Monday, July 17, 2017
"Often he started out with a question: 'So David, what percentage of GDP is healthcare these days?'" Asch recalled during an Alumni Weekend panel discussion marking the LDI's 50th anniversary. "And I'd say, 'Well I don't know, Leonard, 15 percent.' At which point he would go ballistic, and say, 'What are you talking about! When I started the Leonard Davis Institute, it was 6 percent! What the heck are you guys doing over there?!'"
At which point Asch would "very carefully" reply: "But had you not started the Leonard Davis Institute, we'd be at 25 percent!"
Asch, who is currently the John Morgan Professor of Medicine and Medical Ethics and Health Policy and a professor of healthcare management, was one of three former LDI executive directors on a panel moderated by its current chief, Dan Polsky Gr'96. They explored how the business of medical care has changed in the last half-century, and some of the challenges and opportunities ahead. (Video is available at tinyurl.com/y8utkjwl.)
Though the hefty fraction of gross domestic product that goes to healthcare looms large in such discussions, Mark Pauly, the Bendheim Professor of Health Care Management at Wharton, dismissed it as "the world's most pernicious measure of a country's efficiency of its healthcare system."
Thursday, July 13, 2017
Using data from a large Danish health study, researchers have found an association between chocolate consumption and a lowered risk for atrial fibrillation, the irregular heartbeat that can lead to stroke, heart failure and other serious problems. The study is in Heart.
Scientists tracked diet and health in 55,502 men and women ages 50 to 64. They used a well-validated 192-item food-frequency questionnaire to determine chocolate consumption. During an average 14 years of follow-up, there were 3,346 diagnosed cases of atrial fibrillation.
These comments aren't part of a dating site. Rather, they come from physicians' online profiles that prospective patients view when they are looking for a new doctor.
There are good reasons doctors might strive to lead by example. "I practice what I preach by living healthy every day," declares one physician on Kaiser Permanente's online doctor search portal. Patients may trust or be inspired by such a doctor, the thinking goes. And if health care professionals fail to follow their own advice, they may be accused of hypocrisy.
But for some patients, particularly those battling weight issues, a doctor's declarations of personal fitness may not have the intended effect of attracting new patients. Instead, rather than inspiring them, it can drive them away.
Saturday, July 8, 2017
Attend the tale of William Callahan.
He nearly fainted last spring after walking down the block to visit a neighbor in his New Jersey suburb. At 82, he had a long history of cardiac problems and was several years into Alzheimer's disease, but remained mobile and sociable.
He quickly revived, but the neighbor called 911. His daughter, Dr. Eileen Callahan, a geriatrician at Mount Sinai Hospital in New York, met her dad at the local emergency room.
"He was fine, sitting up and chatting," she found. "CT scan, blood work, heart rate, vital signs — all totally normal." He'd probably gotten a bit dehydrated, she figured, and he insisted on going home.
Dr. Callahan promised the E.R. doctor that she'd stay with her father overnight to be sure he was O.K. No dice.
"The doc said no, he really should stay overnight to be monitored and to see the cardiologist in the morning and get cleared."
In hospitals, she knew, her father was prone to sleeplessness and delirium. In unfamiliar surroundings, he might fall.
Still, "I succumbed." The hospital provided an aide to stay with Mr. Callahan overnight until another daughter arrived in the morning.
It did not go well. Mr. Callahan paced for hours, peeled off the heart monitors and grew increasingly confused and agitated. By the next afternoon, despite family calls and complaints, the cardiologist had not materialized and the hospital still wouldn't discharge Mr. Callahan.
Dr. Callahan's sister was growing frantic. "I said, 'Maureen, just do it,'" Dr. Callahan said. "Sign him out."
Her sister signed the A.M.A. form that hospitals typically demand before releasing patients against physician recommendations, acknowledging that patients understand and assume the risks, medically and legally.
Mr. Callahan went home and went to sleep, but his physician daughter remains livid.
"He should have been discharged right from the E.R.," she said. "This was cookbook medicine, done without thinking. It was very adversarial."
Such events happen more commonly than one might think. Though A.M.A. discharges occur far more frequently in younger patients, a recent study in The Journal of the American Geriatrics Society analyzed a large national sample from 2013 and found that 50,650 hospitalizations of patients over age 65 ended with A.M.A. discharges.
Saturday, July 1, 2017
Kinsell runs Clay County Medical Center, a facility with four exam rooms built out of a former Tastee-Freez. It's a private practice, but she is a full-time volunteer. There is a receptionist and two other full-time staff members; they see "around thirty to thirty-five patients a day," Kinsell said. Monty Veazey, the president of the Georgia Alliance of Community Hospitals, told me that "Kinsellcare" is the only health care that's had a meaningful and positive effect here. "She's going bankrupt treating everyone that comes in," he said. "Most have no money, no Internet access, no other basic care. Many don't have insurance. How much longer can she do that? I don't know. But she's their only hope."
On Tuesday, shortly before Senator Mitch McConnell announced a delay in the vote for the Senate Republicans' health-care reform bill, Kinsell spoke by phone about the effects of Obamacare, the prospect of Trumpcare, and the plight of sick people in southwest Georgia. Her account has been edited and condensed.
Wednesday, June 28, 2017
Mr. Erickson, worried, began investigating the options: whether to have his prostate removed, or perhaps to have radiation treatment. But a few days later, the doctor called again.
As it turned out, Mr. Erickson did not have cancer. The lab had mixed up his biopsy with someone else's.
"Obviously, I felt great for me but sad for that other gentleman," Mr. Erickson said.
The other gentleman was Timothy Karman, 65, a retired teacher in Grandy, N.C. At first, of course, he had been told he was cancer-free. The phone rang again a few days later with news of the mix-up and a diagnosis of cancer.
Ultimately he had his prostate removed. "I said, 'Mistakes happen,'" Mr. Karman said.
They may be happening more often than doctors realize. There is no comprehensive data on how often pathology labs mix up cancer biopsy samples, but a few preliminary studies suggest that it may happen to thousands of patients each year.
Thousands of miles from their pediatrician, and unable to find one quickly in L.A., Mintzer didn't know what to do. Then a family friend suggested an app called Heal that could use new technology to drum up a relic from the past: doctors who make house calls.
Once upon a time, a visit with the doctor meant welcoming one into your home, rather than heading out to a clinic or hospital waiting room. But around the 1960s, the house call fell out of favor as doctors' offices sought to become more efficient, and the doctor-patient relationship changed from "Marcus Welby" to something less personal with the rise of hospitals and modern insurance plans.
Now, however, the trend for on-demand service in the age of Uber could revive the house call. Services such as Heal — which launched in the District in June after operating in California since 2014 — and competitors such as Pager and Curbside Care are expanding their footprints across the country. And research suggests that house calls can provide a better standard of care for some patients than a hospital visit. A University of Southern California study of a house call program in the state found that hospitalization rates dropped for patients who were enrolled in the program for six months: Of 1,000 patients, 96 were hospitalized after being enrolled, down from 159 before the program.
Costs can also drop, since patients can avoid hospital visits. A 2013 Brookings Institution report said a Department of Veterans Affairs analysis of its home-based care program found a "25 percent reduction in hospital admissions, a 36 percent reduction in hospital days, and a 13 percent reduction in combined costs."
Friday, June 23, 2017
Now, a growing group of health-care providers are betting that technology—from web-based courses to mobile apps that send prompts via text—can help bridge that gap.
It might seem surprising, since therapy, more than many other kinds of medicine, is so focused on the relationship between patient and therapist. But research, including a meta-analysis of studiesinvolving internet-based cognitive behavioral therapy, or CBT, suggests that digital therapies augmented by coaches who are available by text or phone can be as effective as evidence-based traditional therapy in treating some people with depression.
Thursday, June 22, 2017
Alcides Moreno and his brother Edgar were window washers in New York City. The two Ecuadorian immigrants worked for City Wide Window Cleaning, suspended high above the congested streets, dragging wet squeegees across the acres of glass that make up the skyline of Manhattan.
On 7 December 2007, the brothers took an elevator to the roof of Solow Tower, a 47-storey apartment building on the Upper East Side. They stepped onto the 16-foot-long, three-foot-wide aluminium scaffolding designed to slowly lower them down the black glass of the building.
But the anchors holding the 1,250-pound platform instead gave way, plunging it and them 472 feet to the alley below. The fall lasted six seconds.
Edgar, at 30 the younger brother, tumbled off the scaffolding, hit the top of a wooden fence and was killed instantly. Part of his body was later discovered under the tangle of crushed aluminium in the alley next to the building.
But rescuers found Alcides alive, sitting up amid the wreckage, breathing and conscious when paramedics performed a "scoop and run" – a tactic used when a hospital is near and injuries so severe that any field treatment isn't worth the time required to do it. Alcides was rushed to NewYork-Presbyterian Hospital/Weill Cornell Medical Center, four blocks away.
Falls are one of life's great overlooked perils. We fear terror attacks, shark bites, Ebola outbreaks and other minutely remote dangers, yet over 420,000 people die worldwide each year after falling. Falls are the second leading cause of death by injury, after car accidents. In the United States, falls cause 32,000 fatalities a year (more than four times the number caused by drowning or fires combined). Nearly three times as many people die in the US after falling as are murdered by firearms.
Falls are even more significant as a cause of injury. More patients go to emergency rooms in the US after falling than from any other form of mishap, according to the Centers for Disease Control and Prevention (CDC), nearly triple the number injured by car accidents. The cost is enormous. As well as taking up more than a third of ER budgets, fall-related injuries often lead to expensive personal injury claims. In one case in an Irish supermarket, a woman was awarded 1.4 million euros compensation when she slipped on grapes inside the store.
It makes sense that falls dwarf most other hazards. To be shot or get in a car accident, you first need to be in the vicinity of a gun or a car. But falls can happen anywhere at any time to anyone.
Spectacular falls from great heights outdoors like the plunge of the Moreno brothers are extremely rare. The most dangerous spots for falls are not rooftops or cliffs, but the low-level, interior settings of everyday life: shower stalls, supermarket aisles and stairways. Despite illusions otherwise, we have become an overwhelmingly indoor species: Americans spend less than 7 per cent of the day outside but 87 per cent inside buildings (the other 6 per cent is spent sitting in cars and other vehicles). Any fall, even a tumble out of bed, can change life profoundly, taking someone from robust health to grave disability in less than one second.
On the first weekend of each month, when public benefits like disability get paid out, the local fire chief estimates the city sees about half a million dollars in drug sales. The area is poor — 29 percent of county residents live in poverty, and, amid the retreat of the coal industry, the unemployment rate was 12.2 percent when I visited last August— and those selling pills are not always who you'd expect.
"Elderly folks who depend on blood pressure medications, who can't afford them, they're selling their [painkillers] to get money to buy their blood pressure drug," Williamson fire chief Joey Carey told me when I visited Williamson. "The opioids are still $5 or $10 copays. They can turn around and sell those pills for $5 or $10 each."
Opioids are everywhere in Williamson, because chronic pain is everywhere in Williamson.
Dino Beckett opened a primary care clinic there in March 2014, on the same street with the hotel and the gas station. A native of the area with a close-cropped beard and a slight Southern drawl, Beckett sees the pain of Williamson day in and day out.
He sees older women who suffer from compression fractures up and down their spines, the result of osteoporosis. He sees men who mined coal for decades, who now experience persistent, piercing low back pain. "We have a population that works in coal mines or mine-supporting industries doing lots of manual labor, lifting equipment," he says. "Doing that for 10 to 12 hours a day for 15 to 20 years, or more, is a bad deal."
Beckett sees more pain than doctors who practice elsewhere. Nationally, 10.1 percent of Americans rate their health as "fair" or "poor." In Mingo County, where Williamson is, that figure stands at 38.9 percent.
Williamson has some of West Virginia's highest rates of obesity, disability, and arthritis — and that is in a state that already ranks among the worst in those categories compared with the rest of the nation. An adult in Williamson has twice the chance of dying from an injury as the average American.
This is why the opioid crisis is so hard to handle, here and in so many communities: The underlying drugs are often being prescribed for real reasons.
Saturday, June 17, 2017
Krall recalls with frightening clarity the words of a critical care specialist. "She put her hand on my knee and said, 'Your husband is very, very sick. You need to be prepared for him not to make it through the day.' "
How, Krall remembers wondering, did her fit and healthy husband of 10 years get so sick so fast? The night before, Krall had driven him to the same ER, sent by an urgent care center for a closer assessment of his fever and malaise. The couple had spent about five hours there but left before seeing a doctor because the ER was so swamped and David's condition seemed unchanged. They figured they'd have better luck in the morning.
That decision, Becky Krall says, was among a cascade of serious missteps that left David, an industrial engineer, battling a catastrophic illness that kills between 60 and 80 percent of its victims. Doctors at the University of Kentucky Albert B. Chandler Hospital in Lexington managed to save David's life, but he was left with profound, permanent hearing loss. Several of his toes had to be partially amputated.
"I felt extremely guilty for a long time," said Becky, an associate professor of STEM education at the university who continues to struggle with the emotional aftermath of the ordeal. "I have lots of information now. But I didn't know any of it then." She hopes her husband's case, which helped spur changes in the emergency department, will serve as a cautionary tale.
Wednesday, June 7, 2017
In the weeks leading up to this moment I have set my affairs in order. Made a will, written letters for the children, waxed my legs. Said my farewells at the airport and boarded the flight from Melbourne with my mother. It is July 2010.
Today's specialist anaesthetists train for 12 to 13 years. The death rate from general anaesthesia has dropped from about one in 20,000 in the 1970s to one or two in 200,000 this century. Photo: Fuse
Some months before this, after decades of resistance, I gave in at last to the inevitability of major surgery. My capitulation was sudden and took place in a different wing of this same hospital, where I had come to consult a respected spinal surgeon. The surgeon had a quiet, almost diffident, manner and a moustache that put me in mind of a doleful Groucho. I am not sure what made my mind up, the moustache or the way his finger traced my wayward spine quite gently on the X-ray before him. But just as he began to tell me that I would not be a candidate for the non-invasive surgery we had been talking about, I realised with a small thud of certainty that, not only was I going to have this surgery – invasive though it might be – I was going to come back to Brisbane and he was going to do it.
In the aftermath of my decision, I was buoyed in a backwash of something like relief; a giving up of hope and its attendant efforts, a yielding to forces beyond my will. But when I lay awake at night, disquiet rose around me. It was not just the surgery that was worrying me – the cutting and drilling, the inevitable risk – it was that in some blank corner of myself I felt that I would not wake up afterwards. I knew logically, and during the day could convince myself, that for an otherwise healthy 48-year-old, the likelihood of calamity was low. But at night, in my bed in Melbourne, the conviction multiplied that even if everything went according to plan, the me who woke after surgery would not be the same in some essential way as the me who had been wheeled into the operating theatre beforehand.
I developed a dread of the moment when the anaesthetic drugs would take effect and I would cease to be. I pictured myself in a stark, poorly lit room with two doors, one in, one out, neither of which I could open from within. Otherwise the room was empty. No windows, no furniture. In this darkness – which I now realise had the same sinuous quality as the shadows beneath my childhood bed – I would be trapped alone. Perhaps forever. At least until such time as someone else chose to release, not me but some other version of me who would slip soundlessly into the life that had once been mine.
Shortly after making my decision, I rang a separate Brisbane medical practice. I asked to speak to the doctor whose job it would be to render me unconscious and keep me that way during the long operation. Halting, almost apologetic, I explained to the receptionist that I had spent some years researching the process known as anaesthesia, and that I was now rather nervous about what was going to happen to me. "I think I know too much," I said.
"Oh dear," they said. "That's not good."
Tuesday, June 6, 2017
The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50.
Although the data is preliminary, the Times's best estimate is that deaths rose 19 percent over the 52,404 recorded in 2015. And all evidence suggests the problem has continued to worsen in 2017.
Because drug deaths take a long time to certify, the Centers for DiseaseControl and Prevention will not be able to calculate final numbers until December. The Times compiled estimates for 2016 from hundreds of state health departments and county coroners and medical examiners. Together they represent data from states and counties that accounted for 76 percent of overdose deaths in 2015. They are a first look at the extent of the drug overdose epidemic last year, a detailed accounting of a modern plague.
The initial data points to large increases in drug overdose deaths in states along the East Coast, particularly Maryland, Florida, Pennsylvania and Maine. In Ohio, which filed a lawsuit last week accusing five drug companies of abetting the opioid epidemic, we estimate overdose deaths increased by more than 25 percent in 2016.
"Heroin is the devil's drug, man. It is," Cliff Parker said, sitting on a bench in Grace Park in Akron. Mr. Parker, 24, graduated from high school not too far from here, in nearby Copley, where he was a multisport athlete. In his senior year, he was a varsity wrestler and earned a scholarship to the University of Akron. Like his friends and teammates, he started using prescription painkillers at parties. It was fun, he said. By the time it stopped being fun, it was too late. Pills soon turned to heroin, and his life began slipping away from him.
Monday, June 5, 2017
"They're taking him to a local hospital," Mr. Battelle's wife, Michelle, told Dr. Shlain as the boy rode in an ambulance to a nearby emergency room in Marin County. "No, they're not," Dr. Shlain instructed them. "You don't want that leg set by an E.R. doc at a local medical center. You want it set by the head of orthopedics at a hospital in the city."
Within minutes, the ambulance was on the Golden Gate Bridge, bound for California Pacific Medical Center, one of San Francisco's top hospitals. Dr. Shlain was there to meet them when they arrived, and the boy was seen almost immediately by an orthopedist with decades of experience.
For Mr. Battelle, a veteran media entrepreneur, the experience convinced him that the annual fee he pays to have Dr. Shlain on call is worth it, despite his guilt over what he admits is very special treatment.
"I feel badly that I have the means to jump the line," he said. "But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?"
Increasingly, it is a question being asked in hospitals and doctor's offices, especially in wealthier enclaves in places like Los Angeles, Seattle, San Francisco and New York. And just as a virtual velvet rope has risen between the wealthiest Americans and everyone else on airplanes, cruise ships and amusement parks, widening inequality is also transforming how health care is delivered.
Monday, May 29, 2017
Then his son-in-law discovered online that — for a price — companies were willing to help critically ill Chinese people seek treatment abroad. Soon Mr. Guo was at the Dana-Farber Cancer Institute in Boston, receiving a new immunotherapy drug, Keytruda, which is not available in China. In April, nearly four months later, his tumor has shrunk and his weight has gone up.
"When I arrived, I could feel how large the gap was," said Mr. Guo of the difference in care.
The cost: about $220,000 — all paid out of pocket.
China's nearly 1.4 billion people depend on a strained and struggling health care system that belies the country's rise as an increasingly wealthy global power. But more and more, the rich are finding a way out.
Western hospitals and a new group of well-connected companies are reaching for well-heeled Chinese patients who need lifesaving treatments unavailable at home. The trend is a twist on the perception of medical tourism as a way to save money, often on noncritical procedures like dental work and face-lifts. For these customers, getting out of China is a matter of life or death.
Wednesday, May 24, 2017
It is the first time the agency has approved a cancer treatment based solely on a genetic biomarker.
"Until now, the FDA has approved cancer treatments based on where in the body the cancer started - for example, lung or breast cancers," said Richard Pazdur, head of oncology products for the FDA's Center for Drug Evaluation and Research. "We have now approved a drug based on a tumor's biomarker without regard to the tumor's original location."
Friday, May 19, 2017
Monday, May 15, 2017
Inside, reclining dental chairs were arrayed in neat rows across the arena's vast floor. Days later, the venue would host Disney on Ice. On this Friday morning, dentists arriving from five states were getting ready to fix the teeth of the first 1,000 people in line.
Matello was No. 503. The small-business owner who supports President Trump had a cracked molar, no dental insurance and a nagging soreness that had forced her to chew on the right side of her mouth for years.
"It's always bothering me," she said. And although her toothache wasn't why she voted for Trump, it was a constant reminder of one reason she did: the feeling that she had been abandoned, left struggling to meet basic needs in a country full of fantastically rich people.
Saturday, May 13, 2017
NFL players fight pain with medical marijuana: ‘Managing it with pills was slowly killing me’ - The Washington Post
"Every day, I wake up in pain, from my ankles to my neck," said Ebenezer Ekuban, 40, who played defensive end for nine NFL seasons. "It's part of the territory. I know what I signed up for."
Retirement is a daily exercise in managing pain, which is what brought the men to the unmarked CW Hemp offices on a recent Friday for a tour and a firsthand lesson on the potential benefits of the marijuana plant. As the country's discussion on the drug broadens, state laws change and public perception shifts, there's a movement in football circles to change the way marijuana is viewed and regulated within the NFL, which still includes cannabis on its list of banned substances.
For decades, football players have treated pain with postgame beers, over-the-counter anti-inflammatories and powerful prescription painkillers. The sport's overreliance on drugs for pain management is the subject of a federal lawsuit and has sparked an investigation by the Drug Enforcement Administration. Retired NFL players use opioids at four times the rate of the general population, according to one study, and marijuana advocates say there's a safer, healthier alternative available.
More than a million patients flock to this website. Drug companies are in hot pursuit. - The Washington Post
During the thick of the dot-com mania 20 years ago, Loew and some friends built an online publishing company called Worldweb.net. It had 150 employees and $15 million in revenue but, like many start-ups from the era, it never posted a profit.
Worldweb.net created website software in the Internet's early days for Elle, Car and Driver, the ill-fated George magazine and other publications.
"I was going to be rich beyond my wildest dreams," Loew said, recounting what his bankers had told him at the time.
Ten days away from the company's initial public offering, the go-go, dot-com age imploded and Loew's path to riches vaporized. The company, which bankers predicted could eventually be worth $1 billion, was sold off for a small fraction of that.
"Investors got their money back, but nobody got rich," Loew said.
The 46-year-old entrepreneur appears to be on to something with a better future this time around. His nine-year-old medical-website business, known as Inspire, has 1.1 million members, 33 employees and nearly $10 million in revenue, and it will turn its first profit this year.
Inspire essentially is a giant, online discussion community where people can use real or assumed names to share experiences, information and advice about their various medical conditions.
"Join many others who understand what you're going through and are making important decisions about their health," says the greeting on Inspire's website.
Loew and his company are attached to the surge of patient assertiveness, with more people questioning their health care and taking more of the responsibility out of the hands of professionals.
"Patient centricity really matters," said Loew, who owns a big chunk of the company, along with investors and employees.
Membership is free and increasing by 1,000 per day. Seventy-eight percent of members are women.
"Women are the chief medical officers of the home," Loew said. "Many of our female members represent a member of the family — husbands, fathers, fathers-in-law, siblings, children. So sometimes a woman would join and say, 'I'm a parent of a 'preemie,' a child of someone with a medical condition, a sister of someone else.' "
The company has a team of community moderators to make sure members get along on chats.
Revenue comes from advertising and from companies looking for hard-to-find patients to participate in clinical drug trials or market research.
Many of the research contracts come from pharmaceutical giants to carry out drug trials or marketing studies on everything from psoriasis (one of the most common ailments among members) to cancer. The contracts can pay anywhere from $50,000 to $750,000, Loew said. It usually amounts to about $1,000 per patient for market research and up to $10,000 for clinical trials.
Inspire's clients include the top 10 pharmaceutical companies in the world, as well as most of the top 25.
"It matters to these companies what patients think and want and how they make decisions," Loew said.
Thursday, May 11, 2017
I'd just arrived for the night shift in the I.C.U. when her breathing quickened. I didn't know much about the patient, and the little I did know wasn't good: She had cancer. Her lungs were filled with fluid. As her breathing deteriorated and her oxygen levels plunged, I searched the chart for her wishes in an emergency. Nothing.
I explained to her how rapidly her condition had worsened and asked if she'd discussed intubation and mechanical ventilation. She shook her head; she didn't think it would get so bad so fast. Together we called her husband, who had just left for the evening, but there was no answer.
"If we do it, when will I…" she paused. "When will I wake up?"
I hesitated. It was as likely as not that she wouldn't. I explained that we never leave patients intubated longer than necessary, but when people were as sick as she was it was impossible to know when — or even if — they would be extubated.
"O.K.," she said. "Do it."
There are, no doubt, differing opinions on what constitutes a good death. But this, inarguably, was not one.
Tuesday, May 9, 2017
The National Children's Hospital study, published in the The Journal of Pediatrics, found that over a 21-year-period from 1990 to 2010, 263,000 children — ages 18 and younger — were treated in emergency rooms for cotton-tip related ear injuries. That works out to 12,500 annual visits, or 34 visits every day.
According to the report — compiled using data from the Consumer Product Safety Commission's National Electronic Injury Surveillance System — the majority of these injuries (about 73% ) occurred as a result of using cotton tip applicators to clean the ears.
Another 10% of injuries occurred when children were playing with the applicators, and 9% when they fell with he cotton tip applicator in their ears.
"The two biggest misconceptions I hear as an otolaryngologist are that the ear canals need to be cleaned in the home setting, and that cotton tip applicators should be used to clean them; both of those are incorrect," co-author of the study, Dr. Kris Jatana said in a statement, noting that ear canals are typically self-cleaning.
In the face of this epidemic, Cambridge could become the first city to take a step that until recently might have seemed unthinkable: It might place lockboxes on street corners to give the public easy access to Narcan, the brand name for naloxone, a medication that can rapidly revive people who have overdosed.
The idea is in its earliest stages, and any concrete plan for the city, and residents, to consider seems at least a year away. But several days ago, the city police and area doctors who support the boxes conducted an experiment here, asking people who walked by if they would help a stranger who had overdosed.
The officials placed a dummy on the ground on a brick plaza along busy Massachusetts Avenue in Central Square, between two of this city's most drug-infested areas. Passers-by were asked to pretend they had just found an unconscious person. They were handed a cellphone, which was connected to someone acting as an emergency dispatcher.
The dispatcher directed them to a nearby lockbox, gave them a code to open it and then explained how to administer Narcan, a nasal spray. Doctors say Narcan is safe; if given to someone who has not overdosed, it does no harm. It is not addictive and cannot be abused.
"We want to see if regular people walking down the street would be willing to help someone who appeared to be overdosing," said Dr. Scott Goldberg, director of emergency services at Brigham and Women's Hospital, who oversaw the experiment. "And if they were willing to help, would they be able to help?"
Friday, May 5, 2017
The synthetic biologists from Imperial College London have re-engineered yeast cells to manufacture the nonribosomal peptide antibiotic penicillin. In laboratory experiments, they were able to demonstrate that this yeast had antibacterial properties against streptococcus bacteria.
The authors of the study, which is published today in the journal Nature Communications, say their new method demonstrates the effectiveness of using this kind of synthetic biology as a route for discovering new antibiotics. This could open up possibilities for using re-engineered yeast cells to develop new forms of antibiotics and anti-inflammatory drugs from the nonribosomal peptide family.
Nonribosomal peptides are normally produced by bacteria and fungi, forming the basis of most antibiotics today. Pharmaceutical companies have long experimented with nonribosomal peptides to make conventional antibiotics. The rise of antimicrobial resistance means there is a need to use genetic engineering techniques to find a new range of antibiotics from bacteria and fungi. However, genetically engineering the more exotic fungi and bacteria- the ones likely to have antibacterial properties—is challenging because scientists don't have the right tools and they are difficult to grow in a lab environment, requiring special conditions.
Baker's yeast on the other hand is easy to genetically engineer. Scientists can simply insert DNA from bacteria and fungi into yeast to carry out experiments, offering a viable new host for antibiotic production research. The rise of synthetic biology methods for yeast will allow researchers to make and test many new gene combinations that could produce a whole new range of new antibiotics.
Tuesday, May 2, 2017
Imagine you were plagued by severe food allergies, rheumatoid arthritis, attention deficit hyperactivity disorder or intractable epilepsy. Would you be willing or desperate or brave enough to step outside the realm of established medicine and seek help from an unconventional therapist — even someone with no medical or scientific training?
What if you heard about others in a similar situation who had tried a purported remedy that appeared to work, or the method seemed to make biological sense?
In her new book, "The Other Side of Impossible," Susannah Meadows, a Brooklyn-based former senior writer for Newsweek, has compiled compelling stories about people who faced and ultimately surmounted daunting medical challenges. The book focuses on several families, including her own, who felt they had no choice but to wade into the world of unproven therapies.
Thursday, April 27, 2017
But while those games are entertainment designed to grab players by their adrenal glands, Dr. Popović's latest creation asks players to trace lines over fuzzy images with a computer mouse. It has a slow pace with dreamy music that sounds like the ambient soundtrack inside a New Age bookstore.
The point? To advance neuroscience.
Since November, thousands of people have played the game, "Mozak," which uses common tricks of the medium — points, leveling up and leader boards that publicly rank the performance of players — to crowdsource the creation of three-dimensional models of neurons.
The Center for Game Science, a group at the University of Washington that Dr. Popović oversees, developed the game in collaboration with the Allen Institute for Brain Science, a nonprofit research organization founded by Paul Allen, the billionaire co-founder of Microsoft, that is seeking a better understanding of the brain. Dr. Popović had previously received wide attention in the scientific community for a puzzle game called "Foldit," released nearly a decade ago, that harnesses the skills of players to solve riddles about the structure of proteins.
The Winner Of The $1 Million TED Prize Is Bringing Health Care To The World’s Most Remote Communities - Fast Company
The winner of this year's $1 million TED Prize–Rajesh Panjabi, the founder of a nonprofit called Last Mile Health–has a solution for poor, remote communities that can't afford to hire doctors and nurses. Instead of recruiting trained medical professionals, the organization hires local community members, some of whom may have only a middle-school education. Then it gives them the training needed to screen and treat common illnesses like malaria, providing local jobs as it fills the health care gap.
Sunday, April 23, 2017
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.
Saturday, April 22, 2017
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.
Friday, April 21, 2017
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.
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.
Wednesday, April 19, 2017
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."
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.
Google’s Massive Health Study Seeks 10,000 Volunteers to Give Up Their Medical Secrets - MIT Technology Review
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."
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.
Saturday, April 15, 2017
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.
Friday, April 14, 2017
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.
Monday, April 10, 2017
"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.
Saturday, April 8, 2017
Diabetes Epidemic In Mexico Is Fueled By Deep-Fried Tamales And Many Gallons Of Soda : Goats and Soda : NPR
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.
Tuesday, April 4, 2017
Sunday, April 2, 2017
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."
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.
Friday, March 31, 2017
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.
Thursday, March 30, 2017
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.
Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much. - The New York Times
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.
Wednesday, March 29, 2017
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.
Tuesday, March 28, 2017
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.