most insurers will cut benefits before raising premiums, but that some “who were going to raise premiums anyway” will say that it’s because of the new requirements. Insurers have been in the hot seat recently for proposing rate increases of 35 to 40 percent for individuals and small groups.

As HHS pursues quick regulations, Secretary Kathleen Sebelius has significant leeway to interpret and make decisions about the law. Lobbyists jokingly call health reform the “full employment act for K Street.” Because so much fine print is yet to be written, they feel secure in their jobs for at least a decade.

The phrase “as determined by the secretary” appears frequently in the law. Federal policy makers “have to define how to think about the issue of annual limits,” Ignagni said. “They have to think about how to define ‘no lifetime maximum.’ They have to make a definition of dependent care. They have to define the children’s issue and what they mean by pre-existing conditions.”

Public perception this year may be key to the long-term success or failure of the reform law. Will people believe opponents who argue that the law has immediately raised health care costs, or will they buy the message from Obama and public-interest advocates that costs would have gone up anyway this year, and that the act provides desperately needed benefits?<p>Premium Predicament

Although the reform law doesn’t require individuals to purchase health care coverage until 2014, insurers will feel the pinch of some changes by the end of September. If they raise premiums and thus induce healthier individuals to drop coverage, Ignagni said, the pool of insured people would become sicker and costlier. That, in turn, could jack premiums even higher. The recession has already caused some healthier people to drop their coverage, she said.

Will HHS and state governments fight the expected premium increases? Some carriers worry that the recent experience in Massachusetts foreshadows a broader government resistance to rate hikes. Earlier this year, the state’s insurance commissioner, Joseph Murphy, denied 235 of 274 proposed premium increases. The insurers sued, and the premium increases are now part of a court battle.

Raising premiums could backfire on insurers. Currently, states monitor increases, and some regulators have authority to reject them. Under the new law, which will create state-based insurance exchanges, states will report premium trend increases to HHS and recommend whether the exchanges should exclude certain health plans because of unjustified increases. That’s a serious disincentive for insurers to raise premiums, because the exchanges set to open in 2014 promise to provide insurers with a critical link to new business.

Insurers have another deterrent to raising premiums. Starting in 2011, health plans must spend 80 percent (individual and small group insurance) and 85 percent (large group health plans) of their premiums on medical services and some quality improvements. If they don’t, they will have to rebate money to consumers.

These so-called medical loss ratio rules go into effect at the beginning of next year, but the calculations are based on 2010 health plans. That could present a problem because insurers “have long-term contracts with agents that control administrative costs,” said David Kendall, senior fellow for health policy at the progressive think tank Third Way. “In the small-group markets, premium payments are predetermined and need to be factored into what the medical loss ratio is for those years.” In other words, some insurers cannot realign their spending overnight.

But Senate Commerce Committee Chairman Jay Rockefeller of West Virginia has little sympathy for this excuse. Earlier this month, his committee found that large health insurers in the individual market spent in 2009 more than 26 cents out of every premium dollar on administrative costs and profits. Under some individual and small-group insurance policies, he said, insurers are spending more than one-third of premiums on nonmedical expenses.

Meanwhile, late-September deadlines loom for insurers to implement other benefit requirements. For starters, the law bans health plans from requiring patients to share the cost of preventive medical services. Insurers may no longer charge individuals any type of co-payment, deductible, or fee for certain preventive services, which will be spelled out by the U.S. Preventive Services Task Force.

In another big change, the health reform act requires insurers to cover adult children up to age 26 on their parents’ policies. This is a dream come true for many parents whose children are not in school but haven’t landed jobs that offer coverage. Some experts worry, however, that only sicker people will take advantage of this provision in the short term; individuals are not mandated to have insurance until 2014.

Also under the regime that begins in September, insurers may not exclude children from insurance coverage because they have pre-existing medical conditions, may not cancel policies unless the initial application was fraudulent, and may not limit an individual’s lifetime benefits.

The law spends $5 billion over three years to create temporary high-risk pools to help provide coverage for people who are considered hard to insure. The pools will be available until 2014. To qualify for the program, applicants must have been uninsured for the previous six months and have a pre-existing medical condition.

Health care experts warn that the $5 billion could run out in a matter of months, and insurers worry that they could find themselves responsible for some of the cost.

John Sheils, an actuary at the Lewin Group, pointed out on National Journal’s Health Care experts blog on April 13 that the program will be “of little use to people with illnesses who are trying to preserve their coverage once their COBRA or other insurance options terminate,” because they wouldn’t qualify.

Although more than 30 states already have high-risk pools, funding shortages often translate into long waiting lists and prohibitively high premiums. State pools cover 200,000 people, according to Sheils, who noted that premiums often run 150 to 200 percent higher than those for healthier people. “Even at these premiums, expenses in the pool generally exceed premium revenues,” Sheils wrote. “Most states pay for losses with an assessment on insurance in the fully insured markets. Others pay for losses with tobacco taxes or other revenues.”

As is the case for all of the provisions that kick in this year, HHS will have to write regulations in less than half the typical timeline; health care experts caution that the deadlines could slide.

James Gelfand, the senior manager for health policy at the U.S. Chamber of Commerce, vowed that his group will do all it can to hold regulators to deadlines. “If regulations don’t come out before these effective dates, what are our members supposed to do?”

The White House, however, is confident that deadlines will be met. “I don’t look at this as that hard,” DeParle said. “It’s something that we’ve been through before. It’s very manageable.”

From the Hill to K Street

For Bill Hoagland, the top lobbyist for Cigna, this is a hair-tearing kind of month.

He is fielding a multitude of questions from company executives, but he can’t answer many of them because so many details are yet to be decided. “I have a group of managers who are champing at the bit on how this will impact us,” the longtime Hill veteran said. “We have got to plan now for the coming year, and it’s just been a nightmare trying to answer these questions.”

Trying to influence the rule-making may be a challenge, given the vitriolic nature of the health reform debate, when Obama, Sebelius, and congressional Democrats demonized carriers. “The insurers are in an uncomfortable circumstance in that they have to implement a law they opposed, while trying to influence the process,” said one K Street strategist who has worked with the industry. “They have to be cooperative but still figure out how to get to those in Congress who might be able to fix parts of this that they don’t like.”

Sheryl Skolnick, senior vice president of CRT Capital Group, said, “As a health plan, you are in troubled times. You are going to have to spend a lot of money to make the best of a law that is dangerous for you.”

The insurers will probably have more sway in the states, where they have relationships with insurance commissioners and lawmakers, she said.

Much of the immediate lobbying will focus on the definition of medical loss ratio — the share of premium dollars that insurers must spend on medical services and quality. State insurance commissioners will have a big role in fleshing out those details. Sebelius this month directed the National Association of Insurance Commissioners to establish uniform definitions by June 1.<p>For now, instead of attacking, insurers say they are concentrating on inserting their views into the process of standardizing medical loss ratios and other provisions, and they are working closely with the insurance commissioners group.

Cigna and other large national insurance companies, including Aetna, Humana, Kaiser Foundation Health Plans, UnitedHealth Group, and WellPoint, spent millions of dollars to oppose major provisions of the reform effort, but Hoagland isn’t looking backward. “It is the law of the land, and we will comply with it as the regulations come down,” he said. “We aren’t out there to sabotage this.”

He disagrees with Skolnick that the industry will have lots of money to spend on advocacy. “Implementation will require restructuring and fees on top of that,” he said. “Monies that were available in the past for advocacy will be diverted for implementing the law, and there won’t be resources like in the past.”

But some health-industry players are still finding money for campaign contributions: AHIP has donated $135,000 in the 2010 election cycle, with 56 percent going to Republicans and 44 percent to Democrats. Almost all of the large health insurers have given the majority of their 2010 campaign donations to Republicans, according to the Center for Responsive Politics.

End of the Beginning

Health care reform is the gift that keeps on giving to K Street.

Lobbyists reported earning more than $527.8 million on health care-related issues in 2009, and that figure could go even higher in 2010 as insurers and others grapple with impending changes. Buchanan Ingersoll & Rooney is one of many lobbying firms now shifting gears from Capitol Hill to the executive branch. “The old phrase ‘the devil is in the details’ is exactly why you hire someone like me,” said Alan Rubin, director of federal government relations at Buchanan, whose influential health policy team includes former House Ways and Means Committee Chairman Bill Thomas, R-Calif., and Marty Corry, a former Medicare official.

Lobbyists say that their phones are ringing off the hook as clients try to understand the law’s bottom line. Some are hoping to influence the makeup of key panels to be created under the legislation, such as the Patient-Centered Outcomes Research Institute that will focus on research to compare the effectiveness of medical services.

“There will be a huge effort to lobby [HHS] to interpret vague provisions in favorable ways,” said Rich Gold, who heads Holland & Knight’s lobbying practice. Ed Kutler, a senior partner at Clark & Weinstock, agreed. “New regulations are uncharted territory,” he said, “and that means more lobbying.”

The biggest mistake is “not to engage with the agency,” one former HHS official who now works on K Street said. “There were times when I remember someone coming in with good, solid information about how a proposed regulation would have some unintended consequence, and the agency would say, ‘OK, we think you made a good case.'”

To be sure, lobbyists will still have chances to work Capitol Hill. Clients can persuade lawmakers, particularly those who worked most closely on health reform, to weigh in with the executive branch if lobbyists can make a case that a certain regulation might be a problem. Mehlman Vogel Castagnetti, which represents health insurers, laid out many of those challenges for its clients in a 17-page analysis of the final law, titled “The End of the Beginning.”

“Any good [lobbying] effort in the regulatory phase involves Congress in some way,” said firm partner Dean Rosen, who was previously a health care adviser to then-Senate Majority Leader Bill Frist, R-Tenn., and also served as an insurance association executive. “And we fully expect to be engaged in this new phase.”

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Big Sales Job

Reform advocates are focused on stabilizing popular support for the reform law by explaining its benefits. Families USA, AARP, and Health Care for America Now all have plans to send supporters across the country to highlight the benefits.

They will attempt to counter opponents who see an opportunity to capitalize on the public nervousness as the congressional elections in November draw closer. These and other activists are looking to Obama, who they believe will be crucial in selling the public on the law’s upsides.

“We are entering a new phase, when people will learn more concretely about how the law will affect the country as a whole and their own family in particular and will come to a more final judgment about this major health care reform,” Blendon wrote in an April 8 New England Journal of Medicine article. “Its provisions are to be phased into actual practice over a long period, during which there will be three congressional elections and one presidential election. The state of public opinion, and specifically voters’ attitudes, could play a role in future congressional support for implementation of the law’s various elements.”

Gruber envisions Republican candidates “holding up graphs which show the cost of insurance premiums in 2010 and 2012 and saying, ‘Since Obamacare, premiums have gone up X percent.’ Obama has to say they would have gone up anyway…. The challenge is explaining to people that this law is making things better relative to where they would have been.”

Blendon added: “All the politically oriented groups understand that the November election could turn out to seem like a referendum on this bill. They have to convince people that, actually, the way this will turn out will work well. It requires real explanations of what happens in the future, how the exchange will work, and what happens in Medicare.”

If they don’t, and Republicans win control of the House or Senate, the problems for the administration worsen. The GOP would probably push to block funding of certain provisions rather than try to undo the law, he said. “I don’t think they can repeal the bill, because it would take two [chambers] plus the president,” Blendon said. “But you can modify the bill by not having appropriations…. That’s where the [Republicans] will say they want to come back to the table.”

Supporters of the law will be pushing hard to bolster public opinion to hold off just such a scenario. The White House is planning to hire a high-profile individual to spearhead health reform communications. Families USA is readying a reform road show with state health care organizations such as AARP chapters to explain the sweeping act. “The more people understand what’s in it, the more they will like it,” said Ron Pollack, executive director of Families USA. His group plans to release a monthly reform report tailored to each state, followed by media conference calls. The giant seniors group AARP, meanwhile, is preparing field hearings, question-and-answer sessions, and inserts in its member newspaper.<p>Health Care for America Now, which has union support, is working to forge a strong political presence in swing congressional districts by attending town hall meetings, sending direct mail, knocking on doors, and making phone calls. “We want to make sure that people know where their lawmakers stand. Was it on the side of the insurance companies or on our side?” Executive Director Ethan Rome said.

In one area of the new health care world, the industry and the reform interest groups are working together: Families USA, America’s Health Insurance Plans, and other stakeholders on opposite sides of the issue are establishing a nonprofit called Enroll America to help newly eligible people sign up for state insurance exchanges and for Medicaid.

Still, despite this one instance of accord, the rules to come from the federal government remain the key for all parties, especially for the business community. “If the regulations don’t accurately reflect congressional intent, we will sue,” the U.S. chamber’s Gelfand said.

Marilyn Werber Serafini and Bara Vaida

>>> Click here: Nothing but the tooth: how to keep your choppers healthy

Nothing but the tooth: how to keep your choppers healthy

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Do you go to bed without brushing your teeth? Are you too busy to floss? You may think that skipping brushing or flossing is not a big deal, but neglecting your teeth can lead to some serious (and embarrassing) health problems.

Cavities and gum disease are infections that can cause really stinky breath, incredible pain, and a lot of swelling. Left untreated, those infections can eventually lead to tooth loss. But there are simple steps you can take to prevent tooth decay. Read on to learn everything you need to know about how to keep your mouth healthy for life.

You have a cavity–so what?

Cavities–known by dental professionals as dental caries–are actually infectious diseases. Simply put, a cavity is a diseased spot in the tooth. It all starts with plaque, a sticky bacterial film that coats your teeth and gums. (That’s what feels slimy on your teeth when you first wake up in the morning!) The bacteria eat sugars from things you eat and drink, producing acids. Then, the acids eat away at your tooth’s hard outer coating, or enamel.

If you don’t brush and floss regularly to remove plaque–or if you keep missing a spot–that acid will eventually eat away the enamel entirely, forming a cavity (or a hole in the enamel). “The larger [the cavity] gets, the closer it gets to the nerve, increasing the chance of incredible pain,” according to Lynn Ramer, president of the American Dental Hygienists‘ Association.

A cavity will never just go away by itself. There’s no brushing the problem under the proverbial rug. “Left untreated, 100 percent of the time a cavity will spread,” says Dr. William Berlocher, a dentist who is also president of the American Academy of Pediatric Dentistry.

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If a cavity is caught early enough, your dentist will be able to fix your tooth with simple filling. First, he or she will give you a shot to numb the area so you won’t feel anything. Next, the infection will be removed and replaced with a special material, either a metal amalgam, which is a blend of various metals including silver, or a more natural-looking composite, which is made of glass or quartz mixed with resin. Caitlin G., a 10th grader from New Port Richey, Fla., had to get a cavity filled a few years ago. “It hurt a little bit, but not as much as I expected,” she says.

If you ignore that pain in your tooth, the infection will keep spreading–right into the tooth’s root, forming a more serious and painful infection known as an abscess. At this point, the dentist will have to perform a more complicated procedure known as a root canal and remove the tooth’s nerve.

That’s what happened to Kokomo, Ind., senior Becca J., who has undergone two root canals. “Candy was my favorite thing,” she says. “I’d have some before bed and then go to sleep without brushing my teeth.” Becca knew there was a problem when she started feeling intense pain, “like a shock,” when she ate.

Becca was able to get help soon after she started feeling pain. Twelve-year-old Deamonte Driver from Maryland wasn’t so lucky–the bacteria from his severely infected tooth spread to his brain, and he died. Deaths from tooth infections are extremely rare, but they can happen if the infections are left untreated.

Gums are important too!

If you don’t brush and floss regularly, you’re also at risk for developing gum disease. Not only will your gums bleed and swell, they’ll eventually pull away from your teeth permanently. You’ll be in pain, and your breath will smell. “Worst case,” Ramer adds, “you’ll lose your teeth.” While it’s more common to see adults with tooth loss from gum disease, if you consistently neglect your teeth, it can happen to you now.

Sweets aren’t the only cavity culprit. Sure, candy plays a huge role in tooth decay. But so do high-sugar, high-carbohydrate beverages, such as fruit juices and soft drinks. Even diet soft drinks contain phosphoric acid, which can lead to tooth erosion. And according to Berlocher, “sports drinks are horrible for teeth.”

That’s not to say that you shouldn’t have a sports drink if you’re actually playing sports, but you definitely shouldn’t guzzle one all day long. And after indulging in the occasional sugary beverage, soft drink, or sports drink, you should immediately rinse your mouth out with water, Berlocher recommends. That can help wash away many of the sugars left behind by sweet drinks. (Rinsing won’t work for food, so you still have to brush and floss after you eat!)

Brushing and flossing are no-brainers. Caitlin keeps cavities at bay by brushing her teeth two or three times a day, as recommended by dentists. “I even floss while I’m in the car sometimes,” she says.

It doesn’t matter whether you use an electric or regular toothbrush, according to Berlocher. They both work as long as you spend enough time brushing. Two full minutes twice a day is the absolute minimum. Choose a brush with soft bristles to avoid irritating your gums, and make sure to use toothpaste with fluoride, a mineral that has been proved to help prevent cavities.

Flossing is an important part of oral hygiene because it helps remove plaque from between your teeth, where a brush can’t reach. It’s not important what kind of floss you use, though waxed floss can be easier. The key thing is that you do it at least once, and ideally twice, a day.

There are even some treatments that can help give you a leg up on cavity prevention. Sealants are a protective coating that your dentist can put in the pits and fissures in your back teeth-those spots that are sometimes too small for even a single toothbrush bristle to reach. The coating can last up to 10 years, and it helps keep out cavity-causing bacteria. And regular fluoride treatments can help strengthen weak spots on the tooth and prevent tooth decay.

Braces make brushing trickier. Don’t let braces keep you from staying on top of your routine. “Braces double or triple the difficulty of oral hygiene,” Berlocher says. “It’s harder to scrub away the bacteria.” Maneuvering around all those brackets and wires in your mouth can be tough, so it’s important that you take the extra time and effort to make sure your toothbrush has reached every exposed tooth surface.

And ask your orthodontist about a proxy brush. That has a special shape designed to make brushing teeth with braces more effective. “Antibacterial mouthwashes can also help,” Berlocher says.

Cavities aren’t the only things that can cost you teeth!

“Kids involved in sports who don’t wear a mouth guard are at a much higher risk of losing or damaging their teeth” than kids who do wear mouth guards, Ramer says.

And mouth guards aren’t just for football players–you can lose a tooth in any sport, from wrestling and soccer to baseball and softball. “You don’t think it can happen to you until you’re standing there with your tooth in your hand,” Berlocher says. You can get a moldable mouth guard at a sporting goods store or a custom-fitted one from your dentist.

If you do get a tooth knocked out, don’t panic. Rinse it off, place it back in the socket, and get to a dentist right away. If that’s just too painful (or gross!), put it in liquid–milk is a great choice. Go to the dentist immediately because chances are he or she can put the tooth back.

Bottom line? Neglecting your teeth can have serious consequences, something Becca learned the hard way. “Take care of your teeth!” she advises. “If you don’t, you’ll end up in a lot of pain.”

Say Aah

Curtis S., a 10th grader from Spring Hill, Fla., has a fairly common fear. Going to the dentist, he says, “scares me to death. I really have to psych myself out to go.”

Twice-yearly visits to the dentist are a crucial component of keeping your teeth healthy. Dentists and hygienists understand patient concerns and do all they can to make the experience pleasant. The next time you feel anxious or panicked, try these tips to calm your nerves.

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Distract yourself. “I bring my headphones and listen to my iPod,” says Caitlin G. of New Port Richey, Fla. So long, drill noise!

Communicate your fears and concerns. “Tell your provider if you’re sensitive or scared: American Dental Hygienists’ Association President Lynn Ramer says. That way, he or she can address your concerns and maybe help you feel a little better.

Picture yourself somewhere that you like to be, like at the beach.

Think About It …

How might your life be different if you lost your teeth? What everyday activities would be more challenging?

Key Points

1. Taking care of your teeth can prevent health problems.

2. Brushing and flossing help protect teeth from cavities and gums from gum disease.

3. Candy, soft drinks, and sports drinks can wear away at teeth.

4. Sports are a big cause of tooth injuries, and the right protective gear can keep your teeth safe.

Critical Thinking

How might life be different if you were to lose your teeth to illness or injury? What everyday activities would be more challenging?

Extension Activity

Invite a dental hygienist to visit your classroom. He or she can demonstrate proper brushing and flossing techniques, answer students’ questions about oral health, and talk about new improvements in dental care.

Resources

* ADA.org: Games & Puzzles www.ada.org/public/games/ animation/interface.asp

* ADHA: Proper Flossing www.adha.org/oralhealth/ flossing.htm

* Palo Alto Medical Foundation www.pamf.org/teen/health/ diseases/mouth.html

Taking Care of Teeth

Directions: Read the article “Nothing but the Tooth” (page 8). Check out the illustration below. Then research teeth and oral health, and on a separate piece of paper, answer the questions.

1. For each part of the tooth named above, list which body system it belongs to, what its function is, and what illnesses and diseases can affect it.

2. Besides good tooth-care practices, what other habits and behaviors can affect a person’s dental and oral health?

3. Using the article and your research, write a script instructing young children on how to care for their teeth. Be sure to include both good brushing and flossing techniques, and try to use language that children can comprehend. If you’re artistically inclined, try creating drawings to go with the script, and combine them into a comic or picture book.

Middlekauff, Tracey

>>> View more: Getting high falling low

Getting high falling low

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Carly * dreamed of being a musician. Hanging out at clubs to see bands play was part of her plan. One night when Carly was 14, someone offered her cocaine. Curious to try out what her older friends were doing, she snorted a line.

“After the first time … it was all I could think about,” Carly, now 25, says. “I’d always try to find people who had it and hang out with them and mooch off of them, and then I started paying for it a little bit and then paying for it a lot.” Within a couple of years, Carly couldn’t snort cocaine anymore because the powder had put a hole in her septum, the wall of cartilage that separates the nostrils. Rather than stopping, she switched to injecting herself daily to satisfy the craving for a high.

The Straight Dope

Carly lives in Canada, but her experience mirrors that of many U.S. teens. In this country, 6.4 percent of high school students have tried cocaine. Students in 11th and 12th grades are more likely to have tried it than those in ninth and 10th grades, according to the 2009 National Youth Risk Behavior Survey.

Cocaine comes in many forms, and each has different effects and risks. (See “One Drug, Many Variations,” page 22.) But all the forms carry the risk of addiction. The reason is that cocaine affects the reward system in a person’s brain. Normally, pleasing activities, such as playing sports, being with friends, or smelling good food, cause the brain to release a substance called dopamine, which produces a rewarding sensation. But cocaine causes the brain to release dopamine at almost four times its normal level.

“The problem is, the brain does not allow that type of release to continue forever,” explains Dr. Anthony Dekker, the medical director at Brighton Hospital, a rehab center in Brighton, Mich. The overstimulation of dopamine causes the brain to become numb to its effects over time. “Pretty soon you start having a reactive effect where the things that normally made you happy don’t do that anymore because your brain is used to such strong stimulation. The only way to get that feeling back is to score some more cocaine.”

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Your Brain on Coke

Getting hooked is even easier at a young age. Recent studies have shown that teens are more sensitive than adults to the addictive properties of cocaine because their brains are still developing. Researchers have found that people who start using the drug in their early teens are more likely to develop an addiction than those who start later.

“During teenage development, the brain is more sensitive to those rewarding feelings that are associated with cocaine,” says Sue Andersen, director of McLean Hospital’s Developmental Psychopharmacology Laboratory in Boston. The front part of the brain “undergoes these periods during adolescence where it’s learning how to interact with its environment.” A teen’s brain is learning so much, in fact, that it can “overlearn” habits, such as addiction, more than an adult would. As a result, the changes caused by cocaine are about four times greater in a teenage brain than in an adult’s.

Shaun, * who lives in California and started snorting cocaine at 14, felt the urges immediately. The day after his first high, which he describes as a spinning feeling that gave him a massive rush of energy, he bought more. Pretty soon, he was stealing money, phones, and iPods from classmates so that he could buy more coke. When he started showing up high for class and baseball practice, his teammates stopped talking to him.

“It kind of made me want to stop because I thought, I’m losing my friends over this,” Shaun says. “But then again I’d be using, like, right after. And I’d think, They’re my friends but who cares. I don’t need them; I need this.”

Long-Lasting Consequences

Although a cocaine high can span anywhere from 10 minutes to 45 minutes, its consequences are much longer lasting. Users have reported headaches, nausea, respiratory problems, paranoia, and hallucinations while they’re high. Because the drug increases body temperature, heart rate, and blood pressure, it raises the risk of stroke, respiratory failure, seizures, heart attacks, and death. “Cocaine speeds your heart up and makes your heart pump harder and faster, and your heart may not be able to take it,” says Dekker. Because every person’s body reacts differently, there’s no way to know what amount will lead to an overdose. Aside from cocaine’s physical effects, it can also take a toll on a person’s mental health.

In Carly’s case, friends and family stopped talking to her because she was always irritable and angry. She joined a punk rock band and signed with a record label, only to get kicked out of the group because she was missing practice to get high. It wasn’t until Carly started feeling suicidal that she realized she needed help.

Rehab can take almost twice as long for teens as for adults, according to Andersen. That’s because teens develop stronger attachments not only to cocaine, but also to the places and situations they link it with. “It’s like the cologne of a boyfriend. If you smell it again, it kind of takes you back, and you have all these great feelings,” Andersen says. “It takes longer for teens to decrease these associations [with cocaine] even when they’re not using.”

For Carly, detoxification took four months. When she got out of rehab, Carly found living in the same surroundings as she’d been in during her cocaine-using days was difficult. So she moved across the country to start fresh and go to college. Carly says she still has problems with her family because they don’t fully trust her.

As for Shaun, when Current Health spoke with him, he was two weeks away from finishing rehab and had been clean for 60 days. He now sees cocaine very differently. “The only time it did anything for me was when I was high,” Shaun says, “but then when it was over, it wasn’t ever worth it.”

Think About It

Why, do you think, do people use cocaine despite the risks of addiction, serious health problems, and death? What might convince them not to use it?

One Drug, MANY Variations

Cocaine is extracted and chemically processed from the leaf of the coca plant, which is native to the South American Andes. As a drug, it takes many forms:

POWDER A white powder can be snorted through the nose. It can cause nosebleeds, loss of smell, and problems with swallowing. Reports have also shown that substances in contaminated cocaine can cause a person’s outer skin layer to rot.

LIQUID Powder diluted in water can be injected directly into the bloodstream. That can cause allergic reactions and transmit blood-borne pathogens, such as human immunodeficiency virus (HIV), through exposure to contaminated needles.

FREEBASE OR CRACK A crystal form can be heated to release vapors that are inhaled. Smoking produces the fastest high because the cocaine goes straight into the bloodstream (by way of the lungs) and reaches the brain quickly. The rush is short-lived and can be extremely addictive because users will often seek it out again.

Research has shown that people who use cocaine, in any form, have a higher chance of contracting HIV because of contaminated needles, mouth wounds caused by crack pipes, and an increase in risky behaviors, such as unprotected sex.

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* Names have been changed.

Key Points

* Cocaine is a mind-altering drug that carries a risk of addiction in all its forms.

* Teens, whose brains are still forming, are at an even higher risk of cocaine addiction than are adults.

* Health consequences of cocaine use include serious physical and psychiatric problems, as well as death.

* For teens, rehabilitation from cocaine use may be a long struggle because of the deep dependence on the drug they may form and because of the associations they develop to situations in which they use it.

Think and Discuss

Why, do you think, do people use cocaine despite the risks of addiction, serious health problems, and death? What might convince them not to?

Extension Activity

Use the article as a jumping-off place to help students learn and practice strategies for resisting peer pressure. Write a few short scripts depicting teens in scenarios where they must choose whether to use cocaine (or other drugs). Then select students to act out the scenarios. As a class, list and discuss realistic ways that teens can resist using drugs.

Resources

* NIDA for Teens: Mind Over Matter–Cocaine

www.teens.drugabuse.gov/mom/mom_stim1.php

* No Problem, by Dayle Campbell Gaetz (Orca Book Publishers, 2006)

* Neuroscience for Kids–Cocaine

faculty.washington.edu/chudler/coca.html

Sylvester, Natalia M.

>>> Click here:The problem with obesity: are our lifestyles setting us up for shorter lives?

The problem with obesity: are our lifestyles setting us up for shorter lives?

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Shawna R. was 14 years old and weighed 270 pounds when she found out she needed to lower her blood sugar. “The doctor told me if I didn’t start to get healthier, I would become diabetic in the next couple of years,” says the Haydenville, Mass., sophomore. Shawna’s extra weight had bothered her since fifth grade, but her doctor’s words pushed her to action. “That really scared me.”

Shawna isn’t alone. “Over the last 20 years, we have seen a radical increase in obesity,” says S. Bryn Austin of Children’s Hospital in Boston. In fact, three times as many teens are overweight today as were about 25 years ago.

Your Body on Fat

Fat cells store and release energy into the bloodstream, along with hormones and other compounds that help regulate your body’s systems. When you take in more calories than you burn, fat cells start to swell and multiply. More fat requires more blood, which strains your circulatory system. Excess weight around your joints and windpipe make it harder for you to walk and breathe.

Ballooning fat cells also cause your body’s normal chemical signals to go haywire. Too many fat cells make the brain less responsive to signals that the stomach is full. They also interfere with the way the body processes food and release chemicals that can damage the heart, liver, and muscle cells. Doctors are seeing more teens with serious health problems. Some include high blood pressure, fatty liver disease (a buildup of fat in the liver), type 2 diabetes, and signs of artery hardening–all conditions that can lead to heart disease and stroke.

That spells trouble for many overweight and obese teens. Last year, a nationwide study found that at least one-third, or 7.5 million teens, are so out of shape that they are at significant risk of developing heart disease. And the Centers for Disease Control and Prevention released a 30-minute video called The Biggest Generation, which warned that today’s children may have shorter life spans than their parents.

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Food: You’re Surrounded

Some experts lay part of the blame for obesity on technological advances. “People used to have to work pretty hard to get their food. Now we have to make an effort to be physically active,” says Dianne NeumarkSztainer, an epidemiologist at the University of Minnesota. At the same time entrepreneurs were creating more types of fast food, people also started moving less, driving more, and watching more TV. One in every two kids walked or biked to school 30 years ago, but today, just one in eight does.

Being sedentary (not getting enough physical activity) isn’t the only reason people gain weight, though. Food is a major culprit. Just in the past 20 years, the range of convenience-food choices has exploded. Yes, McDonald’s and Dairy Queen existed in the 1980s, but not Starbucks, Chipotle, or Jamba Juice, let alone food courts or vending machines in schools.

And food companies want your money. Roughly half of all U.S. advertising directed at children and teens is for food, with estimated sales exceeding $27 billion in 2002. In a study of Chicago-area schools, Austin and her colleagues found that fast-food restaurants were “three to four times more concentrated around schools” than those that were randomly located, she says. Given these factors and today’s busy lifestyles, it’s no wonder that teens are eating out more than they used to.

That’s not a good thing. Not only are convenience foods higher in calories and saturated fat than home-cooked meals, but their portion sizes also have ballooned. For example, 20 years ago, a cheeseburger had 333 calories. Today, it has 590. Overall, boys and girls are eating an average of 243 and 123 more calories per day, respectively, than their parents did. Consider that 3,500 calories make up a pound of fat, and you can see how easy it is to gain weight.

Nobody knows that better than Jahcobie C. Last fall, at 5 feet 10 inches and 483 pounds, the Boston native may have been one of the heaviest 15-year-olds in the world. “I would eat 10 McChickens, five apple pies, three large fries, and a Diet Coke,” Jahcobie says. “The most food I could get for the cheapest amount of money is what I would eat.”

Not Weight-ing Any Longer

For Shawna and Jahcobie, the turning point came when they each won a scholarship through Louie’s Kids, a nonprofit organization that sends teens to weight-loss camps and schools. Shawna attended the month-long Wellspring summer camp in Canton, N.C. Now 15, she has shed 90 pounds and reduced her risk of developing type 2 diabetes. Jahcobie spent eight months at the Reedley, Calif.-based boarding school Academy of the Sierras, where he learned a lot about healthy weight-loss strategies. Currently 16, Jahcobie has lost 170 pounds and plans to lose 115 more over the next 18 months.

Both teens say the experiences taught them how to eat well, how to make exercise a part of their daily lives, and how to let go of food as a comfort device. As Jahcobie and Shawna lost weight, each gained a healthy new relationship with food.

Who’s Overweight?

Researchers use a measurement called body mass index (BMI), a ratio of weight to height, A person’s BMI is compared against those of other people the same sex and age. Then it is ranked to determine what a healthy weight is.

“BMI is not a perfect indicator and should be followed up with a doctor or nurse;’ says Virginia Chomitz, senior scientist at the Institute for Community Health of Cambridge, Mass, For instance, a 15-year-old boy who is 5 feet 10 inches tall and weighs 150 pounds would fall into the at-risk category if he gained 20 pounds. But if the weight is muscle mass, that’s a good thing. See the BMI calculator that’s designed just for kids and teens at the Centers for Disease Control and Preventlon’s Web site at apps.nccd.cdc.gov/dnpabmi/Calculator.aspx.

Discuss

* How has the number of overweight teens changed since the 1980s? (Three times as many teens are overweight today)

* How are modern lifestyles and environments affecting waistlines? (People get less exercise in their normal daily activities and have more sedentary pastimes; the reach of fastfood outlets is expanding, especially around schools; young people are increasingly the targets of food-related advertising; and convenience foods are served in bigger portions and are more fattening.)

* How do Jahcobie’s current attitudes toward eating compare with his old mind-set? (Jahcobie used to consume large amounts of fast food because it was inexpensive; now be has learned to think of food as fuel for his body.)

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DO

Across the country, school and health officials are trying different approaches to curb teen obesity. Arkansas officials weigh students and send home information about their body-mass index; California officials are raising the nutritional standards of school meals; West Virginia officials are purchasing dance video games for all public schools; and a group of soft-drink manufacturers has agreed to stop selling all but low-calorie soft drinks in schools within a few years. Have your students research those and other initiatives to combat obesity through schools. Then have them write position papers on whether they think the methods will work and why.

Resources

Last year, the American Academy of Pediatrics published a new set of obesity guidelines (www.aap.org/obesity).

Overeaters Anonymous (www.oa.org) is a 12-step program that helps people who have compulsive eating problems.