Thursday, September 21, 2017

‘The Pills Are Everywhere’: How the Opioid Crisis Claims Its Youngest Victims - The New York Times

When Penny Mae Cormani died in Utah, her family sang Mormon hymns — "Be Still My Soul" — and lowered her small coffin into the earth. The latest victim of a drug epidemic that is now taking 60,000 lives a year, Penny was just 1.

Increasingly, parents and the police are encountering toddlers and young children unconscious or dead after consuming an adult's opioids.

At the children's hospital in Dayton, Ohio, accidental ingestions have more than doubled, to some 200 intoxications a year, with tiny bodies found laced by drugs like fentanyl. In Milwaukee, eight children have died of opioid poisoning since late 2015, all from legal substances like methadone and oxycodone. In Salt Lake City, one emergency doctor recently revived four overdosing toddlers in a night, a phenomenon she called both new and alarming.

"It's a cancer," said Mauria Leydsman, Penny's grandmother, of the nation's opioid problem, "with tendrils that are going everywhere."

While these deaths represent a small fraction of the epidemic's toll, they are an indication of how deeply the American addiction crisis has cut.

More ...

https://www.nytimes.com/2017/09/20/us/opioid-deaths-children.html?

Tuesday, September 5, 2017

The First Count of Fentanyl Deaths in 2016: Up 540% in Three Years - The New York Times

Drug overdoses killed roughly 64,000 people in the United States last year, according to the first governmental account of nationwide drug deaths to cover all of 2016. It's a staggering rise of more than 22 percent over the 52,404 drug deaths recorded the previous year — and even higher than The New York Times's estimatein June, which was based on earlier preliminary data.

Drug overdoses are expected to remain the leading cause of death for Americans under 50, as synthetic opioids — primarily fentanyl and its analogues — continue to push the death count higher. Drug deaths involving fentanyl more than doubled from 2015 to 2016, accompanied by an upturn in deaths involving cocaine and methamphetamine. Together they add up to an epidemic of drug overdoses that is killing people at a faster rate than the H.I.V. epidemic at its peak.

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https://www.nytimes.com/interactive/2017/09/02/upshot/fentanyl-drug-overdose-deaths.html?

Artificial Intelligence Could Predict Alzheimer’s Years Before Doctors | Health Care News | US News

Doctors may be no match for computers when it comes to Alzheimer's.

A study published in July in the journal Neurobiology of Aging found that artificial intelligence could detect signs of the disease in patient brain scans before physicians. The computer-based algorithm was able to correctly predict if a person would develop Alzheimer's disease up to two years before he or she actually displayed symptoms. It was correct 84 percent of the time.

Researchers are hopeful that the tool will be helpful in determining before the onset of the disease which patients to choose for clinical trials or for drugs that could slow its progression and delay its crippling effects.

"If you can tell from a group of individuals who is the one that will develop the disease, one can better test new medications that could be capable of preventing the disease," co-lead study author Dr. Pedro Rosa-Neto, an associate professor of neurology, neurosurgery and psychiatry at McGill University, told Live Science.

The researchers were able to train the artificial intelligence program to recognize Alzheimer's disease in the brain by showing it before and after scans of 200 people who had the disease. The AI technology was then shown scans of 270 volunteers – 43 of whom eventually developed Alzheimer's. The AI technology was able to accurately predict 84 percent of the cases in which the volunteers eventually developed the disease.

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https://www.usnews.com/news/health-care-news/articles/2017-09-01/artificial-intelligence-could-predict-alzheimers-years-before-doctors?

Neuroscience News - Medical Xpress

https://medicalxpress.com/neuroscience-news/

Monday, September 4, 2017

Opioids Aren’t the Only Pain Drugs to Fear - The New York Times

Last month, a White House panel declared the nation's epidemic of opioid abuse and deaths "a national public health emergency," a designation usually assigned to natural disasters.

A disaster is indeed what it is, with 142 Americans dying daily from drug overdoses, a fourfold increase since 1999, more than the number of people killed by gun homicides and vehicular crashes combined. A 2015 National Survey on Drug Use and Health estimated that 3.8 million Americans use opioids for nonmedical reasons every month.

Lest you think that people seeking chemically induced highs are solely responsible for the problem, physicians and dentists who prescribe opioids with relative abandon, and patients and pharmacists who fill those prescriptions, lend a big helping hand. The number of prescriptions for opioids jumped from 76 million in 1991 to 219 million two decades later. They are commonly handed to patients following all manner of surgery, whether they need them or not.

A new review of six studies by Dr. Mark C. Bicket and colleagues at Johns Hopkins University School of Medicine found that among 810 patients who underwent seven different kinds of operations, 42 percent to 71 percent failed to use the opioids they received, and 67 percent to 92 percent still had the unused drugs at home.

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https://www.nytimes.com/2017/09/04/well/opioids-arent-the-only-pain-drugs-to-fear.html?_r=0

Wednesday, August 30, 2017

Pioneering cancer drug will cost $475,000. Analysts call it a bargain

The Food and Drug Administration on Wednesday approved a futuristic new approach to treating cancer, clearing a Novartis therapy that has produced unprecedented results in patients with a rare and deadly cancer. The price tag: $475,000 for a course of treatment.

That sounds staggering to many patients — but it's far less than analysts expected.

The therapy, called a CAR-T, is made by harvesting patients' white blood cells and rewiring them to home in on tumors. Novartis's product is the first CAR-T therapy to come before the FDA, leading a pack of novel treatments that promise to change the standard of care for certain aggressive blood cancers.

Novartis's therapy is approved to treat children and young adults with relapsed acute lymphoblastic leukemia. It will be marketed as Kymriah.

The treatment's approval has looked a foregone conclusion for months, but its potential price has been the subject of speculation and debate. Novartis picked the $475,000 price tag in an effort to balance patient access to Kymriah while giving the company a return on its investment, said Bruno Strigini, Novartis's head of oncology, in a conference call Wednesday. The cost is below Wall Street analyst expectations, which reached as high as $750,000 for a dose. And it's considerably cheaper than the roughly $700,000 price tag that U.K. regulators said would be fair considering Kymriah's potential benefits.

Novartis also said it is working with Medicare on a system in which the government would only pay for CAR-T treatment if patients respond within a month.

In a clinical trial, a single dose of Kymriah left 83 percent of participants cancer-free after three months, results oncologists have hailed as a major advance for patients with few other options. The most frequent side effect was an inflammatory storm called cytokine release syndrome, a reaction to CAR-T that can prove fatal in some patients but is commonly controlled with immunosuppressant drugs.

"I think this is most exciting thing I've seen in my lifetime," said Dr. Tim Cripe, an oncologist with Nationwide Children's Hospital, at an FDA meeting on Kymriah in July.

More ...

https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/?

Could Your Next Doctor Be Your Dentist? - Slate

Tooth enamel is the strongest substance in the human body. It's harder than steel. Which helps explain why the three words "root canal treatment" often strike such terror into patients sitting in the dental chair. It starts by boring a hole through enamel as effortlessly as if it were rice paper. Ninety-nine percent of the time, that gaping hole is filled and sealed immediately after treatment. A few months ago, I met a patient I'll call Janet, to protect her privacy. She was one of the 1 percent.

I carefully peered my head into her mouth. The remaining pulp, or core, of the treated tooth—an amalgam of nerves, blood vessels, and immune cells—had blossomed out of the fractured crown into a twisting, intersecting polyp with the color and consistency of bubble gum. She had chronic hyperplastic pulpitis, a rare inflammatory condition that triggers pulp tissue to irreversibly expand above the walls of the enamel shell. I pulled my stethoscope off the shelf and checked what I had been trained to with every new patient: her blood pressure. 174 over 104, I whispered to myself, having expected only a slight deviation from the normal 120 over 80. This seemed impossible. I checked the other arm; 172/104. I waited 15 minutes and checked again. 164/100.

Hypertensive emergency, which can cause patients to spontaneously suffer a severe stroke, heart attack, or kidney damage, occurs when blood pressure reaches 180/110 or higher. While her blood pressure was trending downward, Janet was dangerously close to that threshold. I asked her if any physician in the past had ever told her that she had high blood pressure. A recent Dominican immigrant unsure of her past medical history, she told me she couldn't remember. Her expanding pulp, a rarity for me, was only a distraction from a bigger concern—her heart. I immediately called her primary care physician, discussed the situation, and told her to go see her doctor immediately. Janet, who had showed up for some basic dental work, had been inches away from a medical emergency.

A 2016 Association of American Medical Colleges report projects that over the next 10 years, the U.S. will face a serious physician shortage, especially among primary care physicians in rural geographic areas. Despite increased health insurance coverage for millions of Americans over the last few years, affordable health care is still difficult to access in rural areas. Certain states, such as Tennessee, Iowa, and my home state of Arizona, are seeing insurance companies drop out of individual markets due to political uncertainty, making access to affordable care harder for a significant fraction of the U.S. population, including many of those I grew up with.

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http://www.slate.com/articles/health_and_science/medical_examiner/2017/08/why_your_next_doctor_could_be_your_dentist.html

Tuesday, August 29, 2017

‘Dying: A Memoir’ Is a Bracing Illumination of Terminal Illness - The New York Times

DYING
A Memoir
By Cory Taylor
141 pages. Tin House Books. $18.95.


Years ago, a palliative care doctor told me that what he knew of a patient's personality often had little to do with how he or she coped with dying. Generous people could become ungenerous, and brave people could become frightened. Angry people could become gentle, and controlling people could become Zen. Dying, in other words — like combat, like becoming a parent, like any transformative life event — doesn't always reveal or intensify aspects of our character. It sometimes coaxes out new ones.

For a long time, the writer Cory Taylor took, by her own admission, "a fairly leisurely approach to life." That changed in 2005, just before her 50th birthday, when doctors removed a mole on the back of her leg. Melanoma, Stage 4. She wrote the novel she'd always meant to write, then another. Then she wrote "Dying: A Memoir."

The book rings louder in my imagination the more time I spend apart from it, a kind of reverse Doppler effect. "Dying" is bracing and beautiful, possessed of an extraordinary intellectual and moral rigor. Every medical student should read it. Every human should read it. My own copy is so aggressively underlined it looks like a composition notebook.

"Dying" is short, but as dense as dark matter. There is an electrifying matter-of-factness to it, one that normalizes death, which is part of Taylor's goal. She deplores the "monstrous silence" surrounding the subject of mortality. "If cancer teaches you one thing," she writes, "it is that we are dying in our droves, all the time. Just go into the oncology department of any major hospital and sit in the packed waiting room."

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F.D.A. Panel Recommends Approval for Gene-Altering Leukemia Treatment - The New York Times

A Food and Drug Administration panel opened a new era in medicine on Wednesday, unanimously recommending that the agency approve the first-ever treatment that genetically alters a patient's own cells to fight cancer, transforming them into what scientists call "a living drug" that powerfully bolsters the immune system to shut down the disease.

If the F.D.A. accepts the recommendation, which is likely, the treatment will be the first gene therapy ever to reach the market in the United States. Others are expected: Researchers and drug companies have been engaged in intense competition for decades to reach this milestone. Novartis is now poised to be the first. Its treatment is for a type of leukemia, and it is working on similar types of treatments in hundreds of patients for another form of the disease, as well as multiple myeloma and an aggressive brain tumor.

To use the technique, a separate treatment must be created for each patient — their cells removed at an approved medical center, frozen, shipped to a Novartis plant for thawing and processing, frozen again and shipped back to the treatment center.

A single dose of the resulting product has brought long remissions, and possibly cures, to scores of patients in studies who were facing death because every other treatment had failed. The panel recommended approving the treatment for B-cell acute lymphoblastic leukemia that has resisted treatment, or relapsed, in children and young adults aged 3 to 25.

One of those patients, Emily Whitehead, now 12 and the first child ever given the altered cells, was at the meeting of the panel with her parents to advocate for approval of the drug that saved her life. In 2012, as a 6-year-old, she was treated in a study at the Children's Hospital of Philadelphia. Severe side effects — raging fever, crashing blood pressure, lung congestion — nearly killed her. But she emerged cancer free, and has remained so.

"We believe that when this treatment is approved it will save thousands of children's lives around the world," Emily's father, Tom Whitehead, told the panel. "I hope that someday all of you on the advisory committee can tell your families for generations that you were part of the process that ended the use of toxic treatments like chemotherapy and radiation as standard treatment, and turned blood cancers into a treatable disease that even after relapse most people survive."

The main evidence that Novartis presented to the F.D.A. came from a study of 63 patients who received the treatment from April 2015 to August 2016. Fifty-two of them, or 82.5 percent, went into remission — a high rate for such a severe disease. Eleven others died.

"It's a new world, an exciting therapy," said Dr. Gwen Nichols, the chief medical officer of the Leukemia and Lymphoma Society, which paid for some of the research that led to the treatment.

The next step, she said, will be to determine "what we can combine it with and is there a way to use it in the future to treat patients with less disease, so that the immune system is in better shape and really able to fight." She added, "This is the beginning of something big."

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https://www.nytimes.com/2017/07/12/health/fda-novartis-leukemia-gene-medicine.html?

When Your Doctor Is Fitter Than You Are - The New York Times

"I enjoy working out at the gym," declares one profile. "To keep myself fit, I like to hike, bike and exercise," says another.

These comments aren't part of a dating site. Rather, they come from physicians' online profiles that prospective patients view when they are looking for a new doctor.

There are good reasons doctors might strive to lead by example. "I practice what I preach by living healthy every day," declares one physician on Kaiser Permanente's online doctor search portal. Patients may trust or be inspired by such a doctor, the thinking goes. And if health care professionals fail to follow their own advice, they may be accused of hypocrisy.

But for some patients, particularly those battling weight issues, a doctor's declarations of personal fitness may not have the intended effect of attracting new patients. Instead, rather than inspiring them, it can drive them away.

Recently, my colleague Benoît Monin and I studied doctors who advertise their fitness online. Past research has shown that people worry that those who claim the moral high ground will look down on others whose behavior seems unfavorable by comparison. For example, meat-eaters worry that vegetarians will judge them because of their diet. We wondered: Could emphasizing fitness make doctors seem "healthier than thou" and turn off patients?

We thought that people who are overweight and obese might be particularly sensitive to judgment from doctors. Unlike unhealthy habits such as smoking, weight can't be hidden. Research shows that negative attitudes toward people who are overweight are surprisingly prevalent among health professionals. So potential patients who are overweight might be especially turned off by doctors who show off healthy habits.

To test this idea, in research recently published in the Journal of Personality and Social Psychology, we turned to the real-world examples of physicians practicing what they preach on the website for Kaiser Permanente, the largest managed care organization in the United States. Here, patients choose among dozens of doctors from self-descriptions only a few sentences long, making any information provided consequential. We asked adults who were overweight or obese to rate a sample of these profiles. Some physicians emphasized their fitness in these profiles, while others did not.

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https://www.nytimes.com/2017/07/13/well/family/when-your-doctor-is-fitter-than-you-are.html