Thursday, September 21, 2017

‘The Pills Are Everywhere’: How the Opioid Crisis Claims Its Youngest Victims - The New York Times

When Penny Mae Cormani died in Utah, her family sang Mormon hymns — "Be Still My Soul" — and lowered her small coffin into the earth. The latest victim of a drug epidemic that is now taking 60,000 lives a year, Penny was just 1.

Increasingly, parents and the police are encountering toddlers and young children unconscious or dead after consuming an adult's opioids.

At the children's hospital in Dayton, Ohio, accidental ingestions have more than doubled, to some 200 intoxications a year, with tiny bodies found laced by drugs like fentanyl. In Milwaukee, eight children have died of opioid poisoning since late 2015, all from legal substances like methadone and oxycodone. In Salt Lake City, one emergency doctor recently revived four overdosing toddlers in a night, a phenomenon she called both new and alarming.

"It's a cancer," said Mauria Leydsman, Penny's grandmother, of the nation's opioid problem, "with tendrils that are going everywhere."

While these deaths represent a small fraction of the epidemic's toll, they are an indication of how deeply the American addiction crisis has cut.

More ...

https://www.nytimes.com/2017/09/20/us/opioid-deaths-children.html?

Tuesday, September 5, 2017

The First Count of Fentanyl Deaths in 2016: Up 540% in Three Years - The New York Times

Drug overdoses killed roughly 64,000 people in the United States last year, according to the first governmental account of nationwide drug deaths to cover all of 2016. It's a staggering rise of more than 22 percent over the 52,404 drug deaths recorded the previous year — and even higher than The New York Times's estimatein June, which was based on earlier preliminary data.

Drug overdoses are expected to remain the leading cause of death for Americans under 50, as synthetic opioids — primarily fentanyl and its analogues — continue to push the death count higher. Drug deaths involving fentanyl more than doubled from 2015 to 2016, accompanied by an upturn in deaths involving cocaine and methamphetamine. Together they add up to an epidemic of drug overdoses that is killing people at a faster rate than the H.I.V. epidemic at its peak.

More …

https://www.nytimes.com/interactive/2017/09/02/upshot/fentanyl-drug-overdose-deaths.html?

Artificial Intelligence Could Predict Alzheimer’s Years Before Doctors | Health Care News | US News

Doctors may be no match for computers when it comes to Alzheimer's.

A study published in July in the journal Neurobiology of Aging found that artificial intelligence could detect signs of the disease in patient brain scans before physicians. The computer-based algorithm was able to correctly predict if a person would develop Alzheimer's disease up to two years before he or she actually displayed symptoms. It was correct 84 percent of the time.

Researchers are hopeful that the tool will be helpful in determining before the onset of the disease which patients to choose for clinical trials or for drugs that could slow its progression and delay its crippling effects.

"If you can tell from a group of individuals who is the one that will develop the disease, one can better test new medications that could be capable of preventing the disease," co-lead study author Dr. Pedro Rosa-Neto, an associate professor of neurology, neurosurgery and psychiatry at McGill University, told Live Science.

The researchers were able to train the artificial intelligence program to recognize Alzheimer's disease in the brain by showing it before and after scans of 200 people who had the disease. The AI technology was then shown scans of 270 volunteers – 43 of whom eventually developed Alzheimer's. The AI technology was able to accurately predict 84 percent of the cases in which the volunteers eventually developed the disease.

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https://www.usnews.com/news/health-care-news/articles/2017-09-01/artificial-intelligence-could-predict-alzheimers-years-before-doctors?

Neuroscience News - Medical Xpress

https://medicalxpress.com/neuroscience-news/

Monday, September 4, 2017

Opioids Aren’t the Only Pain Drugs to Fear - The New York Times

Last month, a White House panel declared the nation's epidemic of opioid abuse and deaths "a national public health emergency," a designation usually assigned to natural disasters.

A disaster is indeed what it is, with 142 Americans dying daily from drug overdoses, a fourfold increase since 1999, more than the number of people killed by gun homicides and vehicular crashes combined. A 2015 National Survey on Drug Use and Health estimated that 3.8 million Americans use opioids for nonmedical reasons every month.

Lest you think that people seeking chemically induced highs are solely responsible for the problem, physicians and dentists who prescribe opioids with relative abandon, and patients and pharmacists who fill those prescriptions, lend a big helping hand. The number of prescriptions for opioids jumped from 76 million in 1991 to 219 million two decades later. They are commonly handed to patients following all manner of surgery, whether they need them or not.

A new review of six studies by Dr. Mark C. Bicket and colleagues at Johns Hopkins University School of Medicine found that among 810 patients who underwent seven different kinds of operations, 42 percent to 71 percent failed to use the opioids they received, and 67 percent to 92 percent still had the unused drugs at home.

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https://www.nytimes.com/2017/09/04/well/opioids-arent-the-only-pain-drugs-to-fear.html?_r=0

Wednesday, August 30, 2017

Pioneering cancer drug will cost $475,000. Analysts call it a bargain

The Food and Drug Administration on Wednesday approved a futuristic new approach to treating cancer, clearing a Novartis therapy that has produced unprecedented results in patients with a rare and deadly cancer. The price tag: $475,000 for a course of treatment.

That sounds staggering to many patients — but it's far less than analysts expected.

The therapy, called a CAR-T, is made by harvesting patients' white blood cells and rewiring them to home in on tumors. Novartis's product is the first CAR-T therapy to come before the FDA, leading a pack of novel treatments that promise to change the standard of care for certain aggressive blood cancers.

Novartis's therapy is approved to treat children and young adults with relapsed acute lymphoblastic leukemia. It will be marketed as Kymriah.

The treatment's approval has looked a foregone conclusion for months, but its potential price has been the subject of speculation and debate. Novartis picked the $475,000 price tag in an effort to balance patient access to Kymriah while giving the company a return on its investment, said Bruno Strigini, Novartis's head of oncology, in a conference call Wednesday. The cost is below Wall Street analyst expectations, which reached as high as $750,000 for a dose. And it's considerably cheaper than the roughly $700,000 price tag that U.K. regulators said would be fair considering Kymriah's potential benefits.

Novartis also said it is working with Medicare on a system in which the government would only pay for CAR-T treatment if patients respond within a month.

In a clinical trial, a single dose of Kymriah left 83 percent of participants cancer-free after three months, results oncologists have hailed as a major advance for patients with few other options. The most frequent side effect was an inflammatory storm called cytokine release syndrome, a reaction to CAR-T that can prove fatal in some patients but is commonly controlled with immunosuppressant drugs.

"I think this is most exciting thing I've seen in my lifetime," said Dr. Tim Cripe, an oncologist with Nationwide Children's Hospital, at an FDA meeting on Kymriah in July.

More ...

https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/?

Could Your Next Doctor Be Your Dentist? - Slate

Tooth enamel is the strongest substance in the human body. It's harder than steel. Which helps explain why the three words "root canal treatment" often strike such terror into patients sitting in the dental chair. It starts by boring a hole through enamel as effortlessly as if it were rice paper. Ninety-nine percent of the time, that gaping hole is filled and sealed immediately after treatment. A few months ago, I met a patient I'll call Janet, to protect her privacy. She was one of the 1 percent.

I carefully peered my head into her mouth. The remaining pulp, or core, of the treated tooth—an amalgam of nerves, blood vessels, and immune cells—had blossomed out of the fractured crown into a twisting, intersecting polyp with the color and consistency of bubble gum. She had chronic hyperplastic pulpitis, a rare inflammatory condition that triggers pulp tissue to irreversibly expand above the walls of the enamel shell. I pulled my stethoscope off the shelf and checked what I had been trained to with every new patient: her blood pressure. 174 over 104, I whispered to myself, having expected only a slight deviation from the normal 120 over 80. This seemed impossible. I checked the other arm; 172/104. I waited 15 minutes and checked again. 164/100.

Hypertensive emergency, which can cause patients to spontaneously suffer a severe stroke, heart attack, or kidney damage, occurs when blood pressure reaches 180/110 or higher. While her blood pressure was trending downward, Janet was dangerously close to that threshold. I asked her if any physician in the past had ever told her that she had high blood pressure. A recent Dominican immigrant unsure of her past medical history, she told me she couldn't remember. Her expanding pulp, a rarity for me, was only a distraction from a bigger concern—her heart. I immediately called her primary care physician, discussed the situation, and told her to go see her doctor immediately. Janet, who had showed up for some basic dental work, had been inches away from a medical emergency.

A 2016 Association of American Medical Colleges report projects that over the next 10 years, the U.S. will face a serious physician shortage, especially among primary care physicians in rural geographic areas. Despite increased health insurance coverage for millions of Americans over the last few years, affordable health care is still difficult to access in rural areas. Certain states, such as Tennessee, Iowa, and my home state of Arizona, are seeing insurance companies drop out of individual markets due to political uncertainty, making access to affordable care harder for a significant fraction of the U.S. population, including many of those I grew up with.

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http://www.slate.com/articles/health_and_science/medical_examiner/2017/08/why_your_next_doctor_could_be_your_dentist.html

Tuesday, August 29, 2017

‘Dying: A Memoir’ Is a Bracing Illumination of Terminal Illness - The New York Times

DYING
A Memoir
By Cory Taylor
141 pages. Tin House Books. $18.95.


Years ago, a palliative care doctor told me that what he knew of a patient's personality often had little to do with how he or she coped with dying. Generous people could become ungenerous, and brave people could become frightened. Angry people could become gentle, and controlling people could become Zen. Dying, in other words — like combat, like becoming a parent, like any transformative life event — doesn't always reveal or intensify aspects of our character. It sometimes coaxes out new ones.

For a long time, the writer Cory Taylor took, by her own admission, "a fairly leisurely approach to life." That changed in 2005, just before her 50th birthday, when doctors removed a mole on the back of her leg. Melanoma, Stage 4. She wrote the novel she'd always meant to write, then another. Then she wrote "Dying: A Memoir."

The book rings louder in my imagination the more time I spend apart from it, a kind of reverse Doppler effect. "Dying" is bracing and beautiful, possessed of an extraordinary intellectual and moral rigor. Every medical student should read it. Every human should read it. My own copy is so aggressively underlined it looks like a composition notebook.

"Dying" is short, but as dense as dark matter. There is an electrifying matter-of-factness to it, one that normalizes death, which is part of Taylor's goal. She deplores the "monstrous silence" surrounding the subject of mortality. "If cancer teaches you one thing," she writes, "it is that we are dying in our droves, all the time. Just go into the oncology department of any major hospital and sit in the packed waiting room."

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F.D.A. Panel Recommends Approval for Gene-Altering Leukemia Treatment - The New York Times

A Food and Drug Administration panel opened a new era in medicine on Wednesday, unanimously recommending that the agency approve the first-ever treatment that genetically alters a patient's own cells to fight cancer, transforming them into what scientists call "a living drug" that powerfully bolsters the immune system to shut down the disease.

If the F.D.A. accepts the recommendation, which is likely, the treatment will be the first gene therapy ever to reach the market in the United States. Others are expected: Researchers and drug companies have been engaged in intense competition for decades to reach this milestone. Novartis is now poised to be the first. Its treatment is for a type of leukemia, and it is working on similar types of treatments in hundreds of patients for another form of the disease, as well as multiple myeloma and an aggressive brain tumor.

To use the technique, a separate treatment must be created for each patient — their cells removed at an approved medical center, frozen, shipped to a Novartis plant for thawing and processing, frozen again and shipped back to the treatment center.

A single dose of the resulting product has brought long remissions, and possibly cures, to scores of patients in studies who were facing death because every other treatment had failed. The panel recommended approving the treatment for B-cell acute lymphoblastic leukemia that has resisted treatment, or relapsed, in children and young adults aged 3 to 25.

One of those patients, Emily Whitehead, now 12 and the first child ever given the altered cells, was at the meeting of the panel with her parents to advocate for approval of the drug that saved her life. In 2012, as a 6-year-old, she was treated in a study at the Children's Hospital of Philadelphia. Severe side effects — raging fever, crashing blood pressure, lung congestion — nearly killed her. But she emerged cancer free, and has remained so.

"We believe that when this treatment is approved it will save thousands of children's lives around the world," Emily's father, Tom Whitehead, told the panel. "I hope that someday all of you on the advisory committee can tell your families for generations that you were part of the process that ended the use of toxic treatments like chemotherapy and radiation as standard treatment, and turned blood cancers into a treatable disease that even after relapse most people survive."

The main evidence that Novartis presented to the F.D.A. came from a study of 63 patients who received the treatment from April 2015 to August 2016. Fifty-two of them, or 82.5 percent, went into remission — a high rate for such a severe disease. Eleven others died.

"It's a new world, an exciting therapy," said Dr. Gwen Nichols, the chief medical officer of the Leukemia and Lymphoma Society, which paid for some of the research that led to the treatment.

The next step, she said, will be to determine "what we can combine it with and is there a way to use it in the future to treat patients with less disease, so that the immune system is in better shape and really able to fight." She added, "This is the beginning of something big."

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https://www.nytimes.com/2017/07/12/health/fda-novartis-leukemia-gene-medicine.html?

When Your Doctor Is Fitter Than You Are - The New York Times

"I enjoy working out at the gym," declares one profile. "To keep myself fit, I like to hike, bike and exercise," says another.

These comments aren't part of a dating site. Rather, they come from physicians' online profiles that prospective patients view when they are looking for a new doctor.

There are good reasons doctors might strive to lead by example. "I practice what I preach by living healthy every day," declares one physician on Kaiser Permanente's online doctor search portal. Patients may trust or be inspired by such a doctor, the thinking goes. And if health care professionals fail to follow their own advice, they may be accused of hypocrisy.

But for some patients, particularly those battling weight issues, a doctor's declarations of personal fitness may not have the intended effect of attracting new patients. Instead, rather than inspiring them, it can drive them away.

Recently, my colleague Benoît Monin and I studied doctors who advertise their fitness online. Past research has shown that people worry that those who claim the moral high ground will look down on others whose behavior seems unfavorable by comparison. For example, meat-eaters worry that vegetarians will judge them because of their diet. We wondered: Could emphasizing fitness make doctors seem "healthier than thou" and turn off patients?

We thought that people who are overweight and obese might be particularly sensitive to judgment from doctors. Unlike unhealthy habits such as smoking, weight can't be hidden. Research shows that negative attitudes toward people who are overweight are surprisingly prevalent among health professionals. So potential patients who are overweight might be especially turned off by doctors who show off healthy habits.

To test this idea, in research recently published in the Journal of Personality and Social Psychology, we turned to the real-world examples of physicians practicing what they preach on the website for Kaiser Permanente, the largest managed care organization in the United States. Here, patients choose among dozens of doctors from self-descriptions only a few sentences long, making any information provided consequential. We asked adults who were overweight or obese to rate a sample of these profiles. Some physicians emphasized their fitness in these profiles, while others did not.

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https://www.nytimes.com/2017/07/13/well/family/when-your-doctor-is-fitter-than-you-are.html

The Conversation Placebo - The New York Times

In my daily work as a primary care internist, I see no letup from pain. Every single patient, it seems, has an aching shoulder or a bum knee or a painful back. "Our bodies evolved to live about 40 years," I always explain, "and then be finished off by a mammoth or a microbe." Thanks to a century of staggering medical progress, we now live past 80, but evolution hasn't caught up; the cartilage in our joints still wears down in our 40s, and we are more obese and more sedentary than we used to be, which doesn't help.

So it's no surprise that chronic arthritis and back pain are the second and third most common non-acute reasons that people go to the doctor and that pain costs America up to $635 billion annually. The pain remedies developed by the pharmaceutical industry are only modestly effective, and they have side effects that range from nausea and constipation to addiction and death.

What's often overlooked is that the simple conversation between doctor and patient can be as potent an analgesic as many treatments we prescribe.

In 2014, researchers in Canada did an interesting study about the role of communication in the treatment of chronic back pain. Half the patients in the study received mild electrical stimulation from physical therapists, and half received sham stimulation (all the equipment is set up, but the electrical current is never activated). Sham treatment — placebo — worked reasonably well: These patients experienced a 25 percent reduction in their levels of pain. The patients who got the real stimulation did even better, though; their pain levels decreased by 46 percent. So the treatment itself does work.

Each of these groups was further divided in half. One half experienced only limited conversation from the physical therapist. With the other half, the therapists asked open-ended questions and listened attentively to the answers. They expressed empathy about the patients' situation and offered words of encouragement about getting better.

Patients who underwent sham treatment but had therapists who actively communicated reported a 55 percent decrease in their pain. This is a finding that should give all medical professionals pause: Communication alone was more effective than treatment alone. The patients who got electrical stimulation from engaged physical therapists were the clear winners, with a 77 percent reduction in pain.

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https://www.nytimes.com/2017/01/19/opinion/sunday/the-conversation-placebo.html

‘No Apparent Distress’ Tackles the Distress of the Sick, Poor and Uninsured - Book review - The New York Times

NO APPARENT DISTRESS 
A Doctor's Coming-of-Age on the Front Lines of American Medicine
By Rachel Pearson 
260 pp. W. W. Norton & Company. $26.95.


Just after residency at Bellevue Hospital in New York City, I worked briefly in a private practice in rural Florida. One afternoon, the E.R. called about a man with very high blood pressure — not high enough to be admitted to the hospital, but high enough to need prompt treatment. "Send him over to our office," I said.

When the Mexican farmworker arrived, the office manager hissed at me: "You can't just bring these patients here." Initially I was perplexed; I was preventing an admission to the hospital, saving thousands of dollars. But then I realized — this office would not treat him because he lacked insurance and means.

As the only person in the office who spoke Spanish, I had to break the news. This was the lowest moment in my medical career and I vowed never to have to utter such words to a patient again. I scrambled back to Bellevue and never looked back.

Rachel Pearson repeatedly found herself in the same miserable situation during her medical school training in Galveston, Tex. The island city had been devastated by Hurricane Ike in September 2008, just before Pearson arrived. There's no doubt that the University of Texas Medical Branch (U.T.M.B.) took a financial hit from the natural disaster, but many suspected that the draconian cuts to charity care were already in the works; the hurricane was merely convenient cover.

"It was January when Susan's patients began to die," Pearson writes in her engrossing book, part med-school memoir, part probing moral inquiry. Susan, a cancer surgeon at U.T.M.B., was unable to treat her patients after the medical center — without her knowledge — sent her patients a letter saying the doctor would be "discontinuing her professional relationship" with the people in her care. Without an operating room (and access to chemotherapy and radiation), the surgeon could only visit her patients at home and hold their hands as the disease killed them.

Pearson, who comes from a working-class family herself, finds her element at St. Vincent's House, a social-services center in one of Galveston's poorer neighborhoods, which were disproportionately devastated by Hurricane Ikeand then disproportionately ignored during the rebuilding. At first, she is "under the impression that there was a safety net." With the bare bones of donated supplies, the students diagnose cancer, heart disease and other standard medical fare. But they quickly learn that U.T.M.B. and other hospitals would not be stepping in to deliver medical treatment. A fellow medical student concludes bitterly, "I didn't realize that we were the safety net."

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Monday, August 28, 2017

Etiquette and the Cancer Patient – Season of the Witch – Ted Rheingold - Medium

I've failed to complete this post a number of times. It's laden with caveats and nuances and limited to just my learning, but it's important that everyone becomes familiar and adept at how to support the cancer patient. But I think it's applicable to any patient whose life is threatened.

Thanks to science and medicine, many Americans get well into middle age before a friend becomes gravely ill. We know how to talk about in hushed tones amongst ourselves but barring previous misfortune have no idea how to properly respond. But even more importantly I found many adults flounder to respond because they haven't had to grapple with overwhelming senses of despair and helplessness and the secret they dare not verbalize that they and their family are just as vulnerable. The last thing a patient needs is for their friends and acquaintances to respond from a crazed, fearful place. For some it's just too much and they can't even show up. For others it's becomes about them, offering to help just to avoid facing what I describe above. Plenty of others want to help simply because they don't know what to do. Some people figure it out quickly and get with the program. A small few have the life experience to approach it the right way, while some other expert humans are simply so comfortable accepting that life is change and emotions are life that they're naturals.

So, the first part of being good to the patient is to get your own head together. Be mindful of how this is making you feel. Channel your fear of this happening to your family into a celebration of being alive. Accept that feeling helpless isn't a shortcoming. Recognize despair and grief are part of the pantheon of life experiences. You do this because you don't want to make any of this about you. Support and love must flow to the patient and fear and discomfort must flow away. If you are not good at expressing love and gratefulness to your friend, learn how to do so quickly.

More ...

https://medium.com/season-of-the-witch/etiquette-and-the-cancer-patient-630a50047448

Sunday, August 27, 2017

Ecstasy could be ‘breakthrough’ therapy for soldiers, others suffering from PTSD - The Washington Post

For Jon Lubecky, the scars on his wrists are a reminder of the years he spent in mental purgatory. 

He returned from an Army deployment in Iraq a broken man. He heard mortar shells and helicopters where there were none. He couldn't sleep and drank until he passed out. He got every treatment offered by Veterans Affairs for post-traumatic stress disorder. But they didn't stop him from trying to kill himself — five times.

Finally, he signed up for an experimental therapy and was given a little green capsule. The anguish stopped.

Inside that pill was a compound named MDMA, better known by dealers and rave partygoers as ecstasy. That street drug is emerging as the most promising tool to come along in years for the military's escalating PTSD epidemic.

The MDMA program was created by a small group of psychedelic researchers who had toiled for years in the face of ridicule, funding shortages and skepticism. But the results have been so positive that this month the Food and Drug Administration deemed it a "breakthrough therapy" — setting it on a fast track for review and potential approval.

The prospect of a government-sanctioned psychedelic drug has generated both excitement and concern. And it has opened the door to scientists studying new uses for other illegal psychedelics like LSD and psilocybin (commonly known as magic mushrooms).

"We're in this odd situation where one of the most promising therapies also happens to be a Schedule 1 substance banned by the [Drug Enforcement Administration]," said retired Brig. Gen. Loree Sutton, who until 2010 was the highest ranking psychiatrist in the U.S. Army. 

Because of the stigma attached to psychedelics since the trippy 1960s, many military and government leaders still hesitate to embrace them. Some scientists are also wary of the nonprofit spearheading ecstasy therapy, a group with the stated goal of making the banned drugs part of mainstream culture.

But the scope and severity of PTSD makes it all irrelevant, said Sutton, who now works as New York City's commissioner of veteran services. "If this is something that could really save lives, we need to run and not walk toward it. We need to follow the data."

More ...

https://www.washingtonpost.com/national/health-science/ecstasy-could-be-breakthrough-therapy-for-soldiers-others-suffering-from-ptsd/2017/08/26/009314ca-842f-11e7-b359-15a3617c767b_story.html?

Major drug study opens up vast new opportunities in combating heart disease - The Washington Post

A landmark drug study has opened up a potent way to lower the risk of heart attacks — beyond the now standard advice of reducing cholesterol — promising new avenues of treatment of Americans' number one killer.

The findings, more than two decades after the discovery of powerful cholesterol-lowering drugs, called statins, taken by tens of millions, were announced Sunday at a medical conference in Barcelona and published in two leading medical journals.

Physicians not involved in the study described the results as a scientific triumph, calling the implications for drug treatment of heart disease "huge."

The findings provide validation of an idea that has been tantalizing cardiologists for years: that reducing inflammation could be a way to treat artery-clogging heart disease.

"It's a new paradigm: a new opportunity to further reduce death and disability," said Mark Creager, a past president of the American Heart Association, who was not involved in the study. "We've made such tremendous inroads in treating heart disease over the last couple of decades, and it's hard to imagine we could confer additional benefits, but here you go."

But the implications and timing of any benefit for patients remain to be seen. The drug company that sponsored the trial, Novartis, plans to meet with regulators this fall and file for approval by the end of the year. The drug, an injection given once every three months, would then be reviewed by the Food and Drug Administration.

A key question is which patients will benefit; the study showed its effect — a 15 percent drop in a combined measure of heart attacks, stroke and cardiovascular death — in a select, high-risk population of people who had suffered a previous heart attack and had high levels of a marker of inflammation in their blood. But a subset of patients appeared to get greater benefit from the drug, called canakinumab.

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https://www.washingtonpost.com/news/wonk/wp/2017/08/27/major-drug-study-opens-up-vast-new-opportunities-in-combating-heart-disease/?

Wednesday, August 23, 2017

The Case for a Breakfast Feast - The New York Times

Many of us grab coffee and a quick bite in the morning and eat more as the day goes on, with a medium-size lunch and the largest meal of the day in the evening. But a growing body of research on weight and health suggests we may be doing it all backward.

A recent review of the dietary patterns of 50,000 adults who are Seventh Day Adventists over seven years provides the latest evidence suggesting that we should front-load our calories early in the day to jump-start our metabolisms and prevent obesity, starting with a robust breakfast and tapering off to a smaller lunch and light supper, or no supper at all.

More research is needed, but a series of experiments in animals and some small trials in humans have pointed in the same direction, suggesting that watching the clock, and not just the calories, may play a more important role in weight control than previously acknowledged.

And doctors' groups are taking note. This year, the American Heart Association endorsed the principle that the timing of meals may help reduce risk factors for heart disease, like high blood pressure and high cholesterol. The group issued a scientific statement emphasizing that skipping breakfast — which 20 to 30 percent of American adults do regularly — is linked to a higher risk of obesity and impaired glucose metabolism or diabetes, even though there is no proof of a causal relationship. The heart association's statement also noted that occasional fasting is associated with weight loss, at least in the short term.

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https://www.nytimes.com/2017/08/21/well/eat/the-case-for-a-breakfast-feast.html?

More Young People Are Dying of Colon Cancer - The New York Times

When researchers reported earlier this year that colorectal cancer rates were rising in adults as young as their 20s and 30s, some scientists were skeptical. The spike in figures, they suggested, might not reflect a real increase in disease incidence but earlier detection, which can be a good thing.

Now a sobering new study has found that younger Americans aren't just getting cancer diagnoses earlier. They are dying of colorectal cancer at slightly higher rates than in previous decades, and no one really knows why.

"This is real," said Rebecca L. Siegel, an epidemiologist with the American Cancer Society and the lead author of the current study, published as a research letter in JAMA, as well as of the earlier report. "It's a small increase, and it is a trend that emerged only in the past decade, but I don't think it's a blip. The burden of disease is shifting to younger people."

The study found that even though the risk of dying from colon and rectal cancers has been declining in the population over all, death rates among adults aged 20 to 54 had increased slightly, to 4.3 deaths per 100,000 people in 2014, up from 3.9 per 100,000 in 2004.

"This is not merely a phenomenon of picking up more small cancers," said Dr.Thomas Weber, who was not involved in the study but is a member of the steering committee of the National Colorectal Cancer Roundtable. "There is something else going on that's truly important."

No one knows what underlying lifestyle, environmental or genetic factors may be driving the rise in cases.

More ...

https://www.nytimes.com/2017/08/22/well/live/more-young-people-are-dying-of-colon-cancer.html?

Sunday, August 20, 2017

Women are flocking to wellness because modern medicine still doesn’t take them seriously - Quartz

The wellness movement is having a moment. The more luxurious aspects of it were on full display last weekend at the inaugural summitof Gwyneth Paltrow's lifestyle brand Goop, from crystal therapy to $66 jade eggs meant to be worn in the vagina. Meanwhile, juice cleanses, "clean eating," and hand-carved lamps made of pink Himalayan salthave all gone decidedly mainstream. I myself will cop to having participated in a sound bath—basically meditating for 90 minutes in a dark room while listening to gongs and singing bowls. (I felt amazingly weird afterward, in the best possible way.)

It seems that privileged women in the US have created their own alternative health-care system—with few of its treatments having been tested for efficacy, or even basic safety. It's easy to laugh at the dubious claims of the wellness industrial complex, and reasonable to worry about the health risks involved. But the forces behind the rise of oxygen bars and detox diets are worth taking seriously—because the success of the wellness industry is a direct response to a mainstream medical establishment that frequently dismisses and dehumanizes women.

To be fair, the American health-care system is generally unpleasant for everyone: impersonal, harried, and incredibly expensive. "The doctor-patient relationship has been slowly eroding, not only with specialization and the fact that people now see panels of doctors, but because emergency rooms are slammed, there are insurance-coverage problems, et cetera," Travis A. Weisse, a science historian at the University of Wisconsin, told Taffy Brodesser-Akner in an article for Outside magazine. "It can make a patient feel devalued."

The medical system is even more terrible for women, whose experience of pain is routinely minimized by health practitioners. In the emergency room, women routinely wait longer than men to receive medication for acute pain. At the gynecologist's office, severe period-related pain is often dismissed or underestimated. Ingrained sexism means that doctors may regard women as either earth mothers or hypochondriacs; that is, either women possess deep wellspring of internal pain control that they ought to be able to channel during childbirth, or their pain is psychological in nature—a symptom of hysteria.

Conditions that affect women at higher rates than men, including depression and autoimmune diseases like fibromyalgia, are much more likely to be dismissed as having a psychological rather than a physiological source. Chronic fatigue syndrome sufferers are still instructed to rely on exercise and positive thinking, despite research that indicates these measures do not cure the condition. Many women with autoimmune diseases, endometriosis, or even multiple sclerosis go undiagnosed for years, despite multiple trips to doctors and specialists—all the while being told that their symptoms could just be stress.

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https://qz.com/1006387/women-are-flocking-to-wellness-because-traditional-medicine-still-doesnt-take-them-seriously/

Saturday, August 19, 2017

The Appointment Ends. Now the Patient Is Listening. - The New York Times

The next time you see your cardiologist or internist, what would happen if you took out your smartphone or a digital recorder and said you'd like to record your appointment?

The doctor might be startled, might bridle, might have visions of a supposedly confidential discussion showing up on YouTube — or in a malpractice lawyer's files.

Or the doctor might think more like Dr. James Ryan, a family practitioner in Ludington, Mich.

With his patients' approval, Dr. Ryan routinely records appointments, then uploads the audio to a secure web platform so that patients can listen whenever they need to recall what they discussed with him. They can give family members access to the recordings as well.

Sheri Piper, who has seen Dr. Ryan almost monthly for a host of medical problems — gout, high blood pressure, hypothyroidism, anxiety and depression — has come to rely on this system.

"As aging continues, it's harder to not be overwhelmed by what you hear in a doctor's office," said Ms. Piper, 63, a retired administrative assistant.

An extended round of hospitalizations and operations in 2013 affected her memory, she said, so "you can tell me something today and I won't remember tomorrow."

Thus, last month, straining to recall what Dr. Ryan had said about how often to take allopurinol for gout, she turned to the recording (annotated so that patients can easily locate specific topics of conversation) for clarification.

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https://www.nytimes.com/2017/08/18/health/recording-your-doctors-appointment.html

Thursday, August 17, 2017

A Start-Up Suggests a Fix to the Health Care Morass - The New York Times

WINFIELD, Kan. — If you watched the drama in Washington last month, you may have come away with the impression that the American health care system is a hopeless mess.

In Congress, a doomed plan to repeal the Affordable Care Act, President Obama's health care law, has turned into a precarious effort to rescue it. Meanwhile, President Trump is still threatening to mortally wound the law — which he insists, falsely, is collapsing anyway — while his administration is undermining its being carried out.

So it is surprising that across the continent from Washington, investors and technology entrepreneurs in Silicon Valley see the American health care system as the next great market for reform.

Some of their interest is because of advances in technology like smartphones, wearable health devices (like smart watches), artificial intelligence, and genetic testing and sequencing. There is a regulatory angle: The Affordable Care Act added tens of millions of people to the health care market, and the law created several incentives for start-ups to change how health care is provided. The most prominent of these is Oscar, a start-up co-founded by Joshua Kushner (the younger brother of Mr. Trump's son-in-law, Jared Kushner), which has found ways to mine health care data to create a better health insurance service.

But perhaps the most interesting and potentially groundbreaking company created in connection with the Affordable Care Act is Aledade, a start-up founded in 2014 by Farzad Mostashari, a doctor and technologist who was the national coordinator for health information technology at the Department of Health and Human Services in the Obama administration.

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https://www.nytimes.com/2017/08/16/technology/a-start-up-suggests-a-fix-to-the-health-care-morass.html?

Wednesday, August 16, 2017

Teen Drug Overdoses Doubled From 1999 to 2015, CDC Reveals - NBC News

From 1999 to 2015, while America was grappling with wars in Iraq and Afghanistan, and the worst economic crisis since the Depression, another tragedy quietly unfolded — the death rate of teenagers overdosing on drugs more than doubled.

In 2015 alone, there were 772 drug overdose deaths for adolescents ages 15 through 19 and they died at a rate of 3.7 per 100,000, according to figures newly released Wednesday from the federal Centers for Disease Control and Prevention.

By contrast, the death rate was 1.6 per 100,000 in 1999.

"For both male and female adolescents, the majority of drug overdose deaths in 2015 were unintentional," the CDC report states.

And the chief culprits that year were the same drugs that the National Institute on Drug Abuse say killed a total 35,000 Americans of all ages across the country — opiods, specifically heroin.

"Drug deaths are rising very rapidly for this group (although not as fast as at slightly older ages) and opioid analgesics and particularly heroin and fentanyl are the most important contributors," Dr. Christopher Ruhm, author of a recent University of Virginia study which found the national overdose crisis may be even worse than reported, wrote in an email to NBC News.

Ruhm said he expects the death toll for 15- to 19-year-olds will likely be higher after the CDC compiles its figures for 2016 and 2017.

"Not, primarily, because of opioid analgesics but rather because of rapid growth in deaths due to heroin and (often unintentionally) fentanyl use," he wrote. "Prescription opioids have played a role in all of this earlier, particularly in establishing patterns that led to increased heroin use."

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http://www.nbcnews.com/storyline/americas-heroin-epidemic/teen-drug-overdoses-doubled-1999-2015-cdc-reveals-n793006

10 Things My Chronic Illness Taught My Children - The New York Times

My children have a mother with a chronic illness. They live with my rheumatoid arthritis just as much as I do. I was given my diagnosis when all three of them were young, and since then I've spent a lot of time worrying about what the daily uncertainty of my condition would mean to them, and whether it would affect their development.

They are all teenagers now, one getting ready for college, and I can attest that my illness has indeed affected them. Here's how.

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https://www.nytimes.com/2017/08/16/opinion/chronic-rheumatoid-arthritis-children.html?

Monday, August 14, 2017

IBM Watson Makes a Treatment Plan for Brain-Cancer Patient in 10 Minutes; Doctors Take 160 Hours - IEEE Spectrum

A new study, in which IBM Watson took just 10 minutes to analyze a brain-cancer patient's genome and suggest a treatment plan, demonstrates the potential of artificially intelligent medicine to improve patient care. But although human experts took 160 hours to make a comparable plan, the study's results weren't a total victory of machine over humans.

The patient in question was a 76-year-old man who went to his doctor complaining of a headache and difficulty walking. A brain scan revealed a nasty glioblastoma tumor, which surgeons quickly operated on; the man then got three weeks of radiation therapy and started on a long course of chemotherapy. Despite the best care, he was dead within a year. While both Watson and the doctors analyzed the patient's genome to suggest a treatment plan, by the time tissue samples from his surgery had been sequenced the patient had declined too far.

IBM has been outfitting Watson, its "cognitive computing" platform, to tackle multiple challenges in health care, including an effort to speed up drug discovery and several ways to help doctors with patient care. In this study, a collaboration with the New York Genome Center (NYGC), researchers employed a beta version of IBM Watson for Genomics.

IBM Watson's key feature is its natural-language-processing abilities. This means Watson for Genomics can go through the 23 million journal articles currently in the medical literature, government listings of clinical trials, and other existing data sources without requiring someone to reformat the information and make it digestible. Other Watson initiatives have also given the system access to patients' electronic health records, but those records weren't included in this study.

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http://spectrum.ieee.org/the-human-os/biomedical/diagnostics/ibm-watson-makes-treatment-plan-for-brain-cancer-patient-in-10-minutes-doctors-take-160-hours

Sunday, August 13, 2017

Forever Yesterday: Peering Inside My Mom’s Fading Mind

Every time I talk to my mom on the phone, just as I'm getting ready to say goodbye, she slips in an abrupt update about her parents — my grandparents. Sometimes they're in Switzerland. Sometimes they're in Loma, Montana. Sometimes they've gotten "mixed up with bad people." Sometimes they've completely disappeared or died mysteriously. Sometimes it sounds like a government conspiracy — a murder plot. At first, I didn't know what to say in return. I'd ask how they died or what they were doing in Switzerland. In more recent conversations, I tried to place her back in reality. I'd say, "Mom, your parents have been dead for forty years." I'd ask her how old they were and she would say 60, 70, or 75. She's not sure. She says that all the time: I'm not sure. "How old are you?" I ask, and she laughs and says, "Oh, I think I'm about 25." Once she said she was 18. She's actually 88 years old.

For about two years now, my mother has been fighting with Alzheimer's and the dementia that comes from that disease. She's had years of struggle with diabetes and epilepsy — but her mental condition was always sharp. A lifelong democrat and the mother of six, Patsy loved sewing, making quilts, reading mystery novels, and watching Seattle Mariners baseball while enjoying a Pepsi (never Coke). I am her youngest son.

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https://longreads.com/2017/08/11/forever-yesterday-peering-inside-my-moms-fading-mind/?

The Symptoms of Dying - The New York Times

You and I, one day we'll die from the same thing. We'll call it different names: cancer, diabetes, heart failure, stroke.

One organ will fail, then another. Or maybe all at once. We'll become more similar to each other than to people who continue living with your original diagnosis or mine.

Dying has its own biology and symptoms. It's a diagnosis in itself. While the weeks and days leading up to death can vary from person to person, the hours before death are similar across the vast majority of human afflictions.

Some symptoms, like the death rattle, air hunger and terminal agitation, appear agonizing, but aren't usually uncomfortable for the dying person. They are well-treated with medications. With hospice availability increasing worldwide, it is rare to die in pain.

While few of us will experience all the symptoms of dying, most of us will have at least one, if not more. This is what to expect.

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https://www.nytimes.com/2017/06/20/well/live/the-symptoms-of-dying.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

Should I Help My Patients Die? - The New York Times

I was leafing through a patient's chart last year when a colleague tapped me on the shoulder. "I have a patient who is asking about the End of Life Option Act," he said in a low voice. "Can we even do that here?"

I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.) Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.

That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn't.

I could see my own discomfort mirrored in his face. "Can you help us with it?" he asked me. "Of course," I said. Then I felt my stomach lurch.

California's law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.

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https://www.nytimes.com/2017/08/05/opinion/sunday/dying-doctors-palliative-medicine.html?

Surgery Is One Hell Of A Placebo | FiveThirtyEight

The guy's desperate. The pain in his knee has made it impossible to play basketball or walk down stairs. In search of a cure, he makes a journey to a healing place, where he'll undergo a fasting rite, don ceremonial garb, ingest mind-altering substances and be anointed with liquids before a masked healer takes him through a physical ritual intended to vanquish his pain.

Seen through different eyes, the process of modern surgery may look more more spiritual than scientific, said orthopedic surgeon Stuart Green, a professor at the University of California, Irvine. Our hypothetical patient is undergoing arthroscopic knee surgery, and the rituals he'll participate in — fasting, wearing a hospital gown, undergoing anesthesia, having his surgical site prepared with an iodine solution, and giving himself over to a masked surgeon — foster an expectation that the procedure will provide relief, Green said.

These expectations matter, and we know they matter because of a bizarre research technique called sham surgery. In these fake operations, patients are led to believe that they are having a real surgical procedure — they're taken through all the regular pre- and post- surgical rituals, from fasting to anesthesia to incisions made in their skin to look like the genuine operation occurred — but the doctor does not actually perform the surgery. If the patient is awake during the "procedure," the doctor mimics the sounds and sensations of the true surgery, and the patient may be shown a video of someone else's procedure as if it were his own.

Sham surgeries may sound unethical, but they're done with participants' consent and in pursuit of an important question: Does the surgical procedure under consideration really work? In a surprising number of cases, the answer is no.

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https://fivethirtyeight.com/features/surgery-is-one-hell-of-a-placebo/?

Saturday, August 12, 2017

A Cancer Conundrum: Too Many Drug Trials, Too Few Patients - The New York Times

With the arrival of two revolutionary treatment strategies, immunotherapy and personalized medicine, cancer researchers have found new hope — and a problem that is perhaps unprecedented in medical research.

There are too many experimental cancer drugs in too many clinical trials, and not enough patients to test them on.

The logjam is caused partly by companies hoping to rush profitable new cancer drugs to market, and partly by the nature of these therapies, which can be spectacularly effective but only in select patients.

In July, an expert panel of the Food and Drug Administration approved a groundbreaking new leukemia treatment, a type of immunotherapy. Companies are scrambling to develop other drugs based on using the immune system itself to attack cancers.

Many of these experimental candidates in trials are quite similar. Yet each drug company wants to have its own proprietary version, seeing a potential windfall if it receives F.D.A. approval.

As a result, there are more than 1,000 immunotherapy trials underway, and the number keeps growing. "It's hard to imagine we can support more than 1,000 studies," said Dr. Daniel Chen, a vice president at Genentech, a biotechnology company.

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https://www.nytimes.com/2017/08/12/health/cancer-drug-trials-encounter-a-problem-too-few-patients.html

Wednesday, August 2, 2017

Almost half of all opioid misuse starts with a friend or family member's prescription | PBS NewsHour

More than half of adults who misused opioids did not have a prescription, and many obtained drugs for free from friends or relatives, according to a national survey of more than 50,000 adults.

Although many people need medical narcotics for legitimate reasons, the National Survey on Drug Use and Health reported Monday that regular access to prescription opioids can facilitate misuse. The results, outlined in the Annals of Internal Medicine, indicate when the medical community overprescribes opioids, unused drugs are then available for abuse.

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http://www.pbs.org/newshour/rundown/opioid-misuse-starts-friend-family-members-prescription/?

Monday, July 31, 2017

Double-Booked: When Surgeons Operate On Two Patients At Once | Kaiser Health News

The controversial practice has been standard in many teaching hospitals for decades, its safety and ethics largely unquestioned and its existence unknown to those most affected: people undergoing surgery.

But over the past two years, the issue of overlapping surgery — in which a doctor operates on two patients in different rooms during the same time period — has ignited an impassioned debate in the medical community, attracted scrutiny by the powerful Senate Finance Committee that oversees Medicare and Medicaid, and prompted some hospitals, including the University of Virginia's, to circumscribe the practice.

Known as "running two rooms" — or double-booked, simultaneous or concurrent surgery — the practice occurs in teaching hospitals where senior attending surgeons delegate trainees — usually residents or fellows — to perform parts of one surgery while the attending surgeon works on a second patient in another operating room. Sometimes senior surgeons aren't even in the OR and are seeing patients elsewhere.

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http://khn.org/news/double-booked-when-surgeons-operate-on-two-patients-at-once/

Monday, July 17, 2017

The Pennsylvania Gazette » The State of the Health-Care Economy

When David Asch GM'87 WG'89 was executive director of the Leonard Davis Institute of Health Economics, he would occasionally receive phone calls from the institute's founding benefactor.

"Often he started out with a question: 'So David, what percentage of GDP is healthcare these days?'" Asch recalled during an Alumni Weekend panel discussion marking the LDI's 50th anniversary. "And I'd say, 'Well I don't know, Leonard, 15 percent.' At which point he would go ballistic, and say, 'What are you talking about! When I started the Leonard Davis Institute, it was 6 percent! What the heck are you guys doing over there?!'"

At which point Asch would "very carefully" reply: "But had you not started the Leonard Davis Institute, we'd be at 25 percent!"

Asch, who is currently the John Morgan Professor of Medicine and Medical Ethics and Health Policy and a professor of healthcare management, was one of three former LDI executive directors on a panel moderated by its current chief, Dan Polsky Gr'96. They explored how the business of medical care has changed in the last half-century, and some of the challenges and opportunities ahead. (Video is available at tinyurl.com/y8utkjwl.)

Though the hefty fraction of gross domestic product that goes to healthcare looms large in such discussions, Mark Pauly, the Bendheim Professor of Health Care Management at Wharton, dismissed it as "the world's most pernicious measure of a country's efficiency of its healthcare system."

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http://thepenngazette.com/the-state-of-the-health-care-economy/

Thursday, July 13, 2017

The weird power of the placebo effect, explained - Vox

Over the last several years, doctors noticed a mystifying trend: Fewer and fewer new pain drugs were getting through double-blind placebo control trials, the gold standard for testing a drug's effectiveness.

In these trials, neither doctors nor patients know who is on the active drug and who is taking an inert pill. At the end of the trial, the two groups are compared. If those who actually took the drug report significantly greater improvement than those on placebo, then it's worth prescribing.

When researchers started looking closely at pain-drug clinical trials, they found that an average of 27 percent of patients in 1996 reported pain reduction from a new drug compared to placebo. In 2013, it was 9 percent.

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https://www.vox.com/science-and-health/2017/7/7/15792188/placebo-effect-explained

Why Chocolate May Be Good for the Heart - NYTimes.com

Eating chocolate has been tied to a reduced risk of heart disease. Now scientists have uncovered one possible reason.

Using data from a large Danish health study, researchers have found an association between chocolate consumption and a lowered risk for atrial fibrillation, the irregular heartbeat that can lead to stroke, heart failure and other serious problems. The study is in Heart.

Scientists tracked diet and health in 55,502 men and women ages 50 to 64. They used a well-validated 192-item food-frequency questionnaire to determine chocolate consumption. During an average 14 years of follow-up, there were 3,346 diagnosed cases of atrial fibrillation.

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https://mobile.nytimes.com/2017/05/23/well/why-chocolate-may-be-good-for-the-heart.html

When Your Doctor Is Fitter Than You Are - The New York Times

"I enjoy working out at the gym," declares one profile. "To keep myself fit, I like to hike, bike and exercise," says another.

These comments aren't part of a dating site. Rather, they come from physicians' online profiles that prospective patients view when they are looking for a new doctor.

There are good reasons doctors might strive to lead by example. "I practice what I preach by living healthy every day," declares one physician on Kaiser Permanente's online doctor search portal. Patients may trust or be inspired by such a doctor, the thinking goes. And if health care professionals fail to follow their own advice, they may be accused of hypocrisy.

But for some patients, particularly those battling weight issues, a doctor's declarations of personal fitness may not have the intended effect of attracting new patients. Instead, rather than inspiring them, it can drive them away.

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https://www.nytimes.com/2017/07/13/well/family/when-your-doctor-is-fitter-than-you-are.html?

Saturday, July 8, 2017

The Smart-Medicine Solution to the Health-Care Crisis - WSJ

The controversy over Obamacare and now the raucous debate over its possible repeal and replacement have taken center stage recently in American politics. But health insurance isn't the only health-care problem facing us—and maybe not even the most important one. No matter how the debate in Washington plays out in the weeks ahead, we will still be stuck with astronomical and ever-rising health-care costs. The U.S. now spends well over $10,000 per capita on health care each year. A recent analysis in the journal Health Affairs by the economist Sean P. Keehan and his colleagues at the federal Centers for Medicare and Medicaid Services projects that health spending in the U.S. will grow at a rate of 5.8% a year through 2025, far outpacing GDP growth.

More...

https://www.wsj.com/amp/articles/the-smart-medicine-solution-to-the-health-care-crisis-1499443449

The Patient Wants to Leave. The Hospital Says ‘No Way.’ - The New York Times

Why would an older person essentially discharge himself from a hospital, defying a physician's recommendation and signing a daunting form that acknowledges he is leaving A.M.A. — against medical advice?

Attend the tale of William Callahan.

He nearly fainted last spring after walking down the block to visit a neighbor in his New Jersey suburb. At 82, he had a long history of cardiac problems and was several years into Alzheimer's disease, but remained mobile and sociable.

He quickly revived, but the neighbor called 911. His daughter, Dr. Eileen Callahan, a geriatrician at Mount Sinai Hospital in New York, met her dad at the local emergency room.

"He was fine, sitting up and chatting," she found. "CT scan, blood work, heart rate, vital signs — all totally normal." He'd probably gotten a bit dehydrated, she figured, and he insisted on going home.

Dr. Callahan promised the E.R. doctor that she'd stay with her father overnight to be sure he was O.K. No dice.

"The doc said no, he really should stay overnight to be monitored and to see the cardiologist in the morning and get cleared."

In hospitals, she knew, her father was prone to sleeplessness and delirium. In unfamiliar surroundings, he might fall.

Still, "I succumbed." The hospital provided an aide to stay with Mr. Callahan overnight until another daughter arrived in the morning.

It did not go well. Mr. Callahan paced for hours, peeled off the heart monitors and grew increasingly confused and agitated. By the next afternoon, despite family calls and complaints, the cardiologist had not materialized and the hospital still wouldn't discharge Mr. Callahan.

Dr. Callahan's sister was growing frantic. "I said, 'Maureen, just do it,'" Dr. Callahan said. "Sign him out."

Her sister signed the A.M.A. form that hospitals typically demand before releasing patients against physician recommendations, acknowledging that patients understand and assume the risks, medically and legally.

Mr. Callahan went home and went to sleep, but his physician daughter remains livid.

"He should have been discharged right from the E.R.," she said. "This was cookbook medicine, done without thinking. It was very adversarial."

Such events happen more commonly than one might think. Though A.M.A. discharges occur far more frequently in younger patients, a recent study in The Journal of the American Geriatrics Society analyzed a large national sample from 2013 and found that 50,650 hospitalizations of patients over age 65 ended with A.M.A. discharges.

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https://www.nytimes.com/2017/07/07/health/hospitals-patients-leave-against-medical-advice.html?

Saturday, July 1, 2017

A Doctor’s View of Obamacare and Trumpcare from Rural Georgia | The New Yorker

Nineteen years ago, after medical school at Columbia University; a stint at Montefiore Medical Center, in the Bronx; and a period running homeless shelters in Times Square; Karen Kinsell moved to Fort Gaines, a tiny town in southwest Georgia, on the Alabama line. Fort Gaines is in Clay County, which is consistently ranked among the poorest of the hundred and fifty-nine counties in the state. It currently ranks third-to-last in "health outcomes," according to the Robert Wood Johnson Foundation, up from dead last. Clay County's only hospital closed its doors in 1983, long before Kinsell, who is now in her sixties, arrived and became its only doctor. "It's a bad place to live," Kinsell said recently by phone, between seeing patients, "which is why I moved here. I was looking for a place that needed me."

Kinsell runs Clay County Medical Center, a facility with four exam rooms built out of a former Tastee-Freez. It's a private practice, but she is a full-time volunteer. There is a receptionist and two other full-time staff members; they see "around thirty to thirty-five patients a day," Kinsell said. Monty Veazey, the president of the Georgia Alliance of Community Hospitals, told me that "Kinsellcare" is the only health care that's had a meaningful and positive effect here. "She's going bankrupt treating everyone that comes in," he said. "Most have no money, no Internet access, no other basic care. Many don't have insurance. How much longer can she do that? I don't know. But she's their only hope."

On Tuesday, shortly before Senator Mitch McConnell announced a delay in the vote for the Senate Republicans' health-care reform bill, Kinsell spoke by phone about the effects of Obamacare, the prospect of Trumpcare, and the plight of sick people in southwest Georgia. Her account has been edited and condensed.

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http://www.newyorker.com/news/news-desk/what-health-care-means-in-clay-county?

Wednesday, June 28, 2017

How ‘Wellness’ Became an Epidemic - New York Magazine

Why are so many privileged people feeling so sick? Luckily, there's no shortage of cures.

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https://www.thecut.com/2017/06/how-wellness-became-an-epidemic.html

The Lab Says It’s Cancer. But Sometimes the Lab Is Wrong. - The New York Times

It was the sort of bad news every patient fears. Merlin Erickson, a 69-year-old retired engineer in Abingdon, Md., was told last year that a biopsy of his prostate was positive for cancer.

Mr. Erickson, worried, began investigating the options: whether to have his prostate removed, or perhaps to have radiation treatment. But a few days later, the doctor called again.

As it turned out, Mr. Erickson did not have cancer. The lab had mixed up his biopsy with someone else's.

"Obviously, I felt great for me but sad for that other gentleman," Mr. Erickson said.

The other gentleman was Timothy Karman, 65, a retired teacher in Grandy, N.C. At first, of course, he had been told he was cancer-free. The phone rang again a few days later with news of the mix-up and a diagnosis of cancer.

Ultimately he had his prostate removed. "I said, 'Mistakes happen,'" Mr. Karman said.

They may be happening more often than doctors realize. There is no comprehensive data on how often pathology labs mix up cancer biopsy samples, but a few preliminary studies suggest that it may happen to thousands of patients each year.

More ..

https://www.nytimes.com/2017/06/26/health/the-lab-says-its-cancer-but-sometimes-the-lab-is-wrong.html?

Doctor on demand: How app culture is reviving the house call - The Washington Post

Alison Mintzer and her family were on a flight from New York to Los Angeles when her daughter complained that she felt sick. By the time they landed, Mintzer's normally uncomplaining 6-year-old said that her neck and ears hurt. When a fever soon followed, it was enough to convince her parents that she needed to see a doctor.

Thousands of miles from their pediatrician, and unable to find one quickly in L.A., Mintzer didn't know what to do. Then a family friend suggested an app called Heal that could use new technology to drum up a relic from the past: doctors who make house calls.

Once upon a time, a visit with the doctor meant welcoming one into your home, rather than heading out to a clinic or hospital waiting room. But around the 1960s, the house call fell out of favor as doctors' offices sought to become more efficient, and the doctor-patient relationship changed from "Marcus Welby" to something less personal with the rise of hospitals and modern insurance plans.

Now, however, the trend for on-demand service in the age of Uber could revive the house call. Services such as Heal — which launched in the District in June after operating in California since 2014 — and competitors such as Pager and Curbside Care are expanding their footprints across the country. And research suggests that house calls can provide a better standard of care for some patients than a hospital visit. A University of Southern California study of a house call program in the state found that hospitalization rates dropped for patients who were enrolled in the program for six months: Of 1,000 patients, 96 were hospitalized after being enrolled, down from 159 before the program.

Costs can also drop, since patients can avoid hospital visits. A 2013 Brookings Institution report said a Department of Veterans Affairs analysis of its home-based care program found a "25 percent reduction in hospital admissions, a 36 percent reduction in hospital days, and a 13 percent reduction in combined costs."

More …

https://www.washingtonpost.com/business/economy/doctor-on-demand-how-app-culture-is-reviving-the-house-call/2017/06/23/b10cd314-505d-11e7-b064-828ba60fbb98_story.html?

Friday, June 23, 2017

To Treat Depression, Try a Digital Therapist - WSJ

The World Health Organization estimates that more than 300 million people suffer from clinical depression world-wide. But cost, time, stigma, distance to travel, language barriers and other factors prevent many from seeking help.

Now, a growing group of health-care providers are betting that technology—from web-based courses to mobile apps that send prompts via text—can help bridge that gap.

It might seem surprising, since therapy, more than many other kinds of medicine, is so focused on the relationship between patient and therapist. But research, including a meta-analysis of studiesinvolving internet-based cognitive behavioral therapy, or CBT, suggests that digital therapies augmented by coaches who are available by text or phone can be as effective as evidence-based traditional therapy in treating some people with depression.

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https://www.wsj.com/articles/to-treat-depression-try-a-digital-therapist-1498227092?

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.

§

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.

More ...

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.

More ...

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.

More ...

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.

More ...

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."
More ...

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.

More ...

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.

More ...

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?