Monday, February 20, 2017

Medical Mystery: Why Is Back Surgery So Popular in Casper, Wyo.? - The New York Times

You might think that once drugs, devices and medical procedures are shown to be effective, they quickly become available. You might also think that those shown not to work as well as alternatives are immediately discarded.

Reasonable assumptions both, but you'd be wrong.

Instead, innovations in health care diffuse unevenly across geographic regions — not unlike the spread of a contagious disease. And even when studies show a new technology is overused, retrenchment is very slow and seemingly haphazard.

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https://www.nytimes.com/2017/02/13/upshot/medical-mystery-why-is-back-surgery-so-popular-in-casper-wyo.html?

The Worst That Could Happen? Going Blind, People Say - The New York Times

"Feeling My Way Into Blindness," an essay published in The New York Times in November by Edward Hoagland, an 84-year-old nature and travel writer and novelist, expressed common fears about the effects of vision loss on quality of life.

Mr. Hoagland, who became blind about four years ago, projected deep-seated sadness in describing the challenges he faces of pouring coffee, not missing the toilet, locating a phone number, finding the food on his plate, and knowing to whom he is speaking, not to mention shopping and traveling, when he often must depend on the kindness of strangers. And, of course, he sorely misses nature's inspiring vistas and inhabitants that fueled his writing, though he can still hear birds chatter in the trees, leaves rustle in the wind and waves crash on the shore.

Mr. Hoagland is hardly alone in his distress. According to Action for Blind People, a British support organization, those who have lost some or all sight "struggle with a range of emotions — from shock, anger, sadness and frustration to depression and grief."

When eyesight fails, some people become socially disengaged, leading to isolation and loneliness. Anxiety about a host of issues — falls, medication errors, loss of employment, social blunders — is common.

A recent study from researchers at the Wilmer Eye Institute at Johns Hopkins University School of Medicine found that most Americans regard loss of eyesight as the worst ailment that could happen to them, surpassing such conditions as loss of limb, memory, hearing or speech, or having H.I.V./AIDS. Indeed, low vision ranks behind arthritis and heart disease as the third most common chronic cause of impaired functioning in people over 70, Dr. Eric A. Rosenberg of Weill Cornell Medical College and Laura C. Sperazza, a New York optometrist, wrote in American Family Physician.

Some 23.7 million American adults reported in 2015 that they are unable to see at all or have trouble seeing even with corrective lenses. This number is projected to perhaps double by 2050 based on the aging of the population and increasing prevalence of diseases that can cause vision loss. Yet, the Wilmer Eye Institute's national study of 2,044 adults found that many Americans are unaware of the diseases and factors that can put their vision at risk and steps they might take to lower their risk.

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https://www.nytimes.com/2017/02/20/well/the-worst-that-could-happen-going-blind-people-say.html?

When Retirement Comes With a Daily Dose of Cannabis - The New York Times

Ruth Brunn finally said yes to marijuana. She is 98.

She pops a green pill filled with cannabis oil into her mouth with a sip of vitamin water. Then Ms. Brunn, who has neuropathy, settles back in her wheelchair and waits for the jabbing pain in her shoulders, arms and hands to ebb.

"I don't feel high or stoned," she said. "All I know is I feel better when I take this."

Ms. Brunn will soon have company. The nursing home in New York City where she lives, the Hebrew Home at Riverdale, is taking the unusual step of helping its residents use medical marijuana under a new program to treat various illnesses with an alternative to prescription drugs. While the staff will not store or administer pot, residents are allowed to buy it from a dispensary, keep it in locked boxes in their rooms and take it on their own.

From retirement communities to nursing homes, older Americans are increasingly turning to marijuana for relief from aches and pains. Many have embraced it as an alternative to powerful drugs like morphine, saying that marijuana is less addictive, with fewer side effects.

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https://www.nytimes.com/2017/02/19/nyregion/retirement-medicinal-marijuana.html?

Thursday, February 16, 2017

How to Get a Better Night’s Sleep - Well Guides - The New York Times

Most people know they need to eat right and exercise to be healthy. But what about sleep? We spend about one-third of our lives asleep, and sleep is essential to better health. But many of us are struggling with sleep. Four out of five people say that they suffer from sleep problems at least once a week and wake up feeling exhausted. So how do you become a more successful sleeper? Grab a pillow, curl up and keep reading to find out.

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https://www.nytimes.com/well/guides/how-to-sleep?

Tuesday, February 14, 2017

Sharp Rise Reported in Older Americans’ Use of Multiple Psychotropic Drugs - NYTimes.com

The number of retirement-age Americans taking at least three psychiatric drugs more than doubled between 2004 and 2013, even though almost half of them had no mental health diagnosis on record, researchers reported on Monday.

The new analysis, based on data from doctors' office visits, suggests that inappropriate prescribing to older people is more common than previously thought. Office visits are a close, if not exact, estimate of underlying patient numbers. The paper appears in the journal JAMA Internal Medicine.

Geriatric medical organizations have long warned against overprescribing to older people, who are more susceptible to common side effects of psychotropic drugs, such as dizziness and confusion. For more than 20 years, the American Geriatrics Society has published the so-called Beers Criteria for potentially inappropriate use, listing dozens of drugs and their mutual interactions.

In that time, prescription rates of drugs like antidepressants, sleeping pills and painkillers nonetheless generally increased in older people, previous studies have found. The new report captures one important dimension, the rise in so-called polypharmacy — three drugs or more — in primary care, where most of the prescribing happens. Earlier research has found that elderly people are more likely to be on at least one psychiatric drug long term than younger adults, even though the incidence of most mental disorders declines later in life.

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https://mobile.nytimes.com/2017/02/13/health/psychiatric-drugs-prescriptions.html?

NYTimes: Lower Back Ache? Be Active and Wait It Out, New Guidelines Say

Dr. James Weinstein, a back pain specialist and chief executive of Dartmouth-Hitchcock Health System, has some advice for most people with lower back pain: Take two aspirin and don't call me in the morning.

On Monday, the American College of Physicians published updated guidelines that say much the same. In making the new recommendations for the treatment of most people with lower back pain, the group is bucking what many doctors do and changing its previous guidelines, which called for medication as first-line therapy.

Dr. Nitin Damle, president of the group's board of regents and a practicing internist, said pills, even over-the-counter pain relievers and anti-inflammatories, should not be the first choice. "We need to look at therapies that are nonpharmacological first," he said. "That is a change."

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https://www.nytimes.com/2017/02/13/health/lower-back-pain-surgery-guidelines.html?

Saturday, February 11, 2017

Doctors See Gains Against ‘an Urgent Threat,’ C. Diff - The New York Times

Tom Bocci's encounter with a bacterium he had never heard of began in April, when his doctor suggested a test for prostate cancer. Because the results appeared slightly abnormal, Mr. Bocci underwent a biopsy, taking antibiotics beforehand as a standard precaution against infection.

There was no problem with his prostate, it turned out. But a few days later, Mr. Bocci developed severe diarrhea, fever and vomiting. He grew dehydrated. Five days afterward, in a hospital emergency room, doctors diagnosed a Clostridium difficile infection.

Antibiotics appeared to squelch the infection but, as happens in 20 to 30 percent of cases, the symptoms returned with a vengeance as soon as he finished the drugs. Over several months, Mr. Bocci suffered from migraines, weakness, anxiety and hypertension.

Told to isolate himself, he warned family members not to visit his home in Troy, Mich.; his wife, Wendy, moved into a spare bedroom. He lost 30 pounds. After the third recurrence, "I really thought I was going to die," Mr. Bocci, now 71, said. "And sometimes I felt I wanted to."

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https://www.nytimes.com/2017/02/10/health/clostridium-difficile-c-diff.html?

Addiction Treatment Grew Under Health Law. Now What? - The New York Times

MANCHESTER, N.H. — Chad Diaz began using heroin when he was 12. Now 36 and newly covered by Medicaid under the Affordable Care Act, he is on Suboxone, a substitute opioid that eases withdrawal symptoms and cravings, and he is slowly pulling himself together.

"This is the best my life has gone in many, many years," Mr. Diaz, a big man wearing camouflage, said as he sat in a community health center here.

If Congress and President Trump succeed in dismantling the Affordable Care Act, he will have no insurance to pay for his medication or counseling, and he fears he will slide back to heroin.

"If this gets taken from me, it's right back to Square 1," he said. "And that's not a good place. I'm scary when I'm using. I don't care who I hurt."

As the debate over the fate of the health law intensifies, proponents have focused on the lifesaving care it has brought to people with cancer, diabetes and other physical illnesses. But the law has also had a profound, though perhaps less heralded, effect on mental health and addiction treatment, vastly expanding access to those services by designating them as "essential benefits" that must be covered through the A.C.A. marketplaces and expanded Medicaid.

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https://www.nytimes.com/2017/02/10/health/addiction-treatment-opiods-aca-obamacare.html

Thursday, February 9, 2017

As mental health crises soar, colleges can't meet student needs - STAT

Colleges across the country are failing to keep up with a troubling spike in demand for mental health care — leaving students stuck on waiting lists for weeks, unable to get help.

STAT surveyed dozens of universities about their mental health services. From major public institutions to small elite colleges, a striking pattern emerged: Students often have to wait weeks just for an initial intake exam to review their symptoms. The wait to see a psychiatrist who can prescribe or adjust medication — often a part-time employee — may be longer still.

Students on many campuses are so frustrated that they launched a petition last month demanding expanded services. They plan to send it to 20 top universities, including Harvard, Princeton, Yale, MIT, and Columbia, where seven students have died this school year from suicide and suspected drug overdose.

"Students are turned away every day from receiving the treatment they need, and multiple suicide attempts and deaths go virtually ignored each semester," the petition reads. More than 700 people have signed; many have left comments about their personal experiences trying to get counseling at college. "I'm signing because if a kid in crisis needs help they should not have to wait," one wrote.

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https://www.statnews.com/2017/02/06/mental-health-college-students/

Why the advice to take all your antibiotics may be wrong - STAT

You've heard it many times before from your doctor: If you're taking antibiotics, don't stop taking them until the pill vial is empty, even if you feel better.

The rationale behind this commandment has always been that stopping treatment too soon would fuel the development of antibiotic resistance — the ability of bugs to evade these drugs. Information campaigns aimed at getting the public to take antibiotics properly have been driving home this message for decades.

But the warning, a growing number of experts say, is misguided and may actually be exacerbating antibiotic resistance.

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https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/?