Health News

Icelandic lawmakers are considering a law that would ban the circumcision of boys for non-medical reasons, making it the first European country to do so.

Some religious leaders in Iceland and across Europe have called the bill an attack on religious freedom. It is seen as a particular threat by Jews and Muslims who traditionally embrace the practice.

Under the proposed law, the circumcision of boys — removing the foreskin of the penis, usually when the child is a newborn — would be viewed as equal to female genital mutilation and punishable by up to six years in prison.

“This is fundamentally about not causing unnecessary harm to a child,” said Silja Dogg Gunnarsdottir, lawmaker for the centrist Progressive Party, who introduced the bill this month.

The proposed law calls circumcision a violation of human rights “since boys are not able to give an informed consent of an irreversible physical intervention.”

Circumcision is not common in Iceland, a small Atlantic Ocean island nation of 340,000 people that is overwhelmingly Lutheran or atheist, with an estimated 100 to 200 Jews and about 1,100 practicing Muslims.

The bill has eight co-sponsors but is considered unlikely to get a majority in the 63-seat Iceland parliament. It does not have the formal backing of any government ministers but has drawn the support of 422 Icelandic doctors who favor outlawing the 4,000-year-old religious practice.

They issued a joint statement Wednesday saying circumcision violates the United Nations Convention on the Rights of the Child and also the physicians’ Hippocratic Oath that says: “First, do no harm.”

“In Western societies, circumcision of healthy boys has no significant health benefits,” the doctors’ statement read, citing a 2013 paper in the American Academy of Pediatrics journal.

The American academy itself says the health benefits of the practice outweigh the risks but not by enough to recommend universal male circumcision. The U.S. Centers for Disease Control and Prevention says doctors should educate infant boys’ parents about the health benefits of circumcision, which it says reduces the transmission of sexually transmitted diseases including HIV.

Physician Eyjolfur Thorkelsson said the 422 signatures (a quarter of the country’s practicing physicians, based on numbers from the Icelandic Medical Association) were collected in just 48 hours.

Since 2006, only 21 boys under the age of 18 have been circumcised at Icelandic hospitals or private clinics, according to Iceland’s Directorate of Health. The agency could not say how many were for religious reasons.

Thorkelsson said the surgical procedure is painful, and its possible complications are well known to Icelandic doctors since most go abroad for training at hospitals in northern Europe or the United States where circumcision is more common.

“For many doctors, it’s an uncomfortable request from parents,” he said.

This view is not accepted in Jewish and Muslim communities. During Friday services at a prayer space above a home goods store, Imam Salmann Tamimi warned his multinational congregation about the proposed law.

“Circumcision is harmless if it’s done at a hospital,” he said. “This bill is appealing to people’s emotion, not evidence.”

He said circumcision was important to Muslims but even more so to Jews.

“This is an attack on all religion and especially Judaism,” he said.

Rabbi Avi Feldman of the Chabad Jewish Center, who last month became Iceland’s first permanent rabbi since World War II, says he hopes the bill does not become law. In a statement to the AP, he said circumcision is a core Jewish practice that serves as a bedrock of Jewish life.

He was hopeful that the “rights for people of all faiths will be preserved and respected.”

Parliament is to continue the first reading of the bill in the next week.

Legislator Gunnarsdottir said many male “victims” of circumcision had reached out to share their stories and seek support since she introduced the bill.

“It’s important for us as a society to discuss this,” she said. “The experience of many men who have had this done to their body without consent confirms that.”

With medical marijuana already legal in 29 states and even more states considering legalization, some believe that the inevitable next step is an increase in recreational marijuana use among adolescents, but a new study published today in Addiction busted that myth.

“We had done an earlier study published in the Lancet in 2015 of a million adolescents that were surveyed yearly between 1991 and 2014, and found no increase in teen use of cannabis or marijuana. We were surprised by that result,” said Dr. Deborah S. Hasin, an author of the study and professor of epidemiology at Columbia University.

But despite a series of similar studies with the same result, she said, “People were so convinced that medical marijuana laws were going to increase teen use so they questioned the relationship.”

In order to provide a more definite answer, the study authors went back to do a meta-analysis, a look at all the past studies that were rigorous enough to be included. They systematically reviewed 2,999 academic papers to find 11 suitable studies to pool together.

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None of the 11 studies, which covered data from 1991 to 2014, found an increase in past-month marijuana use among teens after medical marijuana was legalized in their state.

“Altogether, if there was any weak relationship, it would have been found,” Hasin said. “But there was no evidence for increased recreational marijuana use post medical marijuana legalization in teens.”

However, this study does not mean that teens are unaffected by any type of marijuana legalization.

“Regular marijuana use in teens has been shown to lead to impairments in neurodevelopment, later academic functioning, and occupational achievement. Rightly so, people are concerned about teen use — whether that’s with medical marijuana legalization or not,” Hasin said. “What we really don’t know about is [the effects of] recreational marijuana laws.”

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So far, the data are inconclusive. A 2016 study by Hasin and others showed that there was an increase in teen marijuana use in Washington, but not in Colorado after recreational marijuana was legalized for adults in those two states.

Dr. M-J Milloy, assistant professor of medicine at the University of British Columbia and research scientist with the BC Centre on Substance Use, agreed that these are the states to closely watch, but said that it’s possible to even see declines in teen use of marijuana in this situation.

“With the current prohibition scheme, teens are still able to access it,” he said. “Hopefully, by forming a public health regulated system — stores that check IDs instead of dealers who do not — we may see a decline in teen use.”

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Hasin cautioned that, given the economic pressure to commercialize this industry, there’s a need for more regulation in advertisement and the number of retail outlets.

“Americans increasingly see cannabis as a harmless substance,” she said. “But even in adults, people can experience cannabis withdrawal and addiction syndromes. These are all things people need to be aware of instead of thinking that it is natural and therefore risk-free.”

Christy Duan is a psychiatry resident physician at Zucker Hillside Hospital in New York and a resident at the ABC News Medical Unit. Read more of her work at www.christyduan.com.

In Italy, the fight against measles has moved from the doctor’s office to the political battleground.

The nation is facing one of its worst epidemics of measles in recent years, reporting a six-fold increase in cases last year that accounted for a quarter of all the cases in Europe.

And yet the government’s response — a new law requiring parents to vaccinate their kids against measles and nine other childhood diseases — has become one of the most divisive issues going into March 4 general elections.

Public health authorities are incredulous that the small but loud anti-vax movement has gained traction during an entirely preventable measles outbreak, thanks to an election campaign where prominent politicians have questioned the safety of shots and denounced obligatory inoculations.

It’s just one example of how anti-establishment politics has upended even the most basic facts of life and death in Italy, and how a now-discredited Lancet article that linked autism to the MMR vaccine — published 20 years ago this week but subsequently retracted — has had lasting impact.

“Politics shouldn’t enter into questions about health, otherwise we’ll start debating using antibiotics for infections,” Dr. Roberto Ieraci, vaccine coordinator for Rome’s district No. 1, said between administering shots to his squirmy, tiny patients.

“Let’s be clear: Vaccines save lives,” he said. “They improve quality of life. They diminish health costs, both for the individual and collective.”

But Italy’s mainstream medical community is up against a rising tide of populist, anti-establishment politicians, who have jumped on the vaccine-skepticism bandwagon. Many have criticized the new law spearheaded by the Democratic Party requiring parents to inoculate their children against 10 diseases before they can enroll them in school.

“Vaccine yes, obligation no,” has become the mantra of Matteo Salvini, leader of the right-wing, euroskeptic League party who is running alongside Silvio Berlusconi’s Forza Italia party on the center-right coalition that leads the polls. Salvini has vowed to scrap the law if the center-right wins next week.

At an anti-vax rally Saturday in Rome, more than 1,000 people turned out in the rain to denounce the new law and demand “freedom of choice” for their children. They carried banners reading “Science: Doubt it to improve it,” and “The risks connected to vaccines are negligible — until it happens to your child.”

“We want to be free to choose ourselves what to do with our children who were born healthy,” said Milena Muccioli, a mother of a 1-year-old from the seaside city of Rimini. “We don’t want to introduce in their bodies medicines or other things that could damage their body.”

The law goes into effect next month and noncompliance can result in fines of up to 500 euros ($615).

The law was passed over the objections of both the League and the populist 5-Star Movement, whose founder Beppe Grillo has cast doubt about vaccines, mammograms and parents’ obligations to vaccinate, part of his overall distrust of pharmaceutical companies and the health industry.

The 5-Stars insist they’re not anti-vaccination, just against obliging parents to inoculate. But until recently, their official program “Vaccinate yes, vaccinate no, Let’s have clarity” posed the question of whether to vaccinate. It highlighted possible side effects, said parents had lost faith in science, doctors, pharmaceutical companies and politicians, and called for a reduction in the number of obligatory inoculations.

One 5-Star candidate for the northern Veneto region, Sara Cunial, once called vaccines “genocide.”

So Health Minister Beatrice Lorenzin, architect of the law and leader of a small party in the center-left coalition, has spent most of her campaign time defending it.

“Too many vaccines? And who decides, Salvini?” Lorenzin said in Rome, denouncing the anti-vax campaigners and noting that France requires 11 vaccinations. “Let’s let mothers and fathers do their jobs, doctors do theirs, and politicians step aside and stop talking about things they don’t know.”

Prior to the new law, parents in Italy were only obliged to vaccinate children against four diseases: diphtheria, tetanus, polio and hepatitis B. But enforcement was uneven and a certain vaccine-skepticism grew, thanks in part to the doubts cast by the Lancet article, since retracted, linking autism to the measles, mumps and rubella vaccine.

By 2015, Italy’s overall vaccination rate among 2-year-olds fell to 93.4 percent, well below the 95 percent threshold set by the World Health Organization as the minimum benchmark to prevent epidemics. For some individual vaccines like MMR, Italy’s inoculation rate in 2015 fell to 85.3 percent, creating ripe conditions for the epidemic that last year led to 5,006 cases and four deaths.

“85.3 percent is simply not good enough,” said Robb Butler, European program manager for WHO’s division of vaccine-preventable diseases. “That places Italy in the bottom handful of countries of the 53 in our region.”

Italy’s measles cases were second only to Romania’s 5,562 cases, and the two together accounted for half the measles cases in Europe last year. Romania, however, has a large population of Roma, also known as Gypsies, who face discrimination and often can’t access health services, which is not the case in Italy, where health care is universal and free, Butler said.

Butler said Italy’s measles outbreak spread in part among adolescents and young adults — precisely the age group who might have missed out on measles vaccinations following the doubts sown by the Lancet article 20 years ago. These unvaccinated young adults, he said, then spread the disease to more vulnerable groups: unvaccinated newborns, immuno-compromised people who can’t be vaccinated, the elderly and the frail.

Dr. Giovanni Rezza, research director at the health ministry’s Superior Institute of Health, said some traits made Italians vulnerable to the power of the internet to spread disinformation.

Italians can be selfish, he said, often question authority and dote excessively over the one or two children they have. He says many parents have forgotten there was a time when people died of the diseases that now can be prevented if everyone is vaccinated.

“Vaccines are victims of their own success,” Rezza said.

Patricia Bath is a pioneering ophthalmologist who invented a technique that revolutionized cataract surgery.

But as an African-American woman, which was rare in her field as she rose in prominence, she said she faced hate, segregation and racism.

“I had a few obstacles but I had to shake it off,” Bath told “Good Morning America” anchor Robin Roberts. “Hater-ation, segregation, racism, that’s the noise you have to ignore that and keep your eyes focused on the prize, it’s just like Dr. Martin Luther King said, so that’s what I did.”

Bath invented a technique called laser phaco that revolutionized cataract surgery, and in doing so became the first African-American female doctor to receive a special patent.

“I knew that that was a groundbreaking discovery. So I immediately did file a patent for this new technology in 1986,” Bath said.

Patricia Bath

She credits all her success to her years of hard work.

She was a National Science Foundation Scholar by the time she reached high school and her cancer research earned her a front-page feature in the New York Times.

“I was in Harlem, it was the tip of the civil rights era, I think that was noteworthy that a black child in Harlem could be doing scientific research alongside a white kid from the Hamptons,” Bath said.

After earning her medical degree from Howard University, Bath rose in her chosen specialty of ophthalmology, a field in which African-American women were rare.

“I did not allow that to phase my vision,” Bath said. “If anything, it challenged and inspired me not to be equal but to be better and the best.”

Patricia Bath

Bath became the first female ophthalmologist at UCLA’s Jules Stein Eye Institute in 1974 and Time calls her one of the “women who changed the world.”

In 2009 her advocacy for the blind was recognized by President Barack Obama, who appointed her to his commission for digital accessibility for the blind.

“It was exciting to become an incidental role model simply by striving for excellence, working hard and, giving back to the community,” Bath said.

She added that optimism and paving a path for future generations helped her overcome other hurdles in her career.

“I want to pass the torch to young girls and have them do S.T.E.M. [science, technology, engineering and mathematics] and have them do ophthalmology,” she said.

The popular Dietary Approaches to Stop Hypertension (DASH) diet was created to lower blood pressure, but new research says it can also reduce the risk of depression later in life.

A study, to be presented at the American Academy of Neurology’s 70th Annual Meeting in April, shows that the popular diet — rich in vegetables, fruit, whole grains, fat-free or low-fat dairy products and very few foods that are high in saturated fats and sugar — does more than what has been shown in multiple studies: Lowering blood pressure, bad cholesterol (LDL) and body weight.

“Depression is common in older adults and more frequent in people with memory problems, vascular risk factors such as high blood pressure or high cholesterol, or people who have had a stroke,” said study author Laurel Cherian, MD, of Rush University Medical Center in Chicago and a member of the American Academy of Neurology, in a press release.

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“Making a lifestyle change such as changing your diet is often preferred over taking medications, so we wanted to see if diet could be an effective way to reduce the risk of depression,” Cherian added.

Almost 1,000 adults with an average age of 81 were followed for an average of six-and-a-half years.

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They were monitored for symptoms of depression and completed yearly surveys about their diets (whether what they ate was closer to the DASH diet, Mediterranean diet or the traditional Western diet).

The odds of becoming depressed over time was 11 percent lower among the adults who followed the DASH diet more closely. The group that followed a Western diet — high in saturated fats and red meats, low in fruits and vegetables — were more likely to develop depression.

The Mediterranean diet recommends emulating how people in the Mediterranean region have traditionally eaten, with a focus on foods like olive oil, fish and vegetables. U.S. News and World Report called the diet a “well-balanced eating plan” when placing it at the top of its best diets for 2018 list in January.

What is the DASH Diet?

The DASH diet has been ranked as the No. 1 overall diet by U.S. News and World Report for eight consecutive rankings. It tied this year in the No. 1 spot with the Mediterranean diet in U.S. News and World Report’s ranking.

Originally started by the National Heart, Lung, and Blood Institute (NHLBI) as a diet to help reduce blood pressure, the DASH diet is made up of low-sodium and healthful foods. The NHLBI publishes free guides on the plan so you can see if it is right for you.

“The thing about the DASH diet is you’re eating specifically the foods you’ve always been told to eat, pretty much fruit, vegetables, whole grain, lean protein and low-fat dairy,” Angela Haupt, assistant managing editor of health at U.S. News and World Report, told ABC News in January. “And it eliminates foods high in fat and sugar-sweetened drinks and sweets.”

What do findings mean for Americans and their families?

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That something as simple as your diet can affect you in multiple ways, according to ABC News’ senior medical correspondent, Dr. Jennifer Ashton — something like depression isn’t just happening in the brain.

“We can’t silo a condition or body part from the rest of our bodies and our behavioral practices. … We should take a holistic view on conditions such as depression, mood, cognitive decline, stroke, cardiovascular disease and how food, nutrition and dietary habits affect risk of disease.”

It’s never too late in life to change eating or exercise habits; the medical effects of both can be wide-ranging.

“The more we can integrate that, the better,” Ashton said.

Jay-Sheree Allen, MD, is a resident in the ABC News Medical Unit.

“Pharma Bro” Martin Shkreli was responsible for nearly $10.5 million in losses in a securities fraud scheme, a judge ruled Monday, a blow to the defense that could result in a harsher sentence for the eccentric former pharmaceutical company CEO.

U.S. District Judge Kiyo Matsumoto rejected arguments by Shkreli’s lawyers that investors in two failed hedge funds didn’t suffer actual losses because he compensated them with drug company stock that, in the end, more than covered their initial investments.

In a written decision in federal court in Brooklyn, the judge found Shkreli should be penalized for the losses because he made risky transactions with investors’ millions without their permission.

After dipping into investor money from one of the hedge funds to keep his drug company startup afloat, Shkreli “used some the funds to satisfy both personal and unrelated professional obligations,” including a $900,000 debt for a bad stock market trade, she wrote.

Shkreli was convicted at trial last year, remains in jail and faces up to 20 years in prison at his sentencing on March 9.

The defense had hoped that under sentencing guidelines he would get little or even no prison time. Monday’s decision on losses appears certain to work against him .

One of Shkreli’s attorneys, Ben Brafman, said in a statement that he was “disappointed by the ruling but still hopeful that the court will find it in her heart to impose a reasonably lenient sentence.”

At a hearing last week, prosecutors asked the judge to order Shkreli to forfeit about $7.3 million in assets, including a one-of-a-kind Wu-Tang Clan “Once Upon a Time in Shaolin” album that he has boasted he bought for $2 million, as part of the punishment. The judge hasn’t ruled on that request.

Shkreli, 34, is perhaps best known for boosting the price of a life-saving drug by 5,000 percent and for trolling his critics on social media, where he became known as “Pharma Bro.” His bail was revoked last year after he posted a veiled threat against Hillary Clinton.

A new drug that its makers say will kill the flu virus in just a day, called Xofluza, just received a fast-tracked approval that could bring it to store shelves in Japan by May.

The drug, which has generic name baloxavir marboxil, promises to be more advanced than Tamiflu, or oseltamivir — the existing drug used to treat flu.

Both drugs work to shorten the duration of flu symptoms by a couple of days. Taking Xofluza won’t end symptoms any sooner. Xofluza, however, promises to deactivate the flu virus in the human body as quickly as 24 hours after it’s taken.

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While existing treatment plans suggest taking antiflu drugs repeatedly over the course of five days, Xofluza is one pill, taken only once.

Though the patient’s experience of the flu will be the same, this means that after that one dose and one day, patients would no longer be infectious. That could be a game-changer in terms of spreading the flu to others.

The Japanese firm that makes Xofluza, Shionogi, received the fast-tracked approval from Japan’s health ministry to make and sell it there. The drug may not be available to buy in Japan until May, though, because no price has been set by the country’s national insurer.

Roche, the drug manufacturer that makes Tamiflu, is already working with Shionogi and another drugmaker on trials in the U.S.

“We believe Shionogi’s innovative influenza compound, combined with Roche and Genentech’s experience and expertise in influenza, will ideally position us to address the unmet need of influenza patients,” the company told ABC News, referring to their positive trial results and the goal of killing the flu virus within a day.

Roche added that the new drug offers “the potential to reduce transmission from one person to the other.”

Though some late-stage drug trials are in progress, the drug has yet to be approved by the FDA for sale in the U.S. The soonest it could be offered would be the 2018 to 2019 flu season, if approval comes this year.

For a country rocked by the intense flu season that may not conclude until April, it offers hope that there might soon be a new weapon against the common, killer disease.

Amid the outcry over the Florida school shootings, the Trump administration says it is “actively exploring” ways to help states expand inpatient mental health treatment using Medicaid funds.

President Donald Trump again brought up the issue of mental hospitals in a meeting with governors on Monday, invoking a time when states maintained facilities for mentally ill and developmentally disabled people.

“In the old days, you would put him into a mental institution,” Trump said, apparently referring to alleged shooter Nikolas Cruz, whose troubling behavior prompted people close to him to plead for help from authorities, without success. “We’re going to have to start talking about mental institutions …we have nothing between a prison and leaving him at his house, which we can’t do anymore.”

Organizations representing state officials and people with mental illness say no one wants to go back to warehousing patients. But they also say that federal action is needed to reverse a decades-old law known as the “IMD exclusion,” which bars Medicaid from paying for treatment in mental health facilities with more than 16 beds. IMD stands for “institution for mental diseases.”

Last year, the Trump administration opened the way for states to seek waivers from the policy in cases involving treatment for substance abuse. On Monday a spokesman said states are pressing the administration for similar waivers for mental health care, and officials are looking for ways to address those requests.

“We’ve continued to receive … proposals and strong interest from states to allow similar demonstrations for individuals with serious mental illness,” Johnathan Monroe, a spokesman for the Centers for Medicare and Medicaid Services, said in a statement. “We are actively exploring how best to provide states with new opportunities to improve their mental health delivery systems.”

There’s no telling if a more robust mental health care system would have saved the 17 lives lost in Parkland, Florida, as well as other victims of mass shootings that have become tragically commonplace. Democrats say it’s no substitute for stronger gun control laws.

But state officials would welcome a change to Medicaid’s exclusionary rule, said Matt Salo, head of the nonpartisan National Association of Medicaid Directors, which supports full repeal of the policy and, short of that, expanded waivers.

“There is a need for a spectrum of services for people suffering from mental illness and substance abuse,” Salo said. “That spectrum should include everything from community-based resources as well as more structured institutional care.”

Medicaid is the federal-state health program for low-income people, a major source of coverage for mental health treatment. Experts say the program’s longstanding restriction on inpatient treatment is at odds with changes in federal law over the last 20 years to create parity between coverage for mental and physical diseases.

The government’s top mental health official said the president is acknowledging that more needs to be done to make Americans safe in their communities.

“The IMD exclusion makes it very difficult for people with serious mental illness to get a bed when they need that care, and the 24-7 safety, security and treatment that an inpatient facility provides,” said Elinore McCance-Katz, assistant secretary of Health and Human Services for Mental Health and Substance Use. “That contributes to jails and prisons becoming de facto mental institutions in this country.”

McCance-Katz also said expansion of community-based and outpatient treatment is needed.

Last year a government advisory panel recommended repealing Medicaid’s IMD exclusion, and the idea has bipartisan support in both chambers of Congress. But the cost of full repeal has been estimated at $40 billion to $60 billion over 10 years, daunting for lawmakers. State waivers may provide a more manageable path.

Advocates question the cost estimates, saying that savings from keeping mentally ill people out of jail should be factored in as well.

Whether mental illness contributes to violence is a debate rife with misconceptions. On the whole, medical experts say people with mental illness are no more likely to be violent than others.

But McCance-Katz and others say research shows that untreated serious mental illness is a risk factor for violent behavior. The term “serious mental illness” connotes a degree of severity that impairs a person’s ability to carry out usual functions of daily life. Treatment effectively reduces risks, said McCance-Katz.

Advocates are making the same point.

“There is no argument that stepping forward and addressing the IMD exclusion would have a huge benefit to mental health systems in states across the country,” said John Snook, executive director of the Treatment Advocacy Center, a nonprofit trying to broaden access to mental health treatment. “We have a situation where the most severely ill are cycling in and out of emergency rooms and jails.”

Germany’s Federal Administrative Court ruled Tuesday that cities can ban diesel cars to lower air pollution. The decision could affect millions of drivers in Germany and have significant repercussions for the country’s auto industry.

Here are five things to know about the case:

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WHAT’S THE PROBLEM?

The air in many German cities is worse than the law allows, contributing to respiratory illnesses and thousands of deaths annually.

According to government figures some 6,000 people die prematurely each year in the country because of excessive levels of harmful nitrogen oxides, or NOx.

About 60 percent of NOx comes from the transportation sector, especially diesel vehicles — an alternative to regular gas that’s particularly popular in Europe.

Measurements show that the threshold of 40 micrograms of NOx per cubic meter is regularly surpassed in dozens of German cities including Munich, Stuttgart and Cologne.

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IS THIS LINKED TO THE VW EMISSIONS SCANDAL?

Not directly.

Environmental campaigners have been demanding action on air pollution for years, but the revelations about carmakers cheating on diesel emissions tests has stoked the political debate in Germany.

Diesel, once considered a ‘cleaner’ fuel because it produces fewer greenhouse gas emissions, is now being scrutinized by environmentalists, government agencies, the media and the courts.

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WHO BROUGHT THE CASE?

The group Environmental Action Germany, known by its acronym DUH, has been filing legal complaints against cities for years, seeking to have them impose measures to reduce air pollution.

Lower court rulings involving two cities — Stuttgart and Duesseldorf — concluded that driving bans for diesel vehicles would be effective and should be considered. Two German states appealed the regional court rulings in Leipzig, arguing there needs to be a nationwide standard for dealing with air pollution.

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WHAT HAPPENS NEXT?

The Leipzig ruling gives cities sufficient legal certainty to impose diesel driving bans. Authorities now have several months to adjust their clean air plans accordingly. Some may choose to ban diesel cars only on certain roads at times when pollution levels are particularly high.

Judges say cities can exempt tradespeople who use diesel vehicles for work from the ban. However, they concluded that diesel owners have to accept a loss in value of their cars and aren’t entitled to compensation from the government.

Sales of diesel cars and the value of second-hand models have already been hit by the VW emissions cheating scandal.

In an effort to avoid diesel bans, the German government recently proposed making public transportation free and physically upgrading old vehicles to reduce their emissions. Both options would cost billions of euros (dollars) and it’s unclear who would pick up the tab — taxpayers, car owners or the auto industry.

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HOW MANY VEHICLES WOULD BE AFFECTED?

According to official figures there are more than 15 million diesel cars registered in Germany. About 6 million of those meet the Euro 6 emissions standard that would likely be exempt from a driving ban, leaving some 9 million diesel cars affected by the verdict.

Additionally there are several million trucks, buses and other heavily utility vehicles than run on diesel and which could be hit by a ban. City officials are particularly worried about the impact on bus services and tradespeople, who may get special exemptions allowing them to drive diesel vehicles even when a ban is in force.

Harley Pasternak is a trainer to the stars, working with everyone from Lady Gaga to Katy Perry, Rihanna, Megan Fox, Halle Berry, Gwen Stefani, Jessica Simpson and Ariana Grande.

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“Good Morning America” paired Pasternak with Nicolette Mason, co-founder of fashion line Premme, to see if the same wellness principles he teaches celebrities could be effective for Mason.

Here is Mason’s experience, in her own words.

I met with Harley for the first time several weeks ago and felt immediately at ease with him.

As a plus-size girl, I’ve dealt with a lot of projection when it comes to fitness. I’m an avid boutique fitness participant, and love my spin classes and barre classes, but I’ve seldom taken a class where I didn’t get unsolicited feedback from strangers or a weird congratulations for “keeping up.” Hello, just ’cause I’m a little bigger than your average cycler doesn’t mean I’m not interested in doing something that genuinely makes me feel good!

Lydia Hudgens

I loved that Harley recognized and affirmed me where I’m at: As someone who wants to use wellness tools to manage and improve my health, stress, and anxiety, not to whittle away at my frame. I know that might be foreign to some people … but it has taken me a long time to love myself and my body, and I’m not trying to make drastic changes to the way I look. My goal, instead, is to just feel my best, especially in terms of managing my pain symptoms and stress.

Let’s talk diet, first. I have Celiac disease and fibromyalgia. To my delight, Harley’s plan was so similar to how I already eat that it felt really seamless, approachable and realistic for me to make the modifications to successfully stay on plan. Like me — Harley doesn’t believe in fad diets; instead, the emphasis is on fresh, whole foods and balanced meals, and if anything, the new plan meant I was eating more and on a more consistent schedule than I was previously doing.

Lydia Hudgens

I started every day with a smoothie and filled the rest of my meals each day with delicious salads, fresh vegetables, grilled fish and seafood, quinoa and fruit. It was all so satisfying, and because I was very intentional about balancing my meals with protein, fat and fiber, I immediately noticed how infrequently I felt hungry.

Next, was the fitness component. We both knew I wasn’t going to become a marathoner overnight, but it was important for me to re-frame my approach to workouts. I’ve been so married to my group fitness classes for so long that on days where I was too busy to schedule in an hour-long class or get to a studio, I was foregoing dedicated workouts entirely. Harley introduced me to seven simple, low impact, non-contact exercises that I could literally do anywhere.

Besides the simple seven, we also set a goal of 12,000 steps a day, which were tracked on my FitBit. [Editors’ note: Harley Pasternak is a FitBit Ambassador.]

Lydia Hudgens

I got kind of competitive with myself and the step number, and felt lucky to already love walking everywhere. Plus, the movement reminders became little benchmarks for me to take breaks from my work, which actually made me feel way more productive, too.

With minimal intervention, the FitBit gave me something that I’ve long desired with my anxiety: Control. It literally gave me a tool, sitting right on my wrist, that handed me the steering wheel to pivot away from my otherwise totally debilitating anxiety. Anxiety attacks have absolutely been one of the triggers to my fibromyalgia flare-ups, and though it’s only been a few weeks, my chronic pain has definitely dissipated a lot.

The verdict: Safe to say, I’m definitely sticking with this approach. It’s so intuitive, honors my approach to wellness and nothing about it is punitive. Living your best life shouldn’t ever feel like a punishment or a chore.

Harley Pasternak’s exercise and nutrition tips:

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*Note: The diet listed below is a weight-loss diet, totaling 1,650 to 1,800 calories a day. A maintenance diet is, for the average woman, 2,000 calories a day.

1. Eat three meals and two snacks every day.

2. Each meal should be approximately 400 calories total and include servings of protein (at least the mass of your hand), high-fiber whole grains or high-fiber fruits (a handful size), unlimited non-starchy vegetables and two thumb-size portions of healthy fats like nuts, seeds, olives and avocado.

3. Snacks should be between 150 to 200 calories each and include protein and fiber.

‘Simple seven’ exercises

Do one exercise each day, for about five minutes, following a brief warm-up. Over seven days, you’ll work every major muscle group. On day eight, repeat this sequence of exercises.

Play

1. Reverse lunge.

2. Superman.

3. Lying dumbbell triceps extension.

4. Stiff-leg dumbbell deadlift.

5. Standing dumbbell curl press.

6. Single-arm dumbbell row.

7. Standing dumbbell side bend.

New research calls into question what’s in those IV bags that nearly every hospitalized patient gets. Using a different intravenous fluid instead of the usual saline greatly reduced the risk of death or kidney damage, two large studies found.

The difference could mean 50,000 to 70,000 fewer deaths and 100,000 fewer cases of kidney failure each year in the U.S., researchers estimate. Some doctors are hoping the results will persuade more hospitals to switch.

“We’ve been sounding the alarm for 20 years” about possible harms from saline, said Dr. John Kellum, a critical care specialist at the University of Pittsburgh. “It’s purely inertia” that prevents a change, he said.

Kellum had no role in the studies, which were discussed Tuesday at a critical care conference in San Antonio and published by the New England Journal of Medicine. Federal grants helped pay for the work.

IVs are one of the most common things in health care. They are used to prevent dehydration, maintain blood pressure or give patients medicines or nutrients if they can’t eat.

Saline — salt dissolved in water — has been the most widely used fluid in the U.S. for more than a century even as evidence has emerged that it can harm kidneys, especially when used a lot.

Other IV solutions called balanced fluids include saline but also contain potassium and other things that make them more like plasma, the clear part of blood. They’re widely used in Europe and Australia.

The studies involved 28,000 patients at Vanderbilt University who were given IVs of saline or a balanced fluid. For every 100 people on balanced fluids, there was one fewer death or severe kidney problem.

Since there are about 30 million people hospitalized in the U.S. alone each year, “there are tens or hundreds of thousands of patients who would be spared death or severe kidney problems by using balanced fluids instead of saline,” said one study leader, Vanderbilt’s Dr. Matthew Semler.

After seeing the results two months ago, Vanderbilt hospital officials decided to primarily use balanced fluids. The University of Pittsburgh also has largely switched to them, Kellum said.

The fluids cost about the same — a dollar or two per IV — and many suppliers make both types, so switching should not be hard or expensive, doctors said.

IV fluids have been in the news since Hurricane Maria hit Puerto Rico last fall, shutting down electricity to three plants owned by Baxter International, one of the biggest makers of these fluids. The shortage has eased, but some supply issues remain.

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Marilynn Marchione can be followed on Twitter: @MMarchioneAP

Handing environmentalists a landmark victory, a German court ruled Tuesday that cities can ban diesel cars and trucks to combat air pollution, a decision with far-reaching and costly implications in the country where the diesel engine was invented in the 1890s.

The ruling by the Federal Administrative Court stirred fears from motorists, auto dealers and other businesses worried about the financial impact. And Chancellor Angela Merkel’s government scrambled to reassure drivers it would seek to prevent such drastic measures by pushing other ways to reduce urban pollution.

Diesel automobiles are a popular alternative to gasoline-powered ones in Germany, with about 9 million diesel cars and several million trucks, buses and other vehicles affected by the ruling.

Overall, 1 in 3 passenger cars in Germany, home to such automakers as Daimler, Volkswagen and BMW, are diesel-powered, though the cleanest, most modern models would probably still be allowed even if cities decided on a ban.

“It’s a great day for clean air in Germany,” said Juergen Resch, head of the group Environmental Action Germany, which had sued dozens of German cities for failing to meet legally binding emissions limits.

While diesel cars produce less carbon dioxide and tend to get better mileage than gas-powered vehicles, they emit higher levels of nitrogen oxides, or NOx, contributing to respiratory illnesses and 6,000 deaths annually, according to government figures.

Two German states had appealed lower court decisions that suggested bans on particularly dirty diesel cars would be effective. Germany’s highest administrative court rejected that appeal Tuesday, effectively instructing two cities at the center of the case — Stuttgart and Duesseldorf — to consider bans as part of their clean air plans.

What comes next is an open question.

It’s not clear whether cities will actually move to ban diesels. And if they do so, it remains to be seen whether automakers will be forced to upgrade exhaust and software systems or buy back vehicles; if the government will offer consumers incentives; or if owners will be left on their own, forced to bear the costs.

The Leipzig-based administrative court said cities won’t be required to compensate drivers for being unable to use their diesel cars.

Speaking on behalf of automakers, Matthias Wissmann, president of the German Association of the Automotive Industry, stressed that the government could ease the uncertainty by not leaving it to cities to decide on a case-by-case basis.

“We hope it comes to sensible national regulations,” he said.

European cities considering diesel bans like Copenhagen and Paris will be watching how the situation plays out in Germany as they make their own decisions.

Jeff Schuster, an analyst with the consulting firm LMC Automotive near Detroit, said diesel bans could spread to other polluted European cities. But he said the market in Europe, China and elsewhere was already headed in that direction because of the big push toward electric vehicles and the damage done by the Volkswagen diesel-emissions cheating scandal.

Diesels make up a smaller part of the American auto market, and so any bans in Europe would have little effect on the U.S., Schuster said. For the past two years in the U.S., only 2.7 percent of registered vehicles were diesel, according to Kelley Blue Book.

New diesel car sales in Germany were already declining in anticipation of the decision, and also because of the VW scandal. Used-car dealers fretted about what the ruling will mean for the vehicles on their lots.

“The prices as well as the demand are going down rapidly,” said Marcel del Arbol, owner of R&M used car dealership in Frankfurt. “What happened today will bring the prices down even more.

German car companies dipped on the stock market following the ruling but mostly recovered, with Volkswagen down 0.9 percent at the end of the day, BMW down 0.06 percent and Daimler up 0.2 percent.

Analysts said the ruling might actually prove to be a boon for the economy if drivers choose to upgrade their engines or buy new models.

Merkel sought to downplay the prospect of widespread diesel driving bans, suggesting that many of the 70 German cities that regularly exceed pollution limits might be able to cut harmful emissions with other measures such as software upgrades in vehicles and converting bus and taxi fleets to electric power.

Experts, however, questioned whether bans can be avoided and accused the German government of ignoring the health problems caused by diesel for too long.

Fritz Kuhn, the Green Party mayor of Stuttgart, home to automakers Daimler and Porsche, accused the government of leaving it to cities to clean up the mess by failing to provide a nationwide solution.

Political leaders stressed that diesel owners shouldn’t have to shoulder the full burden of a ban.

“The auto industry that caused the harmful emissions has to upgrade diesel engines at its expense,” said Kai Wegner, a lawmaker who speaks for Merkel’s party on urban issues.

The ruling alarmed groups representing small and medium-size companies. Diesels — first developed by Rudolf Diesel in Augsburg over a century ago — are a mainstay of many company fleets and are widely used by taxi companies and delivery services.

Berlin’s Chamber of Commerce said companies in the capital would have to spend 240 million euros ($295 million) to replace their fleets if diesel cars were banned — enough to drive many out of business.

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Associated Press writers Kerstin Sopke in Leipzig, Christoph Noelting in Frankfurt and Tom Krisher in Detroit contributed to this report.

The Justice Department said Tuesday it will support local officials in hundreds of lawsuits against manufacturers and distributors of powerful opioid painkillers that are fueling the nation’s drug abuse crisis.

The move is part of a broader effort to more aggressively target prescription drugmakers for their role in the epidemic, Attorney General Jeff Sessions said. The Justice Department will file a statement of interest in the multidistrict lawsuit, arguing the federal government has borne substantial costs as a result of the crisis that claimed more than 64,000 lives in 2016.

The Trump administration has said it is focusing intensely on fighting drug addiction, but critics say its efforts fall short of what is needed. Trump signed off this month on a bipartisan budget deal to provide a record $6 billion over the next two years to fight opioids, but it’s not yet decided how that will be allocated.

The statement of interest was the latest move by the Justice Department, which has also sought to crack down on black market drug peddlers and doctors who negligently prescribe.

It could increase the role of the federal government in talks aimed at reaching a settlement between government entities, drugmakers, distributors and others. A federal judge in Cleveland is overseeing the talks as an attempt to resolve the case rather than hold a trial involving more than 370 plaintiffs, mostly county and local governments. The talks also include a group of about 40 states that are conducting a joint investigation of the crisis but which have not yet sued, as well as states that have sued in state courts.

Targets of the lawsuits include drugmakers such as Allergan, Johnson & Johnson, and Purdue Pharma, and the three large drug distribution companies, Amerisource Bergen, Cardinal Health and McKesson. Drug distributors and manufacturers named in these and other lawsuits have said they don’t believe litigation is the answer but have pledged to help solve the crisis.

Any settlement deal could include billions of dollars in payments that could be used for treatment programs, abuse prevention and to cover some of the costs incurred by government dealing with the crisis. A filing could also put the federal government in line to receive some of the payouts in a deal. But any settlement is not likely to cover the cost of the crisis. A White House report last year estimated the annual cost at about $500 billion, including deaths, health care, lost productivity and criminal justice costs.

“It’s a game-changer,” Ohio’s attorney general Mike DeWine said of the Justice Department’s involvement. “It’s a real realization of what has been going on.”

The latest effort by the Justice Department targets powerful, but legal, prescription painkillers OxyContin and Vicodin, which have been widely blamed for ushering in the drug crisis. But prescribing of those drugs has been falling since 2011 due to policies by government, medical and law enforcement officials designed to reverse years of overprescribing.

The majority of opioid deaths now involve illegal drugs, especially the ultra-potent opioid fentanyl. Deaths tied to those fentanyl and related drugs doubled in 2016, to more than 19,000, dragging down Americans’ life expectancy for the second year in a row.

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Mulvihill reported from Cherry Hill, New Jersey. Associated Press writer Matthew Perrone contributed from Washington.

What people choose to eat doesn’t just affect their waistlines, but maybe also the way they think and feel, according to a growing body of research.

Some Americans may believe that eating “comfort foods” leads to happiness.

But often choosing to eat processed foods like ice cream, macaroni and cheese or chips may eventually be linked to poor mental health, research suggests.

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In some studies, healthy eating — fruits, vegetables, healthy fats and whole grains — was in fact linked to lower risk of depression and even suicide.

“Although the determinants of mental health are complex, the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders,” researchers wrote in a review of the connection between food and mental health published in the medical journal Lancet, “suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology.”

In one recent study, the Dietary Approaches to Stop Hypertension (DASH) diet — low in foods with saturated fat and sugar — was found to reduce the risk of depression later in life.

The risk of becoming depressed over time was 11 percent lower among adults who followed DASH, a diet rich in vegetables, fruit, whole grains, and fat-free or low-fat dairy products, the study found.

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In the same study, which was done by questionnaire regarding food choices and depression symptoms, people who reported following a Western diet — high in saturated fats and red meats, low in fruits and vegetables — were more likely to develop depression.

What is the connection between diet and brain health?

Most people experience occasional, “situational” depression, or what doctors call an adjustment disorder, for example when a person loses a job or experiences a difficult breakup.

Depression is a persistent loss of enjoyment in things you used to love, a slide into lethargy and despair, sleep problems and disinterest.

Since what people eat -– the nutrients available to the body -– affects various bodily functions, it seems logical that diet would affect chemistry and mood as well.

Diet decisions that improve the rest of the body may improve the brain’s outlook on the world.

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“When people are feeling better by dieting and losing weight or resolving symptoms that they’re having, that could have an impact on mood,” said Dr. Sherry Pagoto, a licensed clinical psychologist and University of Connecticut professor. “When people do engage in healthy lifestyle changes, we do see improvements in depression.”

Nutrition also influences the immune system, which has been shown to influence the risk of depression, as well.

It could also come down to inflammation, research shows.

A study published in January gave more support to the theory that increased inflammation in the body could play a role in depression. The study, published in The Journal of Clinical Psychiatry, found that people who had depression had 46 percent higher levels in their blood samples of of C-reactive protein (CRP), a marker of inflammatory disease.

Diets like DASH and the Mediterranean Diet — another brain-healthy diet with a focus on foods like olive oil, fish and vegetables — are both rich in anti-inflammatory foods.

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Foods like white bread, margarine, red meat, processed meat and fried foods can cause inflammation in the body and should be eaten minimally or avoided, according to Harvard Medical School.

Tomatoes, olive oil, green leafy vegetables, nuts, fish like salmon and sardines and fruits like oranges and strawberries are all foods that fight inflammation, according to Harvard’s list.

ABC News’ Ann Reynolds and Jay-Sheree Allen, MD, a resident in the ABC News Medical Unit, contributed to this report.