Thursday, October 19, 2017

Dry eye, other vision problems, affect women more than men - The Washington Post

At first, it felt like something was in her eye. Then her eyes turned red, watery and irritated. Her vision became blurry, and she found it difficult to read. It was painful to fly, and to be in air conditioning. Ilene Gipson, a scientist who studies eye disorders, didn't need a specialist to tell her what she had. "I knew what it was," she says.

Gipson had dry eye disease, an ailment that occurs when the eye does not produce enough tears, or when the tears evaporate too quickly. It is the most common eye problem that older women experience, and it disproportionately affects women: more than 3 million women vs. about 1.7 million men, according to the American Academy of Ophthalmology.

And it's not the only one. Many eye disorders — some of them quite serious — seem to favor women over men.

"Women make up two-thirds of the people who are visually impaired or blind in the world," says Janine Clayton, an ophthalmologist who heads the office of research on women's health at the National Institutes of Health. "Most people would say, 'That can't be the case in the United States.' But it is. Unfortunately, we don't know why."

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https://www.washingtonpost.com/national/health-science/vision-problems--dry-eye-among-them--affect-more-women-than-men/2017/10/13/02c121d6-a79f-11e7-850e-2bdd1236be5d_story.html?

Monday, October 16, 2017

Health care prices are the problem - Vox

On September 28, 2016, a 3-year-old girl named Elodie Fowler slid into an MRI machine at Lucile Packard Children's Hospital in Palo Alto, California. Doctors wanted to better understand a rare genetic condition that was causing swelling along the right side of her body and problems processing regular food.

The scan took about 30 minutes. The hospital's doctors used the results to start Elodie on an experimental new drug regimen.

Fowler's parents knew the scan might cost them a few thousand dollars, based on their research into typical pediatric MRI scans. Even though they had one of the most generous Obamacare exchange plans available in California, they decided to go out of network to a clinic that specialized in their daughter's rare genetic condition. That meant their plan would cover half of a "fair price" MRI.

They were shocked a few months later when a bill arrived with a startling price tag: $25,000. The bill included $4,016 for the anesthesia, $2,703 for a recovery room, and $16,632 for the scan itself plus doctor fees. The insurance picked up only $1,547.23, leaving the family responsible for the difference: $23,795.47.

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https://www.vox.com/policy-and-politics/2017/10/16/16357790/health-care-prices-problem

Sunday, October 15, 2017

What I Learned From Being the Tick Girl - Nautilus

My sister Camilla and I stepped off the passenger ferry onto the dock at Vineyard Haven, Martha's Vineyard's main port, with a group that had already begun their party. They giggled, dragging coolers and beach chairs behind them. We competed to see how many items of Nantucket red we could spot.

Not that we were wearing any. Camilla wore shorts with white long underwear underneath, and I wore beige quick-dry hiking pants. Both of us had on sneakers with long white socks. It was late June, perfect beach weather. The water sparkled. But we weren't headed toward the ocean. We were there to hunt for ticks.

On the island, we hopped in a cab. Camilla looked longingly out the window as we passed the turns for the town beach and Owens Park Beach. The driver pointed out the location of the famous shark attack beach from Jaws. We drove on south to Manuel Correllus State Forest, an unremarkable park in the center of the island and the farthest point from any beach.

Deer ticks, or blacklegged ticks, are poppy-seed sized carriers of Lyme disease. We needed to collect 300 before the last ferry returned to Woods Hole, Massachusetts that night. We each unfurled a drag cloth—a one-meter square section of once-white corduroy attached to a rope—and began to walk, dragging the cloth slowly behind us as if we were taking it for a stroll. The corduroy patch would rise and fall over the leaves and logs in the landscape, moving like a mouse or a chipmunk scurrying through the leaf litter. Ticks, looking for blood, would attach to the cloth. Every 20 meters, we'd stoop to harvest them.

Tick collecting made it to Popular Science's 2004 list of worst science jobs alongside landfill monitor and anal wart researcher. On cool days, though, sweeping the forest floor, kneeling to pluck ticks from corduroy ridges, the job became rhythmic. I felt strangely close to the forest. As I soon found out, the work got me closer to people, too.

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http://nautil.us/issue/53/monsters/what-we-get-wrong-about-lyme-disease?

Saturday, October 14, 2017

'A third of people get major surgery to be born': why are C-sections routine in the US? | Life and style | The Guardian

Carmen Walker didn't realize how bad things had gotten until she heard her doctor's voice from across the operating room: "I'm going to try to save her uterus."

Walker had delivered her first child by caesarean section, so when she became pregnant a second time, doctors didn't think twice before scheduling another. And then another and another. Now, giving birth to her sixth child, she was experiencing the consequences: placenta accreta, a condition which is linked to multiple C-sections and can result in fatal bleeding.

Caesarean sections have saved the lives of millions of infants who might have otherwise been killed or permanently injured during difficult births. But in the US, the rate of caesareans has increased so much over the decades that the surgery has been transformed from a life-saving intervention into a procedure performed as a matter of course during one in three US births.

In 2015, the latest year for which the Centers for Disease Control has data, the share of births by C-section was 32%. The World Health Organization has suggested that the rate should not be higher than 10% - 15%, while other experts have suggested it should not be higher than 19%. The last time the US's rate was that low was during the 1970s.

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https://www.theguardian.com/lifeandstyle/2017/oct/04/one-in-three-us-births-happen-by-c-section-caesarean-births?

Friday, October 13, 2017

Why I Almost Fired My Doctor - The New York Times

I always liked my primary care doctor personally. He routinely welcomed me to his office with a cheery hello and a smile. We asked about each other's children. We often discussed our respective exercise regimens, running in his case and pickup basketball in mine. For more than 20 years, we even confided about our ambitions as writers.

But I often questioned his judgment in medical matters.

Take, for example, the time my neck bothered me. I complained to him about frequent soreness and stiffness – probably a result of spending hours planted in front of a computer. He suggested I obtain a neck brace to wear while working. "Is that necessary?" I asked him. No, he said.

At no point did he ask me where my neck hurt, or how much, or how often. He never physically examined my neck, nor instructed me to turn my head in order to observe my range of motion. He neglected to propose I do specific exercises to rehabilitate my neck or get a new chair or just take frequent breaks from sitting at a keyboard.

Rather, he advised me to see an orthopedist or physiatrist. He also printed out some medical journal articles about neck problems for me to read, all well over my head.

Some time later, my annual physical revealed my overall cholesterol level to be borderline high. "I should probably put you on a statin," my doctor said. "I could prescribe Lipitor." "Would that be necessary?" I asked him. No, he said.

"It's a trend that reflects the state of medicine today," Dr. Danielle Ofri, associate professor of medicine at NYU Langone Medical Center and author of "What Patients Say, What Doctors Hear," told me. "Physicians are so risk-averse they prescribe medications as a default and reflexively refer patients to specialists. It's systemic."

What to do? After all, this was my health here. As a lifelong recreational athlete and fitness enthusiast, I'd entered my 60s healthy, but eventually – inevitably – my age would catch up with me. Was I going to risk my longevity to avoid hurting my doctor's feelings? I needed a physician I respected and trusted. Should I stick with the status quo or take a hike?

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https://www.nytimes.com/2017/10/12/well/live/why-i-almost-fired-my-doctor.html?

Saturday, October 7, 2017

The Touch of Madness - Pacific Standard

By the time Nev Jones entered DePaul University's esteemed doctoral program in philosophy, she had aced virtually every course she ever took, studied five languages and become proficient in three, and seemed to have read and memorized pretty much everything. Small and slightly built, with a commanding presence that emerged when she talked, she was the sort of student that sharp teachers quickly notice and long remember: intellectually voracious, relentlessly curious, endlessly capable, and, as one of her high school teachers put it, "magnificently intense." Her mind drew on a well-stocked, seemingly flawless memory with a probing, synthesizing intelligence. With astounding frequency she produced what one doctoral classmate called "genius-level reflections."

So Jones grew alarmed when, soon after starting at DePaul in the fall of 2007, at age 27, she began having trouble retaining things she had just read. She also struggled to memorize the new characters she was learning in her advanced Chinese class. She had experienced milder versions of these cognitive and memory blips a couple times before, most recently as she'd finished her undergraduate studies earlier that year. These new mental glitches were worse. She would study and draw the new logograms one night, then come up short when she tried to draw them again the next morning.

These failures felt vaguely neurological. As if her synapses had clogged. She initially blamed them on the sleepless, near-manic excitement of finally being where she wanted to be. She had wished for exactly this, serious philosophy and nothing but, for half her life. Now her mind seemed to be failing. Words started to look strange. She began experiencing "inarticulable atmospheric changes," as she put it—not hallucinations, really, but alterations of temporality, spatiality, depth perception, kinesthetics. Shimmerings in reality's fabric. Sidewalks would feel soft and porous. Audio and visual input would fall out of sync, creating a lag between the movement of a speaker's lips and the words' arrival at Jones' ears. Something was off.

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https://psmag.com/magazine/the-touch-of-madness-mental-health-schizophrenia?

We Need to Talk About Madness: A Reading List

When I was 15, a teacher I was very close with killed himself over winter break. I found out about it in an AOL chatroom the night before school resumed. My friends were talking about how the elementary school science teacher had died. "The one from when we were kids?" I typed into the chatroom, sitting on the couch between my parents, as the Jennifer Garner show Alias played on our television. "Shit," one of my classmates typed. "We weren't supposed to tell her," another wrote.

John Wake was my little brothers' science teacher, and my after-school photography teacher. I leapt from the couch and called my homeroom teacher at his home. In a quiet, heavy voice, he confirmed what my friends had let slip. I screamed. My parents hovered around me, trying to understand what was happening. Eventually one of them took the phone. I was sobbing, incoherent, and couldn't breathe. I needed air. I ran to the elevator and my father followed me. He walked me down and back up our Manhattan block in pouring January rain, his arm tight around me as I sobbed, tucked into his armpit. The next day in school I was crying at my locker and the guidance counselor walked by. He stopped and turned around after passing me, and asked if I was okay. I looked at him and said with all the raw teenage emotion in my body, "No. My favorite teacher killed himself." The guidance counselor looked back at me, said he hoped I'd feel better, and walked away.

My own mental illness had made itself known a few years earlier. Mr. Wake and I had a special bond, maybe because something in each of us recognized itself in the other person. I had always been a Good Kid — didn't smoke, didn't drink, had never kissed a boy. But when Mr. Wake died, I became angry at the adults in my school. I needed them to talk about this monster that lived inside some of us, sometimes quiet for years at a time, occasionally rousing to try to kill us. When they wouldn't, I punished them the only way my teenage self knew how: I became Bad. I smoked cigarettes in school, cut class to get stoned, threw tantrums at teachers and stormed out, showed up drunk to a school dance with the valedictorian. The adults in charge ignored my acting out, for the most part. I transferred to a new school at the end of the year, in large part because the adults who interviewed me there didn't look away when I confronted them with my sad, ugly, unwieldy pain.

I try now, as an adult, to be sympathetic to those adults at my old school, who shied away from the conversation I so badly wanted to have. They were probably ill-equipped for it. They were probably dealing with their own pain. They probably worried that I wanted answers they didn't have, that simply didn't exist.

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https://longreads.com/2017/10/04/we-need-to-talk-about-madness-a-reading-list/?

A Surgeon Not Afraid to Face His Mistakes, In and Out of the Operating Room - The New York Times

In 2003, The Washington Post columnist Marjorie Williams, struggling with liver cancer, wrote that she had finally figured out what bothered her so much about then-presidential candidate Howard Dean: His doctorly arrogance. "Where else but in medicine," she asked, "do you find men and women who never admit a mistake?"

Actually, this happens quite frequently in politics too. But point taken.

Henry Marsh is in the business of admitting his mistakes. It's right there in the title of his second memoir — "Admissions: Life as a Brain Surgeon" — and it was the central theme of his first, "Do No Harm," published in his native England to wide acclaim, in 2014, and then here a year later.

One of the reasons patients find condescension from doctors especially loathsome is that it diminishes them — if you're gravely ill, the last thing you need is further diminishment. But the desires of patients, Marsh notes, are often paradoxical. They also pine for supreme confidence in their physicians, surgeons especially, because they've left their futures — the very possibility of one at all, in some cases — in their doctors' custody. "So we quickly learn to deceive," Marsh writes, "to pretend to a greater level of competence and knowledge than we know to be the case, and try to shield our patients a little from the frightening reality they often face."

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https://www.nytimes.com/2017/10/05/books/review-admissions-life-as-brain-surgeon-henry-marsh.html?

Tuesday, September 26, 2017

The Latest Jaw-Dropping Numbers From the Opioid Crisis – Mother Jones

About 64,000 Americans died from drug overdoses last year—a staggering 21 percent increase from the 52,404 in 2015—according to the first government estimate of drug deaths in 2016. Overdoses now kill more Americans than HIV did at its peak in 1995, and far more than guns or cars do today.

The numbers, released by the Centers for Disease Control and Prevention, are provisional and will be updated monthly, according to the agency.

Fueling the rise in deaths is fentanyl, a synthetic opioid up to 100 times more potent than morphine, and fentanyl analogs, or slight tweaks on the fentanyl molecule. This has not always been the case: As the chart below shows, the drivers of the opioid crisis have changed from prescription painkillers to heroin, and then to fentanyl.

As Dan Ciccarone, a professor at the University of California-San Francisco School of Medicine, recently wrote in the International Journal of Drug Policy:

This is a triple epidemic with rising waves of deaths due to separate types of opioids each building on top of the prior wave. The first wave of prescription opioid mortality began in the 1990s. The second wave, due to heroin, began around 2010 with heroin-related overdose deaths tripling since then. Now synthetic opioid-related overdoses, including those due to illicitly manufactured fentanyl and fentanyl analogues, are causing the third wave with these overdose deaths doubling between 2013 and 2014 .

The epidemic is straining the capacity of morgues, emergency services, hospitals, and foster care systems. Largely because of prevalent drug use and overdose, the number of children in foster care nationwide increased by 30,000 between 2012 and 2015.

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http://www.motherjones.com/politics/2017/09/the-latest-jaw-dropping-numbers-from-the-opioid-crisis/?

The Biomechatronic Man | Outside Online

I can see him in his glass-fronted Cambridge office from the foosball table in the light-filled central atrium. He's standing there talking to a visitor and seems to be finishing up. This entire side of the third floor in MIT's new Media Labbuilding is partitioned with glass, and professor Hugh Herr and his colleagues and whatever madness they're up to in their offices and the open, gadget-filled, lower-floor lab are on display. Several people, myself included, are peering down, hoping to see a bit of magic.

Months ago, when I e-mailed Herr to propose writing an article about him, I told him about my rare bone cancer and resulting partial paralysis below the waist as a way to explain my interest in his work. Though I didn't tell him this, I also harbored a secret wish that he could help me. People write to Herr, a 52-year-old engineer and biophysicist, daily about his inspiring example. They've heard him promise an end to disability. They have conditions that medicine can't fix and futures they can't stand to consider. They're wishing for his intervention, wanting of hope. Crossing his threshold, I'm the lucky one. I'm here.

Herr welcomes me into his office, a clean, well-ordered space. There's a round glass table with a laptop on it, a handful of hard office chairs, and a pair of prosthetic legs Herr designed that are arranged like statuary behind us, one in either corner. Above us on a wall looms a large mounted photograph of another pair of prosthetics. These are hand-carved from solid ash, with vines and flowers and six-inch heels. The real-life legs were famously worn by a friend of Herr's, the amputee track-and-field athlete and actress Aimee Mullins.

I have hobbled into Herr's office with a dented $20 stock metal cane on one side and a foot-lifting Blue Rocker brace on the other. (The dent is from my recently firing the cane at the wall.) I had imagined Herr noticing the cane and asking more about my story to see how he could fix me, like he has fixed so many others. The moment I realize that the meeting I'd imagined isn't the meeting we're going to have—I'm here as a reporter, not a friend or patient, after all—I start to stammer. Herr deftly resets the conversation by suggesting we look at his computer.

On it are the PowerPoint slides of his next big project, a breathtaking $100 million, five-year proposal focused on paralysis, depression, amputation, epilepsy, and Parkinson's disease. Herr is still trying to raise the money, and the work will be funneled through his new brainchild, MIT's Center for Extreme Bionics, a team of faculty and researchers assembled in 2014 that he codirects. After exploring various interventions for each condition, Herr and his colleagues will apply to the FDA to conduct human trials. One to-be-explored intervention in the brain might, with the right molecular knobs turned, augment empathy. "If we increase human empathy by 30 percent, would we still have war?" Herr asks. "We may not."

As he continues with the presentation he's been giving to technologists, engineers, health researchers, and potential donors—last December alone, he keynoted in Dubai, Istanbul, and Las Vegas—each revolutionary intervention he mentions yields a boyish grin and a look that affirms: Yes, you heard that right. In a talk I hear him give a few weeks ­later, he'll dare to characterize incurable paralysis as "low-hanging fruit." In his outspoken willingness to fix everything, even things that some argue should be left alone, he knows how he sounds. "If half the audience is frightened and the other half is intrigued, I know I've done a good job," he says.

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https://www.outsideonline.com/2238401/biomechatronic-man?