Thursday, June 22, 2017

How to fall to your death and live to tell the tale | Mosaic

Slipping in the shower, tripping down the stairs, taking a tumble in the supermarket – falls kill over 420,000 people per year and hospitalise millions more. We can't eliminate all falls, says Neil Steinberg. So we must to learn to fall better.

Alcides Moreno and his brother Edgar were window washers in New York City. The two Ecuadorian immigrants worked for City Wide Window Cleaning, suspended high above the congested streets, dragging wet squeegees across the acres of glass that make up the skyline of Manhattan.

On 7 December 2007, the brothers took an elevator to the roof of Solow Tower, a 47-storey apartment building on the Upper East Side. They stepped onto the 16-foot-long, three-foot-wide aluminium scaffolding designed to slowly lower them down the black glass of the building.

But the anchors holding the 1,250-pound platform instead gave way, plunging it and them 472 feet to the alley below. The fall lasted six seconds.

Edgar, at 30 the younger brother, tumbled off the scaffolding, hit the top of a wooden fence and was killed instantly. Part of his body was later discovered under the tangle of crushed aluminium in the alley next to the building.

But rescuers found Alcides alive, sitting up amid the wreckage, breathing and conscious when paramedics performed a "scoop and run" – a tactic used when a hospital is near and injuries so severe that any field treatment isn't worth the time required to do it. Alcides was rushed to NewYork-Presbyterian Hospital/Weill Cornell Medical Center, four blocks away.

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Falls are one of life's great overlooked perils. We fear terror attacks, shark bites, Ebola outbreaks and other minutely remote dangers, yet over 420,000 people die worldwide each year after falling. Falls are the second leading cause of death by injury, after car accidents. In the United States, falls cause 32,000 fatalities a year (more than four times the number caused by drowning or fires combined). Nearly three times as many people die in the US after falling as are murdered by firearms.

Falls are even more significant as a cause of injury. More patients go to emergency rooms in the US after falling than from any other form of mishap, according to the Centers for Disease Control and Prevention (CDC), nearly triple the number injured by car accidents. The cost is enormous. As well as taking up more than a third of ER budgets, fall-related injuries often lead to expensive personal injury claims. In one case in an Irish supermarket, a woman was awarded 1.4 million euros compensation when she slipped on grapes inside the store.

It makes sense that falls dwarf most other hazards. To be shot or get in a car accident, you first need to be in the vicinity of a gun or a car. But falls can happen anywhere at any time to anyone.

Spectacular falls from great heights outdoors like the plunge of the Moreno brothers are extremely rare. The most dangerous spots for falls are not rooftops or cliffs, but the low-level, interior settings of everyday life: shower stalls, supermarket aisles and stairways. Despite illusions otherwise, we have become an overwhelmingly indoor species: Americans spend less than 7 per cent of the day outside but 87 per cent inside buildings (the other 6 per cent is spent sitting in cars and other vehicles). Any fall, even a tumble out of bed, can change life profoundly, taking someone from robust health to grave disability in less than one second.

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https://mosaicscience.com/story/falling-science-injury-death-falls?

The opioid crisis changed how doctors think about pain - Vox

WILLIAMSON, West Virginia — This town on the eastern border of Kentucky has 3,150 residents, one hotel, one gas station, one fire station — and about 50 opiate overdoses each month.

On the first weekend of each month, when public benefits like disability get paid out, the local fire chief estimates the city sees about half a million dollars in drug sales. The area is poor — 29 percent of county residents live in poverty, and, amid the retreat of the coal industry, the unemployment rate was 12.2 percent when I visited last August— and those selling pills are not always who you'd expect.

"Elderly folks who depend on blood pressure medications, who can't afford them, they're selling their [painkillers] to get money to buy their blood pressure drug," Williamson fire chief Joey Carey told me when I visited Williamson. "The opioids are still $5 or $10 copays. They can turn around and sell those pills for $5 or $10 each."

Opioids are everywhere in Williamson, because chronic pain is everywhere in Williamson.

Dino Beckett opened a primary care clinic there in March 2014, on the same street with the hotel and the gas station. A native of the area with a close-cropped beard and a slight Southern drawl, Beckett sees the pain of Williamson day in and day out.

He sees older women who suffer from compression fractures up and down their spines, the result of osteoporosis. He sees men who mined coal for decades, who now experience persistent, piercing low back pain. "We have a population that works in coal mines or mine-supporting industries doing lots of manual labor, lifting equipment," he says. "Doing that for 10 to 12 hours a day for 15 to 20 years, or more, is a bad deal."

Beckett sees more pain than doctors who practice elsewhere. Nationally, 10.1 percent of Americans rate their health as "fair" or "poor." In Mingo County, where Williamson is, that figure stands at 38.9 percent.

Williamson has some of West Virginia's highest rates of obesity, disability, and arthritis — and that is in a state that already ranks among the worst in those categories compared with the rest of the nation. An adult in Williamson has twice the chance of dying from an injury as the average American.

This is why the opioid crisis is so hard to handle, here and in so many communities: The underlying drugs are often being prescribed for real reasons.

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https://www.vox.com/2017/6/5/15111936/opioid-crisis-pain-west-virginia

Saturday, June 17, 2017

A dog bite sent him to the ER. A cascade of missteps nearly killed him. - The Washington Post

Becky Krall hurried through the sliding-glass doors of the hospital emergency room around 8 a.m. on Sept. 25, 2015, expecting to see her feverish husband, David, sitting among the patients waiting to see a doctor. Instead Krall, who had left him for about 15 minutes while parking their car, was met by a nurse with an urgent message: Her 50-year-old husband had suddenly become unresponsive.

Krall recalls with frightening clarity the words of a critical care specialist. "She put her hand on my knee and said, 'Your husband is very, very sick. You need to be prepared for him not to make it through the day.' "

How, Krall remembers wondering, did her fit and healthy husband of 10 years get so sick so fast? The night before, Krall had driven him to the same ER, sent by an urgent care center for a closer assessment of his fever and malaise. The couple had spent about five hours there but left before seeing a doctor because the ER was so swamped and David's condition seemed unchanged. They figured they'd have better luck in the morning.

That decision, Becky Krall says, was among a cascade of serious missteps that left David, an industrial engineer, battling a catastrophic illness that kills between 60 and 80 percent of its victims. Doctors at the University of Kentucky Albert B. Chandler Hospital in Lexington managed to save David's life, but he was left with profound, permanent hearing loss. Several of his toes had to be partially amputated.

"I felt extremely guilty for a long time," said Becky, an associate professor of STEM education at the university who continues to struggle with the emotional aftermath of the ordeal. "I have lots of information now. But I didn't know any of it then." She hopes her husband's case, which helped spur changes in the emergency department, will serve as a cautionary tale.

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https://www.washingtonpost.com/national/health-science/a-dog-bite-sent-him-to-the-er-a-cascade-of-missteps-nearly-killed-him/2017/06/16/5ea17d96-1aed-11e7-bcc2-7d1a0973e7b2_story.html?

Wednesday, June 7, 2017

Anaesthesia: what we still don't know about the 'gift of oblivion' - The Age (Australia)

I am in a smallish, whitish room in a hospital in Brisbane. It is night. On the wall opposite my bed I can dimly make out a crucifix with its limp passenger. Beneath it float wide blank windows through which I watch the synapses of city light: a web of tiny illuminations and extinctions that seem, when I loosen my gaze, almost to form patterns, as if they are about to make sense. I am surprised at how calm I feel.

In the weeks leading up to this moment I have set my affairs in order. Made a will, written letters for the children, waxed my legs. Said my farewells at the airport and boarded the flight from Melbourne with my mother. It is July 2010.

Today's specialist anaesthetists train for 12 to 13 years. The death rate from general anaesthesia has dropped from about one in 20,000 in the 1970s to one or two in 200,000 this century. Photo: Fuse
Some months before this, after decades of resistance, I gave in at last to the inevitability of major surgery. My capitulation was sudden and took place in a different wing of this same hospital, where I had come to consult a respected spinal surgeon. The surgeon had a quiet, almost diffident, manner and a moustache that put me in mind of a doleful Groucho. I am not sure what made my mind up, the moustache or the way his finger traced my wayward spine quite gently on the X-ray before him. But just as he began to tell me that I would not be a candidate for the non-invasive surgery we had been talking about, I realised with a small thud of certainty that, not only was I going to have this surgery – invasive though it might be – I was going to come back to Brisbane and he was going to do it.

In the aftermath of my decision, I was buoyed in a backwash of something like relief; a giving up of hope and its attendant efforts, a yielding to forces beyond my will. But when I lay awake at night, disquiet rose around me. It was not just the surgery that was worrying me – the cutting and drilling, the inevitable risk – it was that in some blank corner of myself I felt that I would not wake up afterwards. I knew logically, and during the day could convince myself, that for an otherwise healthy 48-year-old, the likelihood of calamity was low. But at night, in my bed in Melbourne, the conviction multiplied that even if everything went according to plan, the me who woke after surgery would not be the same in some essential way as the me who had been wheeled into the operating theatre beforehand.

I developed a dread of the moment when the anaesthetic drugs would take effect and I would cease to be. I pictured myself in a stark, poorly lit room with two doors, one in, one out, neither of which I could open from within. Otherwise the room was empty. No windows, no furniture. In this darkness – which I now realise had the same sinuous quality as the shadows beneath my childhood bed – I would be trapped alone. Perhaps forever. At least until such time as someone else chose to release, not me but some other version of me who would slip soundlessly into the life that had once been mine.

Shortly after making my decision, I rang a separate Brisbane medical practice. I asked to speak to the doctor whose job it would be to render me unconscious and keep me that way during the long operation. Halting, almost apologetic, I explained to the receptionist that I had spent some years researching the process known as anaesthesia, and that I was now rather nervous about what was going to happen to me. "I think I know too much," I said.

"Oh dear," they said. "That's not good."

More ...

http://www.theage.com.au/good-weekend/anaesthesia-what-we-still-dont-know-about-the-gift-of-oblivion-20170511-gw2uhh.html?

Tuesday, June 6, 2017

Drug Deaths in America Are Rising Faster Than Ever - The New York Times

Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times.

The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50.

Although the data is preliminary, the Times's best estimate is that deaths rose 19 percent over the 52,404 recorded in 2015. And all evidence suggests the problem has continued to worsen in 2017.

Because drug deaths take a long time to certify, the Centers for DiseaseControl and Prevention will not be able to calculate final numbers until December. The Times compiled estimates for 2016 from hundreds of state health departments and county coroners and medical examiners. Together they represent data from states and counties that accounted for 76 percent of overdose deaths in 2015. They are a first look at the extent of the drug overdose epidemic last year, a detailed accounting of a modern plague.

The initial data points to large increases in drug overdose deaths in states along the East Coast, particularly Maryland, Florida, Pennsylvania and Maine. In Ohio, which filed a lawsuit last week accusing five drug companies of abetting the opioid epidemic, we estimate overdose deaths increased by more than 25 percent in 2016.

"Heroin is the devil's drug, man. It is," Cliff Parker said, sitting on a bench in Grace Park in Akron. Mr. Parker, 24, graduated from high school not too far from here, in nearby Copley, where he was a multisport athlete. In his senior year, he was a varsity wrestler and earned a scholarship to the University of Akron. Like his friends and teammates, he started using prescription painkillers at parties. It was fun, he said. By the time it stopped being fun, it was too late. Pills soon turned to heroin, and his life began slipping away from him.

More ...

https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?

Monday, June 5, 2017

The Doctor Is In. Co-Pay? $40,000. - The New York Times

SAN FRANCISCO — When John Battelle's teenage son broke his leg at a suburban soccer game, naturally the first call his parents made was to 911. The second was to Dr. Jordan Shlain, the concierge doctor here who treats Mr. Battelle and his family.

"They're taking him to a local hospital," Mr. Battelle's wife, Michelle, told Dr. Shlain as the boy rode in an ambulance to a nearby emergency room in Marin County. "No, they're not," Dr. Shlain instructed them. "You don't want that leg set by an E.R. doc at a local medical center. You want it set by the head of orthopedics at a hospital in the city."

Within minutes, the ambulance was on the Golden Gate Bridge, bound for California Pacific Medical Center, one of San Francisco's top hospitals. Dr. Shlain was there to meet them when they arrived, and the boy was seen almost immediately by an orthopedist with decades of experience.

For Mr. Battelle, a veteran media entrepreneur, the experience convinced him that the annual fee he pays to have Dr. Shlain on call is worth it, despite his guilt over what he admits is very special treatment.

"I feel badly that I have the means to jump the line," he said. "But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?"

Increasingly, it is a question being asked in hospitals and doctor's offices, especially in wealthier enclaves in places like Los Angeles, Seattle, San Francisco and New York. And just as a virtual velvet rope has risen between the wealthiest Americans and everyone else on airplanes, cruise ships and amusement parks, widening inequality is also transforming how health care is delivered.

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https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html?

Monday, May 29, 2017

China’s Ill, and Wealthy, Look Abroad for Medical Treatment - The New York Times

China's medical system could not stop the cancer eating at Guo Shushi's stomach. It roared back even after Mr. Guo, a 63-year-old real estate developer, endured surgery, chemotherapy and radiation at two hospitals.

Then his son-in-law discovered online that — for a price — companies were willing to help critically ill Chinese people seek treatment abroad. Soon Mr. Guo was at the Dana-Farber Cancer Institute in Boston, receiving a new immunotherapy drug, Keytruda, which is not available in China. In April, nearly four months later, his tumor has shrunk and his weight has gone up.

"When I arrived, I could feel how large the gap was," said Mr. Guo of the difference in care.

The cost: about $220,000 — all paid out of pocket.

China's nearly 1.4 billion people depend on a strained and struggling health care system that belies the country's rise as an increasingly wealthy global power. But more and more, the rich are finding a way out.

Western hospitals and a new group of well-connected companies are reaching for well-heeled Chinese patients who need lifesaving treatments unavailable at home. The trend is a twist on the perception of medical tourism as a way to save money, often on noncritical procedures like dental work and face-lifts. For these customers, getting out of China is a matter of life or death.

More …

https://www.nytimes.com/2017/05/29/business/china-medical-tourism-hospital.html

Wednesday, May 24, 2017

FDA Clears First Cancer Drug Based on Genetics of Disease, Not Tumor Location - Scientific American

Merck & Co's immunotherapy Keytruda chalked up another approval on Tuesday as the U.S. Food and Drug Administration said the cancer medicine can be used to treat children and adults who carry a specific genetic feature regardless of where the disease originated.
It is the first time the agency has approved a cancer treatment based solely on a genetic biomarker.
"Until now, the FDA has approved cancer treatments based on where in the body the cancer started - for example, lung or breast cancers," said Richard Pazdur, head of oncology products for the FDA's Center for Drug Evaluation and Research. "We have now approved a drug based on a tumor's biomarker without regard to the tumor's original location."
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https://www.scientificamerican.com/article/fda-clears-first-cancer-drug-based-on-genetics-of-disease-not-tumor-location/?

Friday, May 19, 2017

It'll Take an Army to Kill the Emperor - Popular Mechanics

The men and women who are trying to bring down cancer are starting to join forces rather than work alone. Together, they are winning a few of the battles against the world's fiercest disease. For this unprecedented special report, we visited elite cancer research centers around the country to find out where we are in the war.

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http://www.popularmechanics.com/science/health/a26290/we-will-beat-cancer/?

Monday, May 15, 2017

The painful truth about teeth - The Washington Post

SALISBURY, Md. — Two hours before sunrise, Dee Matello joined the line outside the Wicomico Civic Center, where hundreds of people in hoodies, heavy coats and wool blankets braced against a bitter wind.

Inside, reclining dental chairs were arrayed in neat rows across the arena's vast floor. Days later, the venue would host Disney on Ice. On this Friday morning, dentists arriving from five states were getting ready to fix the teeth of the first 1,000 people in line.

Matello was No. 503. The small-business owner who supports President Trump had a cracked molar, no dental insurance and a nagging soreness that had forced her to chew on the right side of her mouth for years.

"It's always bothering me," she said. And although her toothache wasn't why she voted for Trump, it was a constant reminder of one reason she did: the feeling that she had been abandoned, left struggling to meet basic needs in a country full of fantastically rich people.

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http://www.washingtonpost.com/sf/national/2017/05/13/the-painful-truth-about-teeth/?

STAT - Reporting from the frontiers of health and medicine

STAT delivers fast, deep, and tough-minded journalism. We take you inside science labs and hospitals, biotech boardrooms, and political backrooms. We dissect crucial discoveries. We examine controversies and puncture hype. We hold individuals and institutions accountable. We introduce you to the power brokers and personalities who are driving a revolution in human health. These are the stories that matter to us all.

https://www.statnews.com/

Saturday, May 13, 2017

NFL players fight pain with medical marijuana: ‘Managing it with pills was slowly killing me’ - The Washington Post

BOULDER, Colo. — One by one, they entered a nondescript building on the eastern edge of town, 18,000 square feet with no signage out front. They came looking for relief. These nine former professional football players are part of the Denver Broncos Alumni Association. They played in nearly 700 NFL games combined and have enough aches and pains to keep an entire hospital staff busy.

"Every day, I wake up in pain, from my ankles to my neck," said Ebenezer Ekuban, 40, who played defensive end for nine NFL seasons. "It's part of the territory. I know what I signed up for."

Retirement is a daily exercise in managing pain, which is what brought the men to the unmarked CW Hemp offices on a recent Friday for a tour and a firsthand lesson on the potential benefits of the marijuana plant. As the country's discussion on the drug broadens, state laws change and public perception shifts, there's a movement in football circles to change the way marijuana is viewed and regulated within the NFL, which still includes cannabis on its list of banned substances.

For decades, football players have treated pain with postgame beers, over-the-counter anti-inflammatories and powerful prescription painkillers. The sport's overreliance on drugs for pain management is the subject of a federal lawsuit and has sparked an investigation by the Drug Enforcement Administration. Retired NFL players use opioids at four times the rate of the general population, according to one study, and marijuana advocates say there's a safer, healthier alternative available.

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https://www.washingtonpost.com/sports/redskins/nfl-players-fight-pain-with-medical-marijuana-managing-it-with-pills-was-slowly-killing-me/2017/05/02/676e4e62-2e80-11e7-9534-00e4656c22aa_story.html?

More than a million patients flock to this website. Drug companies are in hot pursuit. - The Washington Post

This isn't Brian Loew's first run at Internet success.

During the thick of the dot-com mania 20 years ago, Loew and some friends built an online publishing company called Worldweb.net. It had 150 employees and $15 million in revenue but, like many start-ups from the era, it never posted a profit.

Worldweb.net created website software in the Internet's early days for Elle, Car and Driver, the ill-fated George magazine and other publications.

"I was going to be rich beyond my wildest dreams," Loew said, recounting what his bankers had told him at the time.

Ten days away from the company's initial public offering, the go-go, dot-com age imploded and Loew's path to riches vaporized. The company, which bankers predicted could eventually be worth $1 billion, was sold off for a small fraction of that.

"Investors got their money back, but nobody got rich," Loew said.

The 46-year-old entrepreneur appears to be on to something with a better future this time around. His nine-year-old medical-website business, known as Inspire, has 1.1 million members, 33 employees and nearly $10 million in revenue, and it will turn its first profit this year.

Inspire essentially is a giant, online discussion community where people can use real or assumed names to share experiences, information and advice about their various medical conditions.

"Join many others who understand what you're going through and are making important decisions about their health," says the greeting on Inspire's website.

Loew and his company are attached to the surge of patient assertiveness, with more people questioning their health care and taking more of the responsibility out of the hands of professionals. 

"Patient centricity really matters," said Loew, who owns a big chunk of the company, along with investors and employees.

Membership is free and increasing by 1,000 per day. Seventy-eight percent of members are women.

"Women are the chief medical officers of the home," Loew said. "Many of our female members represent a member of the family — husbands, fathers, fathers-in-law, siblings, children. So sometimes a woman would join and say, 'I'm a parent of a 'preemie,' a child of someone with a medical condition, a sister of someone else.' "

The company has a team of community moderators to make sure members get along on chats.

Revenue comes from advertising and from companies looking for hard-to-find patients to participate in clinical drug trials or market research.

Many of the research contracts come from pharmaceutical giants to carry out drug trials or marketing studies on everything from psoriasis (one of the most common ailments among members) to cancer. The contracts can pay anywhere from $50,000 to $750,000, Loew said. It usually amounts to about $1,000 per patient for market research and up to $10,000 for clinical trials.

Inspire's clients include the top 10 pharmaceutical companies in the world, as well as most of the top 25.

"It matters to these companies what patients think and want and how they make decisions," Loew said.

More ...

https://www.washingtonpost.com/business/economy/more-than-a-million-patients-flock-to-this-website-drug-companies-are-in-hot-pursuit/2017/04/27/7b533944-29ec-11e7-a616-d7c8a68c1a66_story.html?

Thursday, May 11, 2017

We’re Bad at Death. Can We Talk? - The New York Times

Her last conversation should not have been with me.

I'd just arrived for the night shift in the I.C.U. when her breathing quickened. I didn't know much about the patient, and the little I did know wasn't good: She had cancer. Her lungs were filled with fluid. As her breathing deteriorated and her oxygen levels plunged, I searched the chart for her wishes in an emergency. Nothing.

I explained to her how rapidly her condition had worsened and asked if she'd discussed intubation and mechanical ventilation. She shook her head; she didn't think it would get so bad so fast. Together we called her husband, who had just left for the evening, but there was no answer.

"If we do it, when will I…" she paused. "When will I wake up?"

I hesitated. It was as likely as not that she wouldn't. I explained that we never leave patients intubated longer than necessary, but when people were as sick as she was it was impossible to know when — or even if — they would be extubated.

"O.K.," she said. "Do it."

There are, no doubt, differing opinions on what constitutes a good death. But this, inarguably, was not one.

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https://www.nytimes.com/2017/05/10/upshot/were-bad-at-death-first-we-need-a-good-talk.html?

Tuesday, May 9, 2017

Cotton Swab Injuries Send 12,500 Kids To Hospital Each Year – Consumerist

We all know that we're not supposed to stick things in our ear, but we're also told that ear wax is icky and should be removed post-haste. This contradictory set of priorities might explain why thousands of kids show up at the hospital each year with swab-related ear injuries.

The National Children's Hospital study, published in the The Journal of Pediatrics, found that over a 21-year-period from 1990 to 2010, 263,000 children — ages 18 and younger — were treated in emergency rooms for cotton-tip related ear injuries. That works out to 12,500 annual visits, or 34 visits every day.

According to the report — compiled using data from the Consumer Product Safety Commission's National Electronic Injury Surveillance System — the majority of these injuries (about 73% ) occurred as a result of using cotton tip applicators to clean the ears.

Another 10% of injuries occurred when children were playing with the applicators, and 9% when they fell with he cotton tip applicator in their ears.

"The two biggest misconceptions I hear as an otolaryngologist are that the ear canals need to be cleaned in the home setting, and that cotton tip applicators should be used to clean them; both of those are incorrect," co-author of the study, Dr. Kris Jatana said in a statement, noting that ear canals are typically self-cleaning.

More ...

https://consumerist.com/2017/05/08/cotton-swab-injuries-send-12500-kids-to-hospital-each-year/?

PowerPost - The Health 202 Newsletter - The Washington Post

Your daily guide to the health-care debate.

https://www.washingtonpost.com/news/powerpost/wp/category/the-health-202/?

A Public Overdose. An Antidote at Hand. Would Passers-By Use It? - The New York Times

Across the country, someone dies of an opioid overdose every 24 minutes. In Massachusetts, the death toll is five people a day.

In the face of this epidemic, Cambridge could become the first city to take a step that until recently might have seemed unthinkable: It might place lockboxes on street corners to give the public easy access to Narcan, the brand name for naloxone, a medication that can rapidly revive people who have overdosed.

The idea is in its earliest stages, and any concrete plan for the city, and residents, to consider seems at least a year away. But several days ago, the city police and area doctors who support the boxes conducted an experiment here, asking people who walked by if they would help a stranger who had overdosed.

The officials placed a dummy on the ground on a brick plaza along busy Massachusetts Avenue in Central Square, between two of this city's most drug-infested areas. Passers-by were asked to pretend they had just found an unconscious person. They were handed a cellphone, which was connected to someone acting as an emergency dispatcher.

The dispatcher directed them to a nearby lockbox, gave them a code to open it and then explained how to administer Narcan, a nasal spray. Doctors say Narcan is safe; if given to someone who has not overdosed, it does no harm. It is not addictive and cannot be abused.

"We want to see if regular people walking down the street would be willing to help someone who appeared to be overdosing," said Dr. Scott Goldberg, director of emergency services at Brigham and Women's Hospital, who oversaw the experiment. "And if they were willing to help, would they be able to help?"

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https://www.nytimes.com/2017/05/09/us/opioids-narcan-drug-overdose-heroin-fentanyl.html

Friday, May 5, 2017

Scientists engineer baker's yeast to produce penicillin molecules

The synthetic biologists from Imperial College London have re-engineered yeast cells to manufacture the nonribosomal peptide antibiotic penicillin. In laboratory experiments, they were able to demonstrate that this yeast had antibacterial properties against streptococcus bacteria.

The authors of the study, which is published today in the journal Nature Communications, say their new method demonstrates the effectiveness of using this kind of synthetic biology as a route for discovering new . This could open up possibilities for using re-engineered  cells to develop new forms of antibiotics and anti-inflammatory drugs from the nonribosomal peptide family.

Nonribosomal  are normally produced by bacteria and fungi, forming the basis of most antibiotics today. Pharmaceutical companies have long experimented with nonribosomal peptides to make conventional antibiotics. The rise of antimicrobial resistance means there is a need to use genetic engineering techniques to find a new range of antibiotics from bacteria and fungi. However, genetically engineering the more exotic fungi and bacteria- the ones likely to have antibacterial properties—is challenging because scientists don't have the right tools and they are difficult to grow in a lab environment, requiring special conditions.

Baker's yeast on the other hand is easy to genetically engineer. Scientists can simply insert DNA from bacteria and fungi into yeast to carry out experiments, offering a viable new host for antibiotic production research. The rise of synthetic biology methods for yeast will allow researchers to make and test many new gene combinations that could produce a whole new range of new antibiotics.

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https://phys.org/news/2017-05-scientists-baker-yeast-penicillin-molecules.html

Tuesday, May 2, 2017

Hitting a Medical Wall, and Turning to Unproven Treatments - The New York Times

What if you or your child had a chronic illness that seriously limited or threatened life, and modern medicine had no effective or acceptable treatments to offer you?

Imagine you were plagued by severe food allergies, rheumatoid arthritis, attention deficit hyperactivity disorder or intractable epilepsy. Would you be willing or desperate or brave enough to step outside the realm of established medicine and seek help from an unconventional therapist — even someone with no medical or scientific training?

What if you heard about others in a similar situation who had tried a purported remedy that appeared to work, or the method seemed to make biological sense?

In her new book, "The Other Side of Impossible," Susannah Meadows, a Brooklyn-based former senior writer for Newsweek, has compiled compelling stories about people who faced and ultimately surmounted daunting medical challenges. The book focuses on several families, including her own, who felt they had no choice but to wade into the world of unproven therapies.

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https://www.nytimes.com/2017/05/01/well/live/hitting-a-medical-wall-and-turning-to-unproven-treatments.html

Thursday, April 27, 2017

Video Games Help Model Brain’s Neurons - The New York Times

Zoran Popović knows a thing or two about video games. A computer science professor at the University of Washington, Dr. Popović has worked on software algorithms that make computer-controlled characters move realistically in games like the science-fiction shooter "Destiny."

But while those games are entertainment designed to grab players by their adrenal glands, Dr. Popović's latest creation asks players to trace lines over fuzzy images with a computer mouse. It has a slow pace with dreamy music that sounds like the ambient soundtrack inside a New Age bookstore.

The point? To advance neuroscience.

Since November, thousands of people have played the game, "Mozak," which uses common tricks of the medium — points, leveling up and leader boards that publicly rank the performance of players — to crowdsource the creation of three-dimensional models of neurons.

The Center for Game Science, a group at the University of Washington that Dr. Popović oversees, developed the game in collaboration with the Allen Institute for Brain Science, a nonprofit research organization founded by Paul Allen, the billionaire co-founder of Microsoft, that is seeking a better understanding of the brain. Dr. Popović had previously received wide attention in the scientific community for a puzzle game called "Foldit," released nearly a decade ago, that harnesses the skills of players to solve riddles about the structure of proteins.

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https://www.nytimes.com/2017/04/24/science/citizen-science-video-game-neurons.html?

The Winner Of The $1 Million TED Prize Is Bringing Health Care To The World’s Most Remote Communities - Fast Company

If you live in a remote village in Liberia and you get sick, seeing a doctor might involve a canoe ride down a river and two days of walking through the rainforest. Clinics are similarly hard to reach for roughly a billion people around the world.

The winner of this year's $1 million TED Prize–Rajesh Panjabi, the founder of a nonprofit called Last Mile Health–has a solution for poor, remote communities that can't afford to hire doctors and nurses. Instead of recruiting trained medical professionals, the organization hires local community members, some of whom may have only a middle-school education. Then it gives them the training needed to screen and treat common illnesses like malaria, providing local jobs as it fills the health care gap.

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https://www.fastcompany.com/40412591/the-winner-of-the-1-million-ted-prize-is-bringing-healthcare-to-the-worlds-most-remote-communities?

Sunday, April 23, 2017

Idaho sets example: Tiny facility lights the way for stressed rural hospitals - Salon.com

Arco, Idaho — Just before dusk on an evening in early March, Mimi Rosenkrance set to work on her spacious cattle ranch to vaccinate a calf. But the mother cow quickly decided that just wasn't going to happen. She charged, all 1,000 pounds of her, knocking Rosenkrance over and repeatedly stomping on her. "That cow was trying to push me to China," Rosenkrance recalls.

Dizzy and nauseated, with bruises spreading on both her legs and around her eye, Rosenkrance, 58, nearly passed out. Her son called 911 and an ambulance staffed by volunteers drove her to Lost Rivers Medical Center, a tiny, brick hospital nestled on the snowy hills above this remote town in central Idaho.

Lost Rivers has only one full-time doctor and its emergency room has just three beds — not much bigger than a summer camp infirmary. But here's what happened to Rosenkrance in the first 90 minutes after she showed up: She got a CT scan to check for a brain injury, X-rays to look for broken bones, an IV to replenish her fluids and her ear sewn back together. The next morning, although the hospital has no pharmacist, she got a prescription for painkillers filled through a remote prescription service. It was the kind of full-service medical treatment that might be expected of a hospital in a much larger town.

http://www.salon.com/2017/04/23/idahos-admirable-project-tiny-facility-lights-the-way-for-stressed-rural-hospitals_partner/

The Blood of the Crab

Horseshoe crab blood is an irreplaceable medical marvel—and so biomedical companies are bleeding 500,000 every year. Can this creature that's been around since the dinosaurs be saved?

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http://www.popularmechanics.com/science/health/a26038/the-blood-of-the-crab/?

Saturday, April 22, 2017

Sometimes It’s Better Not to Know - The New York Times

"I don't know if I'm looking forward to being 98."

My 97-year-old patient revealed this to me during our first meeting in my clinic examination room. He had just moved to an assisted living facility in Cleveland to be near his son and daughter-in-law, who also sat in the room. They were quiet as they watched us interact.

"What do you mean?" I asked.

He rested both forearms on the high arms of his wheelchair, which caused his shoulders to hunch and gave the impression that he was about to spring into action. He spoke deliberately, choosing his words carefully. His eyes were rheumy but sharply focused, commanding my attention. I got the impression he was used to being in charge.

"I don't want to end up… you know, blotto," he said, quickly pantomiming a person slouched to one side of his chair, mouth open. His son and daughter-in-law glanced at each other and then at me as they arched their eyebrows in surprise.

"Why do you think that might happen?" I asked.

"Because of my medical condition, or whatever you're going to recommend I treat it with," he answered, matter-of-factly.

He had abnormal blood counts, but no established diagnosis. He was anemic, requiring a blood transfusion every two months, just often enough to be a nuisance for anybody. His platelets were low, but not low enough to put him at risk for bleeding or to require platelet transfusions. And his white blood cell count was decreased, though again, not enough to render him prone to infections.

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https://www.nytimes.com/2017/04/20/well/live/sometimes-its-better-not-to-know.html?

Friday, April 21, 2017

‘Pacemaker’ for the Brain Can Help Memory, Study Finds - The New York Times

Well-timed pulses from electrodes implanted in the brain can enhance memory in some people, scientists reported on Thursday, in the most rigorous demonstration to date of how a pacemaker-like approach might help reduce symptoms of dementia, head injuries and other conditions.

The report is the result of decades of work decoding brain signals, helped along in recent years by large Department of Defense grants intended to develop novel treatments for people with traumatic brain injuries, a signature wound of the Iraq and Afghanistan wars. The research, led by a team at the University of Pennsylvania, is published in the journal Current Biology.

Previous attempts to stimulate human memory with implanted electrodes had produced mixed results: Some experiments seemed to sharpen memory, but others muddled it. The new paper resolves this confusion by demonstrating that the timing of the stimulation is crucial.

Zapping memory areas when they are functioning poorly improves the brain's encoding of new information. But doing so when those areas are operating well — as they do for stretches of the day in most everyone, including those with deficits — impairs the process.

"We all have good days and bad days, times when we're foggy, or when we're sharp," said Michael Kahana, who with Youssef Ezzyat led the research team. "We found that jostling the system when it's in a low-functioning state can jump it to a high-functioning one."

Researchers cautioned that implantation is a delicate procedure and that the reported improvements may not apply broadly. The study was of epilepsy patients; scientists still have much work to do to determine whether this approach has the same potential in people with other conditions, and if so how best to apply it. But in establishing the importance of timing, the field seems to have turned a corner, experts said.

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https://www.nytimes.com/2017/04/20/health/brain-memory-dementia-epilepsy-treatments.html?

Doctors Are Human Too - The New York Times

SYDNEY, Australia — How can I tell you what I have done? Let me start with a doorway. I am looking in at a patient handcuffed to the rails of a hospital bed, arms spread out in a crucifixion pose. The prison guards who have brought the patient to the hospital explain what has happened. I hide my horror behind my calm and neutral doctor face as I unfurl crepe bandages from self-inflicted wounds. Just another set of wounds to add to all the others in my head, the weeping pressure sores of nursing home residents, the gangrenous toes that you can smell from the other side of the room.

The job of a doctor in training is unspeakable. It is hard to find the words to describe what we do. It is hard to work out whom to tell. We cannot speak of these things to people outside medicine because it is too traumatic, too graphic, too much. But we cannot speak of these things within medicine, either, because it is not enough, it is just the job we do, hardly worth commenting on.

When I started working as a doctor last year in a metropolitan public hospital in Sydney, rotating through the emergency department and the surgical and medical wards, as all doctors do in their first year of practice in Australia, my experiences were no better or worse than those of any of my colleagues. Nor are they dissimilar to the experiences of junior doctors around the world. But we are speaking about these things now, where I am from, because my colleagues are killing themselves.

It has long been recognized that physicians are more likely than the general population to kill themselves, especially if they are female. A meta-analysis of studies around the world on doctor suicide found that female doctors were more than twice as likely as the general population to die this way.

Younger doctors are particularly vulnerable. In the United States an estimated average of 28 percent of medical residents show signs of depression during training, making them around three times more likely to be depressed than similarly aged Americans. A 2013 survey of Australian doctors by the mental health nonprofit organization Beyond Blue found that young doctors worked longer hours than their older colleagues, in some cases up to 50 hours or more per week on average. Younger doctors were also more psychologically distressed and more burned out, and thought about suicide more often. Here in Sydney we have lost three colleagues in the last seven months alone.

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https://www.nytimes.com/2017/04/21/opinion/doctors-are-human-too.html?

Wednesday, April 19, 2017

Facebook's Building 8 takes its own moonshots - CNET

It looks like just another beige office park building next to a dental office in Menlo Park, California. Yet Building 8, across the street from Facebook's main campus, houses the social network's biggest bets on out-there products.

The tech industry has a term for what people inside Building 8 work on: moonshots. Think potentially groundbreaking projects that could reshape Facebook's long-term future and even how all of us communicate.

CEO Mark Zuckerberg unveiled Building 8 (named for the number of letters in Facebook) at last year's F8 developer conference. He also revealed he'd recruited Regina Dugan from Google's Advanced Technology and Projects (ATAP) group to head Facebook's skunkworks efforts, as part of Zuckerberg's 10-year strategic plan.

Since then, Facebook has given tantalizing hints about Building 8's mission, saying only that it's focused on "seemingly impossible" hardware in augmented and virtual reality, artificial intelligence, connectivity and "other important breakthrough areas," with "clear objectives for shipping products at scale." The one thing we knew for sure: The company had been amassing a dream team of hardware veterans from the likes of Apple, Motorola, Google and other industry heavyweights.

Some of that secrecy faded Wednesday, when the group unveiled its first two projects: a "brain-to-computer interface" that would allow us to send thoughts straight to a computer, and technology to "hear" or absorb language through vibrations on our skin.

"If I'm doing my job well, we should deliver things people didn't know to ask for," Dugan -- who previously headed Darpa, the Defense Department's famed tech arm -- tells me Monday from a working space on Facebook's campus. "There's the risk of failure. But that's precisely the price you pay for the honor of working on something new."

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https://www.cnet.com/uk/news/facebook-f8-building-8-moonshot-projects-zuckerberg-regina-dugan/

Project Baseline

Join us on a journey to better understand health and prevent disease.

We used to think the world was flat, until teams of pioneers discovered new lands and pushed the boundaries of knowledge. We're at a similar turning point with health and disease: we now have the advanced tools and technologies to explore health in greater depth and detail than previously imaginable.

Project Baseline is the quest to collect comprehensive health data and use it as a map and compass, pointing the way to disease prevention.

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https://www.projectbaseline.com/

Google’s Massive Health Study Seeks 10,000 Volunteers to Give Up Their Medical Secrets - MIT Technology Review

Google knows all about your habits and interests online. Now the search company's health spinout, Verily, is asking 10,000 Americans for intimate knowledge of their bodies.

Verily today published a website that marks the launch of its founding idea, the Baseline Project, a multi-year study expected to cost more than $100 million that it says will search for clues to predicting heart disease and cancer.

Volunteers are being asked to submit to an unprecedented regimen of tests and physical monitoring. They'll be asked to wear a heart-tracking watch that follows their pulse and movements in real time and will undergo a detailed workup of x-rays and heart scans, in addition to having their genomes deciphered and their blood tested in so-called liquid biopsies, which might be able to catch cancer early.

Each volunteer will be monitored for four years. As enrolling 10,000 people will take time, the full study could take a decade to complete.

"No one has done this kind of deep dive on so many individuals. This depth has never been attempted," says Sanjiv Sam Gambhir, a physician researcher at Stanford University who is one of Baseline's investigators. "It's to enable generations to come to mine it, to ask questions, without presupposing what the questions are."

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https://www.technologyreview.com/s/604224/googles-massive-health-study-seeks-10000-volunteers-to-give-up-their-medical-secrets/?

Ada is an AI-powered doctor app and telemedicine service | TechCrunch

Ada, a London and Berlin-based health tech startup, sees its official U.K. push today, and in doing so joins a number of other European startups attempting to market something akin to an AI-powered 'doctor'.

The company's mobile offering bills itself as a "personal health companion and telemedicine app" and via a conversational interface is designed to help you work out what symptoms you have and offer you information on what might be the cause. If needed, it then offers you a follow up remote consultation with a real doctor over text.

In a call, two of Ada's founders — CEO Daniel Nathrath and Chief Medical Officer Dr Claire Novorol — explained that the app has been six years in the making, and actually started life out as being doctor-facing, helping clinicians to make better decisions. The same database and smart backend is now being offered to consumers to access, albeit with a much more consumer-friendly front-end.

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https://techcrunch.com/2017/04/19/ada-health/

Saturday, April 15, 2017

How Behavioral Economics Can Produce Better Health Care - The New York Times

Consider the following.

I'm a physician at the end of more than a decade of training. I've dissected cadavers in anatomy lab. I've pored over tomes on the physiology of disease. I've treated thousands of patients with ailments as varied as hemorrhoidsand cancer.

And yet the way I care for patients often has less to do with the medical science I've spent my career absorbing than with habits, environmental cues and other subtle nudges that I think little about.

I'll sometimes prescribe a particular brand of medication not because it has proved to be better, but because it happens to be the default option in my hospital's electronic ordering system. I'm more likely to wash my hands — an activity so essential for safe medical care that it's arguably malpractice not to do so — if a poster outside your room prompts me to think of your health instead of mine. I'll more readily change my practice if I'm shown data that my colleagues do something differently than if I'm shown data that a treatment does or doesn't work.

These confessions can be explained by the field of behavioral economics, which holds that human decision-making departs frequently, significantly and predictably from what would be expected if we acted in purely "rational" ways. People don't always make decisions — even hugely important ones about physical or financial well-being — based on careful calculations of risks and benefits. Rather, our behavior is powerfully influenced by our emotions, identity and environment, as well as by how options are presented to us.

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https://www.nytimes.com/2017/04/13/upshot/answer-to-better-health-care-behavioral-economics.html?

You Draw It: Just How Bad Is the Drug Overdose Epidemic? - The New York Times

How does the surge in drug overdoses compare with other causes of death in the U.S.? Draw your guesses on the charts below.

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https://www.nytimes.com/interactive/2017/04/14/upshot/drug-overdose-epidemic-you-draw-it.html?

Friday, April 14, 2017

Brain-Altering Science and the Search for a New Normal

In 2006, Liss Murphy was in thrall to what she calls a "sepsis of the soul" — an intractable and debilitating depression. She had hardly spoken in two years. She felt almost nothing; she was barely eating; she wanted to die.
No conventional treatments had helped. So when she heard that doctors at Massachusetts General Hospital, in Boston, had developed an experimental cure for severe depression that involved permanently implanting electrodes in the brain, she didn't hesitate. The procedure seemed like no big deal. "I never read the consent form," she says. "I just didn't care." This was her last shot, she thought. She half-hoped they would make a fatal mistake during the operation.

A few months later, on June 6th, 2006, Murphy lay in an operating room in the neurosurgery wing of Mass General. She looked hardly alive — her body emaciated from eating almost nothing, her skull shaved in preparation for the surgery. A shiny, donut-shaped CT scanner surrounded her head. The doctors began their work by drilling two dime-sized openings into her skull. Then they gingerly lowered tiny electrodes, about the width of the graphite in a pencil, into a region of her cerebral cortex known as the internal capsule. Once the electrodes were in place, the doctors asked her to interact with a computer simulation, with the holes in her skull still open. Before the surgery, they had used the CT scanner and a computerized navigation system (a kind of GPS for the brain surgeon) to map her brain and determine the precise spots where they would implant the electrodes.

Together with an electrical pulse generator — a boxy rectangle, like a small external hard drive — sewn into Murphy's chest cavity, the electrode would stimulate the region of her brain that the doctors believed to be responsible for her depression. The device, known as a deep-brain stimulator (DBS), is meant to regulate neural activity and bring the brain's patterns back to normalcy. A wire from the pulse generator snakes up to the electrode, carrying electricity, which the electrode then transmits to the brain.

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https://psmag.com/brain-altering-science-and-the-search-for-a-new-normal-c2759af3f496

Monday, April 10, 2017

Treating depression is guesswork. Psychiatrists are beginning to crack the code. - Vox

Here's a frustrating fact for anyone who has been prescribed medication or therapy for depression: Your doctor doesn't know what treatment will work for you.

"It is currently complete primitive guesswork," Leanne Maree Williams, a professor at Stanford University, says. "It's hard to imagine how you can do worse than the current situation, to be honest."

Depression means being stuck in a chronic state of sad mood or lack of enjoyment in life, to a degree where it starts to degrade quality of life. The two main treatments are cognitive behavioral therapy (CBT), a talk-centered approach that gets patients to readjust their habits, and antidepressant medications.

Both are about equally effective. Around 40 percent of patients will get better on either.

But no one treatment reliably works for everyone. And it's not just about talk therapy versus drugs. Even in the realm of medication, available drugs like Zoloft and Cymbalta will work for some but not others.

Enter "precision psychiatry." Inspired in part by "precision medicine," which changed the way doctors treat certain kinds of cancer, psychiatric researchers are hoping to bring a "precision" approach to diagnosing and treating depression using brain scans and machine learning algorithms. Too many patients are left frustrated after treatments fail. These scientists think they can do better.

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http://www.vox.com/science-and-health/2017/4/4/15073652/precision-psychiatry-depression

Saturday, April 8, 2017

Diabetes Epidemic In Mexico Is Fueled By Deep-Fried Tamales And Many Gallons Of Soda : Goats and Soda : NPR

Anais Martinez is on the hunt in Mexico City's Merced Market, a sprawling covered bazaar brimming with delicacies. "So this is the deep-fried tamale!" she says with delight, as if she'd just found a fine mushroom specimen deep in a forest.

The prized tamales are wrapped in corn husks and piled next to a bubbling cauldron of oil.

"It's just like a corn dough patty mixed with lard, put in a corn husk or banana leaf, steamed and then deep fried," says Martinez of this traditional Mexican breakfast. "And then after you fry it, you can put it inside a bun and make a torta [sandwich] out of it. So it's just like carbs and carbs and fat and fat. But it's actually really good."

And it only costs 10 pesos — roughly 50 cents.

Martinez is a designer in Mexico City. She studied gastronomy here and now moonlights for a company called Eat Mexico giving street food tours.

Deeper in the market there's an area packed with taco stalls. Customers stand at the counters or sit on wobbly plastic stools. The young cooks fry, flip and chop various meats into tortillas. They pound strips of flank steak out on wooden cutting boards. Piles of red chorizo sausage simmer in shallow pools of oil. Yellow slabs of tripe hang from meat hooks.

We've just come to one of Martinez's favorite taco stands. Its specialty is pork tacos served with french fried potatoes piled on top.

"The pork is really thinly sliced, rubbed with chiles and spices and then they fry it," Martinez says as the meat sizzles on a long steel griddle in front of her. "Also, really good."

Rich, fatty street food like this is available all over Mexico — at bus stops, at schools and on street corners. And it's affordable to the masses. A heaping plate of Martinez's favorite pork tacos costs less than a dollar.

All that cheap food — in a country where incomes are rising — is contributing to Mexico's massive diabetes epidemic.

Diabetes is now the leading cause of death in Mexico according to the World Health Organization. The disease takes an estimated 80,000 lives each year. Nearly 14 percent of adults in this country of 120 million suffer from the disease — one of the highest rates of diabetes in the world. And it's all happened over the last few decades.

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http://www.npr.org/sections/goatsandsoda/2017/04/08/522184483/pork-tacos-topped-with-fries-fuel-for-mexicos-diabetes-epidemic?

Tuesday, April 4, 2017

NIH VideoCasting and Podcasting

VideoCasts enable participants to view Division, Institute, and Branch town halls, conferences and seminars remotely while responding to questions during the session. Include a one-way broadcast of the presentation with high-quality video and/or slides to reach a larger target audience.

NYTimes: Good News for Older Mothers

The first time I got pregnant, I was a comparatively young mother, for my demographic: I was 25, in medical school, surrounded by classmates who, for the most part, were not reproducing yet. By the third pregnancy, 11 years later, I was over 35, which classified me, in the obstetric terminology I had learned in medical school, as an "elderly multigravida," that is, someone who was having a child but not her first child, after 35. (If it was your first child, you were an "elderly primigravida," or "elderly primip" for short — even as a medical student, I had a strong sense that no woman had invented this terminology.)

So by certain standards, I have experience as both a somewhat younger mother and a somewhat older mother, though not at the extremes in either direction.

National Vital Statistics Reports data released in January showed that in the United States, birthrates shifted in 2015: The birthrate for teenagers dropped to 22.3 births per 1,000 females ages 15 to 19 that year, a record low for the nation. And for women 30 through 44, the birthrates were the highest they have been since the baby boom era of the 1960s.

And as birthrates shift toward somewhat older mothers, researchers continue to look at what that says, both about who is getting pregnant when, and how that is associated with how their children do, especially when it comes to cognitive outcomes. (There's also been some interesting research recently on paternal age, but these studies focused on the mothers.)

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Patient Voices: A.D.H.D. - The New York Times

About 6.4 million children in the United States have been given diagnoses of attention deficit hyperactivity disorder (A.D.H.D.). But the condition — characterized by impulsiveness and difficulty sitting still and paying attention — is also being recognized more in adults. The challenges faced by those with A.D.H.D. are daunting and deeply personal. Here, in their own words, are the stories of adults and children coping with A.D.H.D.

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https://www.nytimes.com/interactive/2017/04/04/well/patient-voices-adhda.html?

Sunday, April 2, 2017

This Is How The World Gets Sick | Fast Company

In an exclusive excerpt from Deadliest Enemy, a new book on the threat of emerging diseases, epidemiologist Dr. Michael T. Osterholm and writer Mark Olshaker present a fictional tabletop-­like scenario involving an influenza pandemic in today's world, with the virulence of 1918's H1N1 strain, which resulted in the deaths of 50 million to 100 million people. This scenario has been reviewed by colleagues in public health preparedness and business continuity planning. There is general agreement that it is realistic and possible. Keep that in mind as you imagine yourself and your family living through it.

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https://www.fastcompany.com/3068949/the-next-deadly-global-viral-pandemic

A.I. Versus M.D. - The New Yorker

One evening last November, a fifty-four-year-old woman from the Bronx arrived at the emergency room at Columbia University's medical center with a grinding headache. Her vision had become blurry, she told the E.R. doctors, and her left hand felt numb and weak. The doctors examined her and ordered a CT scan of her head.

A few months later, on a morning this January, a team of four radiologists-in-training huddled in front of a computer in a third-floor room of the hospital. The room was windowless and dark, aside from the light from the screen, which looked as if it had been filtered through seawater. The residents filled a cubicle, and Angela Lignelli-Dipple, the chief of neuroradiology at Columbia, stood behind them with a pencil and pad. She was training them to read CT scans.

"It's easy to diagnose a stroke once the brain is dead and gray," she said. "The trick is to diagnose the stroke before too many nerve cells begin to die." Strokes are usually caused by blockages or bleeds, and a neuroradiologist has about a forty-five-minute window to make a diagnosis, so that doctors might be able to intervene—to dissolve a growing clot, say. "Imagine you are in the E.R.," Lignelli-Dipple continued, raising the ante. "Every minute that passes, some part of the brain is dying. Time lost is brain lost."

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http://www.newyorker.com/magazine/2017/04/03/ai-versus-md

High-Tech Hope for the Hard of Hearing - The New Yorker

Scientists searching for ways to restore hearing have been making a number of promising discoveries.

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http://www.newyorker.com/magazine/2017/04/03/high-tech-hope-for-the-hard-of-hearing

NYTimes: My I.C.U. Patient Lived. Is That Enough?

He is breathing better and the doctors say his lungs will recover, but he can't remember his appointments or where he put his keys.

It has been months since the surgery and the scars are fading, yet she still wakes almost nightly to the sound of phantom alarms.

Those are the sorts of stories I heard one morning at a support group for patients who had survived a critical illness and their family members. It seems simple — a few doctors, a social worker, a psychiatrist, former patients and their husbands and wives, a conference room, pastries, coffee. In a way it was. But this was the first time that many of these men and women had been asked to talk about their struggles after critical illness with those who'd shared similar experiences.

And it was among the first times that I — then a doctor in my final year of critical care training — had heard directly from them about their lives after the I.C.U.

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https://www.nytimes.com/2017/04/01/opinion/sunday/my-icu-patient-lived-is-that-enough.html?

Friday, March 31, 2017

For insect detectives, the trickiest cases involve the bugs that aren't there

Gale Ridge could tell something was wrong as soon as the man walked into her office at the Connecticut Agricultural Experiment Station. He was smartly dressed in a collared shirt and slacks, but his skin didn't look right: It was bright pink, almost purple — and weirdly glassy.

Without making eye contact, he sat hunched in the chair across from Ridge and began to speak. He was an internationally renowned physician and researcher. He had taught 20 years' worth of students, treating patients all the while, and had solved mysteries about the body's chemistry and how it could be broken by disease. But now, he was having health issues he didn't know how to deal with.

"He was being eaten alive by insects," Ridge, an entomologist, recalled recently. "He described these flying entities that were coming at him at night and burrowing into his skin."

Their progeny, too, he said, seemed to be inside his flesh. He'd already seen his family doctor and dermatologist. He'd hired an exterminator to no avail. He had tried Epsom salts, vinegar, medication. So he took matters into his own hands, filling his bathtub with insecticide and clambering in for some relief.

But even that wasn't working. The biting, he said, would begin again. Ridge tried her best to help. "What I did was talk to him, explaining the different biologies of known arthropods that can live on people … trying to get him to understand that what he is seeing is not biologically known to science," she said.

She saw him only four or five times. Three weeks after he first walked into her office, she heard that he was dead. Heart attack, the obituaries declared. No mention of invisible bugs, psychological torment, self-mutilation. But the entomologist was convinced that wasn't the whole story.

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https://www.statnews.com/2017/03/22/insect-delusional-parasitosis-entomology/?

Thursday, March 30, 2017

Is Fat Killing You, or Is Sugar? - Jerome Groopman - The New Yorker

In the early nineteen-sixties, when cholesterol was declared an enemy of health, my parents quickly enlisted in the war on fat. Onion rolls slathered with butter, herring in thick cream sauce, brisket of beef with a side of stuffed derma, and other staples of our family cuisine disappeared from our table. Margarine dethroned butter, vinegar replaced cream sauce, poached fish substituted for brisket. I recall experiencing something like withdrawal, daydreaming about past feasts as my stomach grumbled. My father's blood-cholesterol level—not to mention that of his siblings and friends—became a regular topic of conversation at the dinner table. Yet, despite the restrictive diet, his number scarcely budged, and a few years later, in his mid-fifties, he had a heart attack and died.

The dangers of fat haunted me after his death. When, in my forties, my cholesterol level rose to 242—200 is considered the upper limit of what's healthy—I embarked on a regimen that restricted fatty foods (and also cut down on carbohydrates). Six months later, having shed ten pounds, I rechecked my level. It was unchanged; genes have a way of signalling their power. But as soon as my doctor put me on just a tiny dose of a statin medication my cholesterol plummeted more than eighty points.

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http://www.newyorker.com/magazine/2017/04/03/is-fat-killing-you-or-is-sugar

Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much. - The New York Times

The catastrophe struck Wanda Wickizer on Christmas Day 2013. A generally healthy, energetic 51-year-old, she suddenly found herself vomiting all day, racked with debilitating headaches. When her alarmed teenage son called an ambulance, the paramedics thought that she had food poisoning and didn't take her to the emergency room. Later, when she became confused and groggy at 3 a.m., her boyfriend raced her to Sentara Norfolk General Hospital in coastal Virginia, where a scan showed she was suffering from a subarachnoid hemorrhage. A vessel had burst, and blood was leaking into the narrow space between the skull and the brain.

During a subarachnoid hemorrhage, if the pressure in the head isn't relieved, blood accumulates in that narrow space and can push the brain down toward the neck. Vital nerves that control breathing and vision are compressed. Death is imminent. Wickizer was whisked by helicopter ambulance to the University of Virginia Medical Center in Charlottesville, 160 miles away, for an emergency procedure to halt the bleeding.

After spending days in a semi-comatose state, Wickizer slowly recovered and left the hospital three weeks after the hemorrhage, grateful to be alive. But soon after she returned home to her two teenage children, she found herself confronted with a different kind of catastrophe. Wickizer had had health insurance for most of her adult life: Her husband, who died in 2006, worked for the city of Norfolk, which insured their family while he was alive and for three years beyond. After his death, Wickizer worked in a series of low-wage jobs, but none provided health insurance. A minor pre-existing condition — she was taking Lexapro, a common medicine for depression — meant that her only insurance option was to be funneled into the "high-risk pool" (a type of costly insurance option that was essentially rendered obsolete by the Affordable Care Act and now figures in some of the G.O.P. plans to replace it). She would need to pay more than $800 per month for a policy with a $5,000 deductible, and her medical procedures would then be reimbursed at 80 percent. She felt she couldn't afford that. In 2011, she decided to temporarily stop working to tend to her children, which qualified them for Medicaid; with trepidation, she left herself uninsured.

And so in early 2014, without an insurer or employer or government agency to run interference between her and the hospital, she began receiving bills: $16,000 from Sentara Norfolk (not including the scan or the E.R. doctor), $50,000 for the air ambulance. By the end of January, there was also one for $24,000 from the University of Virginia Physicians' Group: charges for some of the doctors at the medical center. "I thought, O.K., that's not so bad," Wickizer recalls. A month later, a bill for $54,000 arrived from the same physicians' group, which included further charges and late fees. Then a separate bill came just for the hospital's charges, containing a demand for $356,884.42 but little in the way of comprehensible explanation.

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https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html?

Wednesday, March 29, 2017

Elon Musk launches Neuralink, a venture to merge the human brain with AI - The Verge

SpaceX and Tesla CEO Elon Musk is backing a brain-computer interface venture called Neuralink, according to The Wall Street Journal. The company, which is still in the earliest stages of existence and has no public presence whatsoever, is centered on creating devices that can be implanted in the human brain, with the eventual purpose of helping human beings merge with software and keep pace with advancements in artificial intelligence. These enhancements could improve memory or allow for more direct interfacing with computing devices.

Musk has hinted at the existence of Neuralink a few times over the last six months or so. More recently, Musk told a crowd in Dubai, "Over time I think we will probably see a closer merger of biological intelligence and digital intelligence." He added that "it's mostly about the bandwidth, the speed of the connection between your brain and the digital version of yourself, particularly output." On Twitter, Musk has responded to inquiring fans about his progress on a so-called "neural lace," which is sci-fi shorthand for a brain-computer interface humans could use to improve themselves.

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http://www.theverge.com/2017/3/27/15077864/elon-musk-neuralink-brain-computer-interface-ai-cyborgs

Tuesday, March 28, 2017

Silicon Valley’s Quest to Live Forever - The New Yorker

On a velvety March evening in Mandeville Canyon, high above the rest of Los Angeles, Norman Lear's living room was jammed with powerful people eager to learn the secrets of longevity. When the symposium's first speaker asked how many people there wanted to live to two hundred, if they could remain healthy, almost every hand went up. Understandably, then, the Moroccan phyllo chicken puffs weren't going fast. The venture capitalists were keeping slim to maintain their imposing vitality, the scientists were keeping slim because they'd read—and in some cases done—the research on caloric restriction, and the Hollywood stars were keeping slim because of course.

When Liz Blackburn, who won a Nobel Prize for her work in genetics, took questions, Goldie Hawn, regal on a comfy sofa, purred, "I have a question about the mitochondria. I've been told about a molecule called glutathione that helps the health of the cell?" Glutathione is a powerful antioxidant that protects cells and their mitochondria, which provide energy; some in Hollywood call it "the God molecule." But taken in excess it can muffle a number of bodily repair mechanisms, leading to liver and kidney problems or even the rapid and potentially fatal sloughing of your skin. Blackburn gently suggested that a varied, healthy diet was best, and that no single molecule was the answer to the puzzle of aging.

Yet the premise of the evening was that answers, and maybe even an encompassing solution, were just around the corner. The party was the kickoff event for the National Academy of Medicine's Grand Challenge in Healthy Longevity, which will award at least twenty-five million dollars for breakthroughs in the field. Victor Dzau, the academy's president, stood to acknowledge several of the scientists in the room. He praised their work with enzymes that help regulate aging; with teasing out genes that control life span in various dog breeds; and with a technique by which an old mouse is surgically connected to a young mouse, shares its blood, and within weeks becomes younger.

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http://www.newyorker.com/magazine/2017/04/03/silicon-valleys-quest-to-live-forever?

Sunday, March 26, 2017

Watching My Surgeon Cut Into My Knee - The New York Times

What if the surgeon started slicing into my knee before it was completely numb?

That was my biggest fear, while weighing whether to remain alert and watch the operation on the cartilage in my right knee, or to be put to sleep, preserving my peaceful ignorance.

Rational or otherwise, my reasons for staying awake — an option increasingly taken by patients, the subject of the accompanying article — prevailed.

1) I don't like general anesthesia's side effects.

2) For a long year, my knee pain had resisted straightforward diagnosis and treatment. I wanted an ah-ha! glimpse of the problem.

3) Ever since I was a child, I have watched when the doctor gives me an injection. Not because I am brave, masochistic or even curious. On the contrary. Looking away, I imagine something far scarier. So watching a medical procedure has always been a form of self-soothing.

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https://www.nytimes.com/2017/03/25/health/watching-my-surgeon-cut-into-my-knee.html?

How Sherpaa Survived Venture Capital’s Unrealistic Expectations | Fast Company

Jay Parkinson's star was rising in 2009. Hailed in the media as the "doctor of the future," Parkinson had created a transformational Facebook-style application for doctor-patient conversations called Hello Health. Then he was brought in by a fast-growing startup called Tumblr to devise a strategy for their employees' health care needs. That conversation, in which Parkinson advocated for a shift to digital methods (like SMS) of communicating with clinicians, inspired him to start his own company, Sherpaa.

Through Sherpaa, employees at companies like Tumblr were given an email address and phone number, which they could use to reach a doctor at any time. After a segment aired on national television in 2012 about the company's simple but effective approach, Parkinson says Sherpaa was able to hire its first seasoned corporate executive. Less than six months later, Parkinson brought on another New York-based senior executive with human resources experience, and raised $1.85 million. Everything was going well.

Less than five years later, Sherpaa's investors had all but given up on the company—and Parkinson was locked in a protracted battle to save it. What happened?

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https://www.fastcompany.com/3067853/how-sherpaa-survived-venture-capitals-unrealistic-expectations

Going Under the Knife, With Eyes and Ears Wide Open - The New York Times

"Do you want to see your tendons?"

Dr. Asif Ilyas, a hand and wrist surgeon, was about to close his patient's wound. But first he offered her the opportunity to behold the source of her radiating pain: a band of tendons that looked like pale pink ribbon candy. With a slender surgical instrument, he pushed outward to demonstrate their newly liberated flexibility.

"That's pretty neat," the patient, Esther Voynow, managed to gasp.

The operation Dr. Ilyas performed, called a De Quervain's release, is usually done with the patient under anesthesia. But Ms. Voynow, her medical inquisitiveness piqued and her distaste for anesthesia pronounced, had chosen to remain awake throughout, her forearm rendered numb with only an injection of a local anesthetic.

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https://www.nytimes.com/2017/03/25/health/surgery-awake-anesthesia.html?

The Tooth Divide: Beauty, Class and the Story of Dentistry - The New York Times

TEETH
The Story of Beauty, Inequality, and the Struggle for Oral Health in America
By Mary Otto
291 pp. The New Press. $26.95.

Politicians, journalists and researchers have a long-running problem when it comes to talking about class. The definitions we use are myriad and not always overlapping. Is the boundary of the middle class a college degree, a certain level of income? Perhaps a certain type of job: a teacher or a doctor versus a coal miner or factory worker? We might be missing a still more useful — and more personal — indicator, however.

This is the premise, though not so bluntly stated, of Mary Otto's new book, "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." The dividing line between the classes might be starkest between those who spend thousands of dollars on a gleaming smile and those who suffer and even die from preventable tooth decay.

If the idea of death from tooth decay is shocking, it might be because we so rarely talk about the condition of our teeth as a serious health issue. Instead, we think of our teeth as the ultimate personal responsibility. We fear the dentist because we fear judgment as well as pain; we are used to the implication that if we have a tooth problem, if our teeth are decaying or crooked or yellow, it is because we have failed, and failed at something so intimate that it means we ourselves are failures.

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https://www.nytimes.com/2017/03/23/books/review/teeth-oral-health-mary-otto.html?

Which Supplements, if Any, May Be Worth Your Money - The New York Times

Hardly a day goes by that people don't tell me that one or more dietary supplement has cured or prevented an ailment of theirs or suggest that I try one to treat a problem of my own. And I am not immune to wishful thinking that an over-the-counter vitamin, mineral or herb may help to keep me healthy or relieve some distress without having to see a doctor.

I have succumbed to several popular suggestions, including melatonin and magnesium to improve my sleep, glucosamine-chondroitin to counter arthritic pain and fish oil to protect my brain and heart. I take these even knowing that irrefutable, scientifically established evidence for such benefits is lacking and I may be paying mightily for a placebo effect.

But as a scientifically trained journalist, I feel obliged to help others make rational decisions about which, if any, dietary supplements may be worth their hard-earned dollars. I'll start with the bottom line on the most popular of these, the daily multivitamin/mineral combo: If you are a healthy adult with no known nutritional deficiencies, save your money.

An independent panel convened by the National Institutes of Health concluded that evidence is lacking for or against the ability of a multivitamin to prevent chronic disease. The American Cancer Society, the American Heart Association and the United States Preventive Services Task Force, among others, have found no role for a one-a-day supplement to prevent cancer or heart disease; they recommend instead a balanced dietwith a variety of foods as likely to be more effective than any capsule.

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https://www.nytimes.com/2016/11/21/well/live/which-supplements-if-any-may-be-worth-your-money.html?

These Are the Most Prestigious Diseases -- Science of Us

This may sound like an obvious statement, but it's an important one: Doctors aren't computers. You can't input a set of symptoms into a doctor and have him or her output a bulletproof diagnosis and treatment. Doctors, like everyone else, are influenced by the world around them, by a bevy of social and cultural and professional cues that affect their work and productivity. This, of course, has important ramifications for the ways in which medicine is structured and practiced.

One fascinating concept within the study of how doctors conceptualize their work is the concept of "disease prestige." As the name suggests, the basic idea is that there's a general hierarchy in which some diseases are seen as more, well, prestigious than others. One Norwegian sociologist, Dag Album, has for a long time been surveying how doctors in Norway rate different diseases in terms of prestige, and in a new paper in Social Science & Medicine, he and two other researchers show that over the decades, there's been a fairly stable — and rather telling — hierarchy.

The authors used data from three studies of Norwegian physicians, conducted in 1990, 2002, and 2014, in which the physicians were asked to rate 38 categories of diseases on a prestige scale from 1 to 9, based on how they felt health professionals viewed the disease-category in question. In all three surveys, there was stability at the top: Leukemia, brain tumors, and myocardial infarctions (heart attacks) were the top three in all three surveys, though the order switched around. At the bottom were fibromyalgia, depression, anxiety, and cirrhosis of the liver.

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http://nymag.com/scienceofus/2017/03/these-are-the-most-prestigious-diseases.html?

First They Got Sick, Then They Moved Into a Virtual Utopia

One afternoon in November, Fran Serenade led me and her daughter Barbie down a steep section of the Appalachian trail. The sun was high and Fran hiked briskly, ducking the blue-green diagonals of fir trees, her hair wild behind her. She wanted to show me her log cabin, which was off the trail next to a red barn by a blue lake with a pretty waterfall. Outside the barn, we met Fran's kitty, Amici, and a handful of other cats, all of them wearing knit caps. Fran pet Amici, who followed her, mewling.

Inside the cabin, a fire raged in the fireplace. Fran pointed out her favorite things: an antique icebox; an embroidered tablecloth; a crochet basket. Then we were off to Tai Chi practice.

With her mountain of blonde curls, heart-shaped face, hip-hugging jeans, and tiny waist, Fran recalls a young Dolly Parton. She's so pretty, she's almost doll-like. Barbie is slim and pretty, too, though, in her leopard print vest and red lipstick, her look is less country, more glam. Mother and daughter both wore heels, even as we hiked.

It turns out heels work perfectly well on virtual trails, no matter how steep. The trail and cabin we visited exist inside an online virtual world called Second Life. They were designed to recall a real-world trail and cabin in the Blue Ridge Mountains of North Carolina, where Fran once lived. Fran Serenade is the avatar of Fran Swenson, an 89-year-old former nurse with a head of silver curls and a Brooklyn accent. Barbie is the avatar of Barbara, her daughter in real life.

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https://backchannel.com/first-they-got-sick-then-they-moved-into-a-virtual-utopia-1dc6c165f3e9#.nqd3n9zff

Friday, March 17, 2017

The Match encourages physician passivity, which hurts health care - Slate

Friday marks another iteration of the National Resident Matching Program—"the Match"—perhaps the best-known bottleneck for aspiring U.S. physicians. Every year, this complex computerized algorithm assigns senior medical students to the next phase of their clinical training. Upon selecting a medical specialty, applicants make a list, ordered by preference, of whichever residency programs grant them an interview. After a few months of waiting, an inscrutable bit of software tells them where to go.

Binding contracts must be signed well in advance to honor these results, whatever they may be. At most American medical schools, Match Day involves the ceremonial distribution of envelopes to be opened at a designated time, sometimes onstage, in front of one's assembled family and friends. Within minutes, a full range of emotions is usually on display—elation or ambivalence, surprise or heartbreak. As a rite of passage, the whole thing requires a certain resignation to fate, the strain of which is often more visible after that fate is sealed.

The Match originated more than 60 years ago, supplanting a more traditional, decentralized market in which job offers were extended one by one, often along progressively unreasonable timelines. The original algorithm has since undergone multiple revisions, most recently in 1998 by the economist (and later Nobel laureate) Alvin E. Roth. The system maximizes efficiency as a proxy for contentedness; last year, 94 percent of participating U.S. medical students secured a residency position, and 96 percent of available training positions were filled.

I have gone through the Match twice now, first for residency and later for fellowship, and for all its aggregate expediency, I recall the individual experience as a stressful one. Both times, I felt the usually taut thread of my life slacken and begin to fray. During my interviews I was buoyed by the false sense that my life was somehow underwritten by several backup trajectories; after submitting each rank list, I settled into a prolonged funk, simultaneously questioning my preferences and wondering if they'd be honored. Not knowing if I'd be moving north or south, inland or to the coast, I settled into a dreamy headspace in which all possible outcomes seemed partially true. Match participants reckon with this peculiar fraction of agency—too little to guarantee a happy ending, too much to feel martyred by a sad one.

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http://www.slate.com/articles/health_and_science/medical_examiner/2017/03/the_match_encourages_physician_passivity_which_hurts_health_care.html?

Sunday, March 12, 2017

As opioid overdoses rise, police officers become counselors, doctors and social workers - The Washington Post

he nation's opioid epidemic is changing the way law enforcement does its job, with police officers acting as drug counselors and medical workers and shifting from law-and-order tactics to approaches more akin to social work.

Departments accustomed to arresting drug abusers are spearheading programs to get them into treatment, convinced that their old strategies weren't working. They're administering medication that reverses overdoses, allowing users to turn in drugs in exchange for treatment, and partnering with hospitals to intervene before abuse turns fatal.

"A lot of the officers are resistant to what we call social work. They want to go out and fight crime, put people in jail," said Capt. Ron Meyers of the police department in Chillicothe, Ohio, a 21-year veteran who is convinced that punitive tactics no longer work against drugs. "We need to make sure the officers understand this is what is going to stop the epidemic."

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https://www.washingtonpost.com/national/as-opioid-overdoses-rise-police-officers-become-counselors-doctors-and-social-workers/2017/03/12/85a99ba6-fa9c-11e6-be05-1a3817ac21a5_story.html?

Friday, March 10, 2017

First-year doctors will be allowed to work 24-hour shifts starting in July - The Washington Post

First-year doctors will be allowed to work 24-hour shifts in hospitals across the United States starting July 1, when a much-debated cap that limits the physicians to 16 consecutive hours of patient care is lifted, the organization that oversees their training announced Friday.

The Accreditation Council for Graduate Medical Education said the change will enhance patient safety because there will be fewer handoffs from doctor to doctor. It also said the longer shifts will improve the new doctors' training by allowing them to follow their patients for more extended periods, especially in the critical hours after admission.

The controversial decision ends the latest phase in a decades-old discussion over how to balance physician training with the safety and needs of patients whose care is sometimes handled by young, sleep-deprived doctors — a practice that a consumer group and a medical students' organization oppose as dangerous. The council said Friday that under the amended standards, the physicians' mental and physical health actually will be bolstered by requiring their supervisors to more closely monitor their well-being.

Those standards will allow four hours to transition patients from one doctor to the next, so first-year residents could work as long as 28 straight hours, the same as more senior medical residents. The 125,000 doctors in training, known as "residents" and "fellows" depending on how many years they've completed, are the backbone of staffs at about 800 hospitals across the country, from large medical centers to smaller community facilities.

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https://www.washingtonpost.com/news/to-your-health/wp/2017/03/10/first-year-doctors-will-be-allowed-to-work-24-hour-shifts-starting-in-july/?

Tuesday, March 7, 2017

Medicine and literature: two treatments of the human condition | Aeon Essays

Every month or so, I see a patient called Fraser in my primary care clinic, a soldier who was deployed in Afghanistan. Fifteen years after coming home, he is still haunted by flashbacks of burning buildings and sniper fire. He doesn't work, rarely goes out, sleeps poorly, and to relieve his emotional anguish he sometimes slices at his own forearms. Since leaving the army, he has never had a girlfriend. Fraser was once thickly muscled, but weight has fallen off him: self-neglect has robbed him of strength and self-confidence. Prescription drugs fail to fully quieten the terror that trembles in his mind. Whenever I used to see him in clinic, he'd sit on the edge of his seat, shakily mopping sweat from his forehead and temples. I'd listen to his stories, tweak his medications, and tentatively offer advice.

When Fraser began coming to see me, I was reading Redeployment (2014) by Phil Klay – short stories about US military operations, not in Afghanistan, but in Iraq. No book can substitute for direct experience, but Klay's stories gave me a way to start talking about what Fraser was going through; when I finished the book, I offered it to him. He found reassurance in what I'd found illuminating; our conversations took new directions as we discussed aspects of the book. His road will be a long one, but I'm convinced those stories have played a part, however modest, in his recovery.

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https://aeon.co/essays/medicine-and-literature-two-treatments-of-the-human-condition