Sunday, April 23, 2017

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

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

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

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

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

The Blood of the Crab

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

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

Saturday, April 22, 2017

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

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

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

"What do you mean?" I asked.

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

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

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

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

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

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

Friday, April 21, 2017

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

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

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

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

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

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

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

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

Doctors Are Human Too - The New York Times

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

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

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

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

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

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

Wednesday, April 19, 2017

Facebook's Building 8 takes its own moonshots - CNET

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

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

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

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

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

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

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

Project Baseline

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

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

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

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https://www.projectbaseline.com/

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

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

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

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

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

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

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

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

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

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

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

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

Saturday, April 15, 2017

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

Consider the following.

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

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

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

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

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

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

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

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

Friday, April 14, 2017

Brain-Altering Science and the Search for a New Normal

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

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

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

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

Monday, April 10, 2017

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

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

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

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

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

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

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

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

Saturday, April 8, 2017

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

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

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

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

And it only costs 10 pesos — roughly 50 cents.

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

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

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

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

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

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

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

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

Tuesday, April 4, 2017

NIH VideoCasting and Podcasting

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

NYTimes: Good News for Older Mothers

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

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

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

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

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

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

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

Sunday, April 2, 2017

This Is How The World Gets Sick | Fast Company

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Friday, March 31, 2017

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

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

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

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

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

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

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

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

Thursday, March 30, 2017

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

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

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

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

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

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

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

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

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

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

Wednesday, March 29, 2017

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

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

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

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

Tuesday, March 28, 2017

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

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

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

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

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

Sunday, March 26, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Do you want to see your tendons?"

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

These Are the Most Prestigious Diseases -- Science of Us

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

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

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

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

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

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

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

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

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

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

Friday, March 17, 2017

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

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

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

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

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

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

Sunday, March 12, 2017

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

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

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

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

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

Friday, March 10, 2017

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

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

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

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

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

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

Tuesday, March 7, 2017

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

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

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

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

As mental health crises soar, colleges can't meet student needs - STAT

Colleges across the country are failing to keep up with a troubling spike in demand for mental health care — leaving students stuck on waiting lists for weeks, unable to get help.

STAT surveyed dozens of universities about their mental health services. From major public institutions to small elite colleges, a striking pattern emerged: Students often have to wait weeks just for an initial intake exam to review their symptoms. The wait to see a psychiatrist who can prescribe or adjust medication — often a part-time employee — may be longer still.

Students on many campuses are so frustrated that they launched a petition last month demanding expanded services. They plan to send it to 20 top universities, including Harvard, Princeton, Yale, MIT, and Columbia, where seven students have died this school year from suicide and suspected drug overdose.

"Students are turned away every day from receiving the treatment they need, and multiple suicide attempts and deaths go virtually ignored each semester," the petition reads. More than 700 people have signed; many have left comments about their personal experiences trying to get counseling at college. "I'm signing because if a kid in crisis needs help they should not have to wait," one wrote.

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https://www.statnews.com/2017/02/06/mental-health-college-students/

Top US hospitals aggressively promoting alternative medicine offerings - STAT

They're among the nation's premier medical centers, at the leading edge of scientific research.

Yet hospitals affiliated with Yale, Duke, Johns Hopkins, and other top medical research centers also aggressively promote alternative therapies with little or no scientific backing. They offer "energy healing" to help treat multiple sclerosis, acupuncture for infertility, and homeopathic bee venom for fibromyalgia. A public forum hosted by the University of Florida's hospital even promises to explain how herbal therapy can reverse Alzheimer's. (It can't.)

This embrace of alternative medicine has been building for years. But a STAT examination of 15 academic research centers across the US underscores just how deeply these therapies have become embedded in prestigious hospitals and medical schools.

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https://www.statnews.com/2017/03/07/alternative-medicine-hospitals-promote/?

Monday, March 6, 2017

Organization for the Study of Sex Differences (OSSD)

OSSD is an international society for basic and clinical scientists from various scientific disciplines who share an interest in exploring sex and gender differences in all areas of biological, medical, and behavioral science. The overall mission of OSSD is to enhance the knowledge of sex and gender differences by facilitating communication and collaboration among scientists and clinicians of diverse backgrounds.

OSSD is the brain child of basic and clinical scientists with established research commitments to the study of sex differences, and staff members of the Society for Women's Health Research (SWHR). SWHR has, since 1990, been a thought leader in research on sex differences and is dedicated to improving women's health through advocacy, education, and research. Beginning in 2000, SWHR convened seven innovative meetings that focused on the emerging field of sex-based biology, the Conferences on Sex and Gene Expression (SAGE). SWHR also supported four interdisciplinary Networks in biomedical sciences to promote collaboration among scientists in areas of sex-differences and women's health (referred to as Interdisciplinary Studies in Sex Differences (ISIS) Networks).

http://www.ossdweb.org/

Sunday, March 5, 2017

Drug overdose fatality rate higher than suicides, cars, guns - Axios

A new Centers for Disease Control and Prevention study shows the rate of fatal drug overdoses has more than doubled since 1999. Those between 55 and 64 years of age were the hardest hit. Rates increased for both males and females and increased across all age groups.

The 2015 rate for fatal drug overdoses is higher than deaths from suicides (13.4 deaths per 100,000) car accidents (11.1 deaths per 100,000) and firearms.

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https://www.axios.com/fatal-drug-overdoses-more-than-doubled-since-1999-2282883694.html

Saturday, March 4, 2017

NYTimes: Whom Do You Tell When You’re Sick? Maybe Everyone You Know

Last year, my mother, a few weeks before a milestone birthday, learned she needed major surgery. The circumstances were not life-threatening. She would not be in the hospital long. But the recovery would still be protracted and restrict her ability to care for my father, who has Parkinson's.

No worries. Her three grown children, all of whom live in distant cities, snapped into action. We would fly in for the surgery, call in extra help, telephone a few of her friends and ask them to check in, drop off some food, otherwise be on call. We congratulated ourselves for a well-designed plan. There was only one problem.

My mother insisted we not tell a soul.

"I don't want to inconvenience my friends," she said. "Also, I don't want people to feel sorry for me, and I absolutely don't want to listen to all their medical stories. It's just so wearying."

How people decide whether to go public with their medical conditions has long been highly sensitive and deeply personal. Certain situations, like broken limbs and cancers that require chemotherapy, are virtually impossible to keep secret. Others, like H.I.V. and mental illness, are easier to keep under wraps, at least for a time. Older people, in my experience, lean more toward secrecy; younger toward disclosure.

These days, all of the old rules have been thrown out. With more and more people used to sharing even the most minute details of their daily lives on social media, centuries of customs have been upended. If you post photos of yourself emptying your cat litter, filing your taxes or getting your cavity filled, you can't as easily come out later and say, "Oh, I've had muscular dystrophy all these years and didn't want to tell you."

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https://www.nytimes.com/2017/03/04/style/health-sick-illness-medical-conditions-social-media.html?

When doctors know that they don’t know - The Boston Globe

Imagine that you are a medical doctor. You need to tell one of your patients that he has advanced-stage pancreatic cancer, an almost incurable condition. You learn that your patient's only daughter is getting married five months from now. Without treatment, your patient has about a year left to live. Chemotherapy would increase his chances of being alive in five years by about 20 percent but would also double his chances of dying before his daughter's wedding. What do you tell him? Of course, the choice is by no means easy or clear-cut.

Doctors are scientists who operate in a world of statistics, odds, and probability. Yet they've long been taught that when dealing with patients they should convey a reassuring level of confidence and certainty. As a result, patients expect their doctors to give them a clear diagnosis and a straightforward course of treatment.

But now that information about every medical condition imaginable is just a few clicks away, experts are asking whether doctors' apparent certainty when communicating with their patients actually does more harm than good. With the information overload brought by the progress of medicine and technology, answers are rarely black or white. Medical schools are only just starting to teach doctors how to deal with this, and patients' expectations haven't adjusted, either.

The fact is that medicine has long been steeped in uncertainty and has arguably even thrived on it. To avoid bias when testing a new drug, researchers must have no preconceived notions of which treatment, the new one, the old one, or even a placebo, is the best option. This principle, called equipoise, protects patients, doctors, and researchers alike from making assumptions before scientific proof of efficacy has been gathered.

More …

http://www.bostonglobe.com/ideas/2017/02/25/uncertainty/ZDpWJHZAWFOBgrtgBptSOO/story.html?

Tuesday, February 28, 2017

Colon and Rectal Cancers Rising in Young People - The New York Times

Cancers of the colon and rectum have been declining in older adults in recent decades and have always been considered rare in young people. But scientists are reporting a sharp rise in colorectal cancers in adults as young as their 20s and 30s, an ominous trend.

The vast majority of colorectal cancers are still found in older people, with nearly 90 percent of all cases diagnosed in people over 50. But a new study from the American Cancer Society that analyzed cancer incidence by birth year found that colorectal cancer rates, which had dropped steadily for people born between 1890 and 1950, have been increasing for every generation born since 1950. Experts aren't sure why.

Rectal cancers are rising particularly sharply, far faster than cancers in other parts of the large intestine or colon. The American Cancer Society estimates about 13,500 new cases of colon and rectal cancers will be diagnosed in Americans under 50 this year, with more than 95,500 cases of colon cancer and nearly 40,000 cases of rectal cancer in all age groups.

"People born in 1990, like my son, have double the risk of colon cancer and quadruple the risk of rectal cancer" compared to the risk someone born in 1950 faced at a comparable age, said Rebecca Siegel, an epidemiologist with the American Cancer Society and the lead author of the new report, published in the Journal of the National Cancer Institute on Tuesday. And though the absolute risk is still small in younger people, she said, "They carry the risk forward with them as they age."

It is the upward trend that is worrisome: The risk of colon cancer for individuals who were born in 1990 was five per million people in that birth group, up from three per million at the same stage of life for those born in 1950. And the risk of rectal cancer for those born in 1990 was four per million, up from 0.9 per million for those born in 1950.

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https://www.nytimes.com/2017/02/28/well/live/colon-and-rectal-cancers-rising-in-young-people.html?

Sunday, February 26, 2017

Netflix’s new documentary Extremis shows the tension of end-of-life care.

Documentaries often deal in sadness and Netflix's new short Extremis is no exception. A film on end-of-life care that is shot entirely in an Intensive Care Unit at Highland Hospital in Oakland, California, the piece centers on Dr. Jessica Zitter, a palliative care specialist who leads a team in helping terminal patients prepare to die. Zitter treats or oversees patients who have no hope of recovery—for example there's Selena, who stopped breathing on the way to the ER and suffered severe brain damage, and Donna, a woman with severe myotonic muscular dystrophy that has severely compromised her existence. Her family is tormented with the knowledge that the breathing tube is likely all that's keeping her alive. A third patient is a woman on a respirator who is unsuccessfully trying to write her intentions on paper. Many of these patients are chained to supportive equipment with no hope to ever get off.

The main tension in the film is Zitter's efforts to help guide her patients and their families toward the ultimate realization that there is often no realistic chance of recovery. She comes across as compassionate and supportive if rational to the point of dogma. There are disturbing points in the film where families such as Selena's try to resist, clinging to a sliver of hope, which Zitter cuts through with reasoning and calm resolve. In this way, the documentary highlights the main tension of end-of-life care: Doctors often have different priorities than the patients and family members they're treating. That's because doctors are often able to see the stark reality of a situation before the patients and family can. "I'm always looking for another miracle," Selena's daughter Tama says, adding that pulling her mother's tube "feels like murder."

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http://www.slate.com/articles/health_and_science/medical_examiner/2016/09/netflix_s_new_documentary_extremis_shows_the_tension_of_end_of_life_care.html

Friday, February 24, 2017

When Evidence Says No, but Doctors Say Yes - The Atlantic

Long after research contradicts common medical practices, patients continue to demand them and physicians continue to deliver. The result is an epidemic of unnecessary and unhelpful treatments.

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https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/

Monday, February 20, 2017

Medical Mystery: Why Is Back Surgery So Popular in Casper, Wyo.? - The New York Times

You might think that once drugs, devices and medical procedures are shown to be effective, they quickly become available. You might also think that those shown not to work as well as alternatives are immediately discarded.

Reasonable assumptions both, but you'd be wrong.

Instead, innovations in health care diffuse unevenly across geographic regions — not unlike the spread of a contagious disease. And even when studies show a new technology is overused, retrenchment is very slow and seemingly haphazard.

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https://www.nytimes.com/2017/02/13/upshot/medical-mystery-why-is-back-surgery-so-popular-in-casper-wyo.html?

The Worst That Could Happen? Going Blind, People Say - The New York Times

"Feeling My Way Into Blindness," an essay published in The New York Times in November by Edward Hoagland, an 84-year-old nature and travel writer and novelist, expressed common fears about the effects of vision loss on quality of life.

Mr. Hoagland, who became blind about four years ago, projected deep-seated sadness in describing the challenges he faces of pouring coffee, not missing the toilet, locating a phone number, finding the food on his plate, and knowing to whom he is speaking, not to mention shopping and traveling, when he often must depend on the kindness of strangers. And, of course, he sorely misses nature's inspiring vistas and inhabitants that fueled his writing, though he can still hear birds chatter in the trees, leaves rustle in the wind and waves crash on the shore.

Mr. Hoagland is hardly alone in his distress. According to Action for Blind People, a British support organization, those who have lost some or all sight "struggle with a range of emotions — from shock, anger, sadness and frustration to depression and grief."

When eyesight fails, some people become socially disengaged, leading to isolation and loneliness. Anxiety about a host of issues — falls, medication errors, loss of employment, social blunders — is common.

A recent study from researchers at the Wilmer Eye Institute at Johns Hopkins University School of Medicine found that most Americans regard loss of eyesight as the worst ailment that could happen to them, surpassing such conditions as loss of limb, memory, hearing or speech, or having H.I.V./AIDS. Indeed, low vision ranks behind arthritis and heart disease as the third most common chronic cause of impaired functioning in people over 70, Dr. Eric A. Rosenberg of Weill Cornell Medical College and Laura C. Sperazza, a New York optometrist, wrote in American Family Physician.

Some 23.7 million American adults reported in 2015 that they are unable to see at all or have trouble seeing even with corrective lenses. This number is projected to perhaps double by 2050 based on the aging of the population and increasing prevalence of diseases that can cause vision loss. Yet, the Wilmer Eye Institute's national study of 2,044 adults found that many Americans are unaware of the diseases and factors that can put their vision at risk and steps they might take to lower their risk.

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https://www.nytimes.com/2017/02/20/well/the-worst-that-could-happen-going-blind-people-say.html?

When Retirement Comes With a Daily Dose of Cannabis - The New York Times

Ruth Brunn finally said yes to marijuana. She is 98.

She pops a green pill filled with cannabis oil into her mouth with a sip of vitamin water. Then Ms. Brunn, who has neuropathy, settles back in her wheelchair and waits for the jabbing pain in her shoulders, arms and hands to ebb.

"I don't feel high or stoned," she said. "All I know is I feel better when I take this."

Ms. Brunn will soon have company. The nursing home in New York City where she lives, the Hebrew Home at Riverdale, is taking the unusual step of helping its residents use medical marijuana under a new program to treat various illnesses with an alternative to prescription drugs. While the staff will not store or administer pot, residents are allowed to buy it from a dispensary, keep it in locked boxes in their rooms and take it on their own.

From retirement communities to nursing homes, older Americans are increasingly turning to marijuana for relief from aches and pains. Many have embraced it as an alternative to powerful drugs like morphine, saying that marijuana is less addictive, with fewer side effects.

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https://www.nytimes.com/2017/02/19/nyregion/retirement-medicinal-marijuana.html?

Thursday, February 16, 2017

How to Get a Better Night’s Sleep - Well Guides - The New York Times

Most people know they need to eat right and exercise to be healthy. But what about sleep? We spend about one-third of our lives asleep, and sleep is essential to better health. But many of us are struggling with sleep. Four out of five people say that they suffer from sleep problems at least once a week and wake up feeling exhausted. So how do you become a more successful sleeper? Grab a pillow, curl up and keep reading to find out.

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https://www.nytimes.com/well/guides/how-to-sleep?

Tuesday, February 14, 2017

Sharp Rise Reported in Older Americans’ Use of Multiple Psychotropic Drugs - NYTimes.com

The number of retirement-age Americans taking at least three psychiatric drugs more than doubled between 2004 and 2013, even though almost half of them had no mental health diagnosis on record, researchers reported on Monday.

The new analysis, based on data from doctors' office visits, suggests that inappropriate prescribing to older people is more common than previously thought. Office visits are a close, if not exact, estimate of underlying patient numbers. The paper appears in the journal JAMA Internal Medicine.

Geriatric medical organizations have long warned against overprescribing to older people, who are more susceptible to common side effects of psychotropic drugs, such as dizziness and confusion. For more than 20 years, the American Geriatrics Society has published the so-called Beers Criteria for potentially inappropriate use, listing dozens of drugs and their mutual interactions.

In that time, prescription rates of drugs like antidepressants, sleeping pills and painkillers nonetheless generally increased in older people, previous studies have found. The new report captures one important dimension, the rise in so-called polypharmacy — three drugs or more — in primary care, where most of the prescribing happens. Earlier research has found that elderly people are more likely to be on at least one psychiatric drug long term than younger adults, even though the incidence of most mental disorders declines later in life.

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https://mobile.nytimes.com/2017/02/13/health/psychiatric-drugs-prescriptions.html?

NYTimes: Lower Back Ache? Be Active and Wait It Out, New Guidelines Say

Dr. James Weinstein, a back pain specialist and chief executive of Dartmouth-Hitchcock Health System, has some advice for most people with lower back pain: Take two aspirin and don't call me in the morning.

On Monday, the American College of Physicians published updated guidelines that say much the same. In making the new recommendations for the treatment of most people with lower back pain, the group is bucking what many doctors do and changing its previous guidelines, which called for medication as first-line therapy.

Dr. Nitin Damle, president of the group's board of regents and a practicing internist, said pills, even over-the-counter pain relievers and anti-inflammatories, should not be the first choice. "We need to look at therapies that are nonpharmacological first," he said. "That is a change."

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https://www.nytimes.com/2017/02/13/health/lower-back-pain-surgery-guidelines.html?

Saturday, February 11, 2017

Doctors See Gains Against ‘an Urgent Threat,’ C. Diff - The New York Times

Tom Bocci's encounter with a bacterium he had never heard of began in April, when his doctor suggested a test for prostate cancer. Because the results appeared slightly abnormal, Mr. Bocci underwent a biopsy, taking antibiotics beforehand as a standard precaution against infection.

There was no problem with his prostate, it turned out. But a few days later, Mr. Bocci developed severe diarrhea, fever and vomiting. He grew dehydrated. Five days afterward, in a hospital emergency room, doctors diagnosed a Clostridium difficile infection.

Antibiotics appeared to squelch the infection but, as happens in 20 to 30 percent of cases, the symptoms returned with a vengeance as soon as he finished the drugs. Over several months, Mr. Bocci suffered from migraines, weakness, anxiety and hypertension.

Told to isolate himself, he warned family members not to visit his home in Troy, Mich.; his wife, Wendy, moved into a spare bedroom. He lost 30 pounds. After the third recurrence, "I really thought I was going to die," Mr. Bocci, now 71, said. "And sometimes I felt I wanted to."

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https://www.nytimes.com/2017/02/10/health/clostridium-difficile-c-diff.html?

Addiction Treatment Grew Under Health Law. Now What? - The New York Times

MANCHESTER, N.H. — Chad Diaz began using heroin when he was 12. Now 36 and newly covered by Medicaid under the Affordable Care Act, he is on Suboxone, a substitute opioid that eases withdrawal symptoms and cravings, and he is slowly pulling himself together.

"This is the best my life has gone in many, many years," Mr. Diaz, a big man wearing camouflage, said as he sat in a community health center here.

If Congress and President Trump succeed in dismantling the Affordable Care Act, he will have no insurance to pay for his medication or counseling, and he fears he will slide back to heroin.

"If this gets taken from me, it's right back to Square 1," he said. "And that's not a good place. I'm scary when I'm using. I don't care who I hurt."

As the debate over the fate of the health law intensifies, proponents have focused on the lifesaving care it has brought to people with cancer, diabetes and other physical illnesses. But the law has also had a profound, though perhaps less heralded, effect on mental health and addiction treatment, vastly expanding access to those services by designating them as "essential benefits" that must be covered through the A.C.A. marketplaces and expanded Medicaid.

More …

https://www.nytimes.com/2017/02/10/health/addiction-treatment-opiods-aca-obamacare.html

Thursday, February 9, 2017

As mental health crises soar, colleges can't meet student needs - STAT

Colleges across the country are failing to keep up with a troubling spike in demand for mental health care — leaving students stuck on waiting lists for weeks, unable to get help.

STAT surveyed dozens of universities about their mental health services. From major public institutions to small elite colleges, a striking pattern emerged: Students often have to wait weeks just for an initial intake exam to review their symptoms. The wait to see a psychiatrist who can prescribe or adjust medication — often a part-time employee — may be longer still.

Students on many campuses are so frustrated that they launched a petition last month demanding expanded services. They plan to send it to 20 top universities, including Harvard, Princeton, Yale, MIT, and Columbia, where seven students have died this school year from suicide and suspected drug overdose.

"Students are turned away every day from receiving the treatment they need, and multiple suicide attempts and deaths go virtually ignored each semester," the petition reads. More than 700 people have signed; many have left comments about their personal experiences trying to get counseling at college. "I'm signing because if a kid in crisis needs help they should not have to wait," one wrote.

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https://www.statnews.com/2017/02/06/mental-health-college-students/

Why the advice to take all your antibiotics may be wrong - STAT

You've heard it many times before from your doctor: If you're taking antibiotics, don't stop taking them until the pill vial is empty, even if you feel better.

The rationale behind this commandment has always been that stopping treatment too soon would fuel the development of antibiotic resistance — the ability of bugs to evade these drugs. Information campaigns aimed at getting the public to take antibiotics properly have been driving home this message for decades.

But the warning, a growing number of experts say, is misguided and may actually be exacerbating antibiotic resistance.

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https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/?

Saturday, January 28, 2017

This physician wants her patients to use fewer medications - The Washington Post

There was nothing unique about that patient encounter except that it was my first appointment of 2017 and everyone at the office was buzzing about their New Year's resolutions.

It went like this:

Me: "Are you taking all of your medications?"

Patient: "Yes, of course."

Me: "Okay, let's review them. Do you remember what they are?"

Patient: "I am not sure, but they are all here." (Patient hands me a plastic bag brimming with orange pill bottles, boxes and over-the-counter containers.)

Me (in my head): Oh, brother!

That's when I made my resolution: In 2017, I will try to tip the balance: I will not only try to write fewer prescriptions, I will also try to get more of my patients off their drugs altogether.

The "why" was obvious to me: Too many patients are taking too many drugs, for too long, in too-high doses, suffering harmful effects.

The "how"? That was less obvious. Starting in the second year of medical school (course name: Pharmacology) and continuing through residency training and beyond, doctors are taught how to prescribe drugs.

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https://www.washingtonpost.com/national/health-science/this-physician-wants-her-patients-to-use-fewer-medications/2017/01/27/29c81bde-d9c0-11e6-9a36-1d296534b31e_story.html?

Tuesday, January 24, 2017

Insomniacs Are Helped by Online Therapy, Study Finds - The New York Times

The same digital screens that have helped nurture a generation of insomniacs can also help restore regular sleep, researchers reported on Wednesday. In a new study, more than half of chronic insomniacs who used an automated online therapy program reported improvement within weeks and were sleeping normally a year later.

The new report, published in the journal JAMA Psychiatry, is the most comprehensive to date suggesting that many garden-variety insomniacs could benefit from the gold standard treatment — cognitive behavior therapy — without ever having to talk to a therapist. At least one in 10 adults has diagnosable insomnia, which is defined as broken, irregular, inadequate slumber at least three nights a week for three months running or longer.

"I've been an insomniac all my life, I've tried about everything," said Dale Love Callon, 70, known as Dacie, a math tutor living in Rancho Palos Verdes, Calif., who recently used the software. "I don't have it 100 percent conquered, but I'm sleeping much better now."

Previous studies have found that online sleep therapy can be effective, but most have been smaller, or focused on a particular sleep-related problem, like depression. The new trial tested the digital therapy in a broad, diverse group of longtime insomniacs whose main complaint was lack of sleep. Most had used medication or supplements over the years, and some still did.

"These results suggest that there are a group of patients who can benefit without the need of a high-intensity intervention," like face-to-face therapy, said Jack Edinger, a professor in the department of medicine at National Jewish Health in Denver, who was not a part of the study. "We don't know yet exactly who they are — the people who volunteer for a study like this in first place are self-motivated — but they're out there."

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https://www.nytimes.com/2016/11/30/health/insomnia-online-therapy.html?

Monday, January 23, 2017

Cervical Cancer Taking Deadlier Toll in U.S. Than Had Been Thought - The New York Times

The death rate from cervical cancer in the United States is considerably higher than previously estimated and the disparity in death rates between black women and white women is significantly wider, according to a study published Monday in the journal Cancer.

The rate at which black American women are dying from the disease is comparable to that of women in many poor developing nations, researchers reported. What makes the findings especially disturbing, said experts not involved in the research, is that when screening guidelines and follow-up monitoring are pursued, cervical cancer is largely preventable.

"This shows that our disparities are even worse than we feared," said Dr. Kathleen M. Schmeler, an associate professor of gynecologic oncology at the University of Texas M. D. Anderson Cancer Center. "We have screenings that are great, but many women in America are not getting them. And now I have even more concerns going forward, with the" expected "repeal of the Affordable Care Act, which covers screening, and the closing of family planning clinics, which do much of that screening."

The racial disparity had been noted in earlier studies, but it had been thought to have narrowed because cervical cancer death rates for black women were declining. But this study said that the gap was far greater than believed.

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https://www.nytimes.com/2017/01/23/health/cervical-cancer-united-states-death-toll.html?

Sunday, January 22, 2017

Why Medical Advice Seems to Change So Frequently - The New York Times

Medical scientists and academics must publish their research to advance. Medical organizations must release health recommendations to remain relevant. News organizations feel they must report on research and recommendations as they are released. But sometimes it's hard to separate what's truly a medical certainty from what is merely solid scientific conjecture.

I thought about this recently when the National Institute of Allergy and Infectious Diseases expert panel changed course and recommended that we start giving babies peanut powder or extract in food before they are six months old rather than make sure they go nowhere near it. The panel said this is good advice, especially if the babies are at higher risk for developing an allergy.

I've written about the research supporting these new recommendations before. A recent well-designed study showed that infants exposed to peanut protein developed significantly fewer peanut allergies than those who were not. The measurement, called number needed to treat (N.N.T.), was powerful: For every seven infants exposed to peanut protein, one fewer developed allergies. In the high-risk population, for every four infants exposed, one fewer became allergic. Those numbers are stunning.

But it's important to remember that the earlier recommendation wasn't made in the Dark Ages. As recently as 2000, the American Academy of Pediatrics declared that children at risk for allergies be given no peanuts until they were 3 years old. It's not unrealistic to think that this might have increased the number of children with peanut allergies, not decreased them.

This isn't an isolated incident. As a pediatrician, I'm more aware of the academy's recommendations than those of some other medical organizations, and I've taken to The Upshot to discuss their statements on car seats on planes, the use of retail clinics and where babies should sleep. In each case, I've expressed concerns that the recommendations, which were not supported by strong evidence, may be doing more harm than good.

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https://www.nytimes.com/2017/01/16/upshot/how-to-prevent-whiplash-from-ever-changing-medical-advice.html?

Friday, January 20, 2017

Donors and Drug Makers Offer $500 Million to Control Global Epidemics - The New York Times

Stung by the lack of vaccines to fight the West African Ebola epidemic, a group of prominent donors announced Wednesday that they had raised almost $500 million for a new partnership to stop epidemics before they spiral out of control.

The partnership, the Coalition for Epidemic Preparedness Innovations, will initially develop and stockpile vaccines against three known viral threats, and also push the development of technology to brew large amounts of vaccine quickly when new threats, like the Zika virus, arise.

With enough money and scientific progress, the strategy could bring a drastic change in the way the world tackles pandemics.

Now the global response often resembles a fire department racing from blaze to blaze. The coalition wants something more like a military campaign, with stores of ammunition and different weapons systems ready to be deployed as soon as a threat emerges.

In theory, health officials could even act pre-emptively — inoculating a population against a dangerous new flu or coronavirus circulating in animals before it infects many people, for example.

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https://www.nytimes.com/2017/01/18/health/partnership-epidemic-preparedness.html

How to Meditate - Well Guides - The New York Times

Meditation is a simple practice available to all, which can reduce stress, increase calmness and clarity and promote happiness. Learning how to meditate is straightforward, and the benefits can come quickly. Here, we offer basic tips to get you started on a path toward greater equanimity, acceptance and joy. Take a deep breath, and get ready to relax.

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http://www.nytimes.com/well/guides/how-to-meditate?

Wednesday, January 18, 2017

Getting Older, Sleeping Less - The New York Times

Insomnia is like a thief in the night, robbing millions — especially those older than 60 — of much-needed restorative sleep. As the king laments in Shakespeare's "Henry IV, Part 2": O sleep, O gentle sleep, Nature's soft nurse, how have I frightened thee. That thou no more will weigh my eyelids down, And steep my senses in forgetfulness?

The causes of insomnia are many, and they increase in number and severity as people age. Yet the problem is often overlooked during routine checkups, which not only diminishes the quality of an older person's life but may also cause or aggravate physical and emotional disorders, including symptoms of cognitive loss.

Most everyone experiences episodic insomnia, a night during which the body seems to have forgotten how to sleep a requisite number of hours, if at all. As distressing as that may seem at the time, it pales in comparison to the effects on people for whom insomnia — difficulty falling asleep, staying asleep or awakening much too early — is a nightly affair.

A survey done in 1995 by researchers at the National Institute on Aging among more than 9,000 people aged 65 and older living in three communities revealed that 42 percent reported difficulty with both falling asleep and staying asleep. The numbers affected are likely to be much larger now that millions spend their pre-sleep hours looking at electronic screens that can disrupt the body's biological rhythms.

Insomnia, Dr. Alon Y. Avidan says, "is a symptom, not a diagnosis" that can be a clue to an underlying and often treatable health problem and, when it persists, should be taken seriously. Dr. Avidan is director of the sleep clinic at the University of California, Los Angeles, David Geffen School of Medicine.

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https://www.nytimes.com/2017/01/16/well/live/getting-older-sleeping-less.html?