Tuesday, September 26, 2017

The Latest Jaw-Dropping Numbers From the Opioid Crisis – Mother Jones

About 64,000 Americans died from drug overdoses last year—a staggering 21 percent increase from the 52,404 in 2015—according to the first government estimate of drug deaths in 2016. Overdoses now kill more Americans than HIV did at its peak in 1995, and far more than guns or cars do today.

The numbers, released by the Centers for Disease Control and Prevention, are provisional and will be updated monthly, according to the agency.

Fueling the rise in deaths is fentanyl, a synthetic opioid up to 100 times more potent than morphine, and fentanyl analogs, or slight tweaks on the fentanyl molecule. This has not always been the case: As the chart below shows, the drivers of the opioid crisis have changed from prescription painkillers to heroin, and then to fentanyl.

As Dan Ciccarone, a professor at the University of California-San Francisco School of Medicine, recently wrote in the International Journal of Drug Policy:

This is a triple epidemic with rising waves of deaths due to separate types of opioids each building on top of the prior wave. The first wave of prescription opioid mortality began in the 1990s. The second wave, due to heroin, began around 2010 with heroin-related overdose deaths tripling since then. Now synthetic opioid-related overdoses, including those due to illicitly manufactured fentanyl and fentanyl analogues, are causing the third wave with these overdose deaths doubling between 2013 and 2014 .

The epidemic is straining the capacity of morgues, emergency services, hospitals, and foster care systems. Largely because of prevalent drug use and overdose, the number of children in foster care nationwide increased by 30,000 between 2012 and 2015.

More …


The Biomechatronic Man | Outside Online

I can see him in his glass-fronted Cambridge office from the foosball table in the light-filled central atrium. He's standing there talking to a visitor and seems to be finishing up. This entire side of the third floor in MIT's new Media Labbuilding is partitioned with glass, and professor Hugh Herr and his colleagues and whatever madness they're up to in their offices and the open, gadget-filled, lower-floor lab are on display. Several people, myself included, are peering down, hoping to see a bit of magic.

Months ago, when I e-mailed Herr to propose writing an article about him, I told him about my rare bone cancer and resulting partial paralysis below the waist as a way to explain my interest in his work. Though I didn't tell him this, I also harbored a secret wish that he could help me. People write to Herr, a 52-year-old engineer and biophysicist, daily about his inspiring example. They've heard him promise an end to disability. They have conditions that medicine can't fix and futures they can't stand to consider. They're wishing for his intervention, wanting of hope. Crossing his threshold, I'm the lucky one. I'm here.

Herr welcomes me into his office, a clean, well-ordered space. There's a round glass table with a laptop on it, a handful of hard office chairs, and a pair of prosthetic legs Herr designed that are arranged like statuary behind us, one in either corner. Above us on a wall looms a large mounted photograph of another pair of prosthetics. These are hand-carved from solid ash, with vines and flowers and six-inch heels. The real-life legs were famously worn by a friend of Herr's, the amputee track-and-field athlete and actress Aimee Mullins.

I have hobbled into Herr's office with a dented $20 stock metal cane on one side and a foot-lifting Blue Rocker brace on the other. (The dent is from my recently firing the cane at the wall.) I had imagined Herr noticing the cane and asking more about my story to see how he could fix me, like he has fixed so many others. The moment I realize that the meeting I'd imagined isn't the meeting we're going to have—I'm here as a reporter, not a friend or patient, after all—I start to stammer. Herr deftly resets the conversation by suggesting we look at his computer.

On it are the PowerPoint slides of his next big project, a breathtaking $100 million, five-year proposal focused on paralysis, depression, amputation, epilepsy, and Parkinson's disease. Herr is still trying to raise the money, and the work will be funneled through his new brainchild, MIT's Center for Extreme Bionics, a team of faculty and researchers assembled in 2014 that he codirects. After exploring various interventions for each condition, Herr and his colleagues will apply to the FDA to conduct human trials. One to-be-explored intervention in the brain might, with the right molecular knobs turned, augment empathy. "If we increase human empathy by 30 percent, would we still have war?" Herr asks. "We may not."

As he continues with the presentation he's been giving to technologists, engineers, health researchers, and potential donors—last December alone, he keynoted in Dubai, Istanbul, and Las Vegas—each revolutionary intervention he mentions yields a boyish grin and a look that affirms: Yes, you heard that right. In a talk I hear him give a few weeks ­later, he'll dare to characterize incurable paralysis as "low-hanging fruit." In his outspoken willingness to fix everything, even things that some argue should be left alone, he knows how he sounds. "If half the audience is frightened and the other half is intrigued, I know I've done a good job," he says.

More ...


The Post-Antibiotic Era Is Here. Now What? | WIRED

When Alexander Fleming came back from a Scottish vacation in the summer of 1928 to find his London lab bench contaminated with a mold called Penicillium notatum, he kicked off a new age of scientific sovereignty over nature. Since then, the antibiotics he discovered and the many more he inspired have saved millions of lives and spared immeasurable suffering around the globe. But from the moment it started, scientists knew the age of antibiotics came stamped with an expiration date. They just didn't know when it was.

Bacterial resistance to antibiotics is both natural and inevitable. By the luck of the draw, a few bacteria will have genes that protect them from drugs, and they'll pass those genes around—not just to their progeny, but sometimes to their neighbors too. Now, computational epidemiologists are finally getting the data and processing to model that phenomenon. But no one's using these tools to predict the end of the antibiotic era—because it's already here. Instead, they're focusing their efforts on understanding how soon resistant bacteria could be in the majority, and what, if anything, doctors can do to stop them.

In 2013, then-director of the Centers for Disease Control and Prevention Tom Frieden told reporters, "If we're not careful, we will soon be in a post-antibiotic era." Today, just four years later, the agency says we've arrived. "We say that because pan-resistant bacteria are now here" says Jean Patel, who leads the CDC's Antibiotic Strategy & Coordination Unit. "Folks are dying simply because there is no antibiotic available to treat their infection, infections that not too long ago were easily treatable."

Last August, a woman in her 70s checked into a hospital in Reno, Nevada with a bacterial infection in her hip. The bug belonged to a class of particularly tenacious microbes known as carpabenem-resistant Enterobacteriaceae, or CREs. Except in addition to carpabenem, this bug was also resistant to tetracycline, and colistin, and every single other antimicrobial on the market, all 26 of them. A few weeks later she developed septic shock and died.

For public health officials like Patel, that case marks the end of an era, and the beginning of a new one. Now, the question is: How fast is that kind of pan-resistance going to spread? "When does it get to the point where it's more common to have an infection that can't be treated with antibiotics than one that can?" says Patel. "That's going to be a very hard thing to predict."

More ...


Dr. Vallentine’s Decision - WSJ

ABOARD THE GOLFO AZZURRO—An urgent plea woke the ship's doctor, John Vallentine, at 6:30 a.m. He was needed on the bridge.

The rescue ship was steaming south in the Mediterranean Sea in a race to reach a deflating rubber dinghy packed with migrants. Italy's coast guard had transmitted the coordinates, along with a warning the makeshift craft could soon sink.

A voice crackling across the radio told of another emergency. A lone West African man plucked from the sea by a nearby vessel was grievously ill with a soaring fever and convulsions. "He is unconscious and not responding," the radio voice said.

Dr. Vallentine and the crew of the Golfo Azzurro had a decision to make. They could help the stricken man, which would delay their mission to find the dinghy. Crew members knew from experience what happens when inflatable crafts fail. Seawater and fuel pool in the middle, weighing boats down into the sea. The liquids form a corrosive mixture that eats away at the flesh of those stuck in the crowded boat. Panic erupts and people drown.

The other option would be to continue on their course. They didn't know the dinghy's exact condition or whether another ship could rescue it. And without immediate medical care, the man on the boat a half-hour west would almost certainly die.

As a professor of medical ethics back home in Australia, Dr. Vallentine delighted in challenging students with the kinds of complex moral questions that can make the practice of medicine uncomfortable. Those often centered on issues of privacy and social responsibility, such as whether doctors should warn police about a mentally ill patient who owns guns.

In the chaos of a humanitarian disaster, such as when thousands of African and Middle Eastern migrants try to cross the Mediterranean in flimsy vessels, there are few rules about whom to help and in what order.

"It's all about finite resources in a world of infinite need," said Dr. Vallentine, who is 70 years old. "Do I look after this one, that 10, this 600?"

Some philosophers and ethicists say the overriding consideration should be to preserve as many lives as possible, even if it requires sacrificing individuals along the way. Others argue that all lives are equally worth saving and it is wrong to deny help to those who need it.

In practice, doctors use all kinds of methods to prioritize care in the pandemonium of a catastrophe. The notion of triage was a creation of battlefield medicine during the Crimean War. Some doctors handle the gravest cases first, others favor children over adults, and others stick to a first-come, first-served system, finding it hard to give up on a suffering patient to help others they haven't yet seen.

The decision in front of him reminded Dr. Vallentine of an exam question from his medical training. If he was treating a casualty in a war zone and the area suddenly became dangerous, would he leave, saving himself and letting his patient die so that he could treat more people on another day?

He recalled his answer: "I said I would leave." That suggested that the Golfo Azzurro should go look for the dinghy.

More ...