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Dress your dog for the sun

Not all dogs tolerate clothing, but for those that do, UV protective clothing can help. Your dog’s hairstyle matters, too: summer is not the time to try out a hairless or super shaved-down look, even if you think it will keep your pet cool. “It’s so important to collaborate with your groomer and say, ‘I want them to get a shorter clip, but I don’t want to see the skin,’” Villanueva says. “You want it to be short, but not too short, especially on the face.”

Read More: Why You Sweat So Much at Night—And What to Do About It

Keep in mind, too, that damage can happen quickly: If a dog is outside in direct sunlight without proper shelter for more than half an hour to an hour, “you run the risk of severe burns, especially on those really tender areas,” Villanueva says. That’s why awareness is so essential. “These sunburns can lead to serious health risks, including skin cancers,” she says. “Be proactive in protecting your pets from sun exposure, so they can remain healthy and safe.”

Bernard J. Wolfson

Republican efforts to restrict taxes on hospitals, health plans, and other providers that states use to help fund their Medicaid programs could strip them of tens of billions of dollars. The move could shrink access to health care for some of the nation’s poorest and most vulnerable people, warn analysts, patient advocates, and Democratic political leaders.

No state has more to lose than California, whose Medicaid program, called Medi-Cal, covers nearly 15 million residents with low incomes and disabilities. That’s twice as many as New York and three times as many as Texas.

A proposed rule by the Centers for Medicare & Medicaid Services, echoed in the Republican House reconciliation bill as well as a more drastic Senate bill, would significantly curtail the federal dollars many states draw in matching funds from what are known as provider taxes. Although it’s unclear how much states could lose, the revenue up for grabs is big. For instance, California has netted an estimated $8.8 billion this fiscal year from its tax on managed care plans and took in about $5.9 billion last year from hospitals.

California Democrats are already facing a $12 billion deficit, and they have drawn political fire for scaling back some key health care policies, including full Medi-Cal coverage for immigrants without permanent legal status. And a loss of provider tax revenue could add billions to the current deficit, forcing state lawmakers to make even more unpopular cuts to Medi-Cal benefits.

“If Republicans move this extreme MAGA proposal forward, millions will lose coverage, hospitals will close, and safety nets could collapse under the weight,” Gov. Gavin Newsom, a Democrat, said in a statement, referring to President Donald Trump’s “Make America Great Again” movement.

The proposals are also a threat to Proposition 35, a ballot initiative California voters approved last November to make permanent the tax on managed care organizations, or MCOs, and dedicate some of its proceeds to raise the pay of doctors and other providers who treat Medi-Cal patients.

All states except Alaska have at least one provider tax on managed care plans, hospitals, nursing homes, emergency ground transportation, or other types of health care businesses. The federal government spends billions of dollars a year matching these taxes, which generally lead to more money for providers, helping them balance lower Medicaid reimbursement rates while allowing states to protect against economic downturns and budget constraints.

New York, Massachusetts, and Michigan would also be among the states hit hard by Republicans’ drive to scale back provider taxes, which allow states to boost their share of Medicaid spending to receive increased federal Medicaid funds.

In a May 12 statement announcing its proposed rule, CMS described a “loophole” as “money laundering,” and said California had financed coverage for over 1.6 million “illegal immigrants” with the proceeds from its MCO tax. CMS said its proposal would save more than $30 billion over five years.

“This proposed rule stops the shell game and ensures federal Medicaid dollars go where they’re needed most — to pay for health care for vulnerable Americans who rely on this program, not to plug state budget holes or bankroll benefits for noncitizens,” Mehmet Oz, the CMS administrator, said in the statement.

Medicaid allows coverage for noncitizens who are legally present and have been in the country for at least five years. And California uses state money to pay for almost all of the Medi-Cal coverage for immigrants who are not in the country legally.

California, New York, Michigan, and Massachusetts together account for more than 95% of the “federal taxpayer losses” from the loophole in provider taxes, CMS said. But nearly every state would feel some impact, especially under the provisions in the reconciliation bill, which are more restrictive than the CMS proposal.

None of it is a done deal. The CMS proposal, published May 15, has not been adopted yet, while the House and Senate bills must be negotiated into one and passed by both chambers of Congress. But the restrictions being contemplated would be far-reaching.

A report by Michigan’s Department of Health and Human Services, ordered by Democratic Gov. Gretchen Whitmer, found that a reduction of revenue from the state’s hospital tax could “destabilize hospital finances, particularly in rural and safety-net facilities, and increase the risk of service cuts or closures.” Losing revenue from the state’s MCO tax “would likely require substantial cuts, tax increases, or reductions in coverage and access to care,” it said.

CMS declined to respond to questions about its proposed rule.

The Republicans’ House-passed reconciliation bill, though not the CMS proposal, also prohibits any new provider taxes or increases to existing ones. The Senate version, released June 16, would gradually reduce the allowable amount of many provider taxes.

The American Hospital Association, which represents nearly 5,000 hospitals and health systems nationwide, said the proposed moratorium on new or increased provider taxes could force states “to make significant cuts to Medicaid to balance their budgets, including reducing eligibility, eliminating or limiting benefits, and reducing already low payment rates for providers.”

Because provider taxes draw matching federal dollars, Washington has a say in how they are implemented. And the Republicans who run the federal government are looking to spend far fewer of those dollars.

In California, the insurers that pay the MCO tax are reimbursed for the portion levied on their Medi-Cal enrollment. That helps explain why the tax rate on Medi-Cal enrollment is sharply higher than on commercial enrollment. Over 99% of the tax money the insurers pay comes from their Medi-Cal business, which means most of the state’s insurers get back almost all the tax they pay.

That imbalance, which CMS describes as a loophole, is one of the main things Republicans are trying to change. If either the CMS rule or the corresponding provisions in the House reconciliation bill were enacted, states would be required to levy provider taxes equally on Medicaid and commercial business to draw federal dollars.

California would likely be unable to raise the commercial rates to the level of the Medi-Cal ones, because state law constrains the legislature’s ability to do so. The only way to comply with the rule would be to lower the tax rate on Medi-Cal enrollment, which would sharply reduce revenue.

CMS has warned California and other states for years, including under the Biden administration, that it was considering significant changes to MCO and other provider taxes. Those warnings were never realized. But the risk may be greater this time, some observers say, because the effort to shrink provider taxes is embedded in both Republican reconciliation bills and intertwined with a broader Republican strategy — and set of proposals — to cut Medicaid spending by $800 billion or more.

“All of these proposals move in the same direction: fewer people enrolled, less generous Medicaid programs over time,” said Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy.

California’s MCO tax is expected to net California $13.9 billion over the next two fiscal years, according to January estimates. The state’s hospital tax is expected to bring in an estimated $9 billion this year, up sharply from last year, according to the Department of Health Care Services, which runs Medi-Cal.

Losing a significant slice of that revenue on top of other Medicaid cuts in the House reconciliation bill “all adds up to be potentially a super serious impact on Medi-Cal and the California state budget overall,” said Kayla Kitson, a senior policy fellow at the California Budget & Policy Center.

And it’s not only California that will feel the pain.

“All states are going to be hurt by this,” Park said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Graphs, visual representations outlining the relationships between different entities, concepts or variables, can be very effective in summarizing complex patterns and information. Past psychology studies suggest that the human brain stores memories and experiences following graph-like and structured patterns, specifically as a network of associations, also referred to as cognitive graphs.

These cognitive graphs are hypothesized to represent different concepts as “nodes” and the relationships between these concepts as edges connecting these nodes. By organizing information in a structured way, they can allow people to apply knowledge they have acquired in the past to new situations and draw conclusions about what is happening based on previous experiences.

The role of cognitive graphs has been widely investigated in the past, with most studies focusing on their contribution to the storage and retrieval of facts and knowledge (i.e., declarative memories). In contrast, the extent to which they influence the planning and control of movements remains poorly understood.

Researchers at Yale University recently set out to investigate the possibility that the human brain also stores memories related to movement as mental graph-like structures, which are then used to plan motor actions in response to visual stimuli. Their paper, published in Nature Human Behavior, presents new evidence suggesting that the brain stores visuomotor associations in structured ways and can then retrieve these associations to plan movements in specific situations.

“Much of human memory takes the form of cognitive graphs that allow us to relate and generalize knowledge,” wrote Juliana E. Trach and Samuel D. McDougle in their paper. “The influence of structured memory in the motor system is less clear. We examine how structured memory representations influence action selection when responses are retrieved from newly learned, hierarchical visuomotor maps.”

As part of their study, the researchers carried out a series of experiments involving 182 participants. These participants were asked to complete a task that required them to press specific buttons in response to different visual cues (e.g., geometrical objects with different shapes or colors) that appeared on a screen.

Notably, they were asked to quickly press a different combination of keys in response to what they saw. For some participants, the associations between what they saw and the keys they were asked to press followed a structured pattern, while for others they were random.

The researchers recorded the time it took for participants to press the correct key combinations. These response times were then analyzed to try to determine whether people were in fact using a mental graph to guide their actions during their experiment.

“Human participants learned visuomotor mappings with (or without) an imposed latent structure that linked visual stimulus features (for example, color or shape) to intuitive motor distinctions, such as hands and pairs of fingers,” explained Trach and McDougle.

“In participants who learned structured visuomotor mappings, transitional response times indicated that retrieving the correct response from memory invoked the ‘traversal’ of a structured mental graph.”

In some trials of the experiment, the researchers also asked participants to press the key combinations as fast as possible or at specific times to determine whether their performance changed when under pressure. Overall, the data they collected suggests that associations between visual stimuli and motor actions are represented as mental graphs, which can be retrieved to guide future actions, even under pressure.

“Forced-response experiments revealed similar computations within individual trials,” wrote Trach and McDougle. “Moreover, graph-like representations persisted even after multiple days of practice with the visuomotor mappings. Our results point to direct links between internal computations over structured memory representations and the preparation of movements.”

This recent study offers new interesting insights into the contribution of mental graphs to the planning and execution of movements. Future research could help to validate the team’s findings, while also potentially examining the role of these structured cognitive representations in a wider range of real-world scenarios.

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Data from CDC indicates this may be a bad tick season. Experts offer tips to reduce your chance of coming down with Lyme disease, ehrlichiosis and other tickborne diseases, and what to watch out for.

ANDREW LIMBONG, HOST:

It’s looking like a bad year for tick bites. Data from the CDC show people are seeking emergency care at the highest rates since 2019. So if you are planning a hike or a trip to the park and you want to avoid these blood-sucking bugs, NPR’s Pien Huang has some tips to help you fend them off.

PIEN HUANG, BYLINE: There are about a dozen different ticks in the U.S. that can cause problems for human health. In the northeast, mid-Atlantic and upper Midwest, the biggest problem is Lyme disease. Thomas Hart is an infectious disease microbiologist at Johns Hopkins University in Maryland. He says Lyme disease is transmitted by infected deer ticks.

THOMAS HART: You can encounter these ticks really at any time of the year, but they’re going to be the most active in warmer months, and they tend to live in woody or grassy areas.

HUANG: In the central and southeastern U.S., ehrlichiosis and spotted fever rickettsiosis are top concerns, along with a tick-induced allergy to red meat. Tick bites are less common in the west, but they also happen there and can spread Lyme disease, anaplasmosis and a few other things. So if all of this is making you itchy, Alison Hinckley, an epidemiologist with CDC, says there are precautions you can take.

ALISON HINCKLEY: You can wear insect-repellent-treated clothing. We call that permethrin-treated clothing. That’s a really easy thing to do.

HUANG: Cover up as much skin as possible and check yourself daily.

HINCKLEY: Showering when you come in from outside really has shown to be a good way to prevent tick-borne diseases.

HUANG: That’s because the longer a tick feeds on you, the higher the risk of infection. So if you find a tick, take it off right away. The best way is to use tweezers, grab it as close to the skin as you can, and find out what type of tick it is and how long it’s been feeding on you. If it’s a deer tick and you’re in an area where Lyme disease is common, Hinckley says see a doctor.

HINCKLEY: The only time you would get an antibiotic after a tick bite and before any symptoms, it would be to prevent Lyme disease. And in that case, we recommend just a single dose.

HUANG: Otherwise, watch for symptoms like fever, aches and rash. If those show up, Hinckley says, seek medical care. You wouldn’t be alone. Some 31 million people get tick bites each year.

Pien Huang, NPR News.

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How much nori, dulse, or arame approximates the recommended daily allowance for iodine?

Dairy milk supplies between a quarter and a half of the daily iodine requirement in the United States, though milk itself has “little native iodine.” The iodine content in cow’s milk is mainly determined by factors like “the application of iodine-containing teat disinfectants,” and the “iodine residues in milk originate mainly from the contamination of the teat surface…” Indeed, the teats of dairy cows are typically sprayed or dipped with betadine-type disinfectants, and the iodine just kind of leaches into their milk, as you can see at 0:35 in my video Friday Favorites: The Healthiest Natural Source of Iodine. 

Too bad most of the plant-based milks on the market aren’t enriched with iodine, too. Fortified soy milk is probably the healthiest of the plant milks, but even if it were enriched with iodine, what about the effects soy may have on thyroid function? When I searched the medical literature on soy and thyroid, this study popped up: “A Cost-Effective, Easily Available Tofu Model for Training Residents in Ultrasound-Guided Fine Needle Thyroid Nodule Targeting Punctures”—an economical way to train residents to do thyroid biopsies by sticking the ultrasound probe right on top a block of tofu and get to business, as you can see below and at 1:10 in my video. It turns out that our thyroid gland looks a lot like tofu on ultrasound.

Anyway, “the idea that soya may influence thyroid function originated over eight decades ago when marked thyroid enlargement was seen in rats fed raw soybeans.” (People living in Asian countries have consumed soy foods for centuries, though, “with no perceptible thyrotoxic effects,” which certainly suggests their safety.) The bottom line is that there does not seem to be a problem for people who have normal thyroid function. However, soy foods may inhibit the oral absorption of Synthroid and other thyroid hormone replacement drugs, but so do all foods. That’s why we tell patients to take it on an empty stomach. But you also have to be getting enough iodine, so it may be particularly “important for soy food consumers to make sure their intake of iodine is adequate.”

What’s the best way to get iodine? For those who use table salt, make sure it’s iodized. “Currently, only 53% of salt sold for use in homes contains iodine, and salt used in processed foods typically is not iodized.” Ideally, we shouldn’t add any salt at all, of course, since it is “a public health hazard.” A paper was titled: “Salt, the Neglected Silent Killer.” Think it’s a little over the top? Dietary salt is the number one dietary risk factor for death on planet Earth, wiping out more than three million people a year, twice as bad as not eating your vegetables, as you can see here and at 2:38 in my video. 

In that case, what’s the best source of iodine then? Sea vegetables, as you can see below and at 2:50. We can get a little iodine here and there from a whole variety of foods, but the most concentrated source by far is seaweed. We can get up to nearly 2,000 percent of our daily allowance in just a single gram, about the weight of a paperclip. 

“Given that iodine is extensively stored in the thyroid, it can safely be consumed intermittently,” meaning we don’t have to get it every day, “which makes seaweed use in a range of foods attractive and occasional seaweed intake enough to ensure iodine sufficiency.” However, some seaweed has overly high iodine content, like kelp, and should be used with caution. Too much iodine can cause hyperthyroidism, a hyperactive thyroid gland. A woman presented with a racing heartbeat, insomnia, anxiety, and weight loss, thanks to taking just two tablets containing kelp a day.

In my last video, I noted how the average urinary iodine level of vegans was less than the ideal levels, but there was one kelp-eating vegan with a urinary concentration over 9,000 mcg/liter. Adequate intake is when you’re peeing out 100 to 199 mcg/liter, and excessive iodine intake is when you break 300 mcg/liter. Clearly, 9,437 mcg/liter is way too much. 
 
As you can see below and at 3:57 in my video, the recommended average daily intake is 150 mcg per day for non-pregnant, non-breastfeeding adults, and we may want to stay below 600 mcg a day on a day-to-day basis, but a tablespoon of kelp may contain about 2,000 mcg. So, I’d stay away from kelp because it has too much iodine, and I’d also stay away from hijiki because it contains too much arsenic. 

This can give you an approximate daily allowance of iodine from some common seaweed preparations: two nori sheets, which you can just nibble on them as snacks like I do; one teaspoon of dulse flakes, which you can just sprinkle on anything; one teaspoon of dried arame, which is great to add to soups; or one tablespoon of seaweed salad.

If iodine is concentrated in marine foods, “this raises the question of how early hominins living in continental areas could have met their iodine requirements.” What do bonobos do? They’re perhaps our closest relatives. During swamp visits, they all forage for aquatic herbs.  

Doctor’s Note:

This is the second in a four-video series on thyroid function. If you missed the previous one, check out Are Vegans at Risk for Iodine Deficiency?.

Coming up are The Best Diet for Hypothyroidism and Hyperthyroidism and Diet for Hypothyroidism: A Natural Treatment for Hashimoto’s Disease.

What else can seaweed do? See the related posts below.