Hillary Clinton this week floated the idea of allowing people over 50 to buy in to Medicare. NPR looks at how that would affect health care costs for everyone else.

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Companies like Google and Fitbit gather all kinds of data on how people behave. Why couldn’t scientists use an app to do the same thing?

Two years ago, mathematicians at the University of Michigan released an app called Entrain to help people get over jet lag. Users entered data on their time zone, when they sleep, what kind of light they’re exposed to, and the app gives them an ideal schedule to recover.

If app users consent, the data get sent back to the researchers. The trade-off — accurate data for useful jet lag advice — motivates people to send in accurate data, says Olivia Walch, a doctoral candidate working on the project. “It’s the path forward for academics,” she says.

The researchers collected data from more than 5,000 users of the Entrain app from 100 countries. The analysis was published last Friday in the journal Science Advances.

Among the findings: Women schedule around 30 minutes more sleep than men; people who spend time in outdoor light tend to go to bed earlier and sleep more than people who spend most of their time in indoor light; and sleep patterns converge as people age, suggesting that there’s a narrower window for when they can fall and stay asleep.

The authors and others say the work shows their app can accurately collect sleep data.

The approach has potential, says Daniel Forger, professor of mathematics and computational medicine and bioinformatics at the University of Michigan and one of the authors. “You could call a million people up, most of those people won’t answer your survey, and spend millions of dollars doing this,” he says. “But what was so remarkable was that — for almost no amount of money and almost instantaneously — we could collect this kind of data.”

Typically, sleep researchers get data from controlled lab environments or large studies with subjects reporting back on what they did, says Jamie Zeitzer of the Stanford Center for Sleep Sciences and Medicine. An app bridges the two, he says.

“This is real life, this is what’s actually happening and … especially in something like sleep, there’s a dichotomy between what people remember they do … and what they actually do,” Zeitzer adds. “This fits quite nicely into that gap and helps us understand actual behavioral patterns.”

Other researchers wonder about generalizations drawn from the data. Among them: Diane Lauderdale, chair of the department of public health sciences at the University of Chicago and a sleep researcher, who says that while the patterns in this paper are plausible, she’s not sure the data support some of the findings.

Her concern is that people who use the app — they have a smartphone, agree to send data back, presumably travel quite a bit — may not be representative of the people in their countries.

“There’s a general challenge as we move into big data sources about how to weigh the attractiveness of using these … to answer questions … that we have not been able to answer and the real limitation that we don’t really have control over, or knowledge about, exactly who we’re getting the data from,” she says. “It’s not just unique to this study.”

Michigan’s Walch agrees, and she says she has spent nights stressing out over this potential selection bias. She points out the patterns they describe match what sleep researchers have previously established in more controlled studies.

“The very first wave of data analysis we did, I was almost distraught,” she says. “A lot of our things are confirmatory, and I came to realize, ‘No, this is great that they’re confirmatory of these smaller studies with fewer people, because it tethers us to reality.’ But then, stepping back, it’s still a problem.”

She says she hopes the spread of the technology and improvements in its ease of use will help.

Ida Sim, co-director of biomedical informatics at the University of California, San Francisco Clinical and Translational Sciences Institute, shares Lauderdale’s concern about selection bias and adds that big data researchers have to go out of their way to get a random representative sample.

They need to hold people’s hands through tech problems, and motivate them to report good data, she said. As an example of something that could meet that standard, she points to the Precision Medicine Initiative from the National Institutes of Health, which aims to recruit 1 million or more people in the U.S. to study treatments that take into account different genes, environments and lifestyles. The president called for $215 million in 2016 for this program.

Sim says another issue is making sure that researchers are measuring the same thing. For instance, an app that reports a blood glucose value isn’t very useful to other researchers unless they know whether it’s fasting blood glucose level, a random level, an average over the past week or a single reading.

“It’s like if people are speaking different languages, and they all use a slightly different word … and it turns out everybody’s talking about the same thing, but the words are slightly different and so communication is impeded.”

She co-founded a nonprofit called Open mHealth that aims to develop open common standards, taking inspiration from the Internet’s open architecture, as explained in a 2010 article in Science.

As for the study on sleep patterns, she says “the findings weren’t that earth-shattering, but the methods and approach are illustrative” and that we can expect more big data research like this in the future.

Alan Yu is a freelance reporter in Hong Kong who contributes regularly to the South China Morning Post. You can follow him on Twitter: @Alan_Yu039

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One aspect of the downfall of Theranos is the blood-testing company’s leveraging of the Do-It-Yourself ethos to promote its product. Theranos provides consumers with a menu of more than 200 low-cost diagnostic blood tests for an array of drugs, ailments, deficiencies and diseases.

It’s legal to order blood tests without consulting a doctor in about two dozen states. But should you?

Theranos and some other medical labs say yes, while critics argue that’s a recipe for disaster.

Here’s Theranos’ founder, Elizabeth Holmes, at TEDMED in 2014, lacing her stemwinder of a presentation with the ideals of patient self-empowerment.

“My own life’s work in building Theranos is to redefine the paradigm of diagnosis away from one in which people have to present with a symptom in order to get access to information about their bodies,” she said, “to one in which every person, no matter how much money they have or where they live, has access to actionable health information at the time it matters.”

She also pitched the crowd an absurdity:

“(T)oday, I can go buy a deadly, exotic animal, a venomous viper, a military truck or armored vehicle. I can buy a tank … but I can’t order a blood-based pregnancy test, or an allergy test. Because that could be dangerous.”

An inspection by the federal government last year found that deficiencies at Theranos’ California lab could “pose immediate jeopardy to patient health and safety.” The company is currently waiting for the Centers for Medicare & Medicaid Services to render a final decision on whether it will lose its license to operate its labs. But, for now, Theranos still does tests at its wellness centers in dozens of Walgreens and other locations in Arizona, plus one in California.

Theranos isn’t the only company marketing blood testing to the worried well. WellnessFX has a partnership with the longtime medical laboratory Quest Diagnostics; consumers in all but seven states can use the WellnessFX website to order their own “biomarker” tests online, along with more traditional tests of thyroid function, blood sugar or testosterone.

Like Theranos, WellnessFX has baked into its marketing campaign the ideals of patient access and independence.

“A lot of the data that can be used to help understand what is best for the patient — historically, that’s always been the clipboard that’s been turned around facing the physician … and never really been shown to the patient,” said WellnessFX co-founder Brent Vaughan in a 2013 promotional video. “Because there’s always been this belief that patients can’t understand — or they don’t want to understand — this information.”

A Growing Trend

Last year, LabCorp, a behemoth in medical diagnostics, dipped a toe in the waters of DIY diagnostics by allowing Arizona consumers to order their own tests. LabCorp CEO David King said in an email that the company’s market research shows a “significant percentage” of consumers are interested in initiating tests on their own. The company plans to expand the service into other states later this year.

“As consumers bear more of the cost of health care out of pocket, they should be, and are becoming, increasingly engaged in managing their health care,” King said. “We absolutely support them in doing so.”

Last April, when the state of Arizona enacted its law — pushed by Theranos — allowing consumers to order their own tests, the bill passed in the House 60-0 and the Senate 26-2. Sen. Steve Farley, a Democrat, was one of the “no” votes. He isn’t surprised at Theranos’ unraveling.

“Really, what we were being asked to do in that bill was to allow our constituents in Arizona to become beta testers, and use their own bodies as the tool of that beta testing,” he said. (Theranos declined to comment.)

The debate over the wisdom of cutting doctors out of the diagnostic loop has been going on for years. Some academics have been vocal about their reservations. Dr. Norman Paradis, an emergency medicine physician and professor of medicine at Dartmouth who has consulted for diagnostic startups, calls the model of offering a wide assortment of tests — as Theranos does — a recipe for disaster.

“If you simply run medical tests in large numbers of people who don’t have the signs and symptoms of a certain disease, then many of the results you get will be false positives,” he explained.

And those patients could then wind up going farther down the rabbit hole of more invasive, potentially harmful tests and treatment.

Paradis said getting medical students and even medical residents to appropriately order tests is difficult enough. “So if it’s difficult for them, it’s even harder for the layperson.”

Dr. H. Gilbert Welch, an internist at the Dartmouth Institute and author of several books on the problems of overdiagnosis, thinks getting your own blood tests is part of the larger negative trend — testing people who aren’t really sick.

“I’m afraid there’s a growing sense that the path to health is through testing,” he said. “But you don’t test yourself to health. Health is much more about how you move, what you eat and finding joy and purpose in life.”

WellnessFX has taken concerns about false positives into account, said Dr. Murdoc Khalegi, an emergency medicine physician, and the company’s medical director. He said the company works with physicians to make sure the tests it offers are not susceptible to inaccurate results.

“We work very hard to [offer tests] that are something a consumer can understand, like having elevated cholesterol or blood sugar,” Khalegi said. “We encourage all of our results to be shared with physicians. But to restrict people from even having that information, which is the way it currently exists in some settings, would be unfortunate. People should be aware if they have certain health risks.”

The Center for Democracy & Technology’s Michelle De Mooy, who has researched the issues of privacy and transparency in health care, dismisses the argument that patients can’t make knowledgeable decisions about when to get tested. She said the issue of false positives is “pretty reasonably addressed” with warnings.

Both she and Khalegi point to the high cost of health care as one reason to give patients more direct access to diagnostic tests. It’s often cheaper for the patient, they say. Having a health insurance policy with a high deductible, or having a lack of access to transportation or child care are reasons people might choose to get tests in the most efficient, least time-consuming way possible.

“The economic disparity question is one that the health care establishment tends to gloss over,” De Mooy said.

One Patient’s Story

Amy, who lives in Santa Cruz, Calif., and asked us not to use her last name to protect her medical privacy, explained why she was motivated to go online last year to order her own test for iron-deficiency anemia, though she was feeling healthy.

Unless somebody has obvious symptoms of anemia, the U.S. Preventive Services Task Force recommends the screening test only for infants and pregnant women. But Amy is vegan, and some of her friends persuaded her to seek out testing because cutting meat and dairy from your diet can increase the risk of iron-deficiency anemia.

And because of her health policy’s high deductible and what she said were bad experiences with insurance companies, Amy didn’t want to go through her health insurer.

Her iron level came back low, according to the test result. But rather than start taking an iron supplement, make changes to her diet or take other action on her own, she made an appointment with a doctor, where she mentioned she’d donated blood a week before the test. Amy hadn’t known this would deplete her iron. And because her other numbers were fine, the doctor told her not to worry.

The whole experience — the blood draw notwithstanding — was painless and reassuring, Amy said.

“I liked being able to answer my own questions and to go to the site and pick which things I was curious about. I like being able to do it independently, since I don’t have a regular general practitioner I go to.”

In some ways Amy fits the profile that both advocates and opponents of self-testing point to: She had no symptoms of anemia and got a test that wound up being unnecessary. But she also felt she had a psychological need to know, and a financial need to pursue the answer cheaply.

Murdoc, of WellnessFX, said that while he defers to official guidelines on medical testing, Amy probably did the right thing in checking for anemia.

“It’s a very cheap blood test,” he said.

This story was produced by KQED’s daily health and technology blog, Future of You. The blog’s host and editor is Jon Brooks.

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Courtney Griffin was addicted to heroin and ready to get help. She packed up her things and her mom drove her to a residential treatment facility about an hour from their home in New Hampshire. There was a bed waiting for her.

But unfortunately, that’s not where her story ends. 90 minutes after they arrived, Pamela Griffin said her daughter was back in the waiting room, shaking her head. Their health insurance company declined to cover the treatment.

“They declined saying that it wasn’t a matter of life and death,” said Pamela Griffin recounting the rejection. “And Courtney said, ‘This drug is going to kill me.’ She knew.”

Without insurance, the treatment would cost $12,000. They left not knowing what to do. The hope of treatment and the letdown of not being able to get it were devastating for the Griffin family.

Less than two months later, Courtney Griffin was dead.

“When you’re the parent of an addict, you’re always afraid of the call,” said Doug Griffin, who signs his emails “Courtney’s Dad.”

He said, “you always know the call is going to come,” but when it did he was shocked anyway. When the phone rang Doug Griffin was at home, full of hope, looking at pictures of Courtney during happier times. With the help of a local police officer and after some time on a waiting list, Courtney was supposed to start treatment the next day.

Instead Courtney died of an overdose of heroin and fentanyl. She was 20 years old and alone.

Her story points to challenges many encounter — not enough capacity in treatment programs and insurance that doesn’t cover the treatment people want or need.

And those delays can be deadly, said Tym Rourke, chairman of the New Hampshire governor’s commission on substance misuse. He said wait lists and insurance denials send the wrong kind of message to people who desperately need help.

“Then the belief is nobody can help me and I’m trapped and nobody can help me and therefore they use again and with this particular epidemic around opiates, there’s no safe use,” said Rourke. “The next time somebody uses could kill them.”

The Wait

There is no good real time tracking of treatment availability or statistics about insurance denials, but one recent study found only about 20 percent of people with moderate to severe drug use disorder received treatment. And when you talk to the family members of people struggling with addiction and you’ll hear countless stories like Courtney Griffin’s.

One issue is that when most people think of treatment, they think of a residential program, 28 days, abstinence and 12 steps. And there simply aren’t enough beds available to help all the people that want that kind of treatment. Many don’t realize there are other options, like medication assisted treatment. But there aren’t enough doctors that do that, either. So there are wait lists for all kinds of treatment.

In 2012, Dean Lemire had been using heroin for about 18 month when he decided he needed to stop.

“The heroin wasn’t doing what I wanted it to,” said Lemire. “When I wasn’t high I was suicidal.”

But when he went to a state funded treatment center, Lemire was put on a waiting list.

“I had to call every day, three times a day for three weeks,” said Lemire. “By the end of two and a half weeks, I gave up.”

He said he downed a fifth of cheap Canadian whiskey from a plastic bottle and got in his car looking for heroin.

“I got in three car accidents, totaled my car. On the third, woke up in a jail cell,” said Lemire. “And when I finally got back home I called the rehab, and I guess they deemed me serious enough to require their services, so they bumped me up and got me in.”

It worked. Lemire is in long-term recovery now. He’s married with a young child and he’s the substance misuse educator at Goodwyn Community Health in New Hampshire, working to help others like himself. But Lemire said the situation hasn’t improved.

“That wait period, you know, has not gotten better,” said Lemire. “It’s actually gotten worse.”

The problem with these wait lists, as Dean Lemeer’s experience makes very clear, is that moment of clarity, when someone who is in the grip of these drugs reaches out for help, can be fleeting. And the system as it exists now isn’t always there with a warm embrace.

Addressing The Problem

Elected officials are now racing to address the obstacles to treatment. States are holding special legislative sessions. The U.S. Senate has already passed a bipartisan package of bills to deal with the opioid crisis, and the House is taking up 18 different bills this week related to opioids. The Centers for Disease Control and Prevention just came out with new guidelines for doctors prescribing these drugs. There is also a White House task force on insurance coverage for drug treatment.

In the inside pocket of his suit coat, Michael Botticelli, the Director of National Drug Control Policy (a.k.a. the White House “drug czar”) carries a small laminated card with a smiling picture of Courtney Griffin. It’s a prayer card from her funeral. Doug Griffin gave it to Botticelli when he met him briefly to talk about addiction issues. Botticelli carries a few of them daily to remind him of the more than 120 people each day, on average, who die from overdoses in America.

“I take them out of my pocket at night and say, ‘What did you do today, to make a difference?'” said Bottacelli. “There are real people behind these numbers.”

He said access to treatment is a very real problem he hears about regularly.

“Too few people are asking for help,” said Botticelli, who himself is in long-term recovery. “And it’s really tragic that people aren’t able to get care and are often dying when they are on waiting lists. We know addiction is a disease. Every other disease you get treatment on-demand, and that’s what we want.”

What The Presidential Candidates Are Saying

When the candidates started going into New Hampshire last year, they were surprised by how much they heard about this issue. They quickly started incorporating it into their campaigns, talking about personal experiences, friends or family members they had lost to addiction.

Donald Trump says he’ll get people as much help as he can, but doesn’t get any more specific than that. And he says the border wall he wants to build will also keep drugs from coming in from Mexico. He is calling for a repeal of the Affordable Care Act, a law that has expanded the access to drug treatment to many that didn’t have coverage for it before, but he insists he will replace it with something “terrific.”

Hillary Clinton released a plan last year that actually has a lot of overlap with what the White House and Congress are working on now. It called for enforcing insurance parity so mental health is treated the same as other medical conditions — making treatment more available, while emphasizing treatment and rehabilitation over prison. She has held multiple town hall-style forums on addiction issues.

Bernie Sanders regularly says addiction should be treated as a disease and not a moral failing.

“When somebody is addicted and seeking help, they should not have to wait three, four months in order to get that help,” Sanders said in a debate moderated by ABC News earlier this year. “They should be able to walk in the door tomorrow and get a variety of treatments that work for them.”

This, he says, is one of the reasons he advocates for a Medicare for all plan.

States where this has been a big problem — like New Hampshire, Ohio, Pennsylvania and West Virginia — are likely to be swing states targeted in the general election.

It looks to be a campaign issue up and down the ballot, too. Ohio, Pennsylvania and New Hampshire all have competitive Senate races.

In New Hampshire, two of the candidates for governor kicked off their campaigns at the same drug treatment center.

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Presidential candidates have been confronted by voters over the crisis of opioid abuse and heroin addiction. One major problem is accessing treatment when someone who needs it is ready to receive it.

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Forty-four states and the District of Columbia have laws on the books requiring health insurers to cover autism treatments. But research evaluating these insurance mandates suggests the efforts are failing to help many children get needed therapy.

The state requirements have increased the number of children by about 12 percent, according to the research presented Wednesday at a major conference on autism spectrum disorder.

There’s been a push for health insurers to better cover often-pricey autism treatments, especially applied behavioral analysis, a type of behavioral modification therapy.

Those efforts come as autism rates have ballooned. In 2014, the most recent year for which data is available, the Centers for Disease Control and Prevention estimated that 1 in 45 children are on the autism spectrum, with symptoms ranging from communication difficulties to repetitive or obsessive behaviors. In 2000, the rate was 1 in 150.

Researchers found that the state mandates, which apply to coverage available on the individual market and some group and employer plans, led to about 12 percent more children getting some kind of treatment for autism. But that’s not nearly enough when compared with the number believed to have the condition, they say.

“These numbers are orders of magnitude below” the CDC’s autism estimates, said David Mandell, one of the researchers and the director of the University of Pennsylvania’s Center for Mental Health Policy and Services Research. “It suggests that a lot of commercially insured kids with autism are not being treated through their insurance.”

The shortfall may have significant health consequences, said Daniele Fallin, who chairs the Johns Hopkins University department of mental health and directs Hopkins’ Wendy Klag Center for Autism and Developmental Disabilities. For children, it’s important to get treatment as soon as possible. If that doesn’t happen, the condition will become more complicated — and more costly — to treat in the long run.

“It’s a big concern any time you see this kind of treatment gap,” said Fallin, who wasn’t affiliated with the study.

The researchers used insurance claims data from 2008 to 2012 compiled by the Health Care Cost Institute, a nonprofit organization that focuses on price transparency. They divided the case files of 154,000 children into four groups.

First, they took states with insurance mandates and split the files between children whose coverage was affected and those whose was exempt. Then, in states without insurance mandates, they divided children with commercial insurance who would have been affected had there been a state mandate, and those who would not.

The study did not include Medicaid plans. The claims data was pulled from three large insurance companies in all 50 states plus the District of Columbia.

The researchers then analyzed how many autism-related treatments were billed to insurance, controlling for factors like age, sex, health plan type and calendar month. They found that having a mandate in place increased the level of treatments billed by an average of about 12.2 percent — 9.9 percent during the mandate’s first year, 16.6 percent the second year and 17.2 percent in subsequent years.

But questions persist beyond whether patients got some form of care. The researchers are still teasing out what kinds of treatments children who used their insurance actually received. And, Mandell said, it leaves open how good that care actually was.

The takeaway is that insurance mandates are “necessary but not sufficient” for helping people get needed therapies, he said.

That makes sense, said Alycia Halladay, chief science officer at the Autism Science Foundation, which helps fund research. Requiring health plans to cover autism therapies was important as a first step, she argued. But more needs to be done.

“You can’t rely on these mandates alone. You can’t say, ‘OK now, everything’s hunky-dory, and everyone’s being served the right way,’ ” she said.

There are a few possible reasons the coverage requirements aren’t always translating to people getting treatment.

Even if insurers have to cover care, there is wide variation in how generous the coverage is. Plans can argue that certain services like speech and occupational therapy as well as applied behavioral therapy aren’t necessary. Or insurers can require higher cost-sharing, or reimburse at a low enough rate that providers don’t participate. Also, not all mandates are equal — some states cap coverage, allow ceilings to the number of visits or limit the age range of beneficiaries.

Even when a mandate is in place, it’s often unclear what insurance plans are actually required to pay for, said Halladay. Plus parents of autistic children may not realize what services are covered, she added.

Then there’s also the fact that, compared to the need, not enough doctors are familiar with autism treatments, noted Mandell, who co-authored a qualitative study published last November in the journal Autism. The research presented Wednesday will appear this summer in JAMA Pediatrics.

“There are long waiting lists for people to get medical referrals for their autism-related problems. There are wait lists all over the place. And that’s because there aren’t enough people trained,” Halladay said. “It’s not an easy problem to solve.”

That could have cost implications, too.

Insurance plans have argued that mandates could drive up premiums. So far, they’ve resulted in increases of about 1 percent, according to the National Conference of State Legislatures, but those could grow if plans cover more services or autism rates keep climbing. That could also color whether other companies not included in the mandates choose to cover these services. For instance, the laws don’t affect large companies that are self-insured, though some, like Home Depot and Microsoft, provide autism treatment coverage.

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Michael Burghardt couldn’t sleep. His legs were shaking, his bones ached and he couldn’t stop throwing up.

Burghardt was in the Valley Street Jail in Manchester, N.H. This was his 11th stay at the jail in the last 12 years. There had been charges for driving without a license, and arguments where the police were called. This time, Burghardt was in after an arrest for transporting drugs in a motor vehicle.

Burghardt, 32, has been taking methadone for 10 years to help his recovery from heroin addiction. Each time he’s been in the jail, he says, he hasn’t been able to continue with the medication-assisted treatment. He hasn’t been able to taper off the medicine either, which means he’s had to go straight into detox.

Four times after he was released from jail, Burghardt says, he relapsed and started using heroin again.

Methadone is a long-acting narcotic that can help people stay off heroin. But the physical symptoms of withdrawal from methadone can last longer than those from the drug it replaces. “You feel like you’re basically dying,” Burghardt says.

The World Health Organization recommends that incarcerated people like Burghardt continue methadone treatment. And if Burghardt lived in most other Western nations – or Iran, Malaysia or Kyrgyzstan for that matter — he likely would be able to do so.

But in the United States, the only people likely to receive methadone or other opioid- replacement drugs, such as buprenorphine, while incarcerated are pregnant women.

That’s the case at the Valley Street Jail. “It’s for the safety and health of the child more than anything,” says Denise Ryan, the jail’s administrator for health services. Withdrawal from opioids can cause miscarriage.

According to a survey published in the journal Drug and Alcohol Dependence, more than half of the nation’s prison systems offer methadone to people behind bars. But most restrict access to pregnant women and, occasionally, those with chronic pain.

Far fewer jails and prisons provide patients with buprenorphine, another opioid replacement drug. Drugs like methadone and buprenorphine are “summarily stopped when people are incarcerated,” says Dr. Josiah Rich, a professor of medicine at Brown University and co-director of the Center for Prisoner Health and Human Rights. “That’s the prevailing practice,” but, he says, it’s one that should change.

Although involuntary opioid withdrawal isn’t directly fatal for adult drug users, it can be “indirectly fatal,” says Dr. Heidi Ginter, assistant chief medical officer for Community Substance Abuse Centers, a chain of treatment centers in New England. As inmates detox from methadone, their tolerance for opioids goes down while their cravings go up. That sets them up for an overdose after they’re released, says Ginter. She says a third of her clients spent time behind bars before they sought treatment.

Burghardt knows how it feels. “You’re dying for a fix,” he says. Scheduling an appointment at a methadone clinic, however, takes days or even weeks. “So you end up relapsing and using again,” he says. Burghardt says this cycle took the lives of three of his friends recently.

In fact, research shows incarcerated drug users are as many as eight times more likely to die immediately after release than at other times in their lives. And, patients who terminate methadone treatment are eight to nine times more likely to die immediately thereafter than those who don’t.

Sometimes, Ginter says, clients end up behind bars while in her care. After undergoing prolonged and painful detox from methadone while incarcerated, she says, many choose heroin over treatment after they get out. “I’m basically having a conversation with somebody where they’re opting for the lesser of two evils,” she says. “That feels really hard.”

Ginter’s experience isn’t unique. In one study, inmates who received methadone behind bars were eight times more likely to seek treatment and stay off drugs during the month following their release than those who received only counseling. In another study, drug users who were not incarcerated were also more likely to seek out methadone treatment when they knew they could continue it behind bars: an indication of how inevitable incarceration can feel for people addicted to illegal substances.

Still, corrections administrators say they prefer abstinence-based treatment programs. They worry that methadone, even when administered as a liquid, can be retained in inmates’ mouths then sold and abused behind bars. Jails and prisons in New Hampshire already face smuggling of Suboxone, a variety of buprenorphine that is manufactured as a papery film, making it easy to conceal in books and mail.

There are practical concerns. Although methadone is inexpensive, facilities would either have to become licensed to administer it or transport patients to methadone clinics, as many do for pregnant women.

Ginter says for her, those reasons don’t cut it. “This is a human rights issue,” she says. “If somebody with diabetes eats a piece of cake at a birthday party, they don’t get incarcerated. And their doctor doesn’t say, ‘Now I’m not going to prescribe your insulin because you ate a piece of cake.’ “

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Our friend and colleague Peggy Girshman, a longtime NPR editor and co-founder of Kaiser Health News, died in March. But her passion for health journalism survives her. She made sure of that.

Beyond the many journalists whose careers she launched and nurtured, Girshman wrote her own eulogy, complete with some hard-earned advice on matters of personal health and how to cover health and medicine.

NPR correspondent Rob Stein read it Saturday at a memorial service attended by more than 150 people, including a who’s who of health and science journalists, at Brookside Gardens in Silver Spring, Md.

Before and after the speeches, there were cookies — lots of cookies — baked by fellow members of her Christmas cookie club.

Mitch Berger, Girshman’s husband, gave us permission to publish her “auto-eulogy,” as she called it, which has been edited lightly for clarity and length.

There’s a common saying that, on their deathbed, no one says, “I wish I had spent more time at work.” I’m an exception to that. A central tragedy in my life is that I couldn’t work longer, if only to convince someone I was right about something.

I also wish I had divided my life to spend more time with my family, especially Beth, Helen, Irv, Natalie, Lianna and Annie, whom I order around and love like a niece. Well, maybe not much more time with my parents. And my friends, including the myriad of best friends, you all know who you are. And you’ve all been the best of friends to me, especially in the last few years.

OK, now that that’s over with, I’m taking a few minutes when you have to listen to me. I’m only sorry I couldn’t be there for your rapt attention and adherence to my advice. Here we go.

For folks with Stage 0 or less cancers, especially DCIS [ductal carcinoma in situ], or prostate, watch and wait. I understand. I was one of those people who say, “Get it out of me.” Please resist that temptation.

At least half of these don’t go on to become invasive cancers. Why should you do all kinds of bad things to your body unnecessarily? And, by the way, it costs waaaay too much.

If you are one of those people who can’t resist the call of the surgeon, do not get a lumpectomy, aka “breast conserving” surgery. I can tell you that from personal and observational experience, it doesn’t conserve the breast.

After the surgery, which often has to be done twice to get clean margins, there is the whole nightmare of radiation, which shrinks tissue and makes for painful inner scarring. Biggest mistake of my life was to do that. And there are a lot of mistakes to choose from.

If I only convince one of you to at least convince one other person, I’ve accomplished something. I know, I’ve done so much good work blah blah blah. But even one person not having surgery would be the crowning achievement of my life. I am not kidding.

Setting aside my own body (oh yeah, it really is set aside now), let’s talk a little about evidence.

If you get nothing else from this memorial service, please think about evidence, truth as best it can be determined. Anecdotal evidence is only meaningful if it involves me, Peggy Girshman. Otherwise, trust the scientific method, where similar groups are compared and with large sample sizes, if possible. Especially when it comes to what you put in your body for medicinal reasons.

OK, I know there’s a lot of eye-rolling out there right now. But why would you take anything that hasn’t been proved to work? Belief is powerful. The placebo effect exists.

While we’re at it, please stop with the lifestyle advice.

Don’t knock people about what they’re eating, how much or when. Yes, if you eat a lot of fresh fruits and vegetables and cut down on fat, you have lowered the chances you’ll get cancer or heart disease.

But that is just one of so many factors, that to judge people about their quantity of fruits and vegetables is simply unfair.

Don’t ask, if someone has lung cancer, if they smoked. Try really, really hard not to even think it in your head. It shows, believe me. It adds pain to an already painful, scary time.

Try to convince yourself that people get sick for so many reasons that we don’t know about. One little mutation in one little cell.

Two people eating the same amount of sugar or carbs every day for years: One might develop diabetes and the other doesn’t. Please don’t examine what one person is eating to cast disapproval in your head while the other one gets a pass.

When 10 studies can’t find any connection between X and Y, please believe it. Don’t think about your friend or even yourself where it seemed to go the other way. Of course it sometimes goes the other way, but why would you want to live your life based on your friend, who is lovely but might have another claim next week.

Don’t say, “I don’t know how you can find anything in your office/house/car.” In other words, wow, you’re a slob. Yes, I’m messy, what do you care? Neat, vegetable-eating people are not morally superior to anyone else.

Be nice to people. Sounds really corny and pedestrian, but it’s how I managed to succeed at work, no s***.

Always make sure there are cookies or something tasty to eat at any in-person meeting. As there should be, right now, in the back. You’ll get to them very soon, I promise.

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Doctors’ scrawls on prescription pads and medical folders are so analog.

These days, they’re prescribing and keeping track of patients’ records using digital devices connected to wireless networks, sometimes remotely. More medical devices are also becoming increasingly small and wearable; they often connect with a handheld controller or even your smartphone through Bluetooth or Wi-Fi, sometimes sending the data directly to physicians.

This convenience, accessibility and cost reduction for our health care comes with risks. A few keystrokes could end in a wrong treatment, for instance — in 2007, Dick Cheney’s cardiologist disabled the wireless functionality of the former vice president’s heart defibrillator out of safety concerns.

The overarching and long-growing problem is this: How do we protect the highly personal data flowing through wirelessly connected medical devices?

Enter Wanda, a prototype developed by Dartmouth College doctoral student Timothy Pierson and his team.

Wanda is essentially two antennae attached to a ruler, in a wand-like fashion. The device uses radio waves to establish a secure wireless connection between devices that generate data.

Here’s how it works: The user turns on the medical device and the digital device it’s getting linked to and then points Wanda — about 11 inches or less away — at the devices one at a time. Wanda then generates and transmits a secret password to each of the devices, connecting them securely within seconds.

Many Wi-Fi networks that transmit personal data aren’t secure connections — and cybercriminals make more money hacking a person’s medical information than from stealing their credit card details, says David Kotz, a Dartmouth computer science professor who leads the Trustworthy Health and Wellness project. It’s developing a technology platform that secures and protects personal health information.

Plus, putting these devices in the hands of patients and relying on them to establish Wi-Fi networks is fraught with difficulties. Some patients don’t have the technical know-how; others have a medical condition that poses a challenge. Most people, however, just create security passwords for their Wi-Fi networks that can easily be hacked, Pierson says.

This could lead to a data breach that may compromise the security of a patient’s records, or even the patient’s health if, for instance, their wireless heart pacemaker or dialysis machine is hacked. Internet security experts have warned for years that these devices are open to data theft and remote control by hackers — and the equipment to do so cost less than $20 in 2011, when a researcher hacked into his insulin pump and altered the settings.

Wanda’s major appeal is its ability to generate a targeted, strong pass code that connects a medical device in essence without the patient’s involvement. Researchers elsewhere have tried similar hypothetical approaches, but they require extra equipment to be included in the medical device, Pierson says.

Some of these ideas suggest that a secret password can be created by using a speaker and a microphone to send sound waves to devices, or by simultaneously shaking devices equipped with accelerometers that detect motion and orientation to establish a secure wireless connection.

Try shaking a treadmill or a refrigerator, Pierson says. “We haven’t seen anything like [Wanda] on the market,” he adds.

Pierson says he and his colleagues envision possibilities for Wanda beyond health care, especially as more of our household items get connected to the Internet. But for now, the team’s focus is on Wanda’s ability to protect sensitive patient data in a medical setting.

Wanda for now is only a prototype. Pierson says it has been received well by volunteer testers who have expressed interest in purchasing the device if and when it hits the market. A release date hasn’t been scheduled because Pierson and his team are still in the process of filing for a patent.

The Senate health committee has been working on legislation that may help spur these kinds of devices through federal regulatory approvals. The lawmakers have set data security as a priority in their latest biomedical innovation agenda.

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Private Medicare Advantage plans treating the elderly have overbilled the government by billions of dollars, but rarely been forced to repay the money or face other consequences for their actions, according to a congressional audit released Monday.

In a sharply critical report, the Government Accountability Office called for “fundamental improvements” to curb overbilling by the health plans, which are paid more than $160 billion annually. The privately run health plans, an alternative to traditional fee-for-service Medicare, have proven popular with seniors and have enrolled more than 17 million people. The plans, which were the subject of a Center for Public Integrity investigation, also enjoy strong support in Congress.

GAO took aim at Medicare’s primary tactic for recouping overcharges, a secretive, and lengthy, audit process called Risk Adjustment Data Validation, or RADV. Unlike many other anti-fraud programs, RADV has cost the government way more than it has returned to the treasury.

The GAO said that the Centers for Medicare and Medicare Services, an arm of the Department of Health and Human Services, has spent about $117 million on these audits, but so far has recouped just $14 million. CMS officials counter that the mere threat of RADV these audits has caused health plans to voluntarily return approximately $650 million in overpayments – and that upcoming audits will recover tens of millions more.

“As the MA (Medicare Advantage) program continues to grow, safeguarding the program from loss is critical,” the GAO report said. The report did not name any of the health plans studied.

The GAO launched its audit in October 2014 in the wake of the Center for Public Integrity’s “Medicare Advantage Money Grab” series. The articles documented nearly $70 billion in “improper” payments to health plans — mostly inflated fees from overstating patients’ health risks — from 2008 through 2013 alone.

The Center’s investigation traced the overpayments to abuse of a billing formula called a risk score, which pays higher rates for sicker patients and less for people in good health. Since 2004, however, the risk score formula has largely operated as an honor system, despite criticism that many health plans have overstated how sick some patients are to boost their revenues. That practice is known in medical circles as “upcoding.”

In addition, CMS records released to the Center for Public Integrity through a court order in a Freedom of Information Act lawsuit show that overbilling has wasted tax dollars almost since risk scores were introduced in 2004. One confidential review of 2005 payments determined that nearly a third of patients enrolled in 22 health plans weren’t as sick as was claimed. The audit projected overpayments of $4.2 billion as a result. Other CMS documents reveal that officials dubbed these health plans “high-flyers,” but did little to reel them in, while RADV audits dragged on for years without reaching conclusions.

Medicare officials have quietly conducted these audits since 2008. But they have never imposed stiff financial penalties, even as evidence built up that billing errors were deeply rooted and wasting tax dollars at an alarming clip.

GAO in its report noted that CMS has failed to target health plans with “known improper payment risk,” thus allowing the worst performers to escape the net. The GAO also criticized the agency for allowing audits and appeals to drag on for years. Some audits of 2007 payments to health plans are still under appeal, for instance.

In response to the GAO report, America’s Health Insurance Plans, the industry’s trade organization, said that an “unconfirmed diagnosis” in an audit doesn’t necessarily mean that the person doesn’t have the disease.

And in recent public comments, the trade group has criticized the RADV audit review process as not yet complete or “fully tested,” to assure that it is “stable and reliable.”

David Lipschuz, an attorney with the Center for Medicare Advocacy, said his group was “troubled” by the extent of the improper payments to Medicare Advantage plans and the government’s “lack of progress on recouping and deterring such payments.”

In an emailed statement, he added: “We hope that policymakers who protect MA (Medicare Advantage) profit at all costs, while at the same time often proposing to shift more costs on to the majority of beneficiaries in traditional Medicare, take heed of this GAO report and ensure that the recommendations are implemented.”

GAO reviewers said that CMS is stepping up the RADV audits, but notes that much more needs to be done. GAO noted that officials expect the upcoming audits to recover $370 million, but that’s just three percent of the total estimated annual overpayment.

CMS officials said they have begun auditing Medicare Advantage payments from 2011 and 2012 and have set a goal to have all Medicare Advantage contracts audited yearly.

“HHS is strongly committed to program integrity in the Medicare Advantage (MA) program and takes seriously our responsibility to protect taxpayer dollars by identifying and correcting improper payments,” the agency said.

While federal auditors have struggled for years to root out these overcharges, at least a half-dozen whistleblowers have filed lawsuits accusing Medicare Advantage plans of ripping off the government.

In the most recent Medicare Advantage whistleblower case to surface, South Florida doctor Mario M. Baez alleges that insurance giant Humana Inc. knew of billing fraud at some South Florida clinics but did little to stop it. Baez argues that inflating risk scores not only wastes taxpayer dollars but also can harm patients. The suit, which was unsealed in late February, is pending. Humana has declined to comment on it.

This piece comes from the Center for Public Integrity, a nonpartisan, nonprofit investigative news organization. To follow CPI’s investigations into Medicare and Medicare Advantage waste, fraud and abuse, go here. You can follow Fred Schulte on Twitter: @fredschulte.

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