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When Ryan Green’s son Joel was 1 year old he was diagnosed with an aggressive brain cancer. Over the next few years, he underwent rounds of chemotherapy and radiation, only to have the cancer return.

Feeling helpless, Ryan turned to what he knew as a video game developer. He began working on a game as a way to understand and confront his son’s deteriorating health. He connected with the Kickstarter community, ultimately raising enough money to back the creation of the game, which made its debut Tuesday. It would have been Joel’s sixth birthday.

The result is That Dragon, Cancer, a deeply intimate, immersive video game that follows Joel’s fight with cancer over four years. But it’s not your typical slay-the-dragon type of game.

“You’re not trying to achieve a high score; you’re not shooting cancer cells with big bazookas, that’s not what this is about,” Ryan says in the Kickstarter trailer.

The game unfolds more like a diary, with the player catching glimpses of memories or snippets of disembodied voices. The player is left trying to make sense of the pieces.

In one scene, Joel floats happily down a playground slide, giggling, and in another he cries uncontrollably while the player navigates an empty hospital crib. Ryan’s tired voice urges, “It’s so late, Joel. Lay down … I can’t make you feel better.”

It’s heartbreaking, and as a player, it’s not always clear what to do to save Joel’s life, or even to help him sleep.

In 2014, the Green family relocated to San Francisco for experimental treatment, but it soon became apparent that it wouldn’t help. In March 2014, while the game was still being created, Joel passed away.

Ryan used recordings of Joel’s laughter and other audio collected during his son’s short life in the game. His wife, Amy Green, a writer and standup comedian, also contributed her voice and writing to the project. It’s part of a growing trend of video games that focus on narrative storytelling.

“We hope that players walk away with a sense of the grace that we experienced and also what it was like to be with Joel and to love him,” Amy says.

The Greens’ story also has been made into a documentary that will be released this year.

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Veteran Dave Manning provided medical support during two combat deployments in Iraq. He’s also been the sole medical provider on a Navy ship with more than 100 people. And yet, after 20 years of service, he says, “Nothing I’ve done really translates over [into civilian jobs] beyond basic EMT.”

But that is about to change. Manning is in the inaugural class of a physician assistant training program launched by the University of North Carolina at Chapel Hill that aims to recruit nontraditional students — specifically, veterans.

UNC staff worked with Army officials at Fort Bragg to figure out how to turn troops’ medical experience into job skills.

“Trying to find something in the medical field without any credentials, without any licensure is tough,” says Manning, who is 43 and lives in Durham, N.C. “There’s nothing out there.”

Manning’s story is becoming more common as the U.S. winds down wars in Iraq and Afghanistan. Some in the UNC medical community and at the state’s huge military bases saw highly trained talent going to waste.

“The medics and the corpsmen are often very skilled in acute medical care of younger people,” says Dr. Paul Chelminski, director of UNC’s new physician assistant program. “They’re extremely skilled in trauma care if they’ve been deployed.”

But, Chelminski says, there are gaps in their ability to diagnose and manage chronic illness, which is a large part of civilian health care. UNC’s program will fill in those missing pieces.

Another part of the UNC program’s appeal is that it will accept some field experience as a prerequisite in lieu of other, more standard, training.

Insurance company BlueCross BlueShield of North Carolina is donating $1.2 million to help launch it and provide scholarships. BlueCross CEO Brad Wilson says the graduates will help with a growing need for care in North Carolina, as more people get insurance through the Affordable Care Act.

“The customers who are accessing the health care system through the ACA are using more services than any other groups,” he says. “Many are in need of primary care, and the physician assistant plays a key role in delivering high-quality, high-value health care.”

The first class, which started in January, will graduate in two years. Nine of the 20 students are veterans. But the program is open to students of all backgrounds.

UNC research shows many veterans with medical training are more interested in becoming physician assistants than doctors. Physician assistants work under the supervision of doctors but still diagnose and treat patients.

Chelminski says the first class comes in with an extraordinary amount of clinical experience compared with the national average. It’ll also be a few years older, with an average age of 33.

Dave Manning explains why becoming a physician assistant feel right for him. “As I was coming out of the military in my early 40s, I didn’t want to spend a decade training and being in school,” he says. “I just wanted to get in and get out, and physician assistant is perfect for that.”

This story is part of a reporting partnership with NPR, WFAE and Kaiser Health News.

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Every year some 2 million Americans get infections from antibiotic-resistant bacteria, and 23,000 of them die from these superbugs.

Superbugs are mostly a hospital problem: They’re where these pathogens are often born and spread, and where the infected come for help. But hospitals are not where the majority of antibiotics sold in the U.S. are used.

Food and Drug Administration data show that 62 percent of antibiotics important for human health are sold to food animal producers and used on farms. And in December, the agency noted that antibiotics for use on the farm increased in 2014, including antibiotics important in human medicine.

Concern about the livestock industry’s overuse of antibiotics has led a number of health care institutions to start choosing meat from animals raised without antibiotics whenever they can. According to Practice Greenhealth, a nonprofit that’s helping the health care industry on this issue, more than 400 U.S. hospitals are working toward a goal of making 20 percent of their meat purchases “antibiotic-free.” And around a dozen hospitals have already switched the majority of their chicken purchases to antibiotic-free.

“Health care is really voicing their demand for [antibiotic-free meat] products,” says Hillary Bisnett, a food expert for Practice Greenhealth and Health Care Without Harm. “Hospitals understand antibiotic resistance, and they’re being asked to steward their own use of antibiotics. So it’s very easy for them to say, ‘Livestock producers need to be doing their part, too.’ “

Is meat from animals raised without antibiotics really better? Public health groups who follow this issue, like the Pew Charitable Trusts, say it can be safer. Of greatest concern is that when chicken, hog or cattle farmers use drugs to promote growth or prevent disease in their animals, they’ll overuse the drugs and create resistant bacteria, like Salmonella and Campylobacter, that could make people sick.

Various studies, including ones by George Washington University microbiologist Lance Price and advocacy groups like Consumer Reports and the Environmental Working Group, have found resistant bacteria on samples of beef, pork, turkey and chicken from supermarkets. If meat contaminated this way isn’t cooked properly, the resistant bacteria can infect humans. And if the pathogens are resistant to antibiotics designed to kill them, then doctors may have few tools to treat the infections.

Among the hospitals that have made antibiotic-free meat a priority for their food services is Hackensack University Medical Center in New Jersey. But according to Kyle Tafuri, senior sustainability adviser at the hospital, it wasn’t easy to figure out how to switch 100 percent of their chicken purchases to antibiotic-free.

At first, the hospital’s distributor said it didn’t have enough antibiotic-free chicken to sell the hospital. But over the course of a few years, and after several meetings with the distributor and a group purchasing organization, they were able to find away to make it work.

Eventually, Tafuri says, the supplier, Perdue, agreed to specially ship the chicken up to the distributor’s warehouse just for the hospital. “It took a lot of work to make this happen and a lot of pushing, but hospitals should be inclined to push the industry to make a change,” he says.

His hospital pays 30 percent more for Perdue’s antibiotic-free chicken under its Harvestland brand, but Tafuri says it’s worth it to his institution to be able to offer a “higher quality and healthier product.” He’s now working on sourcing more antibiotic-free pork and beef, but he says they’re dramatically more expensive, and more difficult to source.

Chris Linamen, executive chef at Overlake Medical Center in Bellevue, Wash., says he’s managed to find antibiotic-free sources for 79 percent of his total meat purchases.

“The biggest challenge is budget,” says Linamen. He’s also struggled to find antibiotic-free sources for specific items, like chicken strips, sausage patties, duck and lamb.

Part of what explains Linamen and Tafuri’s success in getting more antibiotic-free meat on the plates they serve is the fact that neither of their institutions is locked into a contract with a big food service management company, like Aramark, Sodexo or Compass, says Bisnett of Practice Greenhealth. Many other hospitals tell her they would like to source more antibiotic-free meat but can’t, because their contracts do not allow them to.

The biggest food-service management companies have very limited supply of these items. And the hospitals “don’t have flexibility in changing vendors or supply,” says Bisnett.

“That’s why it’s really important that the food service sector get more involved with this issue, too, since one third of hospitals in the U.S. have food service managed by Sodexo, Compass or Aramark,” she says.

Hospitals are far from the only big buyers to get interested in sourcing antibiotic-free meat and apply pressure to biggest meat producers, like Perdue, Tyson, JBS and Smithfield, to make more of it available. Several restaurant and retail chains in 2015 committed to sourcing more antibiotic-free meat, including McDonalds, Subway, Panera, CostCo and Chick-fil-A. Some have committed to sourcing antibiotic-free poultry, while others have also given suppliers of beef and pork a mandatory timetable to go antibiotic-free as well.

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The mammography debate heated up once again in April 2015, when the U.S. Preventive Services Task Force issued a draft of its latest breast cancer screening recommendations.

Now, after the public had a chance to comment, the influential task force has finalized the advice, reiterating that women ages 50-74 ought to receive a screening mammogram every two years. The USPSTF says that women between 40 and 49 don’t get as much benefit from screening as do older women, so they should make an individual decision on when to start based on how they view the benefits and harms. (Women with a family history of breast cancer may benefit more from starting screening before age 50.)

“Our recommendations support the entire range of decisions available to women in their forties,” Kirsten Bibbins-Domingo, a physician and vice chair of the USPSTF, told Shots. Some women may choose to begin at 40 or soon after, deciding they want to lower their cancer risk as much as possible and can handle the chance of false positive results or possible overdiagnosis, when cancer is discovered that never would have been harmful to health.

Other women, she says, may opt to wait until later in their 40s or until they turn 50.

The task force’s supporting materials include statistical models estimating the lifetime consequences of screening women from ages 50-74 and from 40-74. For each 1,000 women screened, the model finds that starting screening at 40 means an estimated one additional breast cancer death averted (deaths drop from eight to seven), with 576 additional false positive tests (1,529 vs. 953), 58 extra benign biopsies (204 vs. 146) and two additional overdiagnosed cases of breast cancer (21 vs. 19).

The task force also says there’s not enough evidence to say whether or not women 75 and older benefit from routine screening for breast cancer. The recommendations were published Monday in the Annals of Internal Medicine.

Since the draft was made public last spring, the American Cancer Society changed its advice for breast cancer screening, saying that average-risk women don’t need to begin annual mammograms until age 45 and can start screening every other year beginning at age 55. Other medical groups still recommend annual screening starting at 40.

While mammography guidelines differ, “it’s important for women and physicians to understand how much convergence there is,” says Bibbins-Domingo. The groups agree that mammography has value as a screening tool, and that the value of screening generally rises with age.

The Affordable Care Act guarantees private insurance coverage of preventive services without out-of-pocket costs for consumers if the evidence supporting the test has an A or B grade from the task force.

But Congress requires full coverage of mammography in women in their forties, despite the C grade, which indicates there is “at least moderate certainty that the net benefit is small.” In an editorial, the task force says that “coverage decisions are the domain of payers, regulators, and legislators” and that the group “cannot exaggerate our interpretation of the science to ensure coverage for a service.”

Just to be clear, this ongoing debate is over screening mammography, which means looking for signs of breast cancer in healthy women who have no symptoms of the disease. No matter your age, or whether or not you’ve started regular screening, if you have symptoms, you need to see a doctor.

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She’s on Twitter: @katherinehobson.

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When Jack O’Connor was 19, he was so desperate to beat his addictions to alcohol and opioids that he took a really rash step. He joined the Marines.

“This will fix me,” O’Connor thought as he went to boot camp. “It better fix me or I’m screwed.”

After 13 weeks of sobriety and exercise and discipline, O’Connor completed basic training, but he started using again immediately.

“Same thing,” he says. “Percocet, like, off the street. Pills.”

Percocet is the brand name for acetaminophen and oxycodone. Oxycodone is a powerful opioid. It’s one of the most commonly prescribed painkillers, and is a key factor in one of the country’s most pressing public health problems — an opioid addiction epidemic. It is a crisis that started, in part, from the over-prescription of painkillers, like Percocet, and then shifted to heroin, as people addicted to prescription drugs looked for a cheaper high.

O’Connor is one of an estimated 2.5 million Americans addicted to opioids and heroin, according to the National Institute on Drug Abuse. Over three years, he detoxed from prescription painkillers — and heroin — more than 20 times. Each time, he started using again. So why is it so hard for opioid addicts to quit? You can boil it down to two crucial bits of science: the powerful nature of opioids and the neuroscience behind how addiction hijacks the brain.

“The first recording of opioid use was 5,000 years ago,” says Dr. Seddon Savage, an addiction and pain specialist at Dartmouth College. It was “a picture of the opium poppy and the words ‘the joy plant.’ “

It Ruined Me But I Loved It

Jack O’Connor says he ended his freshman year of college as an alcoholic. He went home that summer desperate to replace alcohol with something else. And it was not hard to do. In 2012, 259 million opioid pain medication prescriptions were written — that’s enough painkillers for every American to have a bottle of the pills. O’Connor got his hands on some 30-milligram Percocet.

“I ended up sniffing a whole one, and I blacked out, puking everywhere,” says O’Connor. “I don’t remember anything. It ruined me that time. But I loved it.”

Opioids got him higher faster than any drug he had tried. And even though different drugs produce different highs, they all include the same pathway in the brain.

They trigger the release of dopamine, which is a neurotransmitter that causes intense pleasure in parts of the brain that include the limbic system, according to Savage. It links brain areas that control and regulate emotions such as the pleasure of eating, drinking, and sex. “This is a very ancient part of the human brain that’s necessary for survival,” says Savage. “All drugs that people use to get high tickle this part of the brain.”

People can become psychologically and physically dependent on opioids very quickly. Breaking the physical dependence involves a several-day nightmare called detox, when the body gets used to being without the drug.

“It is an amazing thing to see to see someone basically vibrating in their chair, feeling nauseated, looking like hell,” says Jeffrey Ferguson, a detox specialist at Serenity Place in Manchester, N.H.

Jack O’Connor put himself through detox 20 times, but that didn’t stop his addiction. O’Connor’s limbic reward system had hijacked other systems in his brain — systems that drive judgment, planning and organization — driving them all to seek that pleasure of getting high. This process can go on during years of sobriety, according to Savage.

“Addiction recruits memory systems, motivational systems, impairs inhibitory systems and continues to stimulate the drive to use,” she says.

O’Connor says all his decisions began to serve his addiction. When he was using everything was about getting the next drink or drug.

Over his years of addiction, O’Connor lied to his family and stole from his job — all while also trying to get sober. A little over a year ago, he put himself through a five-day detox clinic and managed to get through five more days in the real world sober. Then he couldn’t take it. One day he started obsessively searching his credit cards for drug residue. He found a bag of heroin in his wallet.

“Somebody’s telling me I need to get high,” he thought at the time.

And that’s what he did.

I Don’t Need It Anymore

Feelings like joy and shame also play a role in drug dependence, and make it hard to quit. Practical issues are a challenge, too. “Finding the job, saving money, finding a place to live,” says Ferguson. “Maybe they have some felony convictions. It’s a lot.”

And the country is facing a shortage of addiction treatment facilities and specialists; the shortage ranges wildly from one state to another. Treatment for opioid addiction includes a range of services: medication, talk therapy, job support, all stretched out over years. Detox isn’t enough.

“For people who don’t get intensive treatment, people who are just detoxified [from opioids],” says Savage, “relapse rates can be above 90 percent.”

O’Connor is now 23 and he’s finally sober — Jan. 11 is his one-year sobriety date. In that time he’s been in a nonmedical residential treatment program in Dover, N.H., where he lives and works. He has support — a girlfriend, his family, the Marines. And in the same way that he once replaced his coping skills with drugs, he has now rebuilt his coping skills around quitting drugs.

“I don’t need it anymore,” he says. “I literally, physically and emotionally don’t need it.” And as much as O’Connor loved the feeling of getting high on heroin, now there is something he loves more: “I love the way I feel sober,” he says.

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Promising workers lower health insurance premiums for losing weight did nothing to help them take off the pounds, a recent study found. At the end of a year, obese workers had lost less than 1.5 pounds on average, statistically no different than the minute average gain of a tenth of a pound for workers who weren’t offered a financial incentive to lose weight.

“Our study highlights some of the weaknesses” of workplace wellness programs, said Dr. Mitesh Patel, assistant professor at the University of Pennsylvania’s Perelman School of Medicine and the study’s lead author.

The study, published in January’s issue of the journal Health Affairs, reported the results of a yearlong randomized controlled trial to test the effectiveness of financial incentives to encourage weight loss among 197 obese employees of the University of Pennsylvania health system.

Participants were asked to lose 5 percent of their weight. Each was assigned to one of four study groups. The control group wasn’t offered any financial rewards. The three other groups were offered an incentive valued at $550.

People in one group were told they would begin receiving health insurance premium discounts biweekly immediately after reaching their weight-loss goal. In another group, the people were told they would receive biweekly premium adjustments the following year if they reached their goal. Volunteers in the final group were eligible for a daily lottery payment if they met their daily weight loss goal and weighed in the previous day.

At year’s end, no group had met the 5 percent weight-loss target. Participants’ average weight was virtually unchanged, whether or not they had a financial incentive to lose pounds. Nineteen percent of participants did meet the 5 percent target, but they weren’t concentrated in any particular group.

The study was structured to reflect typical employer workplace wellness plans. “Our study showed that the incentive is not what motivated people, at least in this design,” Patel said.

Eighty-one percent of employers with 200 or more workers that offer health insurance also offered weight loss, smoking cessation or lifestyle coaching programs, according to the 2015 employer health benefits survey by the Kaiser Family Foundation and Health Research and Educational Trust. About two-thirds of large companies offered workers cash or merchandise for participating in these programs, the survey found, with 34 percent offering lower premiums or cost sharing. (Kaiser Health News is an editorially independent program of the foundation.)

The health law encourages wellness incentives by increasing the maximum reward for outcomes-based wellness incentives from 20 to 30 percent of the cost of health coverage, and up to 50 percent if the program is aimed at reducing tobacco use.

This study shows that how incentive programs are designed can make a big difference in how effective they are at changing behavior, Patel said.

The incentives may have failed for a number of reasons, he said. The $550 premium discount may not have been large enough. Bundling the financial reward into the insurance premium on a paycheck rather than making a separate payment to the worker may have affected how it was perceived. Other details — such as the fact that participants weighed themselves at work rather than at home — may have been off-putting to some participants.

Patel also noted that many employer plans don’t pay workers anything until they reach their goal, a situation similar to this study.

“Someone should be encouraged along the way,” he said. “We’ve found from studies that if you want to motivate people, they need regular feedback.”

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

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The U.S. House will vote Wednesday on a bill to repeal the Affordable Care Act. The Senate has already passed it, but President Obama has vowed to veto it.

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Soon after many people fall asleep, they have trouble breathing. Their upper airway constricts and chokes them. They wake, startled, take a deep breath, and fall back to sleep. Then it happens again and again and again.

This condition, obstructive sleep apnea, affects about a fifth of American adults and triples the risk for cardiovascular disease. How exactly has been unclear.

Research published Wednesday suggests that cholesterol, a common culprit in heart disease, plays a special role in raising risk for people with sleep apnea. The findings hint that commonly prescribed cholesterol-lowering drugs called statins could limit the damage sleep apnea does to blood vessels.

In the past, doctors figured the cycle of breathing and choking that happens to sleep apnea patients must be responsible for the heightened risk of heart attack and high blood pressure. But Dr. Sanja Jelic, a physician at Columbia University, says there’s a conundrum: “Why would such a relatively mild [but repetitive] decrease in oxygen cause cardiovascular disease in contrast to other lung diseases that cause more severe [loss of oxygen] but don’t increase risk for cardiovascular disease?”

Jelic figured there might be something happening to the cells lining our blood vessels since they would be the first to experience the particular rise and fall in oxygen afflicting sleep apnea patients. And on the surface of those cells, Jelic says, “We found a protein that protects cells against injury is decreased in obstructive sleep apnea patients.”

But a small group of patients with sleep apnea had normal levels of this protein, called CD59. “We noticed all of these patients were on statins for some other reason — usually to decrease cholesterol,” Jelic says.

When Jelic put blood vessel cells into a chamber that alternated normal and low levels of oxygen, the cells started having trouble purging their insides of excess cholesterol. The cholesterol builds up inside the cells and prompts them to suck the CD59 protein off their membranes. The cells then lose CD59’s protective effect.

Jelic thinks that’s the key to why sleep apnea causes heart attacks and strokes and other cardiovascular diseases and statins seem to help. Without enough CD59 protein on the surface of blood vessel cells, Jelic says, membrane damage will occur. The cells become inflamed and eventually die.

Since statins lower cholesterol, Jelic says the drug would allow more CD59 protein to stay on the cell surface membranes, protecting it from injury. That, in turn, could be lowering harmful inflammation in blood vessels that can lead to cardiovascular diseases.

The study begins to unravel the biology of sleep apnea, says Dr. Atul Malhotra, a heart and sleep medicine physician at University of California, San Diego School of Medicine. “It’s starting to uncover some of the mysteries of why sleep apnea causes heart attacks,” he says. “It helps shed light on how sleep apnea can cause inflammation and how that can lead to cardiovascular risk.”

One implication of the research is that statins could be useful in lowering the risk of strokes and heart attacks in people suffering from sleep apnea, says Dr. Klar Yaggi, a heart and sleep medicine physician at Yale School of Medicine. “The investigators also saw statin treatment reversed that process,” he says. “Statins might complement sleep apnea treatment and play a very important part in reducing cardiovascular risk in sleep apnea patients.”

But Yaggi says there are other ways that sleep apnea could be bad for heart health. “Sleep apnea causes these very transient awakenings, most of the time without the patients realizing they are being woken up. Each of those awakenings is like a jolt of adrenaline,” Yaggi says. Over time, those episodes can cause clots to form in blood vessels and lead to heart attacks.

Taking statins won’t stop people from choking in their sleep. “If you give somebody a statin to prevent sleep apnea complications, they’ll still have fragmented sleep, poor quality of life, and risk for motor vehicle accidents,” says UCSD’s Malhotra. Breathing machines are still an effective treatment for sleep apnea and should continue to be the standard of care, he says. Shedding excess weight can also help.

Jelic says statins might still be useful for sleep apnea patients. He thinks they help patients who have not yet begun using a breathing machine or can’t tolerate using one at night. Or perhaps, he says, there could be an added benefit to using statins on top of the breathing machines.

Follow Angus Chen on Twitter: @angrchen

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