Monday, March 19, 2018

Take This App and Call Me in the Morning - The New York Times

Health tech companies are making a big push to digitize medicine, introducing novel tools like digital pills that track when patients take their drugs and smart spoons that can automatically adjust to hand tremors.

Now they want some patients to get prescription treatments from the app store as well.

Later this year, doctors treating patients addicted to substances like cocaine and amphetamines will be able to prescribe Reset, an app that gives patients lessons to help them modify their behavior. The Food and Drug Administration cleared it in September as the first mobile medical app to help treat substance-use disorders.

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Friday, March 16, 2018

Many Drugs and Many Doctors Lead to Many Mistakes - The New York Times

I am a home hospice nurse, and when I get new patients after they have been discharged from the hospital, the list of drugs included in their paperwork is always wrong. Some mistakes are minor: The list includes a relatively harmless drug the patient no longer needs or it leaves off a minor dose adjustment. But other mistakes are more serious — the list may include an important prescription the patient never knew to fill or may have the patient on two medications that can be dangerous when taken together.

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Tuesday, March 13, 2018

Three Views of the Crisis in Women’s Health - The New York Times

A woman receives a breast cancer diagnosis and opts for a mastectomy — only for her doctor to object: "But you aren't married."

A young girl suffering from endometriosis, a condition in which uterine cells migrate to other areas of the body, is informed by her doctor that childbirth will ease the pain. "I'm only 11," she later tells her support group, baffled.

A woman complains of vomiting uncontrollably, up to 100 times a night. She is offered antidepressants. When it finally occurs to a doctor to examine her further, to discover and perform surgery on her barely functioning gallbladder, she is on the verge of death.

These aren't tales from the dark ages of medicine. They are ordinary modern realities documented in Maya Dusenbery's well researched, wonderfully truculent new book, "Doing Harm," one of a cluster of new investigations into gender bias in medical treatment that also includes "Ask Me About My Uterus," by Abby Norman, and "Invisible," by Michele Lent Hirsch.

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Saturday, March 3, 2018

The Challenge of Doctor-Patient Relations in the Internet Age - The New York Times

"Let me do some research, and I'll get back to you," my patient said.

My patient, a 19-year-old undergraduate, had already taken time off from school because of her anxiety. I was her psychiatrist, with over two decades of experience treating university students, and had just explained my diagnostic impressions based on a lengthy evaluation. I'd recommended that she try a medicine I expected would help. I'd also laid out the risks and benefits of other treatment options.

"Do you have additional questions I can answer?" I asked. I wanted to let her know that's why I was there, to cull the research, to help make sense of it.

"No, I like to go online and look for myself," she said.

More and more, I see students turning away from the expertise that a live person can offer and instead turning to the vast and somehow more objective-seeming "expertise" of the digital world.

In an age when journalism we don't like can be dismissed as "fake news," suggesting that the information we do like is most credible, regardless of its source, it's not hard to understand why young people do this. The medical profession itself, under managed care, has played a role as well, providing less time for doctor-patient interactions and undermining the chances that a personal relationship and trust can develop. Under the guise of efficiency, medical test results are now often released directly to patients, sometimes before or even without the benefit of any interpretation.

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Monday, February 19, 2018

Doctors Said Immunotherapy Would Not Cure Her Cancer. They Were Wrong. - The New York Times

No one expected the four young women to live much longer. They had an extremely rare, aggressive and fatal form of ovarian cancer. There was no standard treatment.

The women, strangers to one another living in different countries, asked their doctors to try new immunotherapy drugs that had revolutionized treatment of cancer. At first, they were told the drugs were out of the question — they would not work against ovarian cancer.

Now it looks as if the doctors were wrong. The women managed to get immunotherapy, and their cancers went into remission. They returned to work; their lives returned to normalcy.

The tale has befuddled scientists, who are struggling to understand why the drugs worked when they should not have. If researchers can figure out what happened here, they may open the door to new treatments for a wide variety of other cancers thought not to respond to immunotherapy.

"What we are seeing here is that we have not yet learned the whole story of what it takes for tumors to be recognized by the immune system," said Dr. Jedd Wolchok, chief of the melanoma and immunotherapeutics service at Memorial Sloan Kettering Cancer Center in New York.

"We need to study the people who have a biology that goes against the conventional generalizations."

Four women hardly constitutes a clinical trial. Still, "it is the exceptions that give you the best insights," said Dr. Drew Pardoll, who directs the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins Medicine in Baltimore.

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Monday, February 12, 2018

A Perfect Storm for Broken Bones - The New York Times

A "perfect storm" threatens to derail the progress that has been made in protecting the bone health of Americans. As the population over 50 swells, fewer adults at risk of advanced bone loss and fractures are undergoing tests for bone density, resulting in a decline in the diagnosis and treatment of osteoporosis, even for people who have already broken bones.

If this trend is not reversed, and soon, by better educating people with osteoporosis and their doctors, the result could be devastating, spawning an epidemic of broken bones, medical office visits, hospital and nursing home admissions and even premature deaths.

Currently, many people at risk of a fracture — and often their doctors — are failing to properly weigh the benefits of treating fragile bones against the very rare but widely publicized hazards of bone-preserving drugs, experts say.

One serious consequence already seems to have happened: a leveling off and possible reversal in what had been a decade-and-a-half-long decline in hip fractures among postmenopausal women, according to a new study of all women on Medicare who were hospitalized with an osteoporotic hip fracture between 2001 and 2015.

The data revealed a steady decline in hip fractures among women 65 and older on Medicare to 730 per 100,000 in 2015 from 931 per 100,000 in 2002. But starting in 2012, the rate adjusted for age suddenly leveled off. Had the decline continued, an estimated 11,464 fewer women would have broken their hips between 2012 and 2015, the researchers reported in December in the journal Osteoporosis International.

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Friday, February 9, 2018

Five major psychiatric diseases have overlapping patterns of genetic activity, new study shows - The Washington Post

Certain patterns of genetic activity appear to be common among five distinct psychiatric disorders — autism, schizophrenia, bipolar disorder, depression and alcoholism — according to a new study. The paper, appearing in the journal Science, was released Thursday.

Scientists analyzed data from 700 human brains, all donated either from patients who suffered one of these major psychiatric disorders or from people who had not been diagnosed with mental illness. The scientists found similar levels of particular molecules in the brains of people with autism, schizophrenia and bipolar disorder; other commonalities between bipolar and major depression; and other matches between major depression and alcoholism.

"We're on the threshold to using genomics and molecular technology to look at [mental illness] in a way we've never been able to do before," said Daniel Geschwind, a neurogeneticist at the University of California at Los Angeles and a leader of the study. "Psychiatric disorders have no obvious pathology in the brain, but now we have the genomic tools to ask what actually goes awry in these brains."

These shared, disease-related "signatures" involve a disruption in how brain cells communicate with one another.

"What we're seeing is giving us a sense of alterations in the way neurons are signaling to each other," Geschwind said. "We think some of it is confused activity. That's the next step, to connect it to the physiology: how do these changes affect neuronal firing and connectivity. We have a clue that it's adding 'noise' to the system. Maybe things are attenuated or jumbled."

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Thursday, February 8, 2018

How People Die in America

Last week I published a long story about my near-fatal bacterial infection six months ago, and the material benefits that kept me alive. Since the piece ran I have been completely overwhelmed by reader responses.

Everyone, it seems, knows someone who has been financially ruined—or, in a roundabout way, killed—by the opaque mechanizations of our privatized health care system.

I survived, and I have a platform. But as one reader put it, "the people who die from having no insurance are not around to tell their stories."

Our politicians are fond of holding the line that no American dies for lack of access. Doctors and hospitals are bound by oath, the thinking goes, to do everything they can to save a life. But that logic doesn't account for the broader significance of the cycle of debt, or the way generations of families can be ruined by a single medical crisis. It glosses over the insane level of trust we are forced to put in the medical industry—the providers, the doctors, the insurance agents—when we have an accident or suddenly fall ill.

Since I published my own account of illness, I've seen lots of references to the now-deceased self-employed New York carpenter who won the lottery, used his newfound wealth to go to the doctor for the first time in decades, and found he had cancer in his brain and lungs. Someone sent me a link to this story about Susan Moore, a woman in Kentucky who elected to stop the dialysis she needed to stay alive because she couldn't afford to travel to the medical center three times a day.

I tweeted a handful of the comments on my story, but I wanted to post a couple more; these are the kinds of testimonies that can get lost in the glut of statistics about healthcare in this country.

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How to Not Die in America 

On the second Tuesday in June, I start to feel fluish. If this is 2016 and I'm still a freelance writer, I'm losing money immediately on the assignments I can't complete because my vision is blurry and my thoughts are erratic. If this is 2013, I am soon taken off the roster at the cafe where I work.

I am out of my mind with anxiety as I hobble to the clinic, sweating, and pay $60 for cough syrup, $300 for the 10-minute visit (if I even have that in the bank; it's about a week's worth of my earnings slinging coffee). Once I realize I can't keep down the cough syrup and start spitting up bile, maybe I'm so feverish and broke I stay in bed without realizing the bacteria I've inhaled is more lethal than the flu. So perhaps I just up and die right there.

But let's say I somehow make it to the hospital. A friend drives me, because a 15-minute ambulance ride can cost nearly $2,000, which I don't have. I'm struggling financially and I've fallen behind on my ACA payments. My friend realizes in the car I'm not making any sense, and that's because my organs have already begun to shut down. My temperature is well over 100. When the doctors can't figure out what's wrong, they submit me to a credit check before advanced treatment.

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Monday, February 5, 2018

My Father’s Body, at Rest and in Motion | Siddhartha Mukherjee | The New Yorker

The call came at three in the morning. My mother, in New Delhi, was in tears. My father, she said, had fallen again, and he was speaking nonsense. She turned the handset toward him. He was muttering a slow, meaningless string of words in an unrecognizable high-pitched nasal tone. He kept repeating his nickname, Shibu, and the name of his childhood village, Dehergoti. He sounded as if he were reading his own last rites.

"Take him to the hospital," I urged her, from New York. "I'll catch the next flight home."

"No, no, just wait," my mother said. "He might get better on his own." In her day, buying an international ticket on short notice was an unforgivable act of extravagance, reserved for transcontinental gangsters and film stars. No one that she knew had arrived "early" for a parent's death. The frugality of her generation had congealed into frank superstition: if I caught a flight now, I might dare the disaster into being.

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