Sunday, February 1, 2015

Dying Shouldn’t Be So Brutal -

"Travel safe!" It has become a nearly reflexive wish I give to friends who are coming or going. This fall, I noticed myself holding back from saying it to Michael, a dear friend who was wrestling with incurable cancer. The journey metaphor was too poignant.

I also avoided "Stay safe." After all, dying is inherently precarious.

Instead I said: "Be well. I'll be thinking about you." That was true. I could have added, "and worrying about you." That was true, too. Michael was receiving state-of-the-art treatments at a renowned cancer center in New York City. As he became sicker, the treatments got more intense. Each decision came with more difficult trade-offs and uncertainties. Each step to stay alive risked making things worse.

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Saturday, January 31, 2015

Vaccine Critics Turn Defensive Over Measles -

Their children have been sent home from school. Their families are barred from birthday parties and neighborhood play dates. Online, people call them negligent and criminal. And as officials in 14 states grapple to contain a spreading measles outbreak that began near here at Disneyland, the parents at the heart of America's anti-vaccine movement are being blamed for incubating an otherwise preventable public-health crisis.

Measles anxiety rippled thousands of miles beyond its center on Friday as officials scrambled to try to contain a wider spread of the highly contagious disease — which America declared vanquished 15 years ago, before a statistically significant number of parents started refusing to vaccinate their children.

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Wednesday, January 28, 2015

An ‘expensive’ placebo is more effective than a ‘cheap’ one, study shows - The Washington Post

Parkinson's Disease patients secretly treated with a placebo instead of their regular medication performed better when told they were receiving a more expensive version of the "drug," researchers reported Wednesday in an unprecedented study that involved real patients.

The research shows that the well-documented "placebo effect" -- actual symptom relief brought about by a sham treatment or medication -- can be enhanced by adding information about cost, according to the lead author of the study. It is the first time that concept has been demonstrated using people with a real illness, in this case Parkinson's, a progressive neurological disease that has no cure, according to an expert not involved in the study.

"The potentially large benefit of placebo, with or without price manipulations, is waiting to be untapped for patients with [Parkinson's Disease], as well as those with other neurologic and medical diseases," the authors wrote in a study published online Wednesday in the journal Neurology.

But deceiving actual patients in a research study raised ethical questions about violating the trust involved in a doctor-patient relationship. Most studies in which researchers conceal their true aims or other information from subjects are conducted with healthy volunteers. This one was subjected to a lengthy review  before it was allowed to proceed, and, in an editorial that accompanied the article, two other physicians wrote that "the authors do not mention whether there was any possible effect (reduction) on trust in doctors or on willingness to engage in future clinical research."

Nor would such a ruse be allowed in clinical practice, said Ted J. Kaptchuk, director of the Program in Placebo Studies and Therapeutic Encounter at Harvard Medical School.  "I don't think it has a direct practical application," Kaptchuk said. "Telling people something is expensive, that's deception. That's not allowed in clinical practice."

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Sunday, January 25, 2015

The Mind Research Network (MRN)

Headquartered in Albuquerque, New Mexico, MRN is a 501(c)3 non-profit organization consisting of an interdisciplinary association of scientists located at universities, national laboratories and research centers around the world and is focused on imaging technology and its emergence as an integral element of neuroscience investigation.

With an extended community of academicians, researchers, graduate students and technicians, the MRN is uniquely positioned with its national infrastructure to link the brightest minds in neuroscience with some of the most cutting-edge neuroimaging capabilities in the world today.

Founded in 1998, the MRN's initial plan called for the building of state-of-the-art magnetic resonance imaging (MRI) and magnetoencephalogram (MEG) neuroimaging systems to be applied to studies of mental illness. This important task was carried out by Mind's initial collaborators: Massachusetts General Hospital's Martinos Biomedical Imaging Center (Harvard and MIT), the University of Minnesota, the University of New Mexico, and Los Alamos National Laboratory. Since both the Network and the mission have expanded beyond building neuroimaging tools, a comprehensive understanding of mental illness and more fundamental and systematic understanding of the brain is possible.

Tuesday, January 20, 2015

The Doctor Is Out; You May Be in Luck -

Professional meetings for cardiologists may have an added benefit: In some cases, heart patients survive longer when their doctors are away at conferences.

In a retrospective analysis, researchers studied 30,000 patients admitted to teaching hospitals for heart attack, heart failure and cardiac arrest during national professional meetings and compared them with 79,000 admitted during the three weeks before and after meetings. The study is in JAMA Internal Medicine.

During nonmeeting days, 24.8 percent of heart failure and 69.4 percent of cardiac arrest patients died within 30 days. But while cardiologists were at meetings, only 17.5 percent of heart failure and 59.1 percent of cardiac arrest patients died within a month. There was no significant difference among heart attack patients, although in high-risk heart attack patients there were fewer insertions of a stent to open blocked coronary arteries during nonmeeting days.

The lead author, Dr. Anupam B. Jena, an assistant professor of health care policy at Harvard, said that the difference in death rates may be attributed in part to overly aggressive treatments, such as when a stent is inserted unnecessarily.

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Sunday, January 18, 2015

When Medical Apps Do More Harm Than Good | Mother Jones

In 2013, when Julie Hudak read about an iPhone app that could diagnose skin cancer, she downloaded it right away. Her husband and sister-in-law had both died of melanoma, and she didn't want to miss any early signs of the disease in her three children. It was easy to use—simply upload a photo of a mole and get a color-coded result: Green meant cancer was unlikely, yellow was a maybe, and red indicated danger. Even though the dermatologist had assured Hudak just a week earlier that her children's skin looked fine, she decided to snap photos of her 11-year-old daughter's moles. Seconds later, the results appeared. "Some came up yellow, and one was red," Hudak recalls. "I panicked." She called the dermatologist for an emergency appointment.

Online retailers like iTunes and Amazon offer thousands of apps promising all kinds of real-time information about your body—they can measure blood pressure, take your pulse, track your menstrual cycle, and tell you how well your lungs are working. Mobile health is one of the fastest-growing app categories: According to the consulting firm research2guidance, there are 100,000 mobile health apps on the market, double the number available two and a half years ago. The industry is worth some $4 billion today, and analysts predict that it will reach $26.5 billion by 2017.

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Thursday, January 15, 2015

Booking a trip to the ER on your smartphone? It's a breeze -

It's like OpenTable for medical appointments.

No waiting weeks to see a dermatologist. No sitting for hours in the emergency room. No frantic calls to find a family doctor with openings.

Online services such as ZocDoc and InQuicker are enabling patients with non-life-threatening conditions to schedule everything from doctor's office visits to emergency room trips on their laptops and smartphones — much like OpenTable users do with restaurant reservations.

Hospitals and doctors increasingly are subscribing to the services to simplify appointment scheduling for patients who dislike waiting on hold and are comfortable doing everything from shopping to banking online.

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Wednesday, January 14, 2015

NYTimes: Why Drugs Cost So Much

ELI LILLY charges more than $13,000 a month for Cyramza, the newest drug to treat stomach cancer. The latest medicine for lung cancer, Novartis's Zykadia, costs almost $14,000 a month. Amgen's Blincyto, for leukemia, will cost $64,000 a month.

Why? Drug manufacturers blame high prices on the complexity of biology, government regulations and shareholder expectations for high profit margins. In other words, they say, they are hamstrung. But there's a simpler explanation.

Companies are taking advantage of a mix of laws that force insurers to include essentially all expensive drugs in their policies, and a philosophy that demands that every new health care product be available to everyone, no matter how little it helps or how much it costs. Anything else and we're talking death panels.

Examples of companies exploiting these fault lines abound. An article in The New England Journal of Medicine last fall focused on how companies buy up the rights to old, inexpensive generic drugs, lock out competitors and raise prices. For instance, albendazole, a drug for certain kinds of parasitic infection, was approved back in 1996. As recently as 2010, its average wholesale cost was $5.92 per day. By 2013, it had risen to $119.58.

Novartis, the company that makes the leukemia drug Gleevec, keeps raising the drug's price, even though the drug has already delivered billions in profit to the company. In 2001 Novartis charged $4,540, in 2014 dollars, for a month of treatment; now it charges $8,488. In its pricing, Novartis is just keeping up with other companies as they charge more and more for their drugs. They know we can't say no.

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Tuesday, January 6, 2015

Do No Harm? It May Be Hard to Avoid With Health Law’s Medicare Cuts -

The Affordable Care Act made changes to government payments for Medicareservices that are expected to save tens to hundreds of billions of dollars per year. This sounds like a good thing — and it very well may be — but only if those spending cuts don't cause harm. Research suggests they just might.

As any business would, hospitals often respond to reduced revenue by cutting costs. They especially tend to cut back on staff, according to a number of researchers.

Reductions in Medicare payments to hospitals between 1996 and 2009 were nearly entirely offset by cuts to operating expenses, and predominantly to personnel, Chapin White and Vivian Wu reported in Health Services Research in 2013. In other work, also published in Health Services Research, Ms. Wu and Yu-Chu Shen found that hospitals responded to lower Medicare payments in part by reducing staff and length of stays.

On the other hand, a study by health economists from Northwestern University's Kellogg School of Management found that hospitals responded to the market collapse in 2008, which reduced revenue through depressed returns on investments, not by cutting staff but by trimming back in other specific areas, including advanced medical records and less profitable services like those for substance use treatment or those provided in trauma centers.

Such cuts by hospitals may harm quality of care. For example, recent work suggests that cutting length of stays increases mortality for heart attack patients and those with pneumoniaOther work, published recently in the journal Medical Care, suggests that an 11.5 percent decrease in nursing staff per 1,000 inpatient days (a standardized measure of staffing levels) could increase adverse events — such as deaths, infections and surgical complications — by 1.2 percent. In their study, Drs. Wu and Shen found higher heart attack mortality rates in hospitals that had experienced larger Medicare payment cuts and had cut spending, "particularly among registered nurses," in response. For each 1 percent payment cut, heart attack mortality was 0.4 percent higher.

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