Aubrey Whelan | (TNS) The Philadelphia Inquirer

Peihua Jiang knows how difficult it can be to convince a child to take a sip of a bitter liquid medication.

When they were young, his kids sometimes balked at taking medicines because they didn’t like how they tasted. And as a neurobiologist, Jiang knew the medical issues at stake went beyond a minor inconvenience.

Swallowing pills can be difficult for many young children and elderly people. Liquid medications are easier to consume, but their taste is often so off-putting that some patients will avoid them entirely — a significant barrier to good health for those who need to take lifesaving medications.

“My kids would refuse to take medicine when they were young,” he said, laughing. “It’s evolution; it makes perfect sense. A bitter taste is a sign you’re not supposed to eat something. But with medicine, it’s a different story.”

That’s why Jiang and his colleagues at Philadelphia’s Monell Chemical Senses Center, have spent years taking on what they describe as one of the most enduring challenges in medicine ― finding a “bitter blocker” substance that can prevent a patient from tasting anything bitter.

This month, Jiang and several colleagues announced a breakthrough: They identified a nerve inhibitor in liquid form that temporarily blocks all taste entirely. The center says it’s the first temporary taste blocker that works universally in humans, and a game-changer in a yearslong research journey.

“We are very pumped,” said Carol Christensen, a consultant to the director at Monell and a coauthor with Jiang of a paper on the compound recently published in British Journal of Pharmacology.

How bitter medication hurts health outcomes

Researchers at Monell, an independent research institution devoted to studying the senses of taste and smell, first began developing a bitter blocker in 2016 with a grant from the Bill and Melinda Gates Foundation. The foundation was concerned about bitter tastes preventing the uptake of medications in developing countries, where many people need to take regular medication for serious chronic illnesses like HIV and tuberculosis.

Ninety percent of U.S. pediatricians cited “a drug’s taste and palatability” as the biggest barrier to getting their patients to complete a course of medication, according to a 2013 review of existing research on bitter medications for children.

The paper noted it’s also hard for young children to swallow pills, even in small sizes, and that people of all ages, especially elderly adults, can have issues taking pills.

And what one might call the Mary Poppins method — a spoonful of sugar to make the medicine go down — comes with its own risks. Adding sweeteners to medications can cause cavities or damage tooth enamel.

For patients with serious conditions that require a long course of treatment, such as HIV, avoiding bitter medications can be dangerous.

“Many, many children, especially in developing countries, are not taking medicines and are dying,” said Linda Flammer, a senior research associate at Monell and the lead author on the new paper. “Simply giving them medication they can tolerate will save their lives.”

‘It’s actually really wonderful’

At first, Monell researchers hoped to develop a bitter blocker by targeting the taste receptors on the tongue that handle bitter sensations. But that’s more complicated than it seems.

Sweet tastes are easier to block, because they affect only two taste receptors on the tongue. But at least 25 taste receptors are devoted to detecting bitter tastes. And a person’s reaction to a bitter taste can vary depending on their genetics.

“Some may have a strong response to one bitter receptor. Some people may not have any response at all,” Flammer said.

So the researchers pivoted to target the nerve receptor that receives signals from the taste buds, Jiang said. In their search, they identified clinical trials for medications that targeted the same nerve receptor to treat various health conditions.

In trials for one of those medications, designed to treat chronic cough, the researchers noticed a curious side effect. “People were taking these medications for chronic cough, but they were saying, ‘It messed up my taste,’” Jiang said. They theorized they might be able to adapt a nerve inhibitor used in the medication to intentionally target a person’s sense of taste.

They discovered that the compound in liquid form, swished around the mouth for less than a minute, blocks all taste for about an hour and a half. Then, taste returns to normal, allowing a patient to go about their daily lives without a bitter taste lingering in their mouths.

The researchers tested it on adult humans and on mice, and found that the inhibitor only blocks taste — not any other sensations in the mouth, like temperature or even the tingling felt from a sip of a carbonated beverage.

“It’s actually really wonderful. We’ve never seen that before,” Jiang said.

Getting the treatment to patients

The bitter blocker is a long way from seeing practical applications in medicine, the researchers said. In general, between further research and safety testing, it can take years for a scientific discovery to roll out to the general public. But drug manufacturers could one day deliver the drug through lollipops, popsicles, or other kid-friendly forms to help young children feel more confident about taking their medications, Jiang said.

“We just hope now that we can take this very exciting finding and then find the right partners and the next funding to really make it happen,” said his colleague, Christensen.

Jiang is also hoping to continue studies on other bitter blockers, including ones that specifically target taste buds.

“We tried to provide a toolbox for blocking bitterness,” he said.

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“Can you take us in your car to the next gate?” the group of migrants asked. I was in Ciudad Juárez, along the U.S.-Mexico border, with another doctor and members of my organization, Hope Border Institute. It was early May, and we were driving along the banks of the Rio Grande, providing whatever humanitarian aid and medical care we could to migrants stopped by the concertina wire put up by the Texas National Guard.

This group of migrants, three young children and several adults, were desperate. They looked exhausted and dehydrated. Their windswept faces looked at us for a response. We looked around uncomfortably. Every bit of me wanted to give these desperate families a ride, but the reality was that it wasn’t safe—for us or for them. They said they had been walking along the concertina wire for four days. They were out of water, and now they were out of money. The day before, they said they’d been robbed of all of their money and material possessions by cartel members. Now, the National Guard was telling them they would have to continue walking for miles to find a point to be processed. The soldiers, clad in desert camouflage and touting assault rifles, looked on as we talked to the migrants.

Between here and the port of entry where they would be processed—wherever it was—another cartel operated. The migrants said they didn’t have anything else to give and were afraid of what the next cartel would do to them. But by picking them up, our group and theirs would both become targets. So we gave them water, food, and the limited medical aid we could provide, and we drove off. A fear gnawed in my stomach as I watched them trudge on along the dusty banks of the Rio Grande, the soldiers looking on.

The National Guard members standing on the other side of the concertina wire were brought to the border by Governor Abbot’s sweeping anti-immigration operation dubbed ‘‘Operation Lone Star.” This operation represents an escalation of policies of deterrence by state officials. It has been an experiment in new ways to maim and mangle migrants and has exacerbated pre-existing patterns contributing to migrant deaths. 

As part of Operation Lone Star, the Texas National Guard has deployed over 100 miles of concertina wire along the banks of the Rio Grande. I’ve treated children whose flesh has been torn by the razor wire. Further down the river, the National Guard has also deployed floating buoys marked by serrated metal blades. Increasingly aggressive vehicular pursuits of migrants by Department of Public Safety officers have killed both Americans and migrants. 

It’s left to border organizations like mine, the Hope Border Institute, to deal with the human costs of failed border policies. “Prevention through deterrence,” America’s strategy to make the border as dangerous to cross as possible, has spawned increasingly macabre policies including family separation, Title 42, the heightening of the border wall, and now Governor Greg Abbott’s Operation Lone Star. These measures have created a growing public-health crisis along the border. 

In 2022, the U.S.-Mexico border was the most dangerous migratory land route in the world, according to the International Organization for Migration. Increasingly desperate migrants are forced to cross in the desert where many will succumb to heat injuries and dehydration. Others will attempt to scale the wall, and many will inevitably fall. Those that survive will often have debilitating injuries. As an emergency medicine physician in El Paso, I treat the traumatic injuries of migrants who could no longer wait. As the co-founder and medical director for Clínica Hope, I treat migrants in Juárez who have yet to cross. 

In response to this growing public health crisis, Clínica Hope was co-founded with Hope Border Institute in 2022 to provide shelter-based medical care to migrants stuck in Juárez. As policies have changed, so has our response—which is why we were cruising along the concertina wire. 

The next group we came across was in dire straits as well. Dozens of migrants huddled under the little shade offered by the meager brush lining the Rio. In the midday heat, the groups slowly stirred. They were apprehensive at first but then began to make their way to our vehicles. Other members of our group started distributing water as I started seeing patients.

We tried to convince the Venezuelan to come with us to a hospital, where he could be evaluated and treated. “I can’t,” he said.

Stories of violence and brutality spilled out as the weary migrants were eager to take the opportunity to share their traumas with sympathetic Americans who were not pointing weapons at them. Their bodies bore witness to the traumatic injuries they claim were done to them. The reality of their desperation was made clear to me by their torn and bruised flesh. The Texas National Guard, Mexican immigration officials, and cartel members were now all working together in this perverse game of deterrence, the goal being to inflict as much suffering as possible on these migrants. In my two years of treating migrants in Juárez, I had never witnessed such desperation. Hemmed in by the cartel, concertina wire, and both U.S. and Mexican security forces, these migrants were completely vulnerable to the depredations of each of these predators.

Texas soldiers have fired non-lethal projectiles at border crossers, as reported by Border Report, and migrants report beatings by Mexican immigration officials and by cartel members.

A Venezuelan migrant approached me, his left arm bandaged in a disintegrating sling. He appeared to be in his thirties, dusty and battered from his journey. His chest was heaving in pain. He was on La Bestia, the train that carries migrants to the north of the country, when it was stopped by Mexican immigration officials outside of Juárez. The migrants scattered and the immigration police gave chase, beating anybody they could get their hands on, he said. This beating had left the migrant with a fractured arm, on which a Mexican physician had haphazardly slapped a splint. 

On making it to the Rio Grande, he told me he was pushed back by National Guard soldiers as he attempted to scamper up the banks of the American side, after which he said he was pelted by rubber bullets. His entire left chest seemed detached from his sternum and clavicle. The left-side of his ribs heaved independently from the rest of his chest. He needed to be evaluated in a hospital and likely would need urgent surgery.

The Texas Military Department did not respond to a Texas Observer request for comment about use of non-lethal projectiles and physical violence.

We tried to convince the Venezuelan to come with us to a hospital, where he could be evaluated and treated. “I can’t,” he said. He didn’t want to miss an opportunity to cross the concertina wire and present himself to the authorities for processing for asylum. I treated a few more injuries, including of children whose flesh was torn by the Texas razor wire. Then, we reluctantly left the seriously injured migrant, exchanging contact information in case he changed his mind.

The next day, his pain had become unbearable and he reached out to us, asking to be taken to a hospital. Crystal Massey, the humanitarian director for Hope Border Institute, sprung into action, coordinating with our Mexican colleagues to pick him up and transport him to a hospital. Our Mexican partners arrived with an ambulance to extract the patient to safety. They told us that an armed cartel member stopped the ambulance as it approached the concertina wire. All of this occurred as the National Guard watched on, only a few yards away on Texas soil.

It occurred to me, in this twilight zone between borders, the most basic right to life had ceased to exist. These human beings, desperately seeking safety and a new future, were completely vulnerable to the cartel and the security forces of both nations. They all were working together to brutalize men, women, and children. Each of these groups acts with impunity and with the same objective: to extract their pound of flesh and make dangerous this border. 

In mid-May, the body of a Honduran migrant was found along the river in Juárez, near where we’d seen patients. As reported by the newspaper El Heraldo de Juárez, his face had been sunken in from the attack that left him dead. A migrant who was with him said the beating was the work of U.S. authorities.

By Lauren Schwahn | NerdWallet

The burden of medical debt may soon become much lighter for millions of Americans.

The Consumer Financial Protection Bureau proposed a rule Tuesday that aims to remove medical bills from credit reports and prevent credit reporting agencies from sharing medical debt information with lenders. The rule would also forbid lenders from basing their lending decisions on medical information.

The proposal isn’t expected to be finalized until early 2025, and it could face challenges. Here’s what to watch out for and what you can do now to protect your credit.

Why this matters

“Medical bills on credit reports too often are inaccurate and have little to no predictive value when it comes to repaying other loans,” CFPB Director Rohit Chopra said in a press release Tuesday.

New safeguards could prevent medical debt from blocking consumers’ access to loans such as mortgages and could elevate credit scores.

Americans who have medical debt on their credit reports may see a 20-point bump in their credit scores on average, the CFPB says.

Beyond its effects on credit, the rule would provide protections that could impact consumers’ health and safety: It would prevent lenders from taking medical devices, such as wheelchairs, as collateral for loans or repossessing medical devices if a loan isn’t repaid.

How does this proposal differ from recent changes to medical debt reporting?

Currently, paid medical bills don’t appear on credit reports or affect credit scores. In April 2023, unpaid medical bills with a starting balance of less than $500 were removed from reports.

Also, as of July 2022, paid medical collections were erased from credit reports, and they are no longer reported by the three major credit bureaus — Equifax, Experian and TransUnion.

Despite the changes, a CFPB report found that more than 15 million Americans still had medical collections on their credit reports as of June 2023. People living in the South and low-income communities were disproportionately affected.

The new proposal would remove all medical bills from credit reports, including unpaid bills of any amount.

Would this rule apply retroactively?

Yes. If finalized, the rule would remove existing medical collections from credit reports and prevent credit reporting companies from sending medical information to lenders going forward.

Will there be exceptions to the rule?

The CFPB says there will be “very limited circumstances” where medical information could still be used in credit decisions, such as where disability income needs to be taken into account for loan consideration or to determine if someone is eligible for medical forbearance.

What to look out for next

The CFPB is accepting comments on the proposal through Aug. 12. The timeline will become clearer once feedback is addressed, but the rule is expected to be finalized early next year, a CFPB official said on Tuesday’s press call.

The 2024 election could also influence the fate of the proposal as well as similar consumer credit protections. A Biden administration fact sheet issued Tuesday cites a recent budget proposal from the Republican Study Committee that calls for defunding the CFPB.

What you can do now

Use AnnualCreditReport.com to check your credit reports for free. Make sure any medical debt information that appears is accurate and in line with the current reporting rules. Unpaid medical collections with an initial balance under $500 shouldn’t be on your reports and neither should paid collections.

If you spot an issue, dispute the error with the credit bureaus right away. Regardless of whether the CFPB’s proposal is finalized, it won’t forgive medical debt or stop medical debt from going to collections. Make a plan to deal with any medical debt you may have. Review your budget and seek help if needed. Your medical provider may be willing to work out a payment plan to help you better manage the bill.

Lauren Schwahn writes for NerdWallet. Email: lschwahn@nerdwallet.com. Twitter: @lauren_schwahn.

The article Medical Debt Could Vanish From Credit Reports. What to Do Now originally appeared on NerdWallet.