Over the past three decades, routine immunizations have prevented 1.1 million deaths and saved the United States $540 billion, the C.D.C. estimated.There’s no way to put a price on the pain and suffering prevented by childhood vaccines. But as it turns out, you can pinpoint the savings to the country.For nearly three decades, childhood vaccines — including those that target measles, tetanus and diphtheria — have saved the United States $540 billion in health care costs, according to a new report from the Centers for Disease Control and Prevention.Routine childhood vaccinations have prevented approximately 508 million cases of illness, 32 million hospitalizations and 1,129,000 deaths, the agency estimated on Thursday.“These vaccine programs, when you create the right infrastructure to implement them, they pay for themselves right away,” said William Padula, a health economist at the University of Southern California who was not involved in the new research.The savings estimate includes money that would have been spent on treating the initial infection and managing later, related conditions. The figure dwarfs the cost of developing the shots.But vaccine-preventable illnesses can also cause indirect economic effects if children become permanently disabled from an infection, or parents miss work while caring for their sick children.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

As videos describing the procedure as agonizing spread on social media, new guidelines advise physicians to consider various anesthetics.In recent years, the process of getting an intrauterine device, or IUD, has become infamous on social media. Videos of women writhing and crying while the T-shaped contraceptive device is inserted have become macabre online staples.“Unless you’re living under a rock, you’re aware of the issue,” said Dr. Beverly Gray, an associate professor of obstetrics and gynecology at Duke University.Doctors have been accused of ignoring the discomfort. For the first time, federal health officials recommended on Tuesday that physicians counsel women about pain management before the procedure.This updated guidance from the Centers for Disease Control and Prevention may lead clinicians to take the pain more seriously and to consider using anesthetics more often, experts said.“Women’s pain and women’s experiences have been downplayed throughout medicine,” Dr. Gray said.“This is really validating that for some people, this can be a really painful experience.”As the number of women opting for IUDs has risen, so have calls for physicians to address the discomfort associated with the procedure. Some women have described it as “the worst pain imaginable” or likened it to a “hot knife” slowly stabbing them.Effective strategies for managing that pain exist, though a 2019 survey found that few doctors offered those options. Less than 5 percent of doctors offered an injection of a local anesthetic during the procedure, many instead prescribing over-the-counter painkillers, which have been shown to be less effective.A study in 2015 found that doctors tended to underestimate the pain their patients experienced during the procedure.While the last version of the C.D.C.’s guidance mentioned pain management for IUD insertion, Dr. Eve Espey, chair of the obstetrics and gynecology department at the University of New Mexico, said she thought these updated guidelines put a much stronger emphasis on the patient’s preferences and experience.“I think it is a significant change,” she said. “The guidance on this topic has gone from a more provider-centered focus to a more patient-centered focus.” Anxiety about pain may dissuade women from considering the contraceptive, which is safe and highly effective, she added.Dr. Antoinette Nguyen, a medical officer in the C.D.C.’s division of reproductive health, said the new guidance emphasized that choices about pain management should be based on “shared decision making,” taking into account patient experiences that may heighten feelings of pain, like anxiety and past trauma.The new guidelines also broadened the pain-relief options available to women during the procedure, a significant addition since lidocaine shots — the sole anesthetic option mentioned in the 2016 guidance — may themselves be uncomfortable, Dr. Espey said.The choices now include anesthetic gel, creams and sprays. While Dr. Espey said the evidence showing these topical anesthetics are effective was not “fabulous,” the new recommendations still expand the arsenal of tools that doctors have at their disposal.“It’s good when the public stamps it’s foot sometimes,” she said.

It’s probably not selfishness, experts say. Even young adults who want children see an increasing number of obstacles.For years, some conservatives have framed the declining fertility rate of the United States as an example of eroding family values, a moral catastrophe in slow motion.JD Vance, the Republican vice-presidential nominee, recently came under fire for saying in 2021 that the nation was run by “childless cat ladies” who “hate normal Americans for choosing family over these ridiculous D.C. and New York status games.”Last year, Ashley St. Clair, a Fox News commentator, described childless Americans this way: “They just want to pursue pleasure and drinking all night and going to Beyoncé concerts. It’s this pursuit of self-pleasure in replace of fulfillment and having a family.”Researchers who study trends in reproductive health see a more nuanced picture. The decision to forgo having children is most likely not a sign that Americans are becoming more hedonistic, they say. For one thing, fertility rates are declining throughout the developed world.Rather, it indicates that larger societal factors — such as rising child care costs, increasingly expensive housing and slipping optimism about the future — have made it feel more untenable to raise children in the United States.“I don’t see it as a lack of a commitment to family,” said Mary Brinton, a sociologist who studies low fertility rates at Harvard. “I think the issues are very much on the societal level and the policy level.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The chief executive and a lead scientist stepped down weeks after a federal grand jury filed fraud charges against a research collaborator.Two top officials at Cassava Sciences — a small pharmaceutical company in Austin, Texas, embroiled in years of controversy over a proposed Alzheimer’s drug — have resigned.Remi Barbier, the chairman and chief executive, stepped down on Wednesday but will remain at Cassava “without duties or responsibilities” until September, according to a company statement.Lindsay Burns, Cassava’s chief scientist, who is married to Mr. Barbier, will also leave the company.In June, a neuroscientist at the City College of New York, Hoau-Yan Wang, was charged with fraud by a federal grand jury for allegedly falsifying data to obtain research grants from the National Institutes of Health.In collaboration with Dr. Burns, Dr. Wang published research studies in support of Cassava’s drug candidate for Alzheimer’s, called simufilam. It is currently in advanced trials, although more than five of Dr. Wang’s studies have been retracted or questioned by scientific journals.Mr. Barbier, Dr. Burns and Dr. Wang could not immediately be reached for comment.In a leaked report last fall, a City University of New York committee investigating the research faulted Dr. Burns for some of the errors discovered in the papers. Its members accused Dr. Wang of “longstanding and egregious misconduct in data management and record keeping.”In a regulatory filing earlier this month, Cassava reported that the Securities and Exchange Commission was investigating the company and two senior employees, who were not identified.Scientists have long criticized the methodological “oddities” in Cassava’s experiments with simufilam, citing suspicious figures in its published papers and questioning the underlying hypotheses about the drug’s mode of action.Dr. William Hu, an Alzheimer’s disease expert at Rutgers University and early critic of Cassava’s studies, said he hoped this was the first of many steps the company would take to make its research rigorous and transparent.Still, significant work needs to be done to “undo the harms from research misconduct,” he wrote in an email.Richard Barry, who has served on Cassava’s board of directors since 2021, has replaced Mr. Barbier as chairman of the board. The company is in the process of finding a new chief executive.Mr. Barry said in the statement that the board was committed to testing simufilam in Alzheimer’s patients with “transparency, accountability and highest ethical business practices.”A spokeswoman at the Food and Drug Administration said it did not discuss ongoing clinical trials or products in development.

As health plans increasingly rely on technology to deny treatment, physicians are fighting back with chatbots that synthesize research and make the case.At his rehabilitation medicine practice in Illinois, Dr. Azlan Tariq typically spent seven hours a week fighting with insurance companies reluctant to pay for his patients’ treatments.He often lost.There was the 45-year-old man who spent five months in a wheelchair while his insurer denied appeal after appeal for a prosthetic leg. Or the stroke survivor who was rehospitalized following a fall after his insurer determined his rehab “could be done at home.”Over the course of Dr. Tariq’s 12-year career, these stories had become more common: The list of treatments that needed pre-approval from insurers seemed ever broadening, and the denials seemed ever rising.So in an effort to spare his patients what he deemed subpar care, and himself mountains of paperwork, Dr. Tariq recently turned to an unlikely tool: generative A.I.For a growing number of doctors, A.I. chatbots — which can draft letters to insurers in seconds — are opening up a new front in the battle to approve costly claims, accomplishing in minutes what years of advocacy and attempts at health care reform have not.“We haven’t had legislative tools or policymaking tools or anything to fight back,” Dr. Tariq said. “This is finally a tool I can use to fight back.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The research, which builds on previous work, eventually may lead to a more objective diagnostic tool, scientists said.The process for diagnosing a child with autism heavily relies on a parent’s description of their child’s behavior and a professional’s observations. It leaves plenty of room for human error.Parents’ concerns may skew how they answer questionnaires. Providers may hold biases, leading them to underdiagnose certain groups. Children may show widely varying symptoms, depending on factors like culture and gender.A study published Monday in Nature Microbiology bolsters a growing body of research that suggests an unlikely path to more objective autism diagnoses: the gut microbiome.After analyzing more than 1,600 stool samples from children ages 1 to 13, researchers found several distinct biological “markers” in the samples of autistic children. Unique traces of gut bacteria, fungi, viruses and more could one day be the basis of a diagnostic tool, said Qi Su, a researcher at the Chinese University of Hong Kong and the author of the study.A tool based on biomarkers could help professionals diagnose autism sooner, giving children access to treatments that are more effective at a younger age, he said.“Too much is left to questionnaires,” said Sarkis Mazmanian, a microbiome researcher at the California Institute of Technology. “If we can get to something we can measure — whatever it is — that’s a huge improvement.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Loaded guns often are not locked, even in homes where there are children, federal researchers reported.Many firearm owners in the United States do not securely store their guns, even when the weapon is kept loaded and there are children in the home, according to a report released on Thursday by the Centers for Disease Control and Prevention.The report, which relied on data from 2021 and 2022 from eight states, found that many gun owners kept weapons unlocked and loaded in their homes despite rising rates of suicides involving guns and firearm fatalities among children. Gun storage practices varied across the eight states: Alaska, California, Minnesota, Nevada, New Mexico, North Carolina, Ohio and Oklahoma.Of those surveyed in Ohio who had both children and a loaded gun in the house, about a quarter said that the weapon was kept unlocked; it was the smallest percentage among the seven states with available data for that metric. In Alaska, more than 40 percent respondents fell into that category.In all eight states, about half of respondents who reported having loaded firearms in their homes said that at least one loaded gun was kept unlocked, a finding consistent with similar studies about firearm storage behavior.The number of children who die by suicide has been trending up for more than a decade. In 2022, firearm suicides among children reached the highest rate in more than 20 years, which public health experts and advocacy groups largely attributed to the Covid-19 pandemic and rising gun sales.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.