Thursday, February 14, 2013

Sex Diseases Cost $16 Billion a Year to Treat, CDC Says - Bloomberg

Sexually transmitted diseases cost $16 billion each year to treat in the U.S., with 19.7 million infections diagnosed annually, the nation's health agency found.
People ages 15 to 24 account for half of the annual cases, according to reports released yesterday by the Centers for Disease Control and Prevention. There are about 110 million total infections among U.S. men and women of all ages, the agency said, with the most common infection human papillomavirus, a virus linked to cancer.
Young people have borne a disproportionate burden of sexually transmitted diseases for as long as the Atlanta-based CDC has kept records, said Catherine Satterwhite, an author of one of the reports and a CDC epidemiologist. They often don't have good insurance or difficulties accessing care, she said.
"We've seen a disproportionate burden for quite a while," Satterwhite said in a telephone interview. "Young women in particular are at greater risk."
The CDC reported data on eight sexually transmitted infections, including HIV, syphilis, gonorrhea, hepatitis B, chlamydia, trichomoniasis, herpes and HPV.
Drug-resistant gonorrhea is a growing threat, the agency said in a separate study published today in the Morbidity and Mortality Weekly Report. There aren't enough antibiotics in development and more experimental therapies are needed immediately, according to the report. For now, to minimize the spread of resistant strains, more people should be screened and treated, the agency said.

Trends Persist

The sexually transmitted diseases study released yesterday, which uses data from 2008, the most recent comprehensive information available, isn't directly comparable with previous studies because of changes in the reporting methods, the CDC said. However, some trends, including that of younger patients, have persisted.
All sexually transmitted diseases are preventable, many are curable and all are treatable, Satterwhite said. Getting more people tested effectively, such as making sure more young women are screened for chlamydia and all sexually active adults are tested for HIV at least once, would help, she said.
The costliest STDs are HIV, which requires lifelong care, and HPV, which causes throat, anal, penile, and cervical tumors. Use of vaccines that can prevent HPV, made by Merck & Co. andGlaxoSmithKline Plc, have remained low as rates of HPV-related cancers have risen, according to a study last month in the Journal of the National Cancer Institute.
Curable sexually transmitted diseases cost $742 million, with chlamydia as the most common and the most expensive.
Prevention strategies for STDs include abstaining from sex, condom use, and mutually monogamous relationships, Satterwhite said. The HPV vaccine made by Merck called Gardasil is recommended for boys and girls to help prevent cancers.
The two reports on sexually transmitted infections' prevalence and cost, were published in the journal Sexually Transmitted Diseases.

U.S. Approves First Method to Give the Blind Limited Vision -

The Food and Drug Administration on Thursday approved the first treatment to give limited vision to people who are blind, involving a technology called the "artificial retina."

With it, people with certain types of blindness can detect crosswalks on the street, burners on a stove, the presence of people or cars, and sometimes even oversized numbers or letters.

The artificial retina is a sheet of electrodes surgically implanted in the eye. The patient is also outfitted with a pair of glasses with an attached camera and a portable video processor. These elements together allow visual signals to bypass the damaged portion of the retina and be transmitted to the brain. The F.D.A. approval covers this integrated system, which the manufacturer calls Argus II.

The approval marks the first milestone in a new frontier in vision research, a field in which scientists are making strides with gene therapy, optogenetics, stem cells and other strategies.

"This is just the beginning," said Grace Shen, director of the retinal diseases program at the National Eye Institute, which helped finance the artificial retina research and is supporting many other blindness therapy projects. "We have a lot of exciting things sitting in the wings, multiple approaches being developed now to address this."

With the artificial retina or retinal prosthesis, a blind person cannot see in the conventional sense, but can identify outlines and boundaries of objects, especially when there is contrast between light and dark — fireworks against a night sky or black socks mixed with white ones in the laundry.

"Without the system, I wouldn't be able to see anything at all, and if you were in front of me and you moved left and right, I'm not going to realize any of this," said Elias Konstantopolous, 74, a retired electrician in Baltimore, one of about 50 Americans and Europeans who have been using the device in clinical trials for several years. He said it helps him differentiate curbs from asphalt roads, and detect contours, but not details, of cars, trees and people. "When you don't have nothing, this is something. It's a lot."

The F.D.A. approved Argus II, made by Second Sight Medical Products, to treat people with severe retinitis pigmentosa, a group of inherited diseases in which photoreceptor cells, which take in light, deteriorate.

The first version of the implant had a sheet of 16 electrodes, but the current version has 60. A tiny camera mounted on eyeglasses captures images, and the video processor, worn on a belt, translates those images into pixelized patterns of light and dark. The processor transmits those signals to the electrodes, which send them along the optic nerve to the brain.

About 100,000 Americans have retinitis pigmentosa, but initially between 10,000 and 15,000 will likely qualify for the Argus II, according to the company. The F.D.A. says that up to 4,000 people a year can be treated with the device. That number represents people who are older than 25, who once had useful vision, have evidence of an intact inner retinal layer, have at best very limited light perception in the retina, and are so visually impaired that the device would prove an improvement. Second Sight will begin making Argus II available later this year.

But experts said the technology holds promise for other people who are blind, especially those with advanced age-related macular degeneration, the major cause of vision loss in older people, affecting about two million Americans. About 50,000 of them are currently severely impaired enough that the artificial retina would be helpful, said Dr. Robert Greenberg, Second Sight's president and chief executive.

In Europe, Argus II received approval in 2011 to treat a broader group of people, those with severe blindness caused by any type of outer retinal degeneration, not just retinitis pigmentosa, although it is currently only marketed in Europe for that condition. In the U.S., additional clinical trials need to be completed before the company can seek broader FDA approval.

Eventually, Dr. Greenberg said, the plan is to implant electrodes not in the eye, but directly into the brain's visual cortex. "That would allow us to address blindness from all causes," he said.

Initially, the artificial retina will be available at seven hospitals in five states: New York, California, Texas, Maryland and Pennsylvania. It will cost about $150,000, not including the surgery and training sessions to use the device. Second Sight said it was optimistic that insurance would cover it.

Developed over 20 years by Dr. Mark S. Humayun, an ophthalmologist and biomedical engineer at the University of Southern California's Doheny Retinal Institute, the artificial retina was inspired by cochlear implants for the deaf. Some financing came from a cochlear implant maker and other private sources, but about $100 million was provided by the National Eye Institute, the National Science Foundation and the Department of Energy, all federal agencies.

Dr. Humayun said he envisioned applying the technology to other conditions than blindness, implanting electrodes in other parts of the body to address bladder control problems, perhaps, or spinal paralysis.

"We don't think of the human body as an electrical grid, but it runs off electrical impulses," he said.

The Argus II has had relatively few safety problems, mostly post-surgical infections and occasional erosions of a thin layer in the eye that covered the implant. Those problems have been addressed, Dr. Greenberg said, and only two people needed to have the implant removed. An F.D.A. advisory panel voted unanimously last September to recommend approval, finding that benefits outweighed the risks.

Some patients experience more improvement than others, for reasons the company has not been able to determine. Kathy Blake of Fountain Valley, Calif., said she has had success with a Second Sight exercise to see if patients can identify large numbers or letters on a computer screen.

Dean Lloyd, a lawyer in Palo Alto, Calif., said he initially wondered, "Is it really worth all the time and expense? I, at first, did not think so." Early on, only nine electrodes were working, but over time his implant was adjusted so more electrodes responded, and now 52 of them work. He can see flashes of color, something not every patient can, and he wears the glasses and video processor constantly.

"If I don't wear it, it's like I don't have my pants on," he said. "I've even fallen asleep with the blooming thing."

Stephen Rose, the chief research officer for the Foundation Fighting Blindness, which supported Dr. Humayun's very early work but has not financed it since, said the artificial retina would eventually be only one of the options to help blind people.

"I think there are tremendous possibilities," he said. "I'm not downplaying the retinal prosthesis, don't get me wrong. It's huge for some individuals, and it's here now."

Barbara Campbell, 59, relishes how the device helps her navigate Manhattan streets, locate her Upper East Side bus stop, and spot her apartment building's foyer light while riding in a taxi.

Most exciting, though, is how it enhances her experience of museums, theater and concerts.

At a performance by Rod Stewart, "I could definitely see his hair," she said, which was white-blond under the lights. At a concert by Diana Ross, even though Ms. Campbell sat far away from the stage, she said Ms. Ross "was wearing a sparkly outfit, and I could see her."

No such luck at a performance by James Taylor, though. His low-key clothing created no contrast for the artificial retina to register. Alas, Ms. Campbell said, "He wasn't so sparkly." 

Tuesday, February 12, 2013

Price for a New Hip? Many Hospitals Are Stumped -

Jaime Rosenthal, a senior at Washington University in St. Louis, called more than 100 hospitals in every state last summer, seeking prices for a hip replacement for a 62-year-old grandmother who was uninsured but had the means to pay herself.
The quotes she received might surprise even hardened health care economists: only about half of the hospitals, including top-ranked orthopedic centers and community hospitals, could provide any sort of price estimate, despite repeated calls. Those that could gave quotes that varied by a factor of more than 10, from $11,100 to $125,798.
Ms. Rosenthal's grandmother was fictitious, created for a summer research project on health care costs. But the findings, which form the basis of a paper released on Monday by JAMA Internal Medicine, are likely to fan the debate on the unsustainable growth of American health care costs and an opaque medical system in which prices are often hidden from consumers.
"Transparency is all the rage these days in government and business, but there has been little push for pricing transparency in health care, and there's virtually no information," said Dr. Peter Cram, an associate professor of internal medicine at the University of Iowa, who wrote the paper with Ms. Rosenthal. He added: "I can get the price for a car, for a can of oil, for a gallon of milk. But health care? That's not so easy."
President Obama's Affordable Care Act focused primarily on providing insurance to Americans who did not have it. But the high price of care remains an elephant in the room. Although many experts have said that Americans must become more discerning consumers to help rein in costs, the study illustrates how hard that can be.
"We've been trying to help patients get good value, but it is really hard to get price commitments from hospitals - we see this all the time," said Jeff Rice, the chief executive of Healthcare Blue Book, a company that collects data on medical procedures, doctors visits and tests. "And even if they say $20,000, it often turns out $40,000 or 60,000."
There are many caveats to the study. Most patients - or insurers - never pay the full sticker price of surgery, because insurance companies bargain with hospitals and doctors for discounted rates. When Ms. Rosenthal balked at initial high estimates, some hospitals produced lower rates for a person without insurance.
But in other ways the telephone quotations underestimated prices, because they did not include the fees for outpatient rehabilitation, for example.
In an accompanying commentary, Andrew Steinmetz and Ezekiel J. Emanuel of the University of Pennsylvania acknowledged that there was "no justification" for the inability to provide estimates or for the wide range of prices. But they said that more rigorous data on quality - like infection rates and unexpected deaths - were required to know when high prices were worth it.
"Without quality data to accompany price data, physicians, consumers and other health care decision makers have no idea if a lower price represents shoddy quality of if it constitutes good value," they wrote.
But, broadly, researchers emphasized that studies had found little consistent correlation between higher prices and better quality in American health care. Dr. Cram said there was no data that "Mercedes" hip implants were better than cheaper options, for example.
Jamie Court, the president of the California-based Consumer Watchdog, said: "If one hospital can put in a hip for $12,000, then every hospital should be able to do it. When there's 100 percent variation in sticker price, then there is no real price. It's about profit."
Dr. Cram said the study did contain some good news: some of the country's top-ranked hospitals came up with "bargain basement prices" in response to repeated calls. "If you're a good consumer and shop around, you can get a good price - you don't have to pay $120,000 for a Honda," he said.
But that shopping can be arduous in a market not set up to respond to consumers. To get a total price, Ms. Rosenthal often had to call the hospital to get its estimate for on-site care, and a separate quote from doctors. And many were simply perplexed when she asked for a price upfront, Ms. Rosenthal said, adding, "The people who answered didn't know what to do with the question."

Health Testing on Mice Is Found Misleading in Some Cases -

For decades, mice have been the species of choice in the study of human diseases. But now, researchers report evidence that the mouse model has been totally misleading for at least three major killers — sepsis, burns and trauma. As a result, years and billions of dollars have been wasted following false leads, they say.

The study's findings do not mean that mice are useless models for all human diseases. But, its authors said, they do raise troubling questions about diseases like the ones in the study that involve the immune system, including cancer and heart disease.

"Our article raises at least the possibility that a parallel situation may be present," said Dr. H. Shaw Warren, a sepsis researcher at Massachusetts General Hospital and a lead author of the new study.

The paper, published Monday in Proceedings of the National Academy of Sciences, helps explain why every one of nearly 150 drugs tested at a huge expense in patients with sepsis has failed. The drug tests all were based on studies in mice. And mice, it turns out, can have something that looks like sepsis in humans, but is very different from the condition in humans.

Medical experts not associated with the study said that the findings should change the course of research worldwide for a deadly and frustrating condition. Sepsis, a potentially deadly reaction that occurs as the body tries to fight an infection, afflicts 750,000 patients a year in the United States, kills one-fourth to one-half of them, and costs the nation $17 billion a year. It is the leading cause of death in intensive-care units.

"This is a game changer," said Dr. Mitchell Fink, a sepsis expert at the University of California, Los Angeles, of the new study.

"It's amazing," said Dr. Richard Wenzel, a former chairman at the department of internal medicine at Virginia Commonwealth University and a former editor of The New England Journal of Medicine. "They are absolutely right on."

Potentially deadly immune responses occur when a person's immune system overreacts to what it perceives as danger signals, including toxic molecules from bacteria, viruses, fungi, or proteins released from cells damaged by trauma or burns, said Dr. Clifford S. Deutschman, who directs sepsis research at the University of Pennsylvania and was not part of the study.

The ramped-up immune system releases its own proteins in such overwhelming amounts that capillaries begin to leak. The leak becomes excessive, and serum seeps out of the tiny blood vessels.Blood pressure falls, and vital organs do not get enough blood. Despite efforts, doctors and nurses in an intensive-care unit or an emergency room may be unable to keep up with the leaks, stop the infection or halt the tissue damage. Vital organs eventually fail.

The new study, which took 10 years and involved 39 researchers from across the country, began by studying white blood cells from hundreds of patients with severe burns, trauma or sepsis to see what genes were being used by white blood cells when responding to these danger signals.

The researchers found some interesting patterns and accumulated a large, rigorously collected data set that should help move the field forward, said Ronald W. Davis, a genomics expert at Stanford University and a lead author of the new paper. Some patterns seemed to predict who would survive and who would end up in intensive care, clinging to life and, often, dying.

The group had tried to publish its findings in several papers. One objection, Dr. Davis said, was that the researchers had not shown the same gene response had happened in mice.

"They were so used to doing mouse studies that they thought that was how you validate things," he said. "They are so ingrained in trying to cure mice that they forget we are trying to cure humans."

"That started us thinking," he continued. "Is it the same in the mouse or not?"

The group decided to look, expecting to find some similarities. But when the data were analyzed, there were none at all.

"We were kind of blown away," Dr. Davis said.

The drug failures became clear. For example, often in mice, a gene would be used, while in humans, the comparable gene would be suppressed. A drug that worked in mice by disabling that gene could make the response even more deadly in humans.

Even more surprising, Dr. Warren said, was that different conditions in mice — burns, trauma, sepsis — did not fit the same pattern. Each condition used different groups of genes. In humans, though, similar genes were used in all three conditions. That means, Dr. Warren said, that if researchers can find a drug that works for one of those conditions in people, it might work for all three.

The study's investigators tried for more than a year to publish their paper, which showed that there was no relationship between the genetic responses of mice and those of humans. They submitted it to the publications Science and Nature, hoping to reach a wide audience. It was rejected from both.

Science and Nature said it was their policy not to comment on the fate of a rejected paper, or whether it had even been submitted to them. But, Ginger Pinholster of Science said, the journal accepts only about 7 percent of the nearly 13,000 papers submitted each year, so it is not uncommon for a paper to make the rounds.

Still, Dr. Davis said, reviewers did not point out scientific errors. Instead, he said, "the most common response was, 'It has to be wrong. I don't know why it is wrong, but it has to be wrong.' "

The investigators turned to Proceedings of the National Academy of Sciences. As a member of the academy, Dr. Davis could suggest reviewers for his paper, and he proposed researchers who he thought would give the work a fair hearing. "If they don't like it, I want to know why," he said. They recommended publication, and the editorial board of the journal, which independently assesses papers, agreed.

Some researchers, reading the paper now, say they are as astonished as the researchers were when they saw the data.

"When I read the paper, I was stunned by just how bad the mouse data are," Dr. Fink said. "It's really amazing — no correlation at all. These data are so persuasive and so robust that I think funding agencies are going to take note." Until now, he said, "to get funding, you had to propose experiments using the mouse model."

Yet there was always one major clue that mice might not really mimic humans in this regard: it is very hard to kill a mouse with a bacterial infection. Mice need a million times more bacteria in their blood than what would kill a person.

"Mice can eat garbage and food that is lying around and is rotten," Dr. Davis said. "Humans can't do that. We are too sensitive."

Researchers said that if they could figure out why mice were so resistant, they might be able to use that discovery to find something to make people resistant.

"This is a very important paper," said Dr. Richard Hotchkiss, a sepsis researcher at Washington University who was not involved in the study. "It argues strongly — go to the patients. Get their cells. Get their tissues whenever you can. Get cells from airways."

"To understand sepsis, you have to go to the patients," he said.

Sunday, February 10, 2013

Unexpected Letter From ER Doctor May Make You Tear Up

True love and compassion aren't easy to ignore.

This week, a 24-year-old Redditor shared a letter received just after the death of his mother. The event, despite being difficult, brought an unexpected source of condolence -- a personal note from a physician who had never contacted a patient's family before.

"The letter was written for my father," he told The Huffington Post on Friday. "He stayed by her side until the very end."

The letter reads:

Dear Mr. (removed),

I am the Emergency Medicine physician who treated your wife Mrs (removed) last Sunday in the Emergency Department at (hospital). I learned only yesterday about her passing away and wanted to write to you to express my sadness. In my twenty years as a doctor in the Emergency Room, I have never written to a patient or a family member, as our encounters are typically hurried and do not always allow for more personal interaction.

However, in your case, I felt a special connection to your wife (removed), who was so engaging and cheerful in spite of her illness and trouble breathing. I was also touched by the fact that you seemed to be a very loving couple. You were highly supportive of her, asking the right questions with calm, care and concern. From my experience as a physician, I find that the love and support of a spouse or a family member is the most soothing gift, bringing peace and serenity to those critically ill.

I am sorry for your loss and I hope you can find comfort in the memory of your wife's great spirit and of your loving bond. My heartfelt condolences go out to you and your family.

(removed), MD

According to the Redditor, his mother had breast cancer. A month ago, breathing difficulties landed her in the hospital, and 16 hours later, she passed away.

Surprisingly, the doctor who wrote the letter had never met or treated his mother until that day.

"If my mother were alive to see this, she would want readers to reflect on the power of showing compassion towards a total stranger," he told HuffPost.

"The support I got from Reddit was amazing -- doctors, nurses and other Redditors who have lost their mothers to cancer were all shocked and amazed that the doctor took the time to write such a heartfelt, meaningful letter," he added.

2013-02-08 Spike activity « Mind Hacks

Quick links from the past week in mind and brain news:

The New York Times covers the recent upsurge of robots-taking-over-the-world anxiety. To the bunkers!

The dodgy practice of psychologists trying to patenttherapeutic techniques is covered by Neuroskeptic.

The Humanist discusses the explosion of the unhelpful concept of sex addition.

Forensic psychology nerds: In The News covers the latest in the debate on theaccuracy of violence risk assessments.

The Bangkok Post on the bizarre Thai government announcement that calculators, phones "and even karaoke machines" could damage memory, lead to Alzheimer's disease. Bryan Adams covers, screaming fits. 80s hair metal, unfortunately lycra incidents.

People without an amygdala can experience fearNeurophilosophy covers an intriguing new study.

Wired Danger Room on the cost of war to the US: currently, at least 253,330 brain injuries, 129,731 cases of PTSD – and counting.

Missouri Public Radio on how ex- Abu Ghraib chief psychologist Larry James wants to launch a national gun violence prevention center. Presumably, by waterboarding assault rifle owners.

Short-term exercise boosts body image without making any physical difference. The BPS Research Digest on the short-term psychological effects of exercise.

Scientific American has an important piece on the science of what life events can trigger depression.

After a nonsense article on 'girls and the science gap' two neuroscientists write a stirling reply on why pseudoscience and stereotyping won't solve the problem inNotes and Queries.

News - Beware of neuro-bunk

Can a cheese sandwich or chocolate help you make better decisions? Can a brain scan cure mental illness?  Or are these just two examples of neuro-bunk, where neuroscience is being overly simplified and distorted to sell products and newspapers?
In a recent TED talk, neuroscientist and Gates Cambridge Alumna Molly Crockett [2006] talks about how to spot when neuroscience has been simplified to support unrealistic claims.
She talks about an experiment she conducted which involved people drinking a horrible-tasting concoction which depleted the amino acid tryptophan. She found that depleting tryptophan made people more likely to take revenge when they were treated unfairly.
The headlines that emerged from the study suggested cheese sandwiches and chocolate, which contain tryptophan, could help people make better decisions.
Does this oversimplification matter, asks Molly. After the reports were published, she was approached by marketeers and others interested in getting her to endorse their products. She says neuroscience is being increasingly used to sell products without any evidence to back up the claims made on their packaging.
In the TED talk, she shows how putting a picture of a brain on something makes people more likely to believe in the product. "Brains sell," she says.
Molly, who did a PhD in Experimental Psychology, says there is some very exciting neuroscience taking place, but a lot of the deductions made by non-scientists about neuroscientific research are neuro-bunk.
One report, for instance, claimed that brain scans show that people love their iPhones because they show that a part of the brain linked to love is active when people look at pictures of iphones. However, that part of the brain - the insula - is also involved in other emotions, such as pain and anger, says Molly.  Another study claims the hormone oxytocin is the 'moral molecule' because it is involved in trust and empathy, but other studies suggest it is also linked to envy and bias towards one's own group. Boosting it could therefore lead to a decrease in co-operation. It could just as easily be called the 'immoral molecule', says Molly.
She adds that clinics in the US are making millions by offering brain scans to people, including children, claiming they can identify and prevent mental illness and help overcome marital conflicts.
"The broad consensus in neuroscience is that you cannot yet diagnose mental illness from a single brain scan," says Molly, who is currently working with support from the four-year Sir Henry Wellcome Postdoctoral Fellowship studying human altruism in laboratories worldwide.
She says there is tremendous potential for neuroscience, but it is too early to make overblown claims about its abilities.
"Real science is playing a much longer game," she says. In the meantime, people should question any claims on products which say they are backed by neuroscience and they should expect the answers not to be simple, because the science is not simple.
She states: "[Neuroscientists] haven't found a 'buy' button inside the brain, we can't tell whether someone is lying or in love just by looking at their brain scans, and we can't turn sinners into saints with hormones."

TED Talk:

Brains are ubiquitous in modern marketing: Headlines proclaim cheese sandwiches help with decision-making, while a "neuro" drink claims to reduce stress. There's just one problem, says neuroscientist Molly Crockett: The benefits of these "neuro-enhancements" are not proven scientifically. In this to-the-point talk, Crockett explains the limits of interpreting neuroscientific data, and why we should all be aware of them.