Tuesday, July 26, 2016

‘How’s Amanda?’ A story of truth, lies and an American addiction | The Washington Post

She had already made it through one last night alone under the freeway bridge, through the vomiting and shakes of withdrawal, through cravings so intense she'd scraped a bathroom floor searching for leftover traces of heroin. It had now been 12 days since the last time Amanda Wendler used a drug of any kind, her longest stretch in years. "Clear-eyed and sober," read a report from one drug counselor, and so Amanda, 31, had moved back in with her mother to begin the stage of recovery she feared most.

"Is this everything I have?" she asked, standing with her mother in the garage of their two-bedroom condominium, taking inventory of her things. There were a few garbage bags filled with clothes. There was a banged-up dresser she had put into storage before moving into her first abandoned house.

"Where's my good makeup?" Amanda asked.

"Maybe you pawned it with the jewelry," said her mother, Libby Alexander.

"What about all of my shoes?"

"Oh, God. Are you serious?" Libby said. "Do you even know how many pairs of shoes you've lost or sold?"

Amanda lit a cigarette and sat in a plastic chair wedged between the cat food and the recycling bins in the garage, the only place where she was allowed to smoke. This was the ninth time she had managed to go at least a week without using. She had spent a full decade trying and failing to get clean, and a therapist had asked her once to make a list of her triggers for relapse. "Boredom, loneliness, anxiety, regret, shame, seeing how I haven't gone up at all in my life when the drugs aren't there," she had written.

She had no job, no high school diploma, no car and no money beyond what her mother gave her for Mountain Dew and cigarettes. A few days earlier, a dentist had pulled all 28 of her teeth, which had decayed from years of neglect. It had been a week since she'd seen her 9-year-old twin sons, who lived in a nearby suburb with their father, and lately the most frequent text messages coming into her phone were from a dealer hoping to lure her back with free samples: "Got testers," he had just written. "Get at me. They're going fast."

In the addicted America of 2016, there are so many ways to take measure of the pain, longing and despair that are said to be driving a historic opiate epidemic: Another 350 people starting on heroin every day, according to estimates from the Centers for Disease Control and Prevention; another 4,105 emergency-room visits; another 79 people dead. Drug overdoses are now the leading cause of injury-related death in the United States — worse than guns, car crashes or suicides. Heroin abuse has quadrupled in the past decade. Most addicts are introduced to heroin through prescription pain pills, and doctors now write more than 200 million opiate prescriptions each year.

But the fact that matters most for a chronic user is what it takes for just one addict to get clean. The relapse rate for heroin has been reported in various studies to be as high as 97 percent. The average active user dies of an overdose in about 10 years, and Amanda's opiate addiction was going on year 11.

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http://www.washingtonpost.com/sf/national/wp/2016/07/23/2016/07/23/numb/?

Monday, July 25, 2016

Vaccination should be mandatory, but it isn’t.

For a baby born at 28 weeks—a full three months early—he was doing remarkably well, "feeding and growing" until he was big and strong enough to be cared for at home. As medical residents on the neonatal unit, we rarely saw this baby's family. But when we were able to reach his mother by telephone in between her work shifts, she was always loving, caring, appropriate, and eager for the day when her son, a perfect illustration of how modern medicine can impact even the tiniest baby's chance for a long and healthy life, would be ready to come home.

We rotated to other parts of the hospital, and this baby faded out of mind until we ran into the new resident caring for him and learned there was a Child Protective Services investigation underway. After a moment of confusion and bewilderment, our hearts sank as we understood what had happened: CPS and the medical team were concerned his mother—young, single, and working two full-time jobs in a town hours away from the hospital while supporting two other toddlers at home—simply could not pull together the resources to be present enough at the hospital to demonstrate her competence and commitment to caring for her baby.

After a few moments of collective frustration, anger, and most of all sadness for this family, we went back to work, shaken by yet another example of poor, disadvantaged parents being held to impossible standards. Cases like this are particularly painful for us because they stand in stark contrast to another situation of, we would argue, more serious parental neglect: Parents who deny their children the basic and essential medical care vaccinations provide.

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http://www.slate.com/articles/health_and_science/medical_examiner/2016/07/vaccination_should_be_mandatory_but_it_isn_t.html?

The puzzle solver | Stanford Medicine

For three years, Whitney Dafoe's world has been a darkened room at the end of a hallway in the back of his childhood home. An insidious disease, one with no known cause or cure, has slowly stolen his life from him, turning his body into a prison.

He doesn't eat. An IV line delivers nutrients and liquids and medicines to keep him alive. He doesn't speak. He's unable to write. Any motion exhausts him. Eye contact hurts him. He can't bear to be touched.

Last December, in desperation, he used Scrabble tiles to communicate, laboriously lining them up to spell out: CANT TAKE CARE OF MYSELF; DONT KNOW WHAT TO DO. At the end of the month, emaciated due to his inability to digest food, he selected five final tiles and spelled out: D, Y, I, N, G. Then he rang a bell for his father.

"My son Whitney woke me this morning to inform me that he is dying," his father, Ron Davis, PhD, posted on the Facebook page for the Stanford Chronic Fatigue Syndrome Research Center that day. "Whitney has severe chronic fatigue syndrome (CFS). He did not say he is dying — he cannot speak. He did not write he is dying — he cannot write. He used Scrabble tiles to spell out his message. I did not answer him — he cannot tolerate anyone speaking to him."

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http://stanmed.stanford.edu/2016spring/the-puzzle-solver.html?

Saturday, July 16, 2016

The Mystery of Urban Psychosis - The Atlantic

Southwyck House in South London is a block of flats so intimidating that it is often mistaken for a prison. Locally known as the Brixton 'barrier block,' it has a stark exterior of brick and concrete that literally looms over you, giving the impression that unseen people are staring down through the sparse rectangular windows.

It was built as a social housing project, designed to shield its residents from the noise of a phantom motorway that was intended to run from Blackheath to Battersea. The road was never built due to petty political squabbles, but the building now stands as a seven-story barricade against its illusory traffic.

If you're not used to the built-up environment of the inner city, the block can certainly feel unsettling. But here, urban alienation may run deeper than mere architecture. The area was found to have the highest rate of diagnosed schizophrenia in a large study of South London, even when compared with directly adjacent neighborhoods.

The research that found this striking variation was led by epidemiologist James Kirkbride, now at University College London. Kirkbride's work is but one in more than a century of studies that have found higher rates of psychosis in cities and which have sparked an intense debate over whether—to put it in its original terms —'cities cause madness' or whether those affected by 'madness' just tend to end up in cities.

The link between psychosis and city living was first noticed by American psychiatrists in the early 1900s who found that asylum patients were more likely to come from built-up areas. This association was sporadically rediscovered throughout the following century until researchers verified the association from the 1990s onwards with systematic and statistically controlled studies that tested people in the community as well as in clinics.

One particularly extensive study using health records for almost the entire population of Denmark found that the risk of being diagnosed with schizophrenia increased in a small but proportional way as people spent more time spent living in urban environments. Many studies have since replicated this finding, with neighborhood levels of social deprivation seeming to amplify the association and levels of social integration seeming to reduce it.

To many, this provides evidence that cities are universally bad for our mental health—something that chimes with a strong cultural belief that associates the natural world with tranquillity. It might seem like common sense that living in a run-down, inner-city neighborhood would wear away at your psychological wellbeing. But here is where the cultural cliché breaks down, because the effect is surprisingly selective.

The data shows that urban environments reliably increase the chances of being diagnosed with schizophrenia or having related experiences like paranoia and hallucinations. This is not the case for other mental health problems primarily caused, for example, by depression or mood instability. If it was a general effect on wellbeing, you would expect the chance of being diagnosed with any mental health problem to increase at an equal rate, but this isn't the case.

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http://www.theatlantic.com/health/archive/2016/07/the-enigma-of-urban-psychosis/491141/

Friday, July 15, 2016

One striking chart shows why pharma companies are fighting legal marijuana - The Washington Post

There's a body of research showing that painkiller abuse and overdose are lower in states with medical marijuana laws. These studies have generally assumed that when medical marijuana is available, pain patients are increasingly choosing pot over powerful and deadly prescription narcotics. But that's always been just an assumption.

Now a new study, released in the journal Health Affairs, validates these findings by providing clear evidence of a missing link in the causal chain running from medical marijuana to falling overdoses. Ashley and W. David Bradford, a daughter-father pair of researchers at the University of Georgia, scoured the database of all prescription drugs paid for under Medicare Part D from 2010 to 2013.

They found that, in the 17 states with a medical-marijuana law in place by 2013, prescriptions for painkillers and other classes of drugs fell sharply compared with states that did not have a medical-marijuana law. The drops were quite significant: In medical-marijuana states, the average doctor prescribed 265 fewer doses of antidepressants each year, 486 fewer doses of seizure medication, 541 fewer anti-nausea doses and 562 fewer doses of anti-anxiety medication.

But most strikingly, the typical physician in a medical-marijuana state prescribed 1,826 fewer doses of painkillers in a given year.

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Saturday, July 9, 2016

Fast-food “swamps” linked to greater diabetes risk | University of Toronto

Canadians under the age of 65 have a greater risk of developing diabetes if they live near a high number of fast-food restaurants and few healthier dining options, known as fast-food swamps, according to researchers at the Dalla Lana School of Public Health.

The study, Relative and absolute availability of fast-food restaurants in relation to the development of diabetes: A population-based cohort study, published on June 9, 2016 in the Canadian Journal of Public Health, is the first in Canada to examine whether living within walking access to various types of restaurants within urban residential areas influences the risk of developing diabetes among adults.

At the outset of the study, researchers identified individuals without diabetes and followed them forward in time to see who did or did not develop diabetes. After accounting for individual- and neighbourhood-level socio-economic factors and neighbourhood walkability, researchers found that individuals had a 79 per cent higher risk of developing diabetes when their neighbourhoods had a disproportionately high volume of fast-food outlets and few restaurants of another type.

"Our results show that having restaurant options that offer healthier alternatives to fast-food — for example cafes, sit-down restaurants or coffee shops — may be important for mitigating people's risk of developing diabetes," said Jane Polsky, a PhD candidate in the Division of Social and Behavioural Health Sciences. "The double whammy of having high numbers of fast food restaurants with few healthier alternatives was associated with the highest risk of diabetes."

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http://www.dlsph.utoronto.ca/2016/06/fast-food-swamps-linked-to-greater-diabetes-risk/?

STAT - Reporting from the frontiers of health and medicine

STAT is a new national publication focused on finding and telling compelling stories about health, medicine, and scientific discovery. We produce daily news, investigative articles, and narrative projects in addition to multimedia features. We tell our stories from the places that matter to our readers – research labs, hospitals, executive suites, and political campaigns.

https://www.statnews.com/

Friday, July 8, 2016

A Medical Mystery of the Best Kind: Major Diseases Are in Decline - The New York Times

Something strange is going on in medicine. Major diseases, like colon cancer, dementia and heart disease, are waning in wealthy countries, and improved diagnosis and treatment cannot fully explain it.

Scientists marvel at this good news, a medical mystery of the best sort and one that is often overlooked as advocacy groups emphasize the toll of diseases and the need for more funds. Still, many are puzzled.

"It is really easy to come up with interesting, compelling explanations," said Dr. David S. Jones, a Harvard historian of medicine. "The challenge is to figure out which of those interesting and compelling hypotheses might be correct."

Of course, these diseases are far from gone. They still cause enormous suffering and kill millions each year.

But it looks as if people in the United States and some other wealthy countries are, unexpectedly, starting to beat back the diseases of aging. The leading killers are still the leading killers — cancer, heart disease, stroke — but they are occurring later in life, and people in general are living longer in good health.

Colon cancer is the latest conundrum. While the overall cancer death rate has been declining since the early 1990s, the plunge in colon cancer deaths is especially perplexing: The rate has fallen by nearly 50 percent since its peak in the 1980s, noted Dr. H. Gilbert Welch and Dr. Douglas J. Robertson of the Geisel School of Medicine at Dartmouth and the Veterans Affairs Medical Center in White River Junction, Vt., in a recent paper.

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http://www.nytimes.com/2016/07/10/upshot/a-medical-mystery-of-the-best-kind-major-diseases-are-in-decline.html?

How Scared Should I Be of Hospitals? | VICE

I've always liked hospitals in a way. They're clean, well-lit places, where smart people rush around trying to fix problems with modern technology.

But being in the hospital is hell. You surrender all power and turn into a prop, to be dealt with by people who are at work. They calmly break your skin, and think nothing of looking at your genitals or your shit. The whole experience is mostly just waiting for something interesting to happen, which means bouncing back-and-forth between boredom and creeping menace. And the whole time you're surrounded by the beeps and whirrs of machines that sound unmistakably like a TV character's death.

Fear of hospitals is visceral. It needs no explanation. But there are real risks involved in being at a hospital. Some, like waking up during surgery, can't be prevented by worrying. But steps can be taken to avoid some things, such as bacterial infections. So is there such a thing as a healthy fear of hospitals that we should actively cultivate?

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http://www.vice.com/read/how-scared-should-i-be-of-hospitals?

Thursday, July 7, 2016

A Snooze-Worthy App Collection to Add to the Smartphone - The New York Times

With smartphones, tablets and smart watches glowing and buzzing on our night stands, it's no wonder that low-quality sleep has become a public health problem. Sleep-monitoring apps for smartphones can help.

One app that has given me good results is SleepBot (free on iOS and Android), which has provided insights into my sleeping habits and helped me work out the distractions and habits that seem to mar my sleep.

As with many other sleep apps, you set an alarm time, then slide your phone under your pillow while keeping the phone plugged in to your charger so you don't wake up to a drained battery. As you shift through various stages of sleep during the night, SleepBot logs your body's moves.

When it's time for your alarm to go off, SleepBot waits until your phone's sensors detect that you're moving more, which means you are probably in a period of light sleep. Then it sets off your alarm.

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http://www.nytimes.com/2016/07/07/technology/personaltech/a-snooze-worthy-app-collection-to-add-to-the-smartphone.html?