Harnessing the Immune System to Fight Cancer - The New York Times

Steve Cara expected to sail through the routine medical tests required to increase his life insurance in October 2014. But the results were devastating. He had lung cancer, at age 53. It had begun to spread, and doctors told him it was inoperable.

A few years ago, they would have suggested chemotherapy. Instead, his oncologist, Dr. Matthew D. Hellmann of Memorial Sloan Kettering Cancer Center in New York, recommended an experimental treatment: immunotherapy. Rather than attacking the cancer directly, as chemo does, immunotherapy tries to rally the patient's own immune system to fight the disease.

Uncertain, Mr. Cara sought a second opinion. A doctor at another major hospital read his scans and pathology report, then asked what Dr. Hellmann had advised. When the doctor heard the answer, Mr. Cara recalled, "he closed up the folder, handed it back to me and said, 'Run back there as fast as you can.'"

Many others are racing down the same path. Harnessing the immune system to fight cancer, long a medical dream, is becoming a reality. Remarkable stories of tumors melting away and terminal illnesses going into remissions that last years — backed by solid data — have led to an explosion of interest and billions of dollars of investments in the rapidly growing field of immunotherapy. Pharmaceutical companies, philanthropists and the federal government's "cancer moonshot" programare pouring money into developing treatments. Medical conferences on the topic are packed.

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http://www.nytimes.com/2016/07/31/health/harnessing-the-immune-system-to-fight-cancer.html?

Stem Cell Therapies Are Still Mostly Theory, Yet Clinics Are Flourishing - The New York Times

Health regulators in the United States are talked about as the best in the world, but a new study on the spread of stem cellclinics shows what can happen when regulations fall behind.

Out of nowhere, over the past two to three years, the clinics have sprung up — 570 in the United States, according to a recent paper — offering untested stem cell treatments for just about every medical use imaginable.

In theory, stem cells might be a useful treatment for certain diseases that involve the loss of cells, like Type 1 diabetes, Parkinson's or osteoarthritis. They are primitive cells that can develop into a range of mature cells and perhaps serve as replacements. But progress is slow. After a flurry of stem cell excitement two decades ago, almost all the research today is still in mice or petri dishes. The very few clinical trials that have begun are still in the earliest phase.

The problem is that stem cell therapies are still mostly theory. So what is going on? How can there be clinics, even chains of clinics run by companies, offering stem cell treatment for almost any disease you can think of — sports injuries, arthritis, autism, cerebral palsy, stroke, muscular dystrophy, A.L.S., cancer?

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http://www.nytimes.com/2016/07/28/upshot/stem-cell-therapies-are-still-mostly-theory-yet-clinics-are-flourishing.html?

Being Unfit May Be Almost as Bad for You as Smoking - The New York Times

Being out of shape could be more harmful to health and longevity than most people expect, according to a new, long-term study of middle-aged men. The study finds that poor physical fitness may be second only to smoking as a risk factor for premature death.

It is not news that aerobic capacity can influence lifespan. Many past epidemiological studies have found that people with low physical fitness tend to be at high risk of premature death. Conversely, people with robust aerobic capacity are likely to have long lives.

But most of those studies followed people for about 10 to 20 years, which is a lengthy period of time for science but nowhere near most of our actual lifespans. Some of those studies also enrolled people who already were elderly or infirm, making it difficult to extrapolate the findings to younger, healthier people.

So for the new study, which was published this week in the European Journal of Preventive Cardiology, researchers from the University of Gothenburg in Sweden and other institutions turned to an impressively large and long-term database of information about Swedish men.

The data set, prosaically named the Study of Men Born in 1913, involved exactly that. In 1963, almost 1,000 healthy 50-year-old men in Gothenburg who had been born in 1913 agreed to be studied for the rest of their lives, in order to help scientists better understand lifetime risks for disease, especially heart disease.

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http://well.blogs.nytimes.com/2016/07/27/being-unfit-may-be-almost-as-bad-for-you-as-smoking/?

NYTimes: Naloxone Eases Pain of Heroin Epidemic, but Not Without Consequences

PORTLAND, Me. — A woman in her 30s was sitting in a car in a parking lot here last month, shooting up heroin, when she overdosed. Even after the men she was with injected her with naloxone, the drug that reverses opioid overdoses, she remained unconscious. They called 911.

Firefighters arrived and administered oxygen to improve her breathing, but her skin had grown gray and her lips had turned blue. As she lay on the asphalt, the paramedics slipped a needle into her arm and injected another dose of naloxone.

In a moment, her eyes popped open. Her pupils were pinpricks. She was woozy and disoriented, but eventually got her bearings as paramedics put her on a stretcher and whisked her to a hospital.
Every day across the country, hundreds, if not thousands, of people who overdose on opioids are being brought back to life with naloxone. Hailed as a miracle drug by many, it carries no health risk; it cannot be abused and, if given mistakenly to someone who has not overdosed on opioids, does no harm. More likely, it saves a life.

As a virulent opioid epidemic continues to ravage the country, with 78 people in the United States dying of overdoses every day, naloxone's use has increasingly moved out of medical settings, where it has been available since the 1970s, and into the homes and hands of the general public.

But naloxone, also known by the brand name Narcan, has also had unintended consequences. Critics say that it gives drug users a safety net, allowing them to take more risks as they seek higher highs. Indeed, many users overdose more than once, some multiple times, and each time, naloxone brings them back.

Advocates argue that the drug gives people a chance to get into treatment and turn their lives around. And, they say, few addicts knowingly risk needing to be revived, since naloxone ruins their high and can make them violently ill.

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http://www.nytimes.com/2016/07/28/us/naloxone-eases-pain-of-heroin-epidemic-but-not-without-consequences.html?

‘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/?

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?