Monday, June 18, 2018

Video Game Addiction Tries to Move From Basement to Doctor’s Office - The New York Times

Video games work hard to hook players. Designers use predictive algorithms and principles of behavioral economics to keep fans engaged. When new games are reviewed, the most flattering accolade might be "I can't put it down."

Now, the World Health Organization is saying players can actually become addicted.

On Monday, "gaming disorder" will appear in a new draft of the organization's International Classification of Diseases, the highly regarded compendium of medical conditions.

Concerns about the influence of video games are dovetailing with increasing scrutiny over the harmful aspects of technology, as consumers look for ways to scale back consumption of social media and online entertainment.

The W.H.O. designation may help legitimize worries about video game fans who neglect other parts of their lives. It could also make gamers more willing to seek treatment, encourage more therapists to provide it and increase the chances that insurance companies would cover it.
"It's going to untie our hands in terms of treatment, in that we'll be able to treat patients and get reimbursed," said Dr. Petros Levounis, the chairman of the psychiatry department at Rutgers New Jersey Medical School. "We won't have to go dancing around the issue, calling it depression or anxiety or some other consequence of the issue but not the issue itself."

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https://www.nytimes.com/2018/06/17/business/video-game-addiction.html?

Thursday, May 31, 2018

Who Gets To Profit From Patients' Medical Data? : Shots - Health News : NPR

If you go to the hospital for medical treatment and scientists there decide to use your medical information to create a commercial product, are you owed anything as part of the bargain?

That's one of the questions that is emerging as researchers and product developers eagerly delve into digital data such as CT scans and electronic medical records, making artificial-intelligence products that are helping doctors to manage information and even to help them diagnose disease.

This issue cropped up in 2016, when Google DeepMind decided to test an app that measures kidney health by gathering 1.6 million records from patients at the Royal Free Hospital in London. The British authorities found this broke patient privacy laws in the United Kingdom and put a stop to it.

But the rules are different in the United States. The most notable cases have involved living tissue, but the legal arguments apply to medical data as well. One of the best examples dates back to 1976, when John Moore went to UCLA to be treated for hairy cell leukemia.

Prof. Leslie Wolf, director of the Center for Health, Law and Society at the Georgia State University College of Law, says Moore's doctors gave him good medical care, "but they also discovered there was something interesting about his cells and created a cell line from his cells without his knowledge," she says.

"And what complicated things even more is they asked Mr. Moore to travel down from his home in Seattle to L.A. multiple times, for seven years, to get additional cells without telling him they had this commercial interest in his cells."

Moore sued. In 1990, The California Supreme Court decided that he did not own his cells, but found his doctors had an obligation to inform him that his tissue was being used for commercial purposes and to give him a chance to object. Moore reached a settlement following his court battle, "but Mr. Moore certainly felt betrayed through the process," Wolf says.

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https://www.npr.org/sections/health-shots/2018/05/31/615501659/when-scientists-develop-products-from-personal-medical-data-who-gets-to-profit?

The Largest Health Disparity We Don’t Talk About - The New York Times

I didn't think our relationship would last, but neither did I think it would end so soon.

My patient had struggled with bipolar disorder his entire life, and his illness dominated our years together. He had, in a fit of hopelessness, tried to take his life with a fistful of pills. He had, in an episode of mania, driven his car into a tree. But the reason I now held his death certificate — his sister and mother in tears by his bed — was more pedestrian: a ruptured plaque in his coronary artery. A heart attack.

Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It's a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world's poorest countries.

National conversations about better mental health care tend to follow a mass shooting or the suicide of a celebrity. These discussions obscure a more rampant killer of millions of Americans with mental illness: chronic disease.

We may assume that people with mental health problems die of "unnatural causes" like suicide, overdoses and accidents, but they're much more likely to die of the same things as everyone else: cancer, heart disease, stroke, diabetes and respiratory problems. Those with serious mental illness are more likely to struggle with homelessness, poverty and social isolation. They have higher rates of obesity, physical inactivity and tobacco use. Nearly half don't receive treatment, and for those who do, there's often a long delay.
When these patients do make it into our clinics and hospitals, it's clear that we could do better. A troubled mind can distract doctors from an ailing heart or a budding cancer.

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https://www.nytimes.com/2018/05/30/upshot/mental-illness-health-disparity-longevity.html

‘Unintended pregnancy’: Nearly 170,000 Allergan birth control packs recalled - The Washington Post

Pharmaceutical company Allergan issued a nationwide recall Tuesday for nearly 170,000 sample packs of the birth control Taytulla after a packaging error caused pills to be placed in the wrong order, a mistake that it said could lead to unintended pregnancies.

The botched packs have placebo pills where active pills should be, Allergan said in a statement. The 28-pill pack should have 24 pink pills with hormones followed by the four maroon capsules that don't have hormones, the company said. However, in the recalled packs, the placebos are at the beginning of the treatment. Taking placebos allow women to still experience period-like bleeding.

"The reversing of the order may not be apparent to either new users or previous users of the product, increasing the likelihood of taking the capsules out of order," the company's statement said. "If patients have concerns regarding the possibility of an unintended pregnancy they should consult their physician."

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https://www.washingtonpost.com/news/morning-mix/wp/2018/05/30/nearly-170000-allergan-birth-control-packs-recalled-after-error-leaves-pills-out-of-order/?

BBC - Future - Pain bias: The health inequality rarely discussed

In 2009, my doctor told me that, like "a lot of women", I was paying too much attention to my body. Saying there wasn't an issue, he suggested I just relax and try to ignore the symptoms.

The decision seemed to run counter to what my records showed. A few weeks earlier, I had ended up in the emergency room with chest pains and a heart rate hitting 220 beats per minute. The ER crew told me it was a panic attack, gave me Xanax and told me to try to sleep.

I'd had panic attacks before. I knew this episode was not one. So I went to my doctor.

He put me on a heart monitor overnight. Bingo: I had another episode, this time recorded. It didn't matter. I still left his office thinking it was perhaps anxiety. And so, listening to the advice, I tried to ignore the pain.­­

Until it happened again. And again. First every month, then every week. Over the following nine years, I would complain about it and be told again that I was having panic attacks or anxiety, that women don't feel heart pain the way I was feeling it, and that maybe I was just confused.

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http://www.bbc.com/future/story/20180518-the-inequality-in-how-women-are-treated-for-pain

BBC - Future - 'Everybody was telling me there was nothing wrong'

Compared to many other diseases, diagnosing a brain tumour is fairly straightforward. Promptly detecting it comes down to being concerned enough about the early symptoms – which range from fatigue to seizures to personality change – to get an image of the brain. Either the tumour is there, or it isn't.

But in 2016, the Brain Tumour Charity released a report on the treatment of brain tumour patients in the United Kingdom. It found that almost one in three of them had visited a doctor more than five times before receiving their diagnosis. Nearly a quarter weren't diagnosed for more than a year.

Women, as well as low-income patients, experienced longer delays. They were more likely than men to see 10 or more months pass between their first visit to a doctor and diagnosis –and to have made more than five visits to a doctor prior to diagnosis.

One 39-year-old woman quoted in the report recalled: "One of the GPs I saw actually made fun of me, saying 'what did I think my headaches were, a brain tumour?' I had to request a referral to neurology. I went back repeated times to be given antidepressants, sleep charts, analgesia, etc. No one took me seriously."

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http://www.bbc.com/future/story/20180523-how-gender-bias-affects-your-healthcare?

Monday, May 28, 2018

When is dentistry not medicine? When insurance is involved - CNN

I'm 61 years old, a San Francisco homeowner with an academic position at the University of California-Berkeley, which provides me with comprehensive health insurance. Yet, to afford the more than $50,000 in out-of-pocket expenses required for the restorative dental work I've needed in the past 20 years, I've had to rely on handouts -- from my mom.

This was how I learned all about the Great Divide between medicine and dentistry -- especially in how treatment is paid for, or mostly not paid for, by insurers. Many Americans with serious dental illness find out the same way: sticker shock.

For millions of Americans -- blessed in some measure with good genes and good luck -- dental insurance works pretty well, and they don't think much about it. But people like me learn the hard way that dental insurance isn't insurance at all -- not in the sense of providing significant protection against unexpected or unaffordable costs. My dental coverage from UC-Berkeley, where I have been on the public health and journalism faculties, tops out at $1,500 a year -- and that's considered a decent plan.

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https://edition.cnn.com/2018/05/28/health/dental-insurance-partner/index.html?

Saturday, May 19, 2018

Opinion | Treat Addiction Like Cancer - The New York Times

Two years ago, I spent a week in Houston helping my stepbrother while he underwent treatment for Stage 4 lymphoma at the University of Texas MD Anderson Cancer Center. I sat with him while a nurse cleaned his chemo port and made records of her work, to keep his medical team updated. I accompanied him for the blood tests that determined his readiness for the next treatment. I stayed by his bed as his stem cells were harvested for a transplant, one of the cutting-edge, evidence-based therapies that ultimately saved his life.

Around the same time, I was helping my 22-year-old daughter, who struggled with alcohol and drug addiction. The contrast between the two experiences was stark. While my stepbrother received a doctor's diagnosis, underwent a clearly defined treatment protocol and had his expenses covered by insurance, there was no road map for my daughter. She had gone undiagnosed for several years, despite my reaching out to her health care providers, who either minimized my concerns or weren't sure what to do.

I had to hire an expensive interventionist — a professional who helps families find appropriate care and runs interventions — to find names of treatment centers. I spent weeks calling programs, asking questions and waiting to learn what insurance would cover. Finally, after my daughter agreed to treatment and we paid all costs up front, I sent her to a 45-day Arizona inpatient program, praying it would work.

Addiction, like cancer, is a complex disease that requires a multipronged approach. It also affects 1.5 times as many people as those with all cancers combined, and it was pivotal in causing some 64,000 overdose deaths in 2016 alone. It makes no sense that what is fast becoming our greatest health care crisis is still dealt with mostly outside the mainstream medical system.

According to a 2016 surgeon general's report, 10 percent of the 21 million Americans with substance-use disorders will receive treatment. This is in part because there are no national standards of care for treating addiction, and the $35 billion rehab industry is regulated piecemeal, state by state. While many treatment programs offer excellent care, others are motivated by profit and engage in practices such as patient brokering (in which hefty sums are paid to those who refer an addict to a program) and charging insurers exorbitant fees.

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https://www.nytimes.com/2018/05/19/opinion/sunday/addiction-cancer-treatment.html

Friday, May 18, 2018

New Drug Offers Hope to Millions With Severe Migraines - The New York Times

The first medicine designed to prevent migraines was approved by the Food and Drug Administration on Thursday, ushering in what many experts believe will be a new era in treatment for people who suffer the most severe form of these headaches.

The drug, Aimovig, made by Amgen and Novartis, is a monthly injection with a device similar to an insulin pen. The list price will be $6,900 a year, and Amgen said the drug will be available to patients within a week.

Aimovig blocks a protein fragment, CGRP, that instigates and perpetuates migraines. Three other companies — Lilly, Teva and Alder — have similar medicines in the final stages of study or awaiting F.D.A. approval.

"The drugs will have a huge impact," said Dr. Amaal Starling, a neurologist and migraine specialist at the Mayo Clinic in Phoenix. "This is really an amazing time for my patient population and for general neurologists treating patients with migraine."

Millions of people experience severe migraines so often that they are disabled and in despair. These drugs do not prevent all migraine attacks, but can make them less severe and can reduce their frequency by 50 percent or more.

As a recent editorial in the journal JAMA put it, they are "progress, but not a panacea."

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https://www.nytimes.com/2018/05/17/health/migraines-prevention-drug-aimovig.html?

Thursday, May 17, 2018

This revolution in our understanding of depression will be life-transforming | The Guardian

Depression runs in families, we know. But it is only very recently, and after considerable controversy and frustration, that we are beginning to know how and why. The major scientific discoveries reported last week by the Psychiatric Genomics Consortium in Nature Genetics are a hard-won breakthrough in our understanding of this very common and potentially disabling disorder.

If your parents have been depressed, the chances that you have been or will be depressed are significantly increased. The background risk of depression in the general population is about one in four – each of us has a 25% chance of becoming depressed at some point in our lives. And if your parents have been depressed, your risk jumps by a factor of three.

However, controversy has long swirled around the question of nature or nurture. Is the depressed son of a depressed mother the victim of her inadequate parenting and the emotionally chilly, unloving environment she provided during the early years of his life? Or is he depressed because he inherited her depressive genes that biologically determined his emotional fate, regardless of her parenting skills? Is it nature or nurture, genetics or environment, which explain why depression runs in families?

In the 20th century, psychiatrists ingeniously teased out some answers to these questions. For example, it was found that pairs of identical twins, with 100% identical DNA, were more likely to have similar experiences of depression than were pairs of non-identical twins, with 50% identical DNA. This indicated clearly that depression is genetically heritable. But well into the 21st century, the precise identity of the "genes for depression" remained obscure. Since 2000, there has been a sustained international research effort to discover these genes, but the field has been bedevilled by false dawns and inconsistent results.

That is why the study published last week is such a significant milestone. For the first time, scientists around the world, with leading contributions from the UK's world-class centres of psychiatric genetics research largely funded by the Medical Research Council at the University of Cardiff University, University of Edinburgh University and King's College London, have been able to combine DNA data on a large enough sample to pinpoint which locations on the genome are associated with an increased risk of depression. So we now know, with a high degree of confidence, something important about depression that we didn't know this time last year. We know that there are at least 44 genes, out of the 20,000 genes comprising the human genome, which contribute to the transmission of risk for depression from one generation to the next.

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https://www.theguardian.com/commentisfree/2018/apr/29/revolution-in-our-understaning-of-depression-will-be-life-transforming?