Saturday, April 23, 2016

Vancouver Prescriptions for Addicts Gain Attention as Heroin and Opioid Use Rises - The New York Times

VANCOUVER, British Columbia — Dave Napio started doing heroin over four decades ago, at 11 years old. Like many addicts these days, he heads to Vancouver's gritty Downtown Eastside neighborhood when he needs a fix.

But instead of seeking out a dealer in a dark alley, Mr. Napio, 55, gets his three daily doses from a nurse at the Crosstown Clinic, the only medical facility in North America permitted to prescribe the narcotic at the center of an epidemic raging across the continent.

And instead of robbing banks and jewelry stores to support his habit, Mr. Napio is spending time making gold and silver jewelry, hoping to soon turn his hobby into a profession.

"My whole life is straightening out," Mr. Napio, who spent 22 of his 55 years in prison, said during a recent interview in the clinic's mirror-lined injection room. "I'm becoming the guy next door."

Mr. Napio is one of 110 chronic addicts with prescriptions for diacetylmorphine hydrochloride, the active ingredient in heroin, which he injects three times a day at Crosstown as part of a treatment known as heroin maintenance. The program has been so successful at keeping addicts out of jail and away from emergency rooms that its supporters are seeking to expand it across Canada. But they have been hindered by a tangle of red tape and a yearslong court battle reflecting a conflict between medicine and politics on how to address drug addiction.

The clinic's prescription program began as a clinical trial more than a decade ago. But it has garnered more interest recently as a plague of illicit heroin use and fatal overdoses of legal painkillers has swept across the United States, fueling frustration over ideological and legal obstacles to forms of treatment that studies show halt the spread of disease through needles and prevent deaths.

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Friday, April 22, 2016

NIH hospital needs sweeping reform to better protect patient safety, panel says - The Washington Post

Practices at the National Institutes of Health Clinical Center, the hospital where cutting-edge medical research is conducted, require sweeping reform to better protect patient safety, a task force appointed by the agency reported Thursday.

The panel of experts, appointed by NIH Director Francis S. Collins, found that the hospital's research focus sometimes took priority over the safety of the critically ill patients treated there. It also said that the center has many "outdated or inadequate facilities" and that personnel lack expertise on regulations that apply to the hospital and its research and drug-manufacturing units.

The task force concluded that while clinical research at the hospital is integral to its mission, "it suffers from shortcomings that potentially impact patient safety and research outcomes." Regulatory deficiences in its drug production components "are examples of sustained weaknesses in structure, facilities, practices and compliance."

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Should Therapists Write About Patients? - The New York Times

When it came time for the pre-publication legal review for my most recent book, I had an idea of what to expect, or so I thought. The book was highly critical of the American Psychiatric Association, a deep-pocketed, fiercely self-protective organization. I took particular aim at its most lucrative product, the Diagnostic and Statistical Manual of Mental Disorders. So I figured the review would rigorously investigate whether my account was fair and accurate enough to withstand any legal challenge.

I was right about one thing: The review was a veritable inquisition. But I was wrong about the subject of the lawyer's concern. It wasn't the A.P.A. Instead, she was worried, nearly obsessively, about my accounts of interactions with my therapy patients. 

I'd told such stories before. My previous book was full of descriptions of therapeutic encounters, and I'd taken the industry-standard precautions. For detailed case studies, I obtained written consent. In cases where that was not possible (for instance, if the therapy had taken place long ago and I'd lost touch with the patient), I changed all the identifying information; a woman became a man, a doctor became a truck driver and so on. And sometimes I would assemble composite characters, golem-like, out of many people I had seen — a physical characteristic here, a verbal tic there — in order to illustrate a clinical point with a brief anecdote.

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Tuesday, April 19, 2016

Developing a Framework for Evaluating the Patient Engagement, Quality, and Safety of Mobile Health Applications - The Commonwealth Fund


Rising ownership of smartphones and tablets across social and demographic groups has made mobile applications, or apps, a potentially promising tool for engaging patients in their health care, particularly those with high health care needs. Through a systematic search of iOS (Apple) and Android app stores and an analysis of apps targeting individuals with chronic illnesses, we assessed the degree to which apps are likely to be useful in patient engagement efforts. Usefulness was determined based on the following criteria: description of engagement, relevance to the targeted patient population, consumer ratings and reviews, and most recent app update. Among the 1,046 health care–related, patient-facing applications identified by our search, 43 percent of iOS apps and 27 percent of Android apps appeared likely to be useful. We also developed criteria for evaluating the patient engagement, quality, and safety of mobile apps.

Health apps: Unlimited promise or 'like having a really bad doctor' - LA Times

For Julie Hadduck, a smartphone app that could diagnose cancer seemed like a miracle.

Her husband died of skin cancer in 2010. She worried that her three children could also be at risk, so she took them to a dermatologist twice a year.

When Hadduck photographed one of her daughter's moles, the app offered a diagnosis within seconds. "It came back red, and I was freaked out," said Hadduck, who lives in Pittsburgh.

She took her 9-year-old to a dermatologist, who reassured them the mole was benign. Hadduck, 47, deleted the app.

The app that Hadduck tried is one of more than 165,000 involving health and wellness currently available for download — a blending of technology and healthcare that has grown dramatically in the last few years. Experts see almost unlimited promise in the rise of mobile medical apps, but they also point out that regulation is sometimes lagging the pace of innovation, which could harm consumers.

"It's clearly a net positive, but I think there are risks to it," said Dr. Karandeep Singh, a professor at the University of Michigan who recently evaluated the quality and safety of hundreds of mobile health apps.

Major changes in the healthcare system set in motion by the Affordable Care Act, passed in 2010, coincided with the proliferation of smartphones. From 2013 to 2015, the number of health and fitness apps available on Apple's mobile operating system increased by 106%, according to one report.

Some of the most popular apps include Plant Nanny, a reminder to drink water; Sworkit, a personalized exercise video player; and HeartWatch, a heart rate tracker that's hooked up to the Apple Watch.

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Biomedicine facing a worse replication crisis than the one plaguing psychology.

This article is part of Future Tense, a collaboration among Arizona State UniversityNew America, and Slate. On Thursday, April 21, Future Tense will hold an event in Washington, D.C., on the reproducibility crisis in biomedicine. For more information and to RSVP, visit the New America website.

The U.S. government spends $5 billion every year on cancer research; charities and private firms add billions more. Yet the return on this investment—in terms of lives saved, suffering reduced—has long been disappointing: Cancer death rates are drifting downward in the past 20 years, but not as quickly as we'd hoped. Even as the science makes incremental progress, it feels as though we're going in a circle.

That's a "hackable problem," says Silicon Valley pooh-bah Sean Parker, who last week announced his founding of a $250 million institute for research into cancer immunotherapy, an old idea that's come around again in recent years. "As somebody who has spent his life as an entrepreneur trying to pursue kind of rapid, disruptive changes," Parker said, "I'm impatient."

Many science funders share Parker's antsiness over all the waste of time and money. In February, the White House announced its plan to put $1 billion toward a similar objective—a "Cancer Moonshot" aimed at making research more techy and efficient. But recent studies of the research enterprise reveal a more confounding issue, and one that won't be solved with bigger grants and increasingly disruptive attitudes. The deeper problem is that much of cancer research in the lab—maybe even most of it—simply can't be trusted. The data are corrupt. The findings are unstable. The science doesn't work.

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