Saturday, May 21, 2016

Among the Healers - The New York Times

TONALÁ, MEXICO — We arrive at noon and take our numbers. The more motivated, having traveled from all over Mexico, began showing up at 3 a.m. About half of the 80 people ahead of us sit in the long waiting room on benches that line the walls, while others stand clustered outside or kill the long hours wandering around Tonalá, a suburb of Guadalajara known for its artisans, its streets edged with handmade furniture, vases as tall as men, mushrooms constructed of shiny tiles. Rafael, the healer, has been receiving one visitor after another since 5. That's what he does every day except Sunday, every week of his life.

To see Rafael, you pay one peso to get your number and then 20 more pesos once you make it into his room. That's roughly $1.25 — a good deal, compared with a $200 reiki session in Manhattan.

Working in central Mexico this year, I've met many healers and shamans: the one who runs sweat lodges in his front yard, the one who can detect water underground with sticks, the one who swung a pendulum in front of me and announced that I only 45 percent love myself.

I watched one shaman give another shaman a hairless puppy in a cardboard box. I met one who is celibate and another who prayed for three wives and another who's romantically involved with his therapist and another who cures illness with bees.

One looked at my palm and told me that my heart was broken. I've watched several wrap red cloth around their heads and cough out bad spirits. I've smelled a lot of burning sage. I've heard assessments of my aura. Once, when I had a bad cold, a shaman snapped my picture with his iPhone and showed me the dark entity hovering over my shoulder.

But none of those people are pilgrimage destinations. Only Rafael, according to his regulars, sees 8,000 to 12,000 people a month.

More ...

Friday, May 20, 2016

Women Deliver 2016 Global Conference - Copenhagen

The world's largest global conference on the health, rights, and wellbeing of girls and women in the last decade.

The Plan to Avert Our Post-Antibiotic Apocalypse - The Atlantic

Under instructions from U.K. Prime Minister David Cameron, economist Jim O'Neill has spent the last two years looking into the problem of drug-resistant infections—bacteria and other microbes that have become impervious to antibiotics. In that time, he estimates that a million people have died from such infections. By 2050, he thinks that ten million will die every year.

O'Neill is most famous for another prediction—that by 2050, the combined economies of Brazil, Russia, India, and China (BRIC), would eclipse those of the world's current richest countries. A former chairman of Goldman Sachs with no scientific training, he was an unorthodox choice to lead an international commission on drug-resistant infections. He was also an inspired one. The problem of drug-resistant microbes isn't just about biology and chemistry; it's an economic problem at heart, a catastrophic and long-bubbling mismatch between supply and demand. It's the result of the many incentives for misusing our drugs, and the dearth of incentives for developing new ones.

More ...

Wednesday, May 18, 2016

Probiotics Won’t Fix All Your Health Problems | FiveThirtyEight

Probiotics are having a moment. The tiny buggers are marketed as health enhancers for adults, for kids, and even for dogs (in a beef flavor, of course). You can now pop a capsule, swig a fruit drink or eat an energy bar that's been spiked with probiotics, which the World Health Organization defines as "live microorganisms" that "confer a health benefit on the host" as long as enough of them enter the system.1

The concept of using "good" bacteria to improve health may feel like a recent idea, but it was first put forward by Ilya Metchnikoff, a Russian scientist born in 1845 who thought the colon was a "vestigial cesspool" and hypothesized that the friendly microbes in yogurt might help improve the population of the bacteria in your gut.2 A century after his death, consumers are snapping up the products based on his idea. According to the National Health Interview Survey, 3.9 million U.S. adults reported using probiotics or prebiotics in 2012, the most recent year for which data is available. That was almost 3 million more than in 2007, so it's safe to assume that even more people are taking them now. Sales of probiotics worldwide passed $32 billion in 2013 and are likely to reach $52 billion by 2020, according to Grand View Research.

It's the third day of this week's series on gut science. We've written about whether gut science is biased, why we're so obsessed with constipation, and we've made a video about what poop can tell us about our health — and there's more to come later in the week.

But there is still so much we don't know about whether and how the probiotic products now on the shelves — which most commonly contain bacteria from the Lactobacillus and Bifidobacterium genera — can improve health.3 Probiotic supplements (and to a lesser extent, prebiotics) have been studied for a host of ailments, including digestive problems, allergic disorders, obesity, dental problems, the common cold, high cholesterol and gestational diabetes. But there's limited evidence that they work for any but a handful of conditions. The probiotic craze has gotten ahead of the science.

More ...

European doctors wouldn’t let him play soccer anymore. U.S. specialists had a different opinion. - The Washington Post

Training camp had just begun this winter, and Alhaji Kamara was poised for a big year.

In 2015, at age 21, he had posted a half-dozen goals during IFK Norrkoping's first Swedish championship in 23 years, raising his two-season total to 16. Last fall, he scored for Sierra Leone's national team in a World Cup qualifier.

The muscle-packed striker, from the hard-luck shadows of Freetown's international airport, was on the rise.

And then in February, as Norrkoping was preparing for a campaign that would include its first appearance in Europe's premier continental competition since 1963, medical test results arrived: Kamara was told he had a congenital heart defect.

Norrkoping shut him down. UEFA, the governing body that administers such tests for participation in the Champions League, wouldn't allow him to play.

"Is this true," Kamara recalled asking himself, "or am I dreaming?"

Less than three months later, the striker is back on the field, cleared by two U.S. cardiologists – one aligned with D.C. United, the other with MLS – who reviewed his case and tested him further.

Yes, they concluded, Kamara did have a deviation of the coronary artery, as the test results in Sweden had uncovered. Medical teams on either side of the Atlantic, however, had differing opinions of the severity of the condition and whether he could resume playing soccer.

Norrkoping released an ominous statement in February, saying Kamara was at a "high risk of sudden cardiac death during maximum exertion."

The American doctors disagreed.

"Under the condition he has, he's fit to play," Allen Taylor, United's team cardiologist and chief of cardiology at Washington's MedStar Heart and Vascular Institute, said in an interview.

More ...

Much of World Suffers Not From Abuse of Painkillers, but Absence of Them - The New York Times

While Americans are confronting an epidemic of prescription drug abuse, particularly for addictive painkillers, the reverse problem prevails in much of the world.

Many ill people with a legitimate need for drugs like oxycodone and other narcotics known as opioid analgesics cannot get them and are suffering and dying in pain, according to health officials, doctors and patients' rights advocates.

In Russia, India and Mexico, many doctors are reluctant to prescribe these painkillers, fearful of possible prosecution or other legal problems, even if they believe the prescriptions are justified.

In Kenya, health officials only recently authorized the production of morphine, one of the most effective drugs for pain relief, after criticism that it was available in only seven of the country's 250 public hospitals. In Morocco, the advocacy group Human Rights Watch reported in February, only a small fraction of physicians are permitted to prescribe opioid analgesics, which the country's law on controlled substances identifies as poisons.

And in most poor and middle-income countries, these drugs are restricted and often unavailable, even for patients with terminal cancer, AIDS or grievous war wounds.

The reasons include an absence of medical training, onerous regulations, costs, a focus on eliminating illicit drug use and, in some cultures, a stoic acceptance of pain without complaint. The problem has been amplified, public health experts say, by the stigmatization of the drugs, partly from fear of what has happened in the United States, where opioid misuse is a growing cause of death.

Reinforcing this view has been publicity about high-profile users like Prince, the pop star who died last month at his Minnesota mansion as friends sought help from an addiction specialist to treat what was apparently a dependence on opioid painkillers.

"While clearly there are issues with some prescribing practices, there's also clearly a risk to vilifying these medicines," said Diederik Lohman, associate director of the health and human rights division at Human Rights Watch.

In some countries, Mr. Lohman said, "a clerical error in a morphine prescription" can lead to criminal inquiries. "The fear associated with prescribing a medicine under strict scrutiny makes physicians afraid," he said.

More ...

Tuesday, May 17, 2016

The case of the $629 Band-Aid — and what it reveals about American health care - Vox

Last January, Malcolm Bird took his 1-year-old daughter, Colette, to the local emergency room. His wife had accidentally cut the young girl's pinky finger while clipping her fingernails, and it had begun to bleed. They were nervous, first-time parents who wanted a doctor's opinion.

Colette turned out to be completely fine. A doctor ran her finger under the tap, stuck a Band-Aid on her pinky, and sent the family home.

A week later, something else showed up at home: a $629 hospital bill for the Band-Aid and its placement on Colette's finger.

His insurance had negotiated the price down to $440.30, the amount Bird — who was still in his deductible — was expected to pay. "My first thought was, how could this possibly cost $629?" Bird told me when we spoke in April. "So I wrote the hospital a letter, expecting them to say, yeah, that's a bit excessive, and lower the price."

That didn't happen. The hospital sent him back a long letter explaining why it would stick with the price. The fees, the hospital's leadership responded, were justified — and it ultimately sent his unpaid bill to a debt collection agency.

Bird sent me all his correspondence with the hospital, which I ran by medical billing experts. His experience provides a unique window into how emergency health care billing works in the United States, and how easy it is for customers to end with a surprise bill for a relatively small service — like a Band-Aid on a child's finger.

More ...

Monday, May 16, 2016

Study of Telemedicine Finds Misdiagnoses of Skin Problems - WSJ

Researchers posing as patients with skin problems sought help from 16 online telemedicine companies—with unsettling results.

Some of the online doctors misdiagnosed syphilis, herpes and skin cancer, and some prescribed medications without asking key questions about patients' medical histories or warning of adverse effects, the researchers found. Two sites linked users with doctors located overseas who aren't licensed to practice where the patients were located, as required by state law.

"The services failed to ask simple, relevant questions of patients about their symptoms, leading them to repeatedly miss important diagnoses," said Jack Resneck, a dermatologist with the University of California, San Francisco, and lead author of the study, published online in JAMA Dermatology on Sunday.

Ateev Mehrotra, an associate professor of health-care policy at Harvard Medical School who wasn't involved with the current study, said it "identifies a number of egregious quality issues that raise significant concern."

He added that studies have identified quality issues with in-person visits as well, and that because many dermatologists don't accept Medicaid, the online visits, which generally cost $35 to $95, may be all that some patients can afford.

Direct-to-consumer telemedicine services have exploded in recent years, with more than one million virtual medical visits expected this year, according to the American Telemedicine Association, a trade group. Many insurers cover the services and promote them as a convenient and low-cost way for plan members to get care.

But some physician groups are concerned that the services are eroding doctor-patient relationships, lowering the quality of care and further fragmenting the health-care system.

The JAMA Dermatology study involved seven general medicine websites and nine devoted to dermatology issues. Researchers created six fictitious scenarios with skin conditions, downloaded stock photos of them from the Internet and prepared more detailed medical histories for the patients to provide if they were asked.

More ...