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Jet lag disorder associated with shift work can lead to brain changes increasing appetite
Press release issued: 11 October 2023
Scientists have uncovered why night shift work is associated with changes in appetite in a new University of Bristol-led study. The findings, published in Communications Biology, could help the millions of people that work through the night and struggle with weight gain.
Scientists from Bristol and the University of Occupational and Environmental Health in Japan, sought to understand how ‘circadian misalignment’ — a phenomenon commonly associated with 'jet-lag' whereby the body's biological clock is disrupted — affects the hormones responsible for regulating appetite.
Prevalent in night shift workers, in this new study, the international team reveal how circadian misalignment can profoundly alter the brain’s regulation of hormones controlling hunger to the detriment of metabolic health.
The team focused on glucocorticoid hormones in the adrenal gland which regulate many physiological functions including metabolism and appetite. Glucocorticoids are known to directly regulate a group of brain peptides controlling appetitive behaviour, with some increasing appetite (orexigenic) and some decreasing appetite (anorexigenic).
In an experiment using animal models, comprising a control group and a out-of-phase 'jet-lagged' group, the team found misalignment between light and dark cues led the out-of-phase group's orexigenic hypothalamic neuropeptides (NPY) to become dysregulated, driving an increased desire to eat significantly more during the inactive phase of the day.
Strikingly, the team discovered that rats in the control group ate 88.4% of their daily intake during their active phase, and only 11.6% during their inactive phase. In contrast, the 'jet-lagged' group consumed 53.8% of their daily calories during their inactive phase (without an increase in activity during this time). This equated to nearly five-times more (460% more) than what the control group consumed during the inactive phase. These results show that it is timing of consumption that has been affected.
This new discovery revealed how completely, and significantly, disordered the neuropeptides become when daily glucocorticoid levels are out of synch with light and dark cues. However, the authors suggest the neuropeptides identified in this study may be promising targets for drug treatments adapted to treat eating disorders and obesity.
Dr Becky Conway-Campbell, Research Fellow in Bristol Medical School: Translational Health Sciences (THS) and the study's senior author, said: "For people working throughout the night, a reversed body clock can play havoc with their health.
"For those who are working night shifts long-term, we recommend they try to maintain daylight exposure, cardiovascular exercise and mealtimes at regulated hours. However, internal brain messages to drive increased appetite are difficult to override with 'discipline' or 'routine' so we are currently designing studies to assess rescue strategies and pharmacological intervention drugs. We hope our findings also provide new insight into how chronic stress and sleep disruption leads to caloric overconsumption."
Stafford Lightman, Professor of Medicine at Bristol Medical School: THS and co-senior author on the study, added: "The adrenal hormone corticosterone, which is normally secreted in a circadian manner, is a major factor in the daily control of brain peptides that regulate appetite. Furthermore when we disturb the normal relationship of corticosterone with the day to night light cycle it results in abnormal gene regulation and appetite during the period of time that the animals normally sleep.
"Our study shows that when we disturb our normal bodily rhythms this in turn disrupts normal appetite regulation in a way that is at least in part a result of desynchrony between adrenal steroid hormone production and the timing of the light and dark cycle."
Dr Benjamin Flynn, one of the study's co-authors who conducted the study while at Bristol but is now based at the University of Bath, added: "This is further evidence of how phase shift ‘jet-lag’ affects feeding behaviours and neuronal gene expression - data important for shift work co-morbidity research."
This research was funded by the Medical Research Council.
Paper
'Phase-shifting the circadian glucocorticoid profile induces disordered feeding behaviour by dysregulating hypothalamic neuropeptide gene expression' by M Yoshimura, B Flynn, Y Kershaw, Z Zhao, Ueta, S Lightman, R Conway-Campbell et al. in Communications Biology [open access]
Further information
About circadian rhythm
Humans have a 24-hour circadian timing system, a biological clock, which controls a range of physiological processes including our sleep, appetite, hormone secretion and blood pressure. Our eyes act as sensors to this timing system to detect the light and dark cues within our environment.
About glucocorticoids
Glucocorticoids (cortisol in humans, corticosterone in rodents) regulate many physiological functions, including metabolism, cardiovascular tone, reproduction, mood and cognition, and the immune system.
About the Medical Research Council
The Medical Research Council is at the forefront of scientific discovery to improve human health. Founded in 1913 to tackle tuberculosis, the MRC now invests taxpayers’ money in some of the best medical research in the world across every area of health. Thirty-three MRC-funded researchers have won Nobel prizes in a wide range of disciplines, and MRC scientists have been behind such diverse discoveries as vitamins, the structure of DNA and the link between smoking and cancer, as well as achievements such as pioneering the use of randomised controlled trials, the invention of MRI scanning, and the development of a group of antibodies used in the making of some of the most successful drugs ever developed. Today, MRC-funded scientists tackle some of the greatest health problems facing humanity in the 21st century, from the rising tide of chronic diseases associated with ageing to the threats posed by rapidly mutating micro-organisms.
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Disease Research
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JAMAICA, Queens (WABC) -- Jamaica Hospital Medical Center is partnering with several local Cure Violence groups to launch an initiative to combat gun violence, the parties announced Monday.As part of the collaboration with King of Kings, Life Camp, and Sheltering Arms Children and Family Services-Rock Safe Streets, the hospital will designate employees who will support the provision of anti-violence and violence interruption services by responding to referrals of traumas associated with gun violence.These designated employees will also assist in coordinating the visitation of responders (individuals appointed by Cure Violence groups) with patients and loved ones, with their consent and as authorized by the law."We're in the hospital connecting with family who are angry, connecting with friends who are in pain," said Erica Ford, with Life Camp. "A lot of this is retaliation, interpersonal retaliation, so if we can stop the next shooting, we're able to saves lives."The collaboration between the hospital and the organizations was made official at a formal signing ceremony Monday, during Gun Violence Awareness Month."This agreement is an important step in the right direction to address the crisis of gun violence in our community," Jamaica Hospital President and CEO Bruce Flanz said. "As a hospital that operates the busiest Level 1 Trauma Center in the city and cares for a disproportionally large number of gun violence patients, we know firsthand the impact and ripple effects it causes to victims, their loved ones, and communities."ALSO READ | Man shot in apartment building lobby in QueensElected official Congressman Gregory Meeks, a staunch advocate for gun violence prevention, joined Jamaica Hospital in commemorating the partnership."Those three organizations are knocking on doors, talking to people on the ground, and in places some of us can't get into," Meeks said.The gun violence epidemic continues to grip our nation and local communities, and proponents say the need to address the issue has only become more urgent after the recent mass shootings in Buffalo and Uvalde.Locally, the urgency is resounding as the number of gun violence victims continues to climb at an alarming rate."Sometimes we're receiving patients who are incapacitated, comatose, and we don't know the full story outside of these doors," Jamaica Hospital Trauma Medical Director Dr. Katherine McKenzie said.Gun violence has increased by 188% in the five boroughs -- and more specifically 190% in Queens -- from 2019 to 2020.According to the Centers for Disease Control and Prevention, firearm violence is a serious public health problem.About 124 people in the U.S. die each day from firearm-related injuries, and gun violence also affects the mental health of patients, their loved ones, and healthcare providers.Studies also show that residents living in neighborhoods with high rates of gun violence are more likely to suffer from anxiety disorders and other mental health illnesses.The objective of the landmark agreement is for all involved to work together to prevent violence and assist in protecting the health of patients and community members.Responders' duties will include conducting follow-up visits during the inpatient stay with identified hospital patients, upon a determination by Jamaica Hospital that the patient is stable.Responders will also provide supportive services such as mediation, conflict resolution, and service referrals to assist in the prevention of re-injury to these patients or to prevent retaliation connected to gun violence incidents.Additionally, Jamaica Hospital and Responders will work together to provide coordinated care and integrative support to victims of gun violence.ALSO READ | Subway surfers caught on video walking atop Brooklyn J trainAt Jamaica Hospital, the rise in gun violence became evident in 2020 after the initial surge of the COVID-19 pandemic. Officials say the number of patients treated for gun violence-related incidents increased by 223% between 2019 and 2020.The dramatic spike prompted the hospital's Trauma Division to create the Violence Elimination and Trauma Outreach (VETO) program."Observing the rise in gun violence in our community, the Trauma Division launched VETO, a hospital-based violence intervention program, in the spring of 2021," Dr. McKenzie said. "The VETO program works to identify victims of gun violence and provide comprehensive coordinated and integrative care to survivors. We are confident that our partnership with King of Kings, Life Camp, and the Sheltering Arms Children and Family Services- Rock Safe Streets program will expand on the outreach work being done in our community to address gun violence, a growing public health crisis."----------* More Queens news* Send us a news tip* Download the abc7NY app for breaking news alerts * Follow us on YouTube Submit a News Tip Copyright © 2022 WABC-TV. All Rights Reserved.
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Epidemics & Outbreaks
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Synchronizing your internal clocks may help mitigate jet lag, effects of aging
Traveling to faraway places is a great way to seek out new experiences, but jet lag can be an unpleasant side effect. Adjusting to a new time zone is often accompanied by fatigue, difficulty sleeping, and a host of other problems that can turn an otherwise exciting adventure into a miserable trip.
Jet lag is caused by a difference between the circadian system—the body's internal clock—and the surrounding environment. Around the turn of the century, scientists began to recognize that the body has multiple internal clocks, calibrated in different ways, and that jet lag-like symptoms can result when these clocks drift out of sync with each other. This can happen in several ways and grows more prevalent with age.
A team of scientists from Northwestern University and the Santa Fe Institute developed a theoretical model to study the interactions between multiple internal clocks under the effects of aging and disruptions like jet lag. The article, "A minimal model of peripheral clocks reveals differential circadian re-entrainment in aging," appeared in the journal Chaos on Sept. 5, 2023.
Modern research has shown that circadian clocks are present in almost every cell and tissue in the body. Each relies on its own set of cues to calibrate; the brain's clock depends on sunlight, for instance, while the peripheral organs calibrate at mealtime.
"Conflicting signals, such as warm weather during a short photoperiod or nighttime eating—eating when your brain is about to rest—can confuse internal clocks and cause desynchrony," said author Yitong Huang.
At this point, little is known about how the body's various internal clocks affect each other. The added complexity of accounting for multiple clocks means researchers tend to use simplified models.
"Most studies primarily focus on one particular time cue or a single clock," said Huang. "Important gaps remain in our understanding of the synchronization of multiple clocks under conflicting time cues."
Huang and her colleagues took a different approach, building a mathematical framework that accounts for this complex interplay between systems. Their model features two populations of coupled oscillators that mimic the natural rhythms of circadian cycles. Each oscillator influences the others while simultaneously adjusting based on unique external cues.
Using this model, the team was able to explore how such a coupled system could be disrupted and what makes the effect worse. They found that common symptoms of aging, such as weaker signals between circadian clocks and a lower sensitivity to light, result in a system that is more vulnerable to disruptions and slower to recover.
They also landed on a new method to speed up recovery from jet lag and similar disruptions. According to their results, the way to better sleep is through the stomach.
"Having a larger meal in the early morning of the new time zone can help overcome jet lag," says Huang. "Constantly shifting meal schedules or having a meal at night is discouraged, as it can lead to misalignment between internal clocks."
The authors plan to investigate the other side of the equation and identify the factors that result in more resilient internal clocks. Such discoveries could result in recommendations to prevent jet lag in the first place, or to keep the circadian system healthy into old age.
More information: A minimal model of peripheral clocks reveals differential circadian re-entrainment in aging, Chaos An Interdisciplinary Journal of Nonlinear Science (2023). DOI: 10.1063/5.0157524
Journal information: Chaos
Provided by American Institute of Physics
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Longevity
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LONDON (AP) — Britain’s medicines regulator has authorized the world’s first gene therapy treatment for sickle cell disease, in a move that could offer relief to thousands of people with the crippling disease in the U.K.
In a statement Thursday, the Medicines and Healthcare Regulatory Agency said it approved Casgevy, the first medicine licensed using the gene editing tool CRISPR, which won its makers a Nobel prize in 2020.
The agency approved the treatment for patients with sickle cell disease and thalassemia who are 12 years old and over. Casgevy is made by Vertex Pharmaceuticals (Europe) Ltd. and CRISPR Therapeutics. To date, bone marrow transplants, extremely arduous procedures that come with very unpleasant side effects, have been the only long-lasting treatment.
“The future of life-changing cures resides in CRISPR based (gene-editing) technology,” said Dr. Helen O’Neill of University College London.
“The use of the word ‘cure’ in relation to sickle cell disease or thalassemia has, up until now, been incompatible,” she said in a statement, calling the MHRA’s approval of gene therapy “a positive moment in history.”
WATCH: A Brief But Spectacular take on the future of CRISPR
Both sickle cell disease and thalassemia are caused by mistakes in the genes that carry hemoglobin, the protein in red blood cells that carry oxygen.
In people with sickle cell — which is particularly common in people with African or Caribbean backgrounds — a genetic mutation causes the cells to become crescent-shaped, which can block blood flow and cause excruciating pain, organ damage, stroke and other problems.
In people with thalassemia, the genetic mutation can cause severe anemia. Patients typically require blood transfusions every few weeks, and injections and medicines for their entire life. Thalassemia predominantly affects people of South Asian, Southeast Asian and Middle Eastern heritage.
The new medicine, Casgevy, works by targeting the problematic gene in a patient’s bone marrow stem cells so that the body can make properly functioning hemoglobin.
Patients first receive a course of chemotherapy, before doctors take stem cells from the patient’s bone marrow and use genetic editing techniques in a laboratory to fix the gene. The cells are then infused back into the patient for a permanent treatment. Patients must be hospitalized at least twice — once for the collection of the stem cells and then to receive the altered cells.
“This is so exciting. It’s a new wave of treatments that we can utilize for patients with sickle cell disease,” said Dr. James LaBelle, director of the pediatric stem cell and cellular therapy program at the University of Chicago. He said Britain’s approval suggested the U.S. authorization was likely “imminent.”
READ MORE: New gene therapy delivers treatment directly to brain
Casgevy is currently being reviewed by the U.S. Food and Drug Administration; the agency is expected to make a decision early next month, before considering another sickle cell gene therapy.
LaBelle said officials at the University of Chicago are “already moving forward to build not only the clinical infrastructure but also the reimbursement infrastructure to get these patients this treatment.”
Britain’s regulator said its decision to authorize the gene therapy for sickle cell disease was based on a study done on 29 patients, of whom 28 reported having no severe pain problems for at least one year after being treated. In the study for thalassemia, 39 out of 42 patients who got the therapy did not need a red blood cell transfusion for at least a year afterwards.
Gene therapy treatments can cost millions of dollars and experts have previously raised concerns that they could remain out of reach for the people who would benefit most.
Last year, Britain approved a gene therapy for a fatal genetic disorder that had a list price of £2.8 million ($3.5 million). England’s National Health Service negotiated a significant confidential discount to make it available to eligible patients.
Vertex Pharmaceuticals said it had not yet established a price for the treatment in Britain and was working with health authorities “to secure reimbursement and access for eligible patients as quickly as possible.”
In the U.S., Vertex has not released a potential price for the therapy, but a report by the nonprofit Institute for Clinical and Economic Review said prices up to around $2 million would be cost-effective. By comparison, research earlier this year showed medical expenses for current sickle cell treatments, from birth to age 65, add up to about $1.6 million for women and $1.7 million for men.
Medicines and treatments in Britain must be recommended by a government watchdog before they are made freely available to patients in the national health care system.
Millions of people around the world, including about 100,000 in the U.S., have sickle cell disease. It occurs more often among people from places where malaria is or was common, like Africa and India, and is also more common in certain ethnic groups, such as people of African, Middle Eastern and Indian descent. Scientists believe being a carrier of the sickle cell trait helps protect against severe malaria.
AP Science Writer Laura Ungar in Louisville, Kentucky contributed to this report.
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Drug Discoveries
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As frustrating as colds and allergies may be to those who suffer from them, even more sobering is the notion that popular remedies we think are treating them may be ineffective at relieving our stuffy noses.
The U.S. Food and Drug Administration (FDA) is deliberating about removing the designation "generally recognized as safe and effective," or "GRASE," for the common ingredient known as phenylephrine in popular nasal decongestants after an advisory panel to the agency found on Tuesday the drug is ineffective when taken orally.
The GRASE designation allows manufacturers to market phenylephrine without filing an FDA application.
Their impending decision could upend the market for the cold and allergy industry, which generated almost $1.8 billion in sales last year, according to data presented by FDA officials.
Companies may be required to remove oral decongestants containing phenylephrine from shelves or reformulate them without the ingredient.
"The FDA held this advisory committee meeting to seek input from the advisory committee on new data on the effectiveness of oral phenylephrine as a nasal decongestant that have become available since the agency last examined the issue," an FDA spokesperson told Fox News Digital.
Phenylephrine is an ingredient in common over-the-counter (OTC) cold and allergy medications, such as Dayquil, Mucinex, Benadryl Allergy Plus Congestion and Sudafed PE.
The 16-member committee unanimously voted "no" to the following question: "Do the current scientific data that were presented support that the monograph dosage of orally administered phenylephrine is effective as a nasal decongestant?"
The FDA previously reviewed the topic in 2007, ultimately deciding to keep the drug on the market at the time — despite a systemic review that year finding "insufficient evidence that oral phenylephrine is effective for nonprescription use as a decongestant."
The 16-member committee unanimously voted "no" to the following question: "Do the current scientific data that were presented support that the monograph dosage of orally administered phenylephrine is effective as a nasal decongestant?"
Since 2007, several large placebo-controlled trials provide more definitive research that there is no evidence that standard and higher doses of oral phenylephrine relieves nasal decongestion.
How does phenylephrine work?
The nose is often the first line of defense when the body is trying to beat a respiratory virus.
When we have a cold, the immune system sends white blood cells to fight the infection in our nasal passages. This can lead to a stuffy nose and mucus production.
Phenylephrine works to decrease the congestion by constricting the blood vessels in our nose and sinuses to reduce swelling.
One adverse side effect is an increase in blood pressure at higher doses.
"It just isn’t effective when swallowed since more than 99% of the dose is inactivated and doesn’t get into the bloodstream," Leslie Hendeles, Pharm.D., professor emeritus in the College of Pharmacy at University of Florida, based in Gainesville, told Fox News Digital.
"There should be no concern on the part of patients since there are many effective alternatives, including a topical nasal spray containing phenylephrine."
Once we ingest phenylephrine, it gets inactivated after it passes through the liver and by gut enzymes, so there is not enough drug left by the time it reaches our nose.
Although phenylephrine is not effective orally — it is effective when administrated in alternative ways, the pharmacist explained.
Phenylephrine is effective via non-tablet routes
These include topically as a nasal spray, as eye drops to dilate pupils, and intravenously into the bloodstream to reverse low blood pressure during surgery.
"Spraying phenylephrine, or the longer acting oxymetazoline, directly into the nose produces about 1 million times more drug in the nasal mucosa than swallowing it," he added.
In 2015, Hendeles, together with another one of his colleagues, petitioned the FDA to reevaluate the decision on allowing oral phenylephrine in nasal decongestants.
This prompted the FDA’s current advisory meeting.
"The FDA Review Team has concluded that oral phenylephrine is not effective at relieving a stuffy nose from either a cold or allergy and the Nonprescription Drugs Advisory Committee has just voted unanimously in agreement with the FDA," Hendeles told Fox News Digital.
"There should be no concern on the part of patients since there are many effective alternatives, including a topical nasal spray containing phenylephrine."
FDA detailed its next steps
Now that the advisory committee has made its recommendation, the FDA will be reviewing cold, cough, allergy, bronchodilator and antiasthmatic drug products for OTC human use (OTC Monograph M012).
An OTC Monograph establishes the active ingredients under certain categories that an OTC drug is GRASE for its intended use, according to the FDA website.
"If the FDA determines that oral phenylephrine is no longer considered [GRASE] under the conditions of use in [OTC Monograph M012], the FDA would issue a proposed order to amend OTC Monograph M012 by removing oral phenylephrine as a GRASE active ingredient from that monograph," a FDA spokesperson told Fox New Digital.
People will have the opportunity to comment on the proposed order.
"During this time period, the marketing status of oral phenylephrine would not change," the FDA spokesperson clarified.
The Consumer Healthcare Products Association (CHPA), which represents leading manufacturers and marketers of OTC drugs, expressed caution before the FDA makes a final decision.
"We are disappointed by the outcome of today’s FDA Advisory Committee meeting because its non-binding recommendation is at odds with the numerous clinical trials and previous regulatory determinations affirming oral phenylephrine (PE) as a safe and effective decongestant at its labeled dose," said Scott Melville, CHPA president and CEO, on Tuesday in a September 12 statement shared with Fox News Digital.
He warned about "significantly negative unintended consequences associated with any potential change in oral PE’s regulatory status."
"The FDA has no further information to provide at this time regarding the timing of any decision the agency may make following the advisory committee meeting," an FDA spokesperson told Fox News Digital.
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Drug Discoveries
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Like most six-year-olds and twins the world over, Savannah and Bella Mines are a joyful, fizzing handful.
Bella, 15 minutes the elder, is tomboy-boisterous and learning to play guitar. Savannah, more shy, is full of beans and into the piano. They are both mad about athletics, Peppa Pig, The Gruffalo…
And every single time their dad, Jamie, 39, reads them that favourite bedtime story, it is with a lump of gratitude in his throat.
A quadruple amputee after an horrific accident that almost killed him, the hands that now turn the pages, cuddle his girls and pick up after them aren’t the hands he was born with.
These hands didn’t hold his daughters in their first moments of life.
Instead they are an incredible, generous, life-changing gift that the single father from Bradford on Avon, Wiltshire, received when he had a double hand transplant.
They are transforming this young family’s life.
“Life is so good since my transplant,” he says. ““I used to have to flick the book pages with my stumps, not any more. It was amazing putting my arms around my daughters again, properly cuddling them for the first time since the accident.
"They ask me, when will you be able to draw with us Daddy? The answer’s one day soon, I hope. I am improving all the time.
“I’ve been on holiday, and gone swimming. And I look forward to all the things I’ll be able to do in the future.”
The day that changed everything for Jamie was December 19, 2016. It dawned wet and windy. Bella and Savannah were five months old, days from their first Christmas.
Jamie was off to his job at a scaffolding firm.
“I was a new dad and loving it. The nappies, the crying, I loved it all,” he laughs. “I’d even got used to the lack of sleep. It’s the meaning of life, really.”
A semi-professional footballer for 17 years, playing for the likes of Larkhall Athletic in Bath, he was fit and energetic, loving the hard, outdoor labour of his work.
After lunch, he was working on a five metre rig at a site in Swindon, lifting a sheet tin roof into place underneath power lines.
And suddenly, from the cables which were too close to him, 33000 volts of electricity arced and surged into his body.
“I remember it belting me inside and out,” he says. “My arms were swelling massively, my legs bursting against my combat trousers. The pain was unbelievable.”
Paramedics arrived, the wintry sky drummed with the beat of an approaching air ambulance.
Conditions were too foggy for the airlift, however. A cherry picker and stretcher ferried Jamie to an ambulance and from there to hospital.
“I thought, I’m going there and I’m going to die,” Jamie says.
But he also thought of his babies, waiting at home.
“There was an inner power inside me and it was for them. Their first Christmas was six days away. I had to live.”
The next days were a fog of sedation and fever dreams.
Jamie remembers trying to get out of bed, to find that his right leg had been amputated below the knee.
The toes and half of his left foot were also gone, that leg would eventually be amputated too. The accident took both Jamie’s hands and half his arms, too.
At first he despaired. “I wondered why they’d saved me,” he says. “I’d been a fit man, playing my football, doing heavy, physical work. Now I wouldn’t be able to hold my girls or brush their hair. All I could think of was the past.”
But it didn’t last for long. That inner strength and grit was still there, if his limbs were not.
His mum, Carla, 70, explains, “The surgeons thought he might last a week if he was lucky. But they didn’t know my Jamie. He was determined. He had those little girls at home and he loved those little girls so much.”
Through long months in ICU, where his children couldn’t come to see him, he focused on getting home to them.
“It was heartbreaking - would I ever be able to hold their hands or tickle them?” he says. “After seven months I was moved to the John Radcliffe Hospital in Oxford for rehab. At last, on the girls’ first birthday, they were able to visit me.
“They remembered me! They called me Daddy, and were laid on my chest. It was amazing.”
Finally, with two prosthetic legs, two prosthetic arms, Jamie was well enough to go home.
A single dad to Savannah and Bella since they turned two, it was a baptism of fire.
Severely disabled, still recovering, Jamie had two little lives depending on him.
“Changing one nappy took me 40 minutes and I had two to do each time!”, he says. “Pull-ups made that easier in the end.”
But his greatest fear did not come to pass.
“I was able to cuddle them with my stumps. I wore my prosthetic arms outside but Savannah and Bella didn’t like the claws so at home they came off.”
He was coping. More than coping.
His former firm, Boundary Scaffolding Ltd, had been fined £80,000 for the accident, its director receiving a six-month suspended sentence.
The compensation Jamie received allowed him to be the best dad he could.
To pay for help to wash his girls’ hair properly and do it nicely for school. To prepare meals…
But he never gave up hope of somehow holding, really holding, his children by the hand.
“I read everything I could about miracle transplants,” he says. “I did loads and loads of research and then the first double hand transplant operation took place at Leeds General Infirmary.”
Jamie sourced an email address for the pioneering Professor Simon Kay, who’d led the operation.
“With special technology that scanned my retina to enable me to type, I told him my story. He was in Sweden at a conference but he got back to me that same day.”
It was the start of another extraordinary journey, at the end of which Jamie would have two arms again, two hands, two sets of fingers…
Once cleared for the double transplant, he joined the list of those waiting for a donor. It would be over two years long.
“I thought about my daughters. They’d had to cope with so many changes,’ says Jamie. “I couldn’t die on them! But my immune system would have to be suppressed to stop my body rejecting the transplants…”
As Prof Kay told the makers of a documentary which airs tonight, telling the story of Jamie’s transplant, “The immune system fights infection, cancer and tumours. But Jamie has a real need and he’s a coper… with a very positive attitude.”
At stake was something deeply important and very human, a prize worth all the risks.
“Hands are what make us human,” says Prof Kay. “We do many things with them that other animals do not. We point, we gesticulate, we caress, we care…”
Jamie had no doubts in the end. He had to do it. “It was for a better life for us,” he says.
His bag was packed and ready. In the afternoon of March 29 last year, the call came. He had a donor.
He sat his daughters down. “I’ve got the call, girls,” he said simply.
Every day for the past two years he’d reminded them that it could be any day.
So there was no drama. Carla, was on hand to look after the girls. Jamie and hospital bag set off.
At 6am next morning a procedure that’s truly incredible began. It was expected to take 14 hours. Three hours in, the donor limbs arrived.
Carla sums up the emotion, “It is so remarkable that they would give this gift of limbs [of their child].”
Ten hours later, Jamie was out of surgery, his new arms in casts.
Coming round, he was on a high. “I think it must have been the drugs, a sort of walking dream but I saw my future and it was so bright and colourful. I was playing with the girls who were skipping around. It was euphoria.”
When he next came around there was only pain.
“But I could see fingers coming out of the bandages. The fingers felt like mine immediately.”
Tonight’s documentary captures the longed-for, magical first bundling of his daughters into those new arms.
Savannah and Bella take it all in their stride. Daddy is just Daddy. Always has been.
But for Jamie, their future is stronger now.
He is in awe of the gift he has been given, the selflessness that has made it possible.
Hands that are warm, that can pick up stray chips and discarded Hula Hoop crisps… Comfort his children or make them shriek with giggles… All little things that matter so much.
“I wanted to write to the donor’s family and put into words what they have done for me,” says Jamie. “I wanted to write it with my new hands.”
But being able to hold a pen is some way off - the transplanted hands will keep improving for the next four years or so.
Jamie’s gratitude couldn’t wait that long to be expressed.
“I have written an email instead,” he says. “Telling them how much this gift is changing my life. And what an amazing, kind and brave thing it was to give me their loved one’s limbs. I’m making good use of them.”
He’s also had the hands tattooed, one especially poignant.
“With a big stopwatch and the words ‘Nothing Is Forever’,” he explains. “A reminder that everything can change in a moment.
“I don’t ever want to forget that.”
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Medical Innovations
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China’s health authorities have said the Covid wave is past its peak, with rapid decline in both severe cases and deaths in hospitals, but experts remain wary of the government’s official data.According to China’s Center for Disease Control (CDC), the number of critically ill patients in hospital peaked in the first week of January, then rapidly declined by more than 70%. The number of deaths also reached its highest level that week, the data said.Prof Chi Chun-huei, director of the centre for global health at Oregon University, said local officials were incentivised – via punishments and rewards – to under-report infection figures during the zero-Covid policy. Now that policy was gone, they were incentivised to exaggerate infection rates and under-report deaths.“Most international experts know this very well – China’s statistics are very unreliable,” he said.Covid cases have swept across China in recent months, escalating rapidly after the government suddenly ended its zero-Covid policy in early December 2022. Last week a senior health official said that 80% of people had been infected in this wave, although it was not clear where the figures came from.According to the data there were 128,000 critically ill Covid patients in Chinese hospitals on 5 January, the highest number reached during this wave. It described a peak inside hospitals over the western new year, with almost 10,000 new critically ill cases a day from 27 December to 3 January.By 23 January the total number of critically ill cases had dropped by 72% to about 36,000 it said.The number of deaths in hospitals reached their highest point on 4 January, with 4,273 recorded, before falling 79% by 23 January to 896.The CDC said the number of visits to fever clinics peaked at 2.867m on 23 December, before falling 96.2% to 110,000 on 23 January. A similar decline was observed in visits to rural clinics, with peaks around the same date, it said.The data, published on Wednesday, was based primarily on hospital in-patients, giving some insight into the severity of the outbreak, but external health experts and observers have cautioned that it only shows one part of the true toll.China’s wave of infections hit major cities first, and there has been concern that travel for lunar new year could spread infections into regional areas. Reporting from inside China has already found apparent high rates of infection and fatalities that appear to exceed official reports.With the end of zero-Covid, travel restrictions, mass testing, mandatory quarantine and other measures were wound back or dropped entirely. Data collection systems quickly fell far behind the reality on the ground, with fewer than 60 deaths officially recorded in the first few weeks until authorities updated the way deaths are attributed.The notice from the CDC acknowledged that PCR testing was not keeping up with infections. Daily tests had dropped to 280,000 by Monday, down from 150m on 9 December, and 7.54m on 1 January. Some provinces had enacted systems for collecting the results of residents or allowing residents to self-report, but the figures were “affected by the willingness of residents to test”.Previously several provinces or major cities had reported infection rates of 70-90%, but some analysts speculated such figures may have been over-inflated to suggest places were on the way to recovery.Prof Antoine Flahault, the director of the institute of global health at the University of Geneva, told the Guardian the figure of 80% total infection rate was “mostly plausible” and in line with global knowledge of Omicron’s attack rate.“Having said that, to transfer that to mortality figures is highly difficult.”
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Epidemics & Outbreaks
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Researchers at the University of Pittsburgh and KU Leuven have discovered a suite of genes that influence head shape in humans. These findings, published this week in Nature Communications, help explain the diversity of human head shapes and may also offer important clues about the genetic basis of conditions that affect the skull, such as craniosynostosis.
By analyzing measurements of the cranial vault -- the part of the skull that forms the rounded top of the head and protects the brain -- the team identified 30 regions of the genome associated with different aspects of head shape, 29 of which have not been reported previously.
"Anthropologists have speculated and debated the genetics of cranial vault shape since the early 20th century," said co-senior author Seth Weinberg, Ph.D., professor of oral and craniofacial sciences in the Pitt School of Dental Medicine and co-director of the Center for Craniofacial and Dental Genetics. "We knew from certain rare human conditions and animal experiments that genes play an important role in vault size and shape, but very little was known about the genetic basis for typical features we see in the general population, such as what makes someone's head long and narrow versus short and wide. This study reveals some of the key genes driving variation in this part of the human body."
According to the researchers, one application of better understanding the factors that drive natural variation in human head shape is informing paleoanthropology studies, potentially shedding light on the early development of modern humans.
Weinberg and colleagues used magnetic resonance (MR) scans from more than 6,000 adolescents to extract 3D surfaces corresponding to the cranial vault. After dividing the 3D vault surfaces into incrementally smaller anatomical subparts and quantifying the shape of these subparts, they tested more than 10 million genetic variants for evidence of statistical association with measures of vault shape.
"Previous genetic studies of the cranial vault involved a small number of relatively simple measures," added Weinberg. "While such measures are often easy to obtain, they may fail to capture features that are biologically relevant. Our analysis used an innovative approach capable of describing 3D vault shape in much more comprehensive and nuanced ways. This approach increased our ability to find genetic associations."
An important discovery was that many of the strong associations are near genes that play key roles in the early formation of the head and face and regulation of bone development. For example, variants in and near the gene RUNX2, a major player in coordinating development of the skull, were associated with multiple aspects of vault shape.
While some genes, including RUNX2, had global effects involving the entire vault, others showed more localized effects that only impacted a specific portion of the vault, such as the central forehead.
When the researchers compared the 30 genomic regions associated with head shape across participants with European, African and Indigenous American ancestry, they found that the majority of genetic associations were shared across these different ancestral groups.
Although the study focused on healthy participants, the findings may reveal important clues about the biological basis of diseases involving the cranial vault, according to Weinberg.
One of these conditions is craniosynostosis, which occurs when the bones of the skull fuse too early while the brain is still growing rapidly. Without neurosurgery, craniosynostosis can cause permanent disfigurement, brain damage, blindness and even death. The team showed that variants near three genes associated with vault shape, BMP2, BBS9 and ZIC2, were also associated with craniosynostosis, suggesting that these genes could play a role in the development of the disease.
"This kind of study is possible due to the availability of publicly funded resources," said Weinberg. "The original study that generated these MR scans is focused on understanding brain development and behavior. By creatively leveraging these resources, we have managed to advance discovery beyond that original scope."
Other authors on the study were Seppe Goovaerts, Hanne Hoskens, Ph.D., Meng Yuan, Dirk Vandermeulen, Ph.D., all of KU Leuven; Ryan J. Eller, Ph.D., Noah Herrick, Ph.D., and Susan Walsh, Ph.D., all of Indiana University-Purdue University Indianapolis; Anthony M. Musolf, Ph.D., and Cristina M. Justice, Ph.D., both of the National Human Genome Research Institute; Sahin Naqvi, Ph.D., and Joanna Wysocka, Ph.D., both of Stanford University; Myoung Keun Lee, Heather L. Szabo-Rogers, Ph.D., Mary L. Marazita, Ph.D., and John R. Shaffer, Ph.D., all of Pitt; Paul A. Romitti, Ph.D., of the University of Iowa; Simeon A. Boyadjiev, M.D., of the University of California, Davis; Mark D. Shriver, Ph.D., of Penn State University; and Peter Claes, Ph.D., of KU Leuven and Murdoch Children's Research Institute.
This research was supported by the National Institute of Dental and Craniofacial Research (R01DE027023, R01DE016886, R03DE031061 and X01HL14053) and the Intramural Research Program of the National Human Genome Research Institute, National Institutes of Health
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Disease Research
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Too many people are still dying from sepsis due to "the same mistakes" highlighted more than 10 years ago, the UK's health ombudsman has warned.
Rob Behrens, who handles complaints about the NHS, said sepsis diagnosis and treatment was taking too long.
The UK Sepsis Trust estimates about 48,000 people die each year from sepsis-related illnesses, "thousands" of which are preventable.
NHS England said it was working to improve sepsis management.
Sepsis develops when the body's immune system overreacts to an infection and starts attacking its own tissues and organs.
Symptoms can be similar to those of flu and include severe breathlessness and a high fever.
In 2013, the ombudsman looked into several sepsis deaths and concluded patients were not being diagnosed or treated quickly enough.
A series of recommendations were made at the time.
However, in a new report the service found that although some improvements had been made in the past decade "significant improvements" were urgently needed to avoid more deaths.
'Harrowing stories'
Mr Behrens found there were still delays in spotting and treating the condition in hospitals.
He also identified issues with insufficient staff training, poor communication, poor record-keeping and missed opportunities for follow-up care.
"I've heard some harrowing stories about sepsis through our investigations and it frustrates and saddens me that the same mistakes we highlighted 10 years ago are still occurring," he said.
Mr Behrens highlighted a series of deaths that he believed may have been preventable.
Among the cases he examined was that of a patient named in the report as Kath, who died at Blackpool Teaching Hospitals Trust after being admitted with pneumonia two weeks earlier.
After her death it was revealed that medical notes showed sepsis was suspected by clinical staff but this was not acted upon.
This was a "missed opportunity" to spot and treat the condition, Mr Behrens said.
The patient's daughter said the report's findings had left the family "grieving all over again".
Another patient, named in the report as "Ms R", died of sepsis which developed after she was discharged from hospital, having had bowel cancer surgery.
She had suffered complications in hospital but her recovery was not monitored.
The ombudsman concluded her death may have been avoided if follow-up appointments had been arranged.
Mr Behrens also said the NHS needed to "listen to patients and their families when they raise concerns".
He said: "Crucially, NHS staff must be sepsis-aware."
The UK Sepsis Trust said there was now a need for sepsis to become a "key priority" for healthcare.
Dr Ron Daniels, the charity's CEO, said: "Although progress was certainly made in the years following the report up until the time of the pandemic, not only is it clear that there is significant opportunity for greater improvement but we are also gravely concerned that attention to sepsis is being afforded lower priority in the wake of the pandemic and in an already emburdened NHS."
NHS England said there had been improvements in sepsis care but admitted more work was needed.
In a separate case that was not investigated by the ombudsman, the family of a 16-month-old boy who died from sepsis after hospital failings recently told the BBC their "parental concerns were dismissed" by medics when their son was ill.
James Philliskirk was wrongly diagnosed with chicken pox by doctors at Sheffield Children's Hospital in May 2022.
James's mother Helen Philliskirk said: "On both trips to the hospital we feel like it was quite a blinkered approach."
Recently, the ombudsman said he wanted to see the introduction of "Martha's rule", which would entitle patients to a second medical opinion about their hospital care.
The rule, which is to be introduced by the NHS, is named after 13-year-old Martha Mills, who died from sepsis following a cycling accident in 2021.
An inquest found she would have survived if her care had been better.
What is sepsis?
- Sepsis is known as the "hidden killer" because it can be so hard to detect.
- It is caused by the immune system going into overdrive. Instead of just fighting an infection, it starts attacking other parts of the body too.
- Ultimately it causes organ failure. Even survivors can be left with long-term damage and disability.
- Bacteria and viruses that cause diarrhoeal infections or lung diseases are the leading triggers of sepsis.
- The symptoms include loss of consciousness, severe breathlessness, a high temperature, slurred speech, nausea and vomiting, diarrhoea and severe muscle pain.
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Disease Research
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Here's why everyone hates hearing the sound of their own voice
The feeling is nearly universal.
Have you ever heard yourself recorded on a voice memo and asked people, “Do I really sound like that?” You’re not alone. There are many people out there who get uncomfortable when they hear the sound of their voice, and there are some excellent reasons why.
The big reason is that the voice we hear when we speak sounds different than it does to other people and on recordings.
The voice we hear when we’re speaking is a mixture of the sound transmitted through the air, known as air conduction, and the sound we hear internally, which is a combination of vibrations from airways, vocal cords and bones inside the head.
These internal vibrations make our voices sound deeper than are in reality.
“When we talk, it’s like everyone hears the sound through speakers, but we’re hearing it through a cave complex inside our own heads,” Martin Birchall, professor of laryngology at University College London, told Time. “The sound is going around our sinuses, all the empty spaces in our heads and the middle part of our ears, which changes the way we hear sounds compared to what other people hear.”
Here's why you hate the sound of your own voice
However, when you hear a recording of your voice, the sound travels through the air into your ears, where it vibrates small ear bones. These vibrations are then sent to the cochlea, which sends an auditory sound to the brain.
These two distinct processes are the reason why people always think that their voice sounds different on a recording. "The voice that you hear on a tape recorder is actually how your voice sounds," Dr. Yale Cohen, director of the Hearing Sciences Center at the University of Pennsylvania's Perelman School of Medicine, told Live Science.
There are a few reasons why many people feel uncomfortable hearing a recording of their voice. First, the fact that it sounds different than we think messes with our self-perception. “Because your voice is unique and an important component of self-identity, this mismatch can be jarring. Suddenly, you realize other people have been hearing something else all along,” [name] writes in The Conversation.
People also don’t like hearing the sound of their voice because they don’t listen to it that often.
"Imagine you didn't have a mirror for six months and you had a perception of what you looked like. Meanwhile, you start eating lots of food and you gain lots of weight. If you [suddenly looked in a mirror], you'd be shocked," Cohen said.
Lastly, when people hear themselves recorded their voice always sounds thinner and higher pitched than it does in their heads, which makes a lot of folks cringe.
The interesting twist in all of this is that people actually prefer the sound of their recorded voice when they don't know that it is them. A study from Science Daily, albeit 10 years old, found that people tend to rate their voice as more attractive than others when they don't know who's speaking.
So, being that most people like their voices but don’t know it, there’s hope. One way to get over the discomfort is by listening to recordings of yourself often. You will get over the initial shock of it sounding different and begin to feel more comfortable listening to it.
Further, by listening to yourself talk you can make modifications to your voice so it’s more pleasing to yourself and others.
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Mental Health Treatments
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When the FDA first asserted the authority to regulate e-cigarettes in 2016, many people assumed the agency would quickly get rid of vapes with flavors like cotton candy, gummy bears, and Froot Loops that appeal to kids.
Instead, the FDA allowed all e-cigarettes already on the market to stay while their manufacturers applied for the OK to market them.
Seven years later, vaping has ballooned into an $8.2 billion industry, and manufacturers are flooding the market with thousands of products — most sold illegally and without FDA permission — that can be far more addictive.
“The FDA has failed to protect public health,” said Eric Lindblom, a former senior adviser to the director of the FDA’s Center for Tobacco Products. “It’s a tragedy.”
Yet the FDA isn’t the only entity that has tolerated the selling of vapes to kids.
Multiple players in and out of Washington have declined to act, tied the agency’s hands, or neglected to provide the FDA with needed resources. Former Presidents Barack Obama and Donald Trump both have prevented the FDA from broadly banning candy-flavored vapes.
Meanwhile, today’s vapes have become “bigger, badder, and cheaper” than older models, said Robin Koval, CEO of the Truth Initiative, a tobacco control advocacy group. The enormous amount of nicotine in e-cigarettes — up 76% over five years — can addict kids in a matter of days, Koval said.
E-cigarettes in the U.S. now contain nicotine concentrations that are, on average, more than twice the level allowed in Canada and Europe. The U.S. sets no limits on the nicotine content of any tobacco product.
“We’ve never delivered this level of nicotine before,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids, which opposes youth vaping. “We really don’t know the long-term health implications.”
Elijah Stone was 19 when he tried his first e-cigarette at a party. He was a college freshman, grappling with depression and attention-deficit/hyperactivity disorder, and “looking for an escape.” Store clerks never asked for his ID.
Stone said he was “hooked instantly.”
“The moment I felt that buzz, how was I supposed to go back after I felt that?” asked Stone, now 23, of Los Angeles.
The e-cigarette industry maintains that higher nicotine concentrations can help adults who smoke heavily switch from combustible cigarettes to vaping products, which are relatively less harmful to them. The FDA has approved high-nicotine, tobacco-flavored e-cigarettes for that purpose, said April Meyers, CEO of the Smoke-Free Alternatives Trade Association.
“The goal is to get people away from combustible products,” said Nicholas Minas Alfaro, CEO of Puff Bar, one of the most popular brands with kids last year. Yet Alfaro acknowledged, “These products are addictive products; there’s no hiding that.”
Although e-cigarettes don’t produce tar, they do contain harmful chemicals, such as nicotine and formaldehyde. The U.S. Surgeon General has warned that vaping poses significant risks: including damage to the heart, lungs, and parts of the brain that control attention and learning, as well as an increased risk of addiction to other substances.
More than 2.5 million kids used e-cigarettes in 2022, including 14% of high school students, according to the Centers for Disease Control and Prevention.
Most U.S. teen vapers begin puffing within an hour of waking up, according to a survey of e-cigarette users ages 16 to 19 presented at the Society for Research on Nicotine and Tobacco in March.
The potential for profits — and lax enforcement of vaping laws — has led to a gold rush. The number of unique vaping products, as measured by their bar codes, quadrupled in just one year, rising from 453 in June 2021 to 2,023 in June 2022, according to a Truth Initiative review of U.S. retail sales data.
FDA officials say they’ve been overwhelmed by the volume of e-cigarette marketing applications — 26 million in all.
“There is no regulatory agency in the world that has had to deal with a volume like that,” said Brian King, who became director of the FDA’s Center for Tobacco Products in July 2022.
The agency has struggled to stop e-cigarette makers who continue selling vapes despite the FDA’s rejection of the products, as well as manufacturers who never bothered to apply for authorization, and counterfeiters hoping to earn as much money as possible before being shut down.
In 2018, public health groups sued the agency, charging that the delay in reviewing applications put kids at risk. Although a court ordered the FDA to finish the job by September 2021, the FDA missed that deadline. An estimated 1.2 million people under the legal age of 21 began vaping over the next year, according to a study published in May in the American Journal of Preventive Medicine.
Recently, the FDA announced it has made decisions on 99% of e-cigarette applications, noting that it had rejected millions and authorized 23. All authorized products have traditional tobacco flavors, and were deemed “appropriate for the protection of public health” because tobacco-flavored products aren’t popular with children but provide adult smokers with a less dangerous alternative, King said.
The agency has yet to make final decisions on the most popular products on the market. Those applications are longer and need more careful scientific review, said Mitch Zeller, former director of the FDA’s Center for Tobacco Products and a current advisory board member for Qnovia, which is developing smoking-cessation products.
Before the FDA can announce new tobacco policies, it needs approval from the president — who doesn’t always agree with the FDA’s priorities.
For example, Obama rejected FDA officials’ proposal to ban kid-friendly flavors in 2016.
And in 2020, Trump backpedaled on his own plan to pull most flavored vapes off the market. Instead of banning all fruit and minty flavors, the Trump administration banned them only in “cartridge-based” devices such as Juul. The flavor ban didn’t affect vapes without cartridges, such as disposable e-cigarettes.
The result was predictable, Zeller said.
After receiving its own warning letter from the FDA last year, Puff Bar now sells only zero-nicotine vapes, Alfaro said.
When the FDA does attempt bold action, legal challenges often force it to halt or even reverse course.
The FDA ordered Juul to remove its products from the market in June 2022, for example, but was immediately hit with a lawsuit. The U.S. Court of Appeals for the D.C. Circuit sided with Juul and issued a temporary stay on the FDA’s order. Within weeks, the FDA announced it would hold off on enforcing its order because of “scientific issues unique to the JUUL application that warrant additional review.”
E-cigarette makers Logic and R.J. Reynolds Vapor Co. both sued the FDA after the agency ordered them to stop selling menthol vapes, a flavor popular with teens. In both cases, court-imposed stays halted the FDA’s orders pending review and the companies’ menthol products remain on the market.
Luis Pinto, a spokesperson for parent company Reynolds American, said, “We remain confident in the quality of all of Reynolds’ applications, and we believe that there is ample evidence for FDA to determine that the marketing of these products is appropriate for the protection of public health.”
Under the Biden administration, the FDA has begun to step up enforcement efforts. It fined 12 e-cigarette manufacturers more than $19,000 each, and has issued more than 1,500 warning letters to manufacturers. The FDA also issued warnings to 120,000 retailers for selling illegal products or selling to customers under 21, King said. Five of the companies that received warning letters made vapes decorated with cartoon characters, such as Minions, or were shaped like toys, including Nintendo Game Boys or walkie-talkies.
In May, the FDA put Elfbar and other unauthorized vapes from China on its “red list,” which allows FDA agents to detain shipments without inspection at the border. On June 22, the FDA announced it has issued warning letters to an additional 189 retailers for selling unauthorized tobacco products, specifically Elfbar and Esco Bars products, noting that both brands are disposable e-cigarettes that come in flavors known to appeal to youth, including bubblegum and pink lemonade.
In October, the Justice Department for the first time filed lawsuits against six e-cigarette manufacturers on behalf of the FDA, seeking “to stop the illegal manufacture and sale of unauthorized vaping products.”
Some lawmakers say the Justice Department should play a larger role in prosecuting companies selling kid-friendly e-cigarettes.
“Make no mistake: There are more than six e-cigarette manufacturers selling without authorization on the market,” Sen. Dick Durbin (D-Ill.) said in a March letter. Children are “vaping with unauthorized products that are on store shelves only because FDA has seemingly granted these illegal e-cigarettes a free pass.”
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Health Policy
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Standard chemotherapy (chemo) was once the only treatment for advanced non-small-cell lung cancer (NSCLC). Now, youâre likely to get chemo plus a targeted medicine or immunotherapy, says Karen Reckamp, MD, co-director of the lung cancer and thoracic oncology program at City of Hope in Duarte, CA.
She says most people need more than one therapy, and often, they get all three at some time during their treatment. Combined treatments may work better because they attack cancer in different ways. And while they arenât likely to cure advanced NSCLC, they may help you live longer with fewer symptoms.
Targeted Therapies
These block gene changes that cause tumors to grow and spread. The meds are more precise in targeting tumors than chemo, so side effects may not be as tough to deal with.
The problem is they often work for a while and then stop. This may be because the gene changes again, so itâs no longer a good target. Or, cancer might find a way around the therapy. Either way, youâll probably need to add another medicine -- usually chemo or a different targeted drug.
Immunotherapy
This treatment works in a different way. It triggers your immune system to attack your cancer. If your tumor has a high level of the protein PD-L1, immunotherapy medicines called checkpoint inhibitors may be your best treatment. These often work better when combined with chemo.
You May Still Need Chemo
If you donât have the PD-L1 protein or a gene target, immunotherapy plus chemo is likely to be your main treatment. Reckamp says that fact disappoints some people.
âBut weâre not at the point where we can do without [chemo],â she says. âIn an era where we have all these new therapies, chemo is still helpful and will be part of most peopleâs treatment.â
Thatâs because chemotherapy can mop up cancer cells that other treatments leave behind.
âMetastatic cancer has spread through the lymph and blood to other places in the body,â Reckamp says. âThatâs billions of cells. Thereâs always some cancer left, no matter what the treatment.â
Dealing With Side Effects
Cancer medicines can have serious side effects. What happens when you get two at the same time, or one right after the other? It can be tough, Reckamp says, especially since therapies can cause so many different problems.
For example, platinum-based chemo -- the kind used for advanced NSCLC -- damages all your fast-growing cells, even the healthy ones. Common side effects are:
- Nausea
- Diarrhea
- Hair loss
- Anemia
- Bleeding
Chemo also can cause liver and kidney damage. If your side effects are severe, you may need a lower dose, or to stop treatment completely. Reckamp says many people can predict how theyâre going to feel on certain days and plan around it. And since chemo is given in cycles, you have a chance to rest during the breaks.
You may not get a break from certain targeted medicine, though. Many targeted medicines are taken every day. That makes you more likely to have constant, but manageable symptoms, like rashes and diarrhea.
âYou might have one really bad day of diarrhea with chemo and mild diarrhea every day with a targeted therapy,â Reckamp says.
Targeted medicines usually wonât make you as tired as chemo. Other side effects are usually easier on your body, too, but they still need to be dealt with.
âAll these drugs are attacking cancer, so there is a level of not feeling like yourself,â Reckamp says. âMost people get used to that feeling. When they stop treatment, they remember what theyâre supposed to feel like.â
What about side effects from immunotherapy, which can be pretty unpredictable?
âThatâs anyoneâs guess,â Reckamp says. âIt can cause inflammation anywhere in your body at any time, even after you stop treatment. You can get inflammation in the brain, colon, thyroid gland, liver, bladder, kidneys, or heart.
âWe can predict when youâll feel bad with chemotherapy, but with immunotherapy, we canât.â
She says people who get both immunotherapy and chemo need to be on high alert. The number of possible side effects is high, and some can come without warning.
âIf youâre not feeling like yourself, call your doctor, and they can help guide you what to do next,â she advises. âAlso, [very serious] problems like colitis and pneumonitis [lung inflammation] can happen quickly and suddenly. We need to hear about that right away.â
Scott Gettinger, MD, an expert in immunotherapy and targeted therapy at Yale Cancer Center in New Haven, CT, also warns about pneumonitis. Itâs inflammation of lung tissue that can cause cough and shortness of breath. For people with NSCLC, it can be deadly.
âWhen you suspect pneumonitis, you need to start steroids right away,â he says.
High-dose steroids can bring down life-threatening inflammation. Lower doses may help treat less serious symptoms.
Despite the intense side effects, Reckamp says most people do pretty well with combined treatments.
âYou can work, travel, and live a fairly normal life, but you need to adjust for days when you donât feel well,â she explains. âHospitals and treatment centers have social workers and many other resources to help you get back into life.â
But, Reckamp says, youâll also need help you canât get from a hospital.
âYou also need strong social support from your family,â she says. âAnd it can be helpful to join a group of like-minded people or talk to a therapist or counselor.
âPatients are living longer, so itâs important to help them figure out how to frame what they want for their lives and how to do what they want to do.â
Show Sources
Photo Credit: fstop123 / Getty Images
SOURCES:
Karen Reckamp, MD, co-director, lung cancer and thoracic oncology program, City of Hope, Duarte, CA.
Scott Gettinger, MD, associate professor of medicine, Yale Cancer Center, New Haven, CT.
American Cancer Society.â Targeted Therapy Drugs for Non-Small Cell Lung Cancer.â
National Cancer Institute. âTargeted Cancer Therapiesâ
The New England Journal of Medicine: âPembrolizumab plus Chemotherapy in Metastatic NonâSmall-Cell Lung Cancer.â
Dalton Transactions: âThe side effects of platinum-based chemotherapy drugs: A Review for chemists.â
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Disease Research
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Anxiety affects millions of people globally, getting in the way of their daily lives and well-being. As public awareness of mental health issues increases, experts have looked into techniques for anxiety management. And interestingly, it turns out that gaming is a very well-researched method for dealing with anxiety. In this post, I want to look at the studies to explain how gaming might help with anxiety, what the potential benefits are, and if there are any negative side effects.
Anxiety is one of the most common mental health issues and is often associated with excessive worry, trouble making decisions, irritation, stress, and, in some cases, even panic attacks. There are also often physical symptoms such as an elevated heart rate, nausea, and sweating. It can have a significant impact on a person’s everyday life, relationships, and general well-being. Most commonly, anxiety can be treated with meditation, breathing exercises, cognitive-behavioral therapy (CBT), and, in more severe cases, medication.
Studies
During my own research, I found that there are quite a few well-researched studies done on the subject. Most studies adopt a mixed-methods approach, analyzing both qualitative and quantitative data from previous research. Participant data is derived from diverse demographics, and various game genres are researched. Assessment tools include standardized questionnaires for anxiety and depression symptoms. These studies collectively suggest that gaming can have positive effects on mental health, particularly in managing symptoms of anxiety and depression, though the effects can vary based on the individual and the type of gaming.
An experiment from 2018 showed that people with anxiety who played the very popular mobile tower defense game “Plants vs. Zombies” four times a week for at least a half hour each session experienced better mental health outcomes than those who took medication. This study is particularly interesting because it compared the effects of a popular commercial video game directly with medication, a more conventional treatment method for anxiety.
An interesting 2011 study trying to find the role of gaming in anxiety and depression suggests that gaming has a dual effect. The study suggests that while gaming can help with anxiety, it’s important to think about how Internet gaming affects anxious gamers by focusing on how much they play and if they have any signs of a gaming disorder.
Another study from 2021 titled “Gaming Your Mental Health” focused on the potential mental health benefits of playing commercial video games, particularly in addressing symptoms of depression and anxiety. The review acknowledges that depression and anxiety are the two most common mental health disorders globally. The study discusses the significant treatment gap and stigma associated with these mental health disorders and emphasizes the need for accessible, cost-effective, and stigma-free methods of treatment, especially in the wake of the COVID-19 pandemic.
The benefits
So what are the potential benefits of gaming related to anxiety? According to the research cited above and other studies I could find online, there are quite a wide range of benefits and effects from gaming that can help with anxiety, depression, stress, and overall mental health.
Therapeutic Benefits. Some studies have found that video games can offer therapeutic benefits for individuals with mental health issues. Games designed with therapeutic intentions, often referred to as “serious games,” can target specific symptoms of anxiety and depression, offering a form of digital therapy.
Stress Reduction. Playing video games can be a form of stress relief for many people. Having an immersive gaming session allows individuals to escape from the stress of daily life, which can have a calming effect and reduce symptoms of anxiety.
Improved Mood. Games can also improve mood and provide a sense of achievement and fulfillment. Completing tasks and achieving goals in games can offer a sense of satisfaction and boost self-esteem, which can be particularly beneficial for individuals suffering from depression.
Social Interaction. Multiplayer games offer opportunities for social interaction, which can be beneficial for those who feel isolated or have social anxiety. Online gaming communities can provide a sense of belonging and support, which is important for mental well-being.
Cognitive Benefits. Gaming can also have cognitive benefits, such as improved attention, problem-solving skills, and brain plasticity. These cognitive enhancements can indirectly contribute to better mental health by improving overall brain function and resilience.
Real-Life Relief Stories
There are many real-life stories of people who have found relief from anxiety through gaming. Jessica, who suffered from social anxiety, provided one firsthand account. Jessica had the ability to communicate and form connections with like-minded people through online multiplayer games.
“Gaming allowed me to break down the barriers of social anxiety and form meaningful friendships. It created a comfortable environment in which I could be myself and gain confidence.” Jessica
Why Gaming Works
The effectiveness of gaming in reducing anxiety is based on psychological and neurological factors. The studies show that gaming helps with nervous thoughts, provides a cognitive break, and reduces stress. The immersive nature of gaming causes the brain’s pleasure chemical, dopamine, to be released, creating a pleasant emotional state. Gaming may improve executive functions and cognitive flexibility, resulting in improved emotional regulation and adaptive coping mechanisms.
Negative Effects
Although there are worries regarding gaming’s possible harmful impact on anxiety, it is critical to evaluate the greater body of evidence that supports its benefits. When used carefully and in moderation, gaming can be a wonderful tool for anxiety alleviation. Excessive gaming, rather than being the cause, has been linked to pre-existing mental health disorders in studies. Setting boundaries, exercising self-regulation, and maintaining a healthy gaming lifestyle, according to researchers, are critical in optimizing the potential advantages.
Effective Gaming Strategies
Several insights and strategies can be used to maximize the positive impact of gaming on anxiety. It is critical to select games that match your personal interests and create a sense of fun. Balance can be maintained through regular breaks, physical activity, and social engagement with friends through gaming. It’s also important to remember that gaming is only one of the methods of dealing with anxiety and shouldn’t be relied on as the cure for everything.
In conclusion, gaming is a very viable path for anxiety management since it provides distraction, creates social relationships, and improves cognitive skills. Research combined with real-life examples shows that it has the ability to help with anxiety, depression, and stress. Gaming can have a very positive effect on overall mental well-being. So I think it’s time for a game break. In the next blog post, I’ll cover some of the best games for anxiety and mental health, so stay tuned!
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Mental Health Treatments
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Sofia Hart is bravely sharing her heart condition with the world.
The TikToker gave followers a look into how she lives while attached to a life-saving medical device called an LVAD—a left ventricular assist device—which keeps her heart pumping.
"Hello, I'm Sofia," the 30-year-old said in a July TikTok video. "I run off batteries, literally, and I don't have a pulse. I'm a human without a pulse, it's true. I'm not making it up."
Sofia added, "I am on a device—I guess you can just call it a life support device called an LVAD and it's called a left ventricular assistive device and it pumps to the left side of my heart."
Although the Massachusetts native noted that viewers wouldn't be able to see her scar, she did reflect on where it came from.
"I had open heart surgery at the end of November to implant the device that's inside of me that basically hugs my heart," Sofia continued before holding up the remote and batteries that are used to control the device. "It's on a continuous flow."
Explaining how she ended up needing open heart surgery, the social media star explained, "I have end-stage heart failure and I'm due for a heart transplant and I'm going to start sharing my story."
Over the past three months, Sofia has continued to document her daily life on TikTok and recently spoke to People about navigating her journey.
"That cord is pretty long, and I have mastered living in places where I can get around on that cord," she told the outlet in an interview published Oct. 24. "There's no turning back for me."
Reflecting back on when she realized something was wrong, Sofia recounted, "I started getting really achy and so fatigued. It's like a fatigue that you can't really describe. I wasn't tired in my brain, but my body was so tired."
@aheartforsofiahart Heart Mate 3 #LVAD youre a literal life saver! Starting to share my heart failure journey. I have no idea where to start or how this app works but here goes nothin! @herschelsupply i bought this fanny pack at a local skate shop and i couldnt live day to day with out it so shout out to unknowingly supporting a medical patient! I highly recommend this pack to other LVAD patients who are on the go or want to be hands / shoulders free. #LVAD #heartmate3 #lifesupport #foryou #fyp #heartfailure #aheaetforsofiahart #heartfailurejourney #cardiomyopathy #learningeveryday #growth #healing #gratitude #happytobehere #roadtotransplant ? original sound - AHeartForSofiaHart
And even though Sofia's twin sister Olivia was diagnosed with the same rare genetic mutation, she initially thought she was suffering from Lyme Disease. Olivia, who was working at the hospital Sofia was at, delivered the hard news.
"My sister said, ‘You don't have Lyme disease,'" she continued, "'and we really wish you did.'"
These days, Sofia is looking ahead to her heart transplant.
"I'm doing the work-up for it," she said to People. "I feel guilty having the option of choice to be finding my footing before jumping into transplant. I came out of the gates hot and then realized, well, the device is doing well, I'm doing well on the device, transplant is such a huge, huge, huge deal that I wanted to learn more about life, transplant, live with 'Janis'—the name I gave my LVAD—accept all that's changed and now I'm ready to go to transplant."
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Medical Innovations
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Leprosy cases are surging in Florida, said the US Centers for Disease Control and Prevention (CDC), with a new report suggesting the central area of the state may have become an “endemic location” for the infectious, potentially debilitating disease.
There were 159 new cases of leprosy in the US in 2020, the most recent year for which data were studied, according to a report published Monday by the CDC. Florida was among the top reporting states, and almost a fifth of all cases were reported in the state’s central region.
Central Florida was responsible for 81% of the cases reported in the state.
Meanwhile, the number of reported cases of leprosy in the south-eastern US has more than doubled over the last decade, the CDC reported, with growing instances of people contracting leprosy within the country.
“Whereas leprosy in the United States previously affected persons who had immigrated from leprosy-endemic areas, [about] 34% of new case patients during 2015–20 appeared to have locally acquired the disease,” the CDC said.
The CDC said the data represents “mounting epidemiological evidence supporting leprosy as an endemic process in the south-eastern United States”.
Nationally, the number of reported leprosy cases in the US fell from 2019 to 2020, according to the federal human resources and services Administration. The increase in central Florida, however, represents a new cause for concern.
“Travel to this area, even in the absence of other risk factors, should prompt consideration of leprosy in the appropriate clinical context,” the CDC said.
Leprosy, which is spread by moisture droplets passed through the air, can lead to serious disabilities, including nerve damage, if left untreated. However, the disease is curable with medication, and damage can be prevented if leprosy is diagnosed in time.
The CDC cited the case of a 54-year-old man who lives in central Florida. The man had not traveled domestically or internationally, had not had “prolonged contact with immigrants from leprosy-endemic countries”, and had denied exposure to armadillos, which are known to carry the disease.
The man, who has since been treated for leprosy, worked in landscaping, the CDC said, “and spends long periods of time outdoors”.
“The absence of traditional risk factors in many recent cases of leprosy in Florida, coupled with the high proportion of residents, like our patient, who spend a great deal of time outdoors, supports the investigation into environmental reservoirs as a potential source of transmission,” the CDC said.
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Epidemics & Outbreaks
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The people of Arkansas spent $23.2 million on medical cannabis in July, Arkansas Democrat-Gazette reports. According to the Department of Finance and Administration, such recent spending is set to surpass the state’s record sales from last year. Scott Hardin, a spokesman for the Department of Finance, said July’s sales numbers demonstrate that Arkansas will exceed 2022’s record medical marijuana sales, which reached $270 million.
Arkansas medical marijuana patients spent $164.6 million on cannabis from January to July of 2023, which marks a $7.3 million increase from the first seven months of 2022. That figure accounts for a whopping 5,157 pounds of bud, bringing the year’s total to 34,214.
“If sales remain consistent for the next several months, we will complete 2023 with total sales reaching more than $280 million,” Hardin shared in a news release. “The state collected $2.5 million in tax revenue from medical marijuana in July. This brings total medical marijuana tax revenue in 2023 to $18.5 million, and $108 million since the first dispensary opened in May 2019.”
July came in fifth in 2023 for sales compared with other months, showing that even an impressive $23.2 million isn’t the biggest figure Arkansas can brag about. The highest-earning month of the year is March, which raked in $25 million worth of sales. The state’s lowest earning month of the year still comes in at $22.4 million, Hardin shares.
However, while sales are up, the tax revenue generated does not necessarily reflect sale numbers. For example, the $18.5 million in tax revenue the state has collected from medical marijuana sales through July 2023 is slightly down from 2022’s figures around this year, which clocked in at $18.7 million.
The highest-earning dispensaries that sold the most medical marijuana were Suite 443 of Hot Springs, selling 551.7 pounds in July, and Natural Relief Dispensary in Sherwood, which sold 462.1 pounds.
Arkansas voters legalized medical marijuana through a constitutional amendment in 2016. The state saw its first dispensaries open shop in 2019. Since then, as these figures reflect, there’s been a gradual and continual increase in the number of medical patients. The current figure clocks in at 94,059, according to the latest numbers from the Department of Health. This number is up from the 88,893 registered cardholders in 2022.
Despite such gains in medical sales, in Arkansas, the state has yet to embrace recreational marijuana. Back in November of 2022, voters rejected Issue 4, a measure that would have legalized adult-use cannabis, to the dismay of Arkansas cannabis advocates who worked so hard to push the bill through.
Those pushing the failed measure were led by Responsible Growth Arkansas, an advocacy group concerned with reforming drug law, prison sentencing, and healthcare research. The bill would have amended the constitution to authorize the possession, personal use, and consumption of cannabis by adults 21 and over, as well as legalizing the cultivation and sale of cannabis by licensed commercial facilities.
However, the measure did face criticism. Some complained that it didn’t include expungement provisions or allow for home growing. There were also questions about the method of implementation. As a constitutional amendment, it would take a lot of work to make those changes further down the line. As a result, even die-hard pro-cannabis reformers weren’t over the moon excited about Issue 4.
And Arkansas is a conservative state, making any change towards cannabis reform trickier, even in a time where some conservatives show bi-partisan support for cannabis and psychedelic legalization. State officials, such as Arkansas’ secretary of state, challenged the measure’s validity.
While those in support submitted more than the number of signatures required for the proposal to qualify for the ballot, the state Board of Election commissioners still rejected the measure, arguing that the ballot title didn’t adequately explain what the measure meant to voters.
Arkansas Gov. Asa Hutchinson even held a joint press briefing on October 31, 2022, at the Arkansas State Chamber of Commerce in Little Rock to speak out against Issue 4. “This puts us at a disadvantage in [the] recruiting industry if Issue 4 passes,” Hutchinson said, citing how workplace drug testing would be affected.
So, for now, Arkansas only has (quite profitable) medical cannabis under Amendment 98. Hutchinson’s concern regarding workplace drug testing comes at a time when changes regarding drug testing are sweeping the nation.
For instance, The Michigan Civil Service Commission recently passed a change that would end drug screenings for cannabis for applicants for many state jobs. This rule would overturn previous state policy that automatically disqualified applicants to state positions that tested positive for cannabis (although applicants to some jobs will still be required to pass a marijuana screening before hiring).
Additionally, as noted regarding bipartisan support in the country, despite what the Republicans in Arkansas believe, Matt Gaetz of Florida recently proposed an amendment to the National Defense Authorization Act that would cease cannabis testing for military members.
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Health Policy
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Coronavirus testing and monitoring are set to be scaled up for the winter, the UK’s public health agency has said, as pressures on the health service are expected to rise in the coming months.
Scientists warned last month that the UK was nearly “flying blind” when it comes to Covid, because many of the surveillance programmes that were in place at the height of the pandemic have been wound down.
Now the UK Health Security Agency (UKHSA) has confirmed that it is planning to boost testing and surveillance as winter approaches.
The announcement has been made as schools and universities prepare for the return of students this week after the summer break, employees head back to work and indoor gatherings become more common – factors that are known to increase the risk of respiratory infections, including Covid, spreading.
Prof Steven Riley, the director general of data, analytics and surveillance at the UKHSA, said: “Planned scaling up of testing and community surveillance for the winter season, when health pressures usually rise, is in progress and UKHSA will make a further announcement regarding community surveillance plans for this winter shortly.
“Protecting the public from Covid-19 remains one of our top priorities. We continue to monitor the threat posed by Covid-19 through our range of surveillance systems and genomics capabilities, which report on infection rates, hospitalisations and the risks posed by new variants.’’
The UKHSA announced last week that the autumn Covid and flu vaccination programme in England was being brought forward to September to ensure that the most vulnerable are protected as the winter draws near.
A new variant, BA.2.86, which has been detected in a number of countries around the world including the UK, the US and Denmark, is probably behind the shift. The variant is being closely monitored because it contains a large number of mutations that might help it to evade immune defences – although experts say little is currently known about how big an impact it may have.
Prof John Edmunds of the London School of Hygiene & Tropical Medicine, said the discovery of the variant in a number of countries in a short space of time was one reason for concern. Another is the large number of genetic differences compared with other Omicron subvariants.
“It is definitely concerning, there’s no question about that,” he said. “The good news is we haven’t seen it suddenly take off anywhere.”.
Edmunds said there were still many unknowns about the variant, making it difficult to assess how much of a risk it posed – including whether it would cause more severe disease than other variants in circulation.
One reason for that, he said, is that there was less data available.
“Our surveillance has been much reduced so we are slightly blinded compared to where we have been in the past,” he said. “If you compare it to where we were with Omicron, it’s really very different in terms of just the quality of our surveillance.”
Dr Emma Hodcroft, a molecular epidemiologist at the University of Berne and the University of Geneva, agreed, adding that time was needed to see how the situation progresses.
“If the ‘slow start’ is real, it may eventually fade away, could linger on at a low frequency, or further mutations could enhance transmission and lead to faster spread,” she said.
Hodcroft said at the moment there was no cause for undue worry about the coming months. But she added:“We should be realistic that we often see waves and that for many people, immunity has waned as they haven’t been boosted or infected in a while.
“At the same time, we have the return from holidays, restart of schools, and resumption of a lot of business travel and meetings – all things we know contribute to respiratory viruses being able to get around.”
Edmunds said Covid had yet to follow seasonal patterns, with cases rising rather than falling over the summer. A key driver in waves so far had been changes to the virus itself, he said.
According to the latest data from UKHSA, largely covering the period between 21 August and 27 August, both the increase in Covid case rates, picked up through testing in hospitals, and the recent rise in Covid hospital admissions in England have stabilised.
Restrictions have been lifted as part of the government’s “living with Covid” strategy, but Dr Mary Ramsay, the head of immunisation at the UKHSA, said people with any symptoms of respiratory illness should avoid mixing with others.
Edmunds agreed. “I doubt whether we’ll see much of a return to a mask-wearing and hand-washing, but those things can help reduce spread as well,” he said.
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Epidemics & Outbreaks
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November 28, 2023
UW research finds that mailing HPV test kits directly to patients increases cervical cancer screening rates
Three years ago, the federal government set a series of targets to improve Americans’ overall health. Among the dozens of goals laid out in the plan, called Healthy People 2030, was a significant increase in the proportion of Americans who kept up to date with cervical cancer screening.
That, in turn, would enable more people to catch cervical cancer early, when it’s most treatable.
New research from the University of Washington and the Kaiser Permanente Washington Health Research Institute (KPWHRI) found that the simplest solution may also be the most effective: mailing test kits directly to patients’ homes. In a study published Nov. 28 in the Journal of the American Medical Association, researchers report that mailing test kits significantly increased cervical cancer screening rates, both in populations overdue for screening and those who had previously kept up to date.
The home test kits detect the presence of the human papillomavirus (HPV), which causes most cervical cancers. And a negative HPV test counts as a negative cervical cancer screening, allowing most people to avoid a clinic visit altogether. Currently, more than half of all cervical cancers diagnosed in the United States are in people who are overdue for screening or have never been screened. The team behind this study believes at-home testing can help close the gap.
“This is an alternative, patient-centered way to get people screened for cervical cancer, because patients tend to prefer testing at home and not having to come into the clinic,” said Rachel Winer, a UW professor of epidemiology who led the research. “This is a strategy that other countries are already using, and there’s overwhelming evidence that an HPV test on a patient-collected sample is similarly accurate to an HPV test on a sample collected by a clinician. So there’s really no reason why this shouldn’t be available in the U.S.”
In partnership with Kaiser Permanente Washington, researchers enrolled more than 31,000 female patients between the ages of 30-64 who were either due or overdue for screening, or whose screening history was unknown. Depending on their screening history, patients were randomly sorted into four groups: One group had HPV test kits mailed directly to participants’ homes, another received information on how to request a test kit, and another received an educational brochure on cervical cancer screening. The fourth group received only a standard reminder that participants were due for screening.
Over the next six months, 62% of people who were due for screening and 36% of people who were overdue were screened for cervical cancer after being directly mailed a kit. Those percentages fell to 48% and 19%, respectively, among patients who received only the educational brochure. Sending information on requesting a kit minimally increased screening.
The results, Winer said, indicate that healthcare systems should prioritize mailing HPV test kits directly to patients to maximize cervical cancer screening participation.
“We just think this should be an option for all patients,” Winer said. “It’s convenient, preferred by most patients and an accurate way to screen for cervical cancer. So why not have it as an option?”
This study builds on previous research conducted by Winer and her colleagues, which found that mailing HPV test kits to under–screened patients increased screening rates, though most people remained untested. That study took place before the cervical cancer screening guidelines were updated to include HPV testing alone, so the test kit did not count as a regular screen.
Self-testing is already an option for other routine screenings, most notably for colorectal cancer. The most recent guidelines encourage home test kits as a primary screening option, suggesting that annual stool samples may be taken in place of a routine colonoscopy, which many patients find uncomfortable. Home test kits are now so commonplace that Saturday Night Live has parodied the ubiquitous TV commercials for one prominent manufacturer.
Colorectal screening rates have risen steadily in recent years.
There are still significant barriers to overcome before HPV self-sampling can become widely available, Winer said. Chief among them is approval by the Food and Drug Administration, which is expected to come in the next few months.
Once HPV self-sampling receives FDA approval for use as a cervical cancer screening tool, healthcare systems that want to implement self-screening need to procure test kits, review their policies and educate both patients and providers. Algorithms used to track patients’ care have to be updated. Health centers serving low-income and marginalized communities may not have the staff or financial resources to distribute test kits. Patients without a primary care physician may slip through the cracks
“HPV self-sampling is a tool certainly designed to increase access and reduce disparities,” Winer said. “But sometimes when a new intervention is introduced, it can further widen disparities if there isn’t attention taken to how to best implement it, or how to specifically make sure that it reaches people who need it the most.”
This research was co-led by Beverly Green, a senior investigator at KPWHRI. Other authors include John Lin, research coordinator in the UW Department of Epidemiology; Melissa Anderson and Kristina Hansen from KPWHRI; Jasmin Tiro and Hongyuan Gao from the University of Chicago; Richard Meenan from the Kaiser Permanente Center for Health Research; Angela Sparks from UnitedHealthcare; and Diana Buist of GRAIL LLC in Menlo Park, Calif. This research was funded by the National Cancer Institute.
For more information, contact Winer at rlw@uw.edu.Tag(s): cancer • Department of Epidemiology • Rachel Winer • School of Public Health
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Disease Research
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Ulcerative colitis (UC) was driving Danielle Gulden to the bathroom up to 25 times a day. Medication after medication failed to control her bloody diarrhea, cramps, and other severe symptoms. And life stayed that way throughout her 20s and early 30s until a device called an "ostomy pouch" made all the difference.
"Normal for me was ⦠insane amounts of pain, and always worried and anxious," says Gulden, now 45 and working in medical sales in Columbus, OH.
She did her best to take charge of her UC with humor and ingenuity. Faced with the prospect of making white-knuckled road trips to visit her parents and in-laws, she and her husband, Dave, had a fully functional toilet installed in the backseat of their car -- complete with curtains and tinted windows for privacy.
"We took the seat out, and we bought ⦠the nicest camping toilet you could buy," she says. "We had a magazine rack. We had a little toilet paper holder. And it was the best thing ever."
It wasn't enough. Ulcerative colitis, a disease that causes inflammation and ulcers in the lining of your colon, had been making Gulden sick since the mid-'90s. It kept her from being spontaneous and social, and stopped her from tackling the jobs she wanted. Worse, she felt like she wasn't being a good enough parent to her young daughter, Lauren.
Rather than try more medications, she opted for surgery. In 2007, she got an operation called a "proctocolectomy with end ileostomy." This surgery and others like it are sometimes called a "permanent ostomy."
Gulden's surgeon removed her colon (large intestine), rectum, and anus. Then they connected the lowest part of her small intestine to an opening about the size of a quarter that they created in her belly, called a stoma.
Now waste leaves Gulden's body through the stoma and into an ostomy pouch. It's a type of bag that's covered by a removable barrier that sticks to skin and forms a seal. You empty the bag periodically and replace it with a new one every few days.
Gulden calls her operation miraculous. Within a day of surgery, she started to feel much better. Within 3 weeks, she enjoyed a baseball game at the ballpark. Within 2 months, she went to her first outdoor concert, not caring where the bathrooms were.
"I was a little sore, but I was out," she says. "And it was such a freeing experience. To this day, when I talk about it, I get kind of choked up. Because ⦠I didn't realize how sick and how unwell that I had been until I had my surgery."
'A New Lease on Life'
An ostomy pouch can give someone with severe ulcerative colitis their life back, says Yosef Nasseri, MD. He's a colorectal surgeon at the Surgery Group of Los Angeles and is affiliated with Cedars-Sinai Medical Center.
"Now they're able to determine when they can schedule emptying their bag. It doesn't interfere with any really major daily activities. They're able to go about doing whatever they want to do -- travel, work -- without needing to be tied to a bathroom," he says.
"It is definitely a new lease on life, no question," agrees Margaret Goldberg, a wound, ostomy, and continence nurse. "The pouches are all completely odor-proof. And most people just empty them, clean the bottom, and go about their business."
With a variety of pouching systems to choose from, Nasseri and Goldberg say it's important to talk with an ostomy nurse about your options. "We know all the systems, and we know for the most part what's going to work best," Goldberg says.
If you choose a system that doesn't feel right for you, talk to your ostomy nurse. If you don't have an ostomy nurse, start searching for one, Goldberg says. The WOCN Society â an organization of wound, continence, and ostomy nurses -- can be a good place to start.
Full Speed Ahead
Gulden took advantage of her freedom after ostomy surgery. She left her marketing career, went back to school, and became an emergency medical technician. To protect her stoma on the job, she wore a belt-like device around it at times, just in case she knocked into something or someone.
Years later, she teamed up with her friend Joe Teeters, who also had a permanent ostomy surgery for Crohn's disease, to do candid and comedic public speaking about their lives with inflammatory bowel disease (IBD). IBD includes ulcerative colitis and Crohn's.
Gulden and Teeters call themselves "Double Baggin It." "A lot of people find ⦠there's such a stigma around it," she says of having an ostomy pouch. "Like, 'Oh, you poop in a bag. Oh, your intestine's outside of your body.' And it's scary. So, we want to just be open and answer questions."
She's yet to find something she can't do with a pouch. "I go swimming. I go hot tubbing. I go in saunas, and steam rooms, and everything that you can think of."
She wears whatever clothes she wants, too. That's thanks in large part to the pre-surgery planning that her ostomy nurses and surgeon did to find the ideal place on her belly for her stoma. Many people who don't need emergency ostomy surgery benefit from this planning, which makes you more likely to be able to dress how you like and get back to your usual activities.
These days, Gulden works in medical sales. She's convinced that getting a permanent ostomy was the best decision she's ever made. "Everybody's journey is completely different. But for me, I felt a difference within 18 hours of surgery," she says. "I cried for like a solid year out of joy every time I could do something with an ostomy that I couldn't do without it."
The Weight of Expectations
Justin Mirigliani dreaded the idea of getting an ostomy pouch. An avid hockey player and weightlifter, he'd been keeping his ulcerative colitis symptoms mostly under control "with a ton of medications" since getting diagnosed in 2002. He figured that if he ever needed an operation for his UC, he'd get the most common one, J-pouch surgery. It allows you to poop normally, and most people only need to wear a temporary ostomy pouch while healing from it.
"I said to anybody who knew me, next to dying, having the bag would be the second-worst thing that could possibly happen to me," says Mirigliani, a 46-year-old husband, father, and corporate software trainer in Cherry Hill, NJ. "My notion was: hockey is done, no more weightlifting, forget skiing. I just thought I'd just shrivel up and get old."
But when his colonoscopy spotted a precancerous change called high-grade dysplasia, Mirigliani's doctor told him he'd need surgery and that J-pouch wasn't a good option for him. Even though it removes your colon and rectum, it leaves the top of the anus, which gets connected to the end of the small intestine to form a pouch inside your body. To have the best chance of avoiding colorectal cancer, Mirigliani would need a total proctocolectomy with a permanent ileostomy, the same surgery that Gulden got.
"I was devastated. I collapsed in tears. I was petrified. Not only that I had the high-grade dysplasia, but I didn't know what life would ever be like with a permanent ostomy," Mirigliani says. Thinking of his family made the decision easier, though. "I have two daughters, and my main thing was: What was going to give me the best chance to walk them down the aisle when they get married?"
Cross-Checking the Stigma
Some of the faulty ideas that people have about modern ostomy pouches stem from memories they have of older folks who wore one a long time ago, Goldberg says. "Most people have a grandfather or some neighbor or somebody who had the surgery and never left the house again. Or if they did leave the house, they stunk to high heaven. Again, the equipment has improved tremendously."
Goldberg would know. She got her ostomy pouch for ulcerative colitis back in 1970. "Fifty percent [of people] that I'm friends with don't know that I have an ostomy. And the other 50% forget."
"We try very hard just to fit in exactly like we have been before," she says. "And there's no reason why you can't."
Some people worry about how ostomy surgery might affect their sex life, intimacy, and body image, Nasseri says. "Especially if you're young and single, the concern and fear is ending up finding someone that will be OK with [an ostomy pouch], finding someone who will be supportive."
If you have a sexual partner, talk openly with them about things like your mutual expectations, bedroom activities you're comfortable with, and any physical limits you have. You can also look up intimate wear made just for people with ostomies. Some companies sell lingerie and waist coverings that either hide a pouch or secure it in place.
Whether you're concerned about your body image or life with an ostomy pouch in general, it can help to talk with other people who understand what you're going through. Nasseri points his patients to ostomy support groups on the web, social media, or through national societies.
Goldberg also recommends finding support through the United Ostomy Associations of America. "It takes a while for you to incorporate [the ostomy pouch] into yourself and to see that, 'I'm feeling so much better. I can do things,' " she says.
Turning the Corner
Mirigliani got his total proctocolectomy surgery in September 2015. His family helped him get through the recovery, which included sickening side effects from pain medication. "My wife had to be a single parent for a little while. I was pretty much down and out for a couple of weeks."
Then in November, about a week before Thanksgiving, he and his wife, Amy, went out to dinner together for the first time since his surgery. "That turned the corner right there. I said, 'All right, this is going to be a normal life.' And I just started skating again and slowly got back into weightlifting, and I really haven't looked back."
The worst of his UC symptoms vanished. Gone were the days of taking a 2-hour car ride and pulling over five times for bathroom stops. Gone was the need to wear an adult diaper in case of an accident, which he'd had in front of software-training classes he taught at work. Mirigliani quickly realized that his preconceived notions about ostomy pouches had been wrong.
"I would say that no matter what your biggest fears are, the odds are that they're not going to come true -- that you're still going to be yourself afterward. That most of the things that you have done before, you'll probably still be able to do. It saves your life."
He pays his gratitude forward with a charitable nonprofit association that he created called Checkmates. The charity holds NHL celebrity hockey games to raise money that goes toward finding a cure for inflammatory bowel disease and helping people in the ostomy community. Checkmates hasn't held a celebrity hockey game since the COVID-19 pandemic began, but Mirigliani plans on having one in 2022.
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Medical Innovations
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Anton Petukhov/Getty Images
Anton Petukhov/Getty Images
Veterinarian Karen Fine continues to be amazed by her patients, despite the fact that she's been in practice for 30 years. Take, for instance, the feral cat she had to capture in a net, who was suffering from an overgrown claw that had punctured and infected his paw pad.
"I knew that I could give him antibiotics for the infection, but it wasn't going to stop until I trimmed that claw," Fine said.
Just as Fine was contemplating how to best access the infected paw, her feline patient stretched it out to her through the net, spreading his toes and staying perfectly still. It was as if the cat knew what he needed and was asking for help — which she provided.
"I think there's so much we don't know and understand about animals, she says. "And I think there's a lot that we sort of assume that we know, but that they really have skills and senses that we don't. I feel that I learn from my patients all the time."
Fine notes that one common veterinarian abbreviation — ADR — stands simply for "ain't doing right," which she describes as "can't put my finger on it. They're not themselves." She says she prefers to visit her patients in their homes, because it gives her a more complete picture of their lives and their owners' habits.
"And at the clinic, people don't remember the name of the food," she says. "You can't tell how much [the pets are being fed]. At home someone might say, 'Oh, he only gets a little bit.' And I can look across the kitchen and see three overflowing food bowls."
Fine reflects on her experience treating pets and counseling their owners in her new memoir, The Other Family Doctor. A big part of the job, Fine says, is witnessing suffering — not just of animals, but also of their owners. It can take an emotional toll; suicide rates among veterinarians are disproportionately higher than those of other professions.
"There's been a big focus on wellness, that veterinarians should try to take good care of ourselves and get enough sleep and eat right and exercise," Fine says. "And I kind of feel like that's a very good start. But we also need to try to focus on why this work is so difficult and how bonded people are to their animals and how intense some of these interactions are. ... I think people, too, need to maybe understand how difficult this work can be."
Interview highlights
On practicing acupuncture and Chinese medicine on animals
I use acupuncture quite a bit and I find that it works well for a lot of chronic conditions [that] Western veterinary medicine maybe either can't really address well, or can address with medications that have other side effects. And in some cases, acupuncture just works better — like, often, for arthritis. That's one of the main things that I use it for, and I really enjoy using it. I feel like it's another way to look at the patient. ...
I use some Chinese herbal formulas and supplements. And the theory is pretty much there's not a magic bullet that we're looking for. We're not saying, take this supplement, it's going to fix everything. It's sort of a holistic approach, looking at everything in the animal's life -- let's look at lifestyle and let's look at diet and those types of things. So sometimes I'll use Chinese medicine and Western medicine together with the same goal, and sometimes I'll be able to use less Western medication or no Western medication because of the Chinese medicine, because of the acupuncture.
On how she figured out her cat had headaches
The first thing he did was he attacked my dog, which was incredibly out of character. He was a very gentle cat. And he was 15 at the time. And when my husband and I talked about it afterward, we realized we had seen him, what we call, "head-pressing." So he had sort of put his head down and pressed his head into her body before he attacked her. And she may have just moved away or something like that. ... Headaches are so universal among people that we would think, why wouldn't animals have headaches? And they're not going to kind of put their paw on their head or something like that. What they're going to do is they're going to isolate themselves. They're going to close their eyes. They're going to go to a quiet, dark place. So when people say, "My animal's hiding," sometimes we think, OK, they're not feeling well. But it may be a headache. ... It's not a very common symptom, this head-pressing. But I think that's what he was doing and that's why he attacked my dog. So then I took him for an MRI and he was diagnosed with a brain tumor.
On helping people make hard decisions about how much to pay for care
That is one of the main curses of veterinary practice and pet ownership, really. It's very difficult. And I myself have been in situations, as have most of my clients, where you're trying to consider, do I have this money? Is it worth spending? And there are so many factors. One is, whether you have it or not, but also how old is the animal? Is it likely to give them a short amount of quality time, a long amount of quality time?
If you have an animal with a broken leg, say [a] cat that had an amputation: Now that cat's likely to live a normal life span, and cats do fine with three legs. So that's a very fixable problem. If someone doesn't have the money for that, then a lot of times you're looking at euthanasia and that is one of the reasons, I think, why veterinary practice is so stressful — even though we may want to, if it's our clinic, maybe do things for less cost or whatever, our bills are very expensive and our debts are expensive. The student loan is incredible and we have to pay bills. And there's almost an expectation, I think, among some clients that we should be doing things for free. And these services, even, say, the blood work, the costs have gone up a lot. It costs us money. So there's very little that's really free and it's a very difficult thing.
On her 16-year-old cat, Daiquiri, being ready to die
We had a little half-bathroom upstairs, which had no windows, and he retreated there. But unlike when he was sick before and I felt that he was having headaches, he seemed comfortable. He was lying there. He was purring. He had stopped eating, which, for him — this was a cat who would eat the house. So the fact that he stopped eating, that's when I really knew that something was wrong. And he just was so calm and serene. And I really felt that he was ready.
And I've felt that from many animals, when I see animals that are near death, that I feel like I see this recognition in them, that there's this process going on. And it made me really think, you know, that they're having this mind-body connection and that their body's breaking down and their mind is accepting that, and that's what they're experiencing.
Sort of like — if you think of an animal giving birth. No one's explained to them, "You're pregnant and you're going to have puppies and this is what's going to happen." They listen to their body and they kind of intuit what to do. And I think death is a similar situation for animals, and that is my opinion after watching so many animals die and be near death.
On the euthanasia process
One of the things I do is I often ask the person: "Have you seen this done before?" I'm trying to gauge their comfort level with it. And some people say, "Oh yeah," and they kind of know what to expect. Some people say no, and then I kind of walk them through it a little bit, that I'll often give [the pet] a tranquilizer injection first, and then the other injection goes right into the vein. It's usually a painless injection. but sometimes they don't like the needle, or their leg being held, or whatever.
It's a whole different thing when their person isn't there. Then it's just me giving an injection and the person holding (usually there's a staff member holding them), and we are very much aware that this is not like any other injection. We're very much aware this is a euthanasia — and there's sort of a respectful silence. It's a strange situation to be euthanizing your patients, I have to say, even after all these years. It's a strange thing. And I feel like I have a lot of respect for that. I want people to feel supported. I know that even though this injection may bring this animal so much peace, if they're suffering, it may bring the person in the room with me or the people much pain and anguish. So it's really sort of a delicate dance in terms of supporting the person. I certainly want to make sure that the animal is comfortable, but we really try hard ... for it to be a good experience, certainly for the animal, but also for any people that are watching.
On when pets grieve a fellow pet
They're very deeply affected, I think sometimes more than people, because we often leave and go to work or go take a walk or socialize or whatever. And our animals are often more confined to the house and they're not watching TV, they're not listening to podcasts. So they are more, maybe, in tune with their environment. And, just like some people, some animals adjust more easily and some really have a difficult time with it. ...
We often see animals grieving. [I recommend keeping] them on a schedule. And sometimes it's a new schedule, sometimes it's keeping up a little bit with an old schedule. If it's a dog, say, get them out of the house. If they don't have their playmate anymore, try to go somewhere where they can see another dog so that they can kind of keep doing a little bit of what they're doing and just allowing them that time and space to grieve, because it is a normal process.
On how to change veterinary medicine to ease the mental health strain
Many of us are perfectionists and, if you're an animal [physician] — just like a human physician — you think, well, if your patient dies, is that a failure? So, kind of, really talking about some of these things and reflecting on them [can help you process that]. And I really feel that reflection, and looking at some of our work, is important. And in human medicine, there's more of a history of that.
Certainly not every physician is necessarily reflective, but you have the medical humanities, which really looks at "What does it mean to be a doctor; what does it mean to be sick?" And we don't have that with veterinary medicine. We're just starting to have a couple of people talking about veterinary humanities and that sort of thing, and about how we can reflect upon our work.
Audio interview produced and edited by: Lauren Krenzel and Thea Chaloner. Audio interview adapted to NPR.org by: Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin.
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Mental Health Treatments
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By Nicole Creech, as told to Hallie Levine
When I was diagnosed with pulmonary hypertension (PH) at age 36, I was terrified.
But then I remembered this wasnât my first rodeo: I was born with sickle cell disease, and doctors said I wouldnât live past the age of 15. I was well versed on how to live with an ongoing and potentially deadly condition.
Iâm 49 now. Hereâs my story.
A Delayed Diagnosis
Like many other people with PH, I went undiagnosed for several years. I had really strange symptoms such as shortness of breath and fatigue that would just come out of nowhere. Iâd feel like I couldnât get enough air into my lungs even though I wasnât exerting myself. I went to the ER and to my doctor several times, but was told I had asthma and given an inhaler. That, of course, did nothing.
Then on Fourth of July weekend in 2008, I began to sweat profusely and had a weird pain in my chest, almost like I had a chicken bone hanging from my ribcage. I couldnât even walk a short distance without feeling like I might pass out. I went back to the ER, where they put me on oxygen right away. Thatâs where I also learned I had pulmonary hypertension.
I was in the hospital for 21 days, and they were the scariest says of my life. They actually told me I needed to get my family in there to tell them what was going on. But when they said Iâd live 5 years at most without treatment, I tuned them out. Inside, I was scared, but there was something that said, âYouâre going to beat this and be fine.â
Doctors placed a catheter into a vein in my chest during the hospital stay. This allows me to give myself medication every day using a small, battery-powered syringe. Iâm very lucky because I responded extremely well to the standard treatment for people with severe pulmonary hypertension. Within a week, I felt great -- better than I had in years. Thatâs when I knew Iâd turned the corner and Iâd be able to live a full life, even with the disease.
Getting Back to Life
The first 4 years after diagnosis, I continued to live my life like Iâd always had. I worked 50-hour weeks as a property manager and partied most nights of the week. Then I realized I needed to slow down, so I retired. My mom had gotten me a Yorkshire terrier that I named Yager (after my fondness for Jägermeister). But she kept him because I was rarely home between work and my social life. Once I quit my job, Yager came to live with me.
That dog completely altered my perspective on life. When he entered my home, I realized I didnât want anything but to be with him. I gave up alcohol, started a plant-based diet, and began walking most days of the week. Instead of nights out at bars, I was content to be home, curled up with Yager and reading a good book or watching TV.
Even though I wasnât technically working, I found myself incredibly busy. I organized a pulmonary hypertension support group through the University of Kentucky. Ten people came, and it was an eye-opening experience. Iâd never seen so many other people with PH in one place.
In the almost 5 years that I led that group, we lost several members, which was sobering. Iâve seen people in the hospital when they were first diagnosed, and I've been bedside with them when the medications were no longer working. Iâve sat with them to keep vigil while they passed. Itâs been such an important way for me to give back.
I also became a founding member of the Pulmonary Hypertension Associationâs Support Group Leader Advisory Board, where I train and mentor new volunteers to help guide the organizationâs support group program.
A New Love
For years, the thought of romance never crossed my mind. That changed in 2018 when I attended a Pulmonary Hypertension Association conference in Florida. While there, I stayed at my best friendâs house and got to know Tommy, her cousin. I thought it would peter out after I returned home, but 4 months later, Tommy had moved to Kentucky to be with me. I made him promise he wouldnât be my caregiver, which he accepted.
Still, Iâm always surprised at how easy itâs been for him to accept me for who I am. I have a pump connected to my body that I can never take off or shut off. Itâs as much a part of me physically as my arms or legs. But Tommy has never batted an eye. He always tells me that he sees my pulmonary hypertension as just another part of me, but one thatâs made me stronger and made me appreciate the small things. I always tell newly diagnosed patients who worry about a romantic relationship to still put themselves out there. When itâs the right person, they will always love you.
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Photo Credit:Â Kriangsak Koopattanakij / Getty Images
SOURCE:
Nicole Creech, 49, Lexington, Kentucky.
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Disease Research
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The 2023 Nobel Prize in Physiology or Medicine went to two scientists whose vaccine breakthrough contributed to developing the mRNA COVID-19 vaccine. Professor Katalin Karikó and Professor Drew Weissman received the honor on Monday for their “groundbreaking findings” in a paper that went largely unnoticed until the COVID-19 pandemic grew rampant in 2020.
When Karikó and Weissman met in 1998, they started studying messenger RNA (mRNA) which was so delicate that the cells destroyed it. However, the two scientists discovered that by slightly altering the mRNA, they were able to direct it to force the cells to make the type of protein they chose. This meant the mRNA would cause the body to produce the antibodies and special immune system cells that could attack the virus.
Karikó and Weissman published their findings in 2005 in a publication called Immunity, after their paper was rejected by the journals Nature and Science. The modification meant they could select how RNA responds to the pathogen, presenting a different approach to tackling diseases like influenza, and later, the coronavirus.
“During the biggest public health crisis of our lifetimes, vaccine developers relied upon the discoveries by Dr. Weissman and Dr. Karikó, which saved innumerable lives and paved a path out of the pandemic,” J. Larry Jameson, executive vice president of UPenn’s School of Medicine told CNN. “More than 15 years after their visionary laboratory partnership, Kati and Drew have made an everlasting imprint on medicine.”
Historically, scientists updated vaccines to introduce a piece of the virus that would prompt the mRNA to respond by giving the immune system a chance to fight the illness in case the person is exposed to the virus at a later time. But Karikó and Weissman changed everything when their paper attracted the attention of Moderna and BioNTech. Both companies studied how the mRNA vaccine could contribute to the flu and cytomegalovirus, among others, but their studies remained in critical trials for years.
When the covid pandemic began, their research became the building blocks for the Pfizer and Moderna vaccines. Their discovery “fundamentally changed our understanding of how mRNA interacts with our immune system,” the Nobel Assembly at Karolinska Institute said in a press release. It added: “The laureates contributed to the unprecedented rate of vaccine development during one of the greatest threats to human health in modern times.”
The chair of the Nobel committee, Professor Gunilla Carlssom said during the announcement: “I think in terms of saving lives, especially in the early phase of the pandemic, it was very important,” The Guardian reported. Karikó and Weissman received 11 million Swedish kronor ($999,513) for their contributions to medicine.
The Nobel Prize announcements will continue throughout the rest of the week including awards in physics, chemistry, literature, and economics. The final award for the Nobel Peace Prize will be announced in Norway on Friday.
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Vaccine Development
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A heat wave brings familiar collective grumbling. We make jokes about ice baths, grouse about sleepless nights, and trade tips about creative ways to cool down.
But with research suggesting that this summer's grueling global heat waves are linked to climate change, we can likely expect seasonal griping to become our new normal. It's a frightening prospect, particularly because the silent struggles we face tell a more complicated story about how humans, and their mental health, fare when subjected to extremely hot temperatures.
Last year, a study published in JAMA Psychiatry demonstrated how higher temperatures are associated with a noticeable uptick in emergency department visits for mental health treatment. Previous studies on the subject have yielded similar results. A recent Lancet Planetary Health meta-analysis of studies on rising temperatures and mental health also identified potential links when researchers looked at heat and suicide, hospital admissions for mental illness, and worsened community health and well-being.
There's something about heat waves that lead to worse mental health, whether that's judged by self-reported measures or medical records like hospital visits.
Research on the subject bolsters the case that extreme heat related to climate change takes a toll not just on the body, but also the spirit and mind. While this might be of particular concern for vulnerable populations with limited access to resources including cool shelter, like farm workers or the unhoused, the association also holds true for people who have access to private insurance and Medicare, according to the JAMA Psychiatry study.
Using data collected over a 10-year period from more than 2 million patients, the researchers found that days with extreme heat were associated with increased emergency department visits for mental health conditions like substance misuse, anxiety, schizophrenia, and self-harm. That span of time represents several of the warmest years on record in the United States.
A 2022 report published by the Intergovernmental Panel on Climate Change included a lengthy discussion of the connection between extreme temperatures and reduced well-being and mental health. That research found that increased heat is associated with suicide, psychiatric hospital visits and ER visits, and heightened anxiety, depression, and stress. Studies have also linked higher summer temperatures to decreased happiness.
Humans want to be resilient in the face of adversity, so they crack jokes about heat exhaustion or jury-rig a swamp cooler in their bedroom. They might wave away mounting anxiety as overreaction or pour another glass of wine to dull the edge of making it through another triple-digit day without air conditioning.
But the scientific research should be a wake-up call to anyone who thinks extreme heat is bearable with the right attitude. Coping skills are always valuable, but what we ultimately need are more adaptive and resilient systems that help shield everyone from the physical, emotional, and psychological toll of extreme heat.
How heat waves affect mental health
While the authors of the JAMA Psychiatry study couldn't conclude how extreme temperatures worsen mental health, they suggested sensible explanations: disrupted sleep, daytime discomfort or irritation, and an "increase in hopelessness, maladaptive anxiety, and stress attributable to the anticipation of climate change and associated extreme events."
Anyone who's waited for their home to cool off without the assistance of air conditioning during an extended heat wave knows the desperation can lead to anxious questioning about the future: How will my children survive a warming planet? Should I even have children if this is the world they'll inherit?
The researchers also speculated that an emergency department could be a refuge on a scorching summer day; the price of admission is to see a doctor about a mental health condition that needs treatment anyway. If patients are indeed using the ER to escape the heat, it represents the crux of this momentous problem.
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Turning to the ER is a resourceful, if expensive, strategy, but improving our collective health will require preventive, equitable solutions. This could include more cooling centers and transportation to reach them, as well as initiatives to reduce the absorption of heat by man-made materials like cement, asphalt, and brick in urban areas through measures like increased tree canopies and green roofs, so that people can remain comfortable in heightened temperatures.
Ways to cope during a heat wave
In a co-authored editorial that accompanied the JAMA Psychiatry study, data scientist Dr. Nick Obradovich, who was not involved in the study, argued that it's vital to understand how extreme heat affects mental health so that public policies can precisely target ways to help people.
Months after the JAMA Psychiatry study appeared, Obradovich published a study that took sleep measurements from smartwatch data across 68 countries and linked it to local daily meteorological data. He and his co-authors found that higher temperatures seemed to shorten sleep by delaying its onset, which increased the chances of insufficient sleep. The results built on Obradovich's previous research on the topic; a 2017 study he co-authored helped identify the relationship between climate change and disrupted sleep.
If the main factor is that people sleep less when temperatures rise, and therefore experience worse mental health, then scientists and legislators could evaluate how best to improve the quality of a good night's rest on a hot day. In the future, that could potentially lead to the widespread adoption of architectural practices like passive cooling or building codes that encourage energy efficiency, which reflect the importance of cool nighttime temperatures.
Obradovich said there is still a critical need for better quality studies to improve our understanding of the relationship between rising temperatures and poorer well-being. He also suggested that by looking exclusively at mental health diagnoses available in medical records, we may miss emotional and psychological turmoil that hasn't risen — or won't rise — to the clinical level.
Imagine, for example, the stressed single parent trying to stay patient with a screaming toddler in an overheated house during a summer of heat waves. Or a lonesome senior who feels trapped and scared in the midst of record-high temperatures. Even if these experiences don't lead to an official diagnosis, they influence people's well-being. Writ large, temperature spikes can send a shockwave of angst through households and communities.
"When you sum total the effect of a million people being a bit more grumpy than they otherwise would on any given day, that's something worth paying attention to as well," Obradovich, chief scientist for environmental mental health at the Laureate Institute for Brain Research, told Mashable.
People with resources may seek therapy to help process their feelings, or turn to other practices like mindfulness and meditation. They may resort to what Obradovich calls private adaptations: installing air conditioning, moving to a region less affected by extreme heat, or simply skipping town when a heat dome arrives.
Obradovich says there's no sense in feeling shame, or shaming others, for making these choices. It's vital that people stay cool, but we must also pursue adaptations that benefit everyone while minimizing carbon emissions and ultimately moving away from energy systems that rely on carbon-emitting fossil fuels.
This is partly an individual responsibility, as much as people can influence politics and the marketplace through their pocketbook, activism, and ballot. Beyond that, this problem is one that will require leadership from elected officials to solve. Their duty to protect and serve constituents not only includes continuing to prevent heat-related deaths, but also acknowledging, and providing resources for, the mental health toll of extreme temperatures.
Whether that's through free or subsidized therapy sessions with climate-aware psychologists, or funding for community-led mental health interventions like support groups, or sponsoring fresh ideas that spring from the inventiveness of their constituents, it's time to imagine alternatives to pretending we're all going to be fine. The problem is at our doorsteps now, and will only continue knocking louder.
UPDATE: Jul. 26, 2023, 12:32 p.m. EDT Originally published in February 2022, this story was updated in July 2023.
UPDATE: Feb. 28, 2022, 1:34 p.m. EST This story has been updated to include findings from the IPCC Sixth Assessment Report on Impacts, Adaptation and Vulnerability.
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Mental Health Treatments
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Regularly finding time for a little snooze is good for our brain and helps keep it bigger for longer, say University College London researchers.
The team showed nappers' brains were 15 cubic centimetres (0.9 cubic inches) larger - equivalent to delaying ageing by between three and six years.
However, the scientists recommend keeping naps to less than half an hour.
But they said a daytime sleep was hard in many careers, with work culture often frowning on the practice.
"We are suggesting that everybody could potentially experience some benefit from napping," Dr Victoria Garfield told me. She described the findings as "quite novel and quite exciting".
Dr Garfield says advice to nap is "something quite easy" to do in comparison to weight loss or exercise which are "difficult for a lot of people".
The brain naturally shrinks with age, but whether naps could help prevent diseases like Alzheimer's will still need extra research.
Overall brain health is important for protecting against dementia and the condition is linked to disturbed sleep.
The researchers suggest poor sleep is damaging the brain over time by causing inflammation and affecting the connections between brain cells.
"Thus, regular napping could protect against neurodegeneration by compensating for deficient sleep," researcher Valentina Paz said.
However, Dr Garfield is not about to find a comfy spot to snooze at work and prefers other ways of looking after her brain.
"Honestly, I would rather spend 30Â minutes exercising than napping, I'll probably try and recommend that my mum does it."
How to find the answer?
Studying napping can be a challenge.
Napping might boost health, but the reverse is also true as your health can leave you so tired you need to nap more.
So the researchers used a clever technique to prove that napping is beneficial.
They used a gigantic natural experiment based on the DNA - the genetic code - with which we are born. Previous studies have identified 97 snippets of our DNA that either make us more likely to be nappers or to power through the day.
So the team took data from 35,000 people, aged 40 to 69, taking part in the UK Biobank project and simply compared those genetic "nappers" and "non-nappers".
The results, published in the journal Sleep Health, showed a 15 cubic centimetre difference - equivalent to 2.6 to 6.5 years of ageing. Total brain volumes were about 1,480 cubic centimetres in the study.
"I enjoy short naps on the weekends and this study has convinced me that I shouldn't feel lazy napping, it may even be protecting my brain," Prof Tara Spires-Jones, from the University of Edinburgh and the president of the British Neuroscience Association, told me.
She said the "interesting" findings study showed a "small but significant increase in brain volume" and "adds to the data indicating that sleep is important for brain health".
The researchers did not directly study having a big sleep in the middle of the day, but said the science pointed towards a cut off of half an hour.
Follow James on Twitter.
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Stress and Wellness
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The relatively new COVID-19 omicron subvariant XBB.1.5 "is the most easily transmissible subvariant so far," Dr. Marc Siegel, a Fox News medical contributor, told Fox News Digital this week.That is because "it not only binds well to cells, but it is also the most immunoevasive," said Siegel, who is also a professor of medicine at NYU Langone Medical Center in New York City.The subvariant — now nicknamed "Kraken" by some — is spreading across the globe, too. NEW COVID OMICRON SUBVARIANT XBB.1.5 IS ‘SPREADING LIKE WILDFIRE’ IN US: HEALTH EXPERTS REVEAL WHYMaria Van Kerkhove, Ph.D, technical lead of the World Health Organization, said XBB.1.5 is "the most transmissible subvariant that has been detected yet," WebMD reported.Though this subvariant continues to spread at a faster pace than other versions of COVID-19 did, the Centers for Disease Control and Prevention (CDC) on Friday did revise downward its estimate of how much XBB.1.5 is circulating in the U.S. A medical technician performs a nasal swab test on a patient. (Getty Images)The CDC had previously said that XBB.1.5 made up some 41% of sequenced cases for the week ending Dec. 31 — more than any other variant.However, the XBB.1.5 subvariant comprised 27.6% of sequenced COVID cases nationally for the week ending Jan. 7, 2023 — compared with 18.3% for the week ending Dec. 31, the CDC said on Friday."The number of cases is far greater than anyone is reporting because of all the home tests that aren't being counted." Dr. Siegel also told Fox News Digital that while the XBB.1.5 subvariant is immunoevasive, "studies show that the bivalent vaccine and recent immunity from [COVID] infection are both effective at decreasing severity and hospitalization" due to the virus."Not only that," Siegel continued, "but there is evidence that this immunity also decreases transmission of the virus to some extent in the short term."Dr. Siegel added, "The number of cases is far greater than anyone is reporting because of all the home tests that aren't being counted." XBB.1.5 remains the only omicron subvariant showing significant growth in the U.S. right now, according to multiple reports. The CDC shares a "prevention action plan" on its site that includes staying up-to-date on vaccination. (Paul Hennessy/SOPA Images/LightRocket via Getty Images)"This means that overall, the subvariant remains mild — and if the number of hospitalizations are increasing, it is because of the sheer number of cases."Siegel added, "So far there are no monoclonal antibodies that work against it, so we are relying on Paxlovid as a mainstay of treatment."He emphasized that "one treatment that has been completely overlooked throughout the pandemic is convalescent plasma (collected after recent infection)."The CDC points out that "projections can be uncertain when a variant is just beginning to spread." Dr. Siegel said this treatment "is once again receiving attention because we don't have the synthetic antibodies to use against this."XBB.1.5 remains the only omicron subvariant showing significant growth in the U.S. right now, according to multiple reports. It is second only to omicron BQ.1.1, according to the CDC.MAJOR FOOD BRANDS ARE ADDING SESAME TO ITEMS IN ‘SHORTCUT’ AFTER FDA DECLARES THE SEED A ‘MAJOR ALLERGEN’On its website, the CDC points out that "projections can be uncertain when a variant is just beginning to spread." When XBB.1.5 infections were predicted at 41%, "there was a wide prediction range of about 23% to 61%," said the CDC. "Since then, more data have come in from mid-December, as well as additional data delayed by the holidays." The CDC had previously said that XBB.1.5 made up some 41% of sequenced cases for the week ending Dec. 31 — more than any other variant. However, the XBB.1.5 subvariant comprised 27.6% of sequenced COVID cases nationally for the week ending Jan. 7, 2023 — compared with 18.3% for the week ending Dec. 31, the CDC said this past Friday. (iStock)The CDC added, "As a result, the projection for the week ending December 31 was revised to 18%, but with a higher degree of certainty (prediction range of 9% to 33%), followed by an increase to 28% for the most recent week of January 6 (prediction range of 14% to 47%)."Overall, the CDC said, "these findings demonstrate that XBB1.5 is spreading quickly."In terms of treatment, the CDC said its COVID guidance "remains the same about how people can best protect themselves from serious illness."PENTAGON DITCHES COVID VACCINE MANDATE FOR TROOPSThe CDC recommends basic health and hygiene practices, such as hand-washing and improved ventilation.It also recommends staying up-to-date with vaccination; getting tested for COVID-19 if needed; staying home if you suspect you have COVID or have confirmation that you have COVID; seeking treatment if you have the virus and are "at high risk of getting very sick"; and avoiding those who have suspected or confirmed cases of COVID. CLICK HERE TO SIGN UP FOR OUR HEALTH NEWSLETTERDr. Ashish K. Jha, M.D., MPH, the White House COVID response coordinator, said people should stay up-to-date on booster shots. He also urged people to wear snug-fitting masks and avoid crowded indoor spaces, WebMD reported.Jha also tweeted on Jan. 4, "So am I concerned about XBB.1.5? Yes. Am I worried this represents some huge setback? No. We can work together to manage the virus. And if we all do our part, we can reduce the impact it will have on our lives."CLICK HERE TO GET THE FOX NEWS APPAs always, anyone with questions about risks or symptoms should check with a health care provider or medical professional. Maureen Mackey is managing editor of lifestyle for Fox News Digital.
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Epidemics & Outbreaks
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Lawrence Faucette, the second living person to receive a genetically modified pig heart in a transplant, has died six weeks after the experimental procedure. The University of Maryland Medical Center, where the experimental procedure had been performed, said the heart began to show signs of rejection in recent days.
“Mr. Faucette’s last wish was for us to make the most of what we have learned from our experience, so others may be guaranteed a chance for a new heart when a human organ is unavailable. He then told the team of doctors and nurses who gathered around him that he loved us. We will miss him tremendously,” Dr. Bartley Griffith, clinical director of the Cardiac Xenotransplantation Program at the University of Maryland School of Medicine, said in a statement. Griffith had performed the experimental surgery.
Faucette, 58, was first admitted to UMMC on September 14 after experiencing symptoms of heart failure and underwent the experimental transplant six days later. His heart disease and pre-existing conditions made him ineligible for a traditional human heart transplant.
“My only real hope left is to go with the pig heart, the xenotransplant,” Faucette told the hospital in an internal interview several days before the surgery.
“We have no expectations other than hoping for more time together,” his wife, Ann Faucette, said at the time. “That could be as simple as sitting on the front porch and having coffee together.”
In the weeks that immediately followed the transplant, his doctors reported that he was making significant progress, including participating in physical therapy and spending time with this family.
One month after his surgery, his doctors said they believed his heart function was excellent and had withdrawn any drugs to support his heart function.
“We’ve had no evidence of infections and no evidence of rejection right now,” Griffith said at the time.
Doctors had treated Faucette with an experimental antibody treatment to further suppress the immune system and prevent rejection. However organ rejection is “the most significant challenge with traditional transplants involving human organs as well,” said UMMC in a statement.
In a statement regarding her husband’s passing, Ann thanked those involved in her husband’s care at UMMC.
“Larry started this journey with an open mind and complete confidence in Dr. Griffith and his staff. He knew his time with us was short, and this was his last chance to do for others,” she said.
According to the federal government, there are more than 113,000 people on the organ transplant list, including more than 3,300 people in need of a heart. The group Donate Life America says that 17 people die each day waiting for a donor organ.
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In January 2022, the University of Maryland also performed the first such experimental surgery on 57-year-old David Bennett, who died two months following the surgery. While there were no signs of rejection in the initial weeks following the transplant, an autopsy concluded that Bennett ultimately died of heart failure from “a complex array of factors,” including Bennett’s condition prior to the surgery. A case study published in the Lancet also noted there was evidence of pig virus that had not been identified previously.
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Medical Innovations
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Lady Hallett’s inquiry was told that Sir Patrick Vallance, at the time the UK’s chief scientific adviser, wrote daily diaries detailing the “chaos” inside Downing Street as the virus took hold in 2020 and how Mr Johnson “panicked” over how far to lift lockdown restrictions in July that year.
The inquiry also heard that in October 2020, Mr Johnson wrote “bollocks” in capital letters across a Department of Health guidance document on long Covid, from which it is estimated more than a million people are suffering. Anthony Metzer KC, representing long Covid sufferers, said the former PM has admitted in his own witness statement that he did not believe the condition “truly existed” and that it was “Gulf War Syndrome stuff”.
It also emerged that neither Sir Patrick nor Professor Sir Chris Whitty, England’s chief medical officer, were consulted by Rishi Sunak, then chancellor, over his restaurant discount plan Eat Out To Help Out before it was announced in the summer of 2020.
Sir Patrick and Sir Chris say in their witness statements that “had they been consulted, they would have advised it was highly likely to increase transmission”, inquiry KC Hugo Keith revealed.
While former advisers such as Dominic Cummings have previously revealed the chaos inside Mr Johnson’s Downing Street when the virus first emerged in early 2020, the evidence from two politically neutral scientific advisers about the then prime minister will be damning.
On 20 April, Simon Case, at the time a senior civil servant but who would go on to be Cabinet Secretary, emailed the then health secretary Matt Hancock to say: “The Cabinet Office is a totally dysfunctional mess to present. Not a great place to be.”
At the time, Sir Patrick wrote in his diary there was “No 10 chaos as usual.” The scientific adviser, describing a meeting in the Cabinet Office about the two metre social distancing rule, said “no one in No 10 had really read or taken the time to understand the science advice”.
On 3 June, Sir Patrick wrote that it was “almost impossible” to get agreement on anything due to the “massive internal operational mess within DHSC [Department of Health] and PHE [Public Health England]”.
Mr Keith said Sir Patrick’s diaries “reflect a growing level of concern” about the government’s approach as it prepared to lift more restrictions in June and July 2020.
The scientific adviser wrote that Mr Johnson had become “more cautious” adding: “The PM is simply not consistent, as he wasn’t at the beginning.”
On 13 July Sir Patrick wrote: “The ridiculous flip flopping is getting worse”, and on 28 July: “The chief medical officer and I are both worried about the extreme inconsistencies in the prime minister lurching from open everything to panic.”
Referring to Mr Sunak’s Eat Out To Help Out scheme, Mr Keith said: “The policy objectives were obvious to support the economic recovery by stimulating consumption in the hospitality sector.
“But it didn’t appear to be discussed with the chief medical officer or the chief scientific adviser, and it was not the subject of advice from Sage, SPI-M or SPI-B [Sage’s modelling and behavioural sub-committees].
“Professor Whitty and Professor Vallance’s written evidence is that had they been consulted, they would have advised he was highly likely to increase transmission.”
Sir Patrick wrote of Mr Johnson on one occasion: “This flip-flopping is impossible. One minute do more, the next do nothing.”
The top scientist described a discussion in one morning meeting with the prime minister as “complete bollocks” adding: “As another person said, it is so inconsistent it is like bipolar decision making.”
On 19 September, as a debate raged on whether to announce a second lockdown or “circuit-breaker”, Sir Patrick described Mr Johnson as “all over the place and completely inconsistent”.
On 11 November, Sir Patrick wrote that No 10 was “at war with itself, the Carrie faction with [Michael] Gove and another with spads [special advisers] downstairs, the PM is caught in the middle … and no one has seen anything like it”.
The inquiry also heard that Mr Cummings’ written evidence states that the government had a “deliberate strategy, a goal of herd immunity” – something that has been heavily contested since March 2020.
On 2 March, Mr Cummings texted the then director of communications, Lee Cain, to say that Mr Johnson, after chairing his first Cobra meeting on the virus, “doesn’t think it [Covid] is a big deal. He doesn’t think anything can be done, and his focus is elsewhere. He thinks it will be like swine flu.”
On 9 March, Steven Riley, a professor of infectious disease dynamics at Imperial College London – who is now at the UK Health Security Agency – emailed Sage to say that schools should close and people should start working from home to limit transmission. These measures would not be taken until a week later and a full lockdown was not ordered until 23 March.
In the middle of March, according to Mr Cummings, Mr Johnson was distracted by reports in the press about his personal life.
On 13 March, a senior Cabinet Office official walked into No 10 to tell officials there: “I think this country is headed for disaster. I think we’re going to kill thousands of people”, and at a meeting later that day Mr Cummings said it was likely the country would have to go into lockdown.
WhatsApp and diary entries will reveal that the prime minister and his advisers believed Mr Hancock got “over-excited and makes stuff up”, the inquiry was told.
Summing up the first day of module 2 of the inquiry, Mr Keith said Lady Hallett would have to conclude whether there was a failure of leadership from Mr Johnson and others in government but added, with repetition for emphasis: “Ultimately, the UK was spared worse. It was spared worse by the individual efforts and heroism of civil servants and public servants and workers who battled the pandemic”.
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Epidemics & Outbreaks
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Novo Nordisk Introduces Weight-Loss Medication Wegovy to the UK Market
Danish pharmaceutical giant Novo Nordisk has introduced its weight-loss injection, Wegovy, in the United Kingdom, marking its second European launch in a little over a month. The move comes as Novo Nordisk seeks to expand its presence in the region, even as it grapples with overwhelming demand.
In an official statement, Novo Nordisk announced the controlled and limited release of Wegovy in the UK. The soaring demand for Wegovy, coupled with the success of Novo's highly effective diabetes drug, Ozempic, has propelled the company's shares and earnings to unprecedented heights. On Friday, Novo Nordisk dethroned LVMH as Europe's most valuable publicly traded company, ending the French luxury conglomerate's 2.5-year reign at the top.
Wegovy, which has demonstrated the ability to help patients reduce body weight by approximately 15% when combined with exercise and lifestyle adjustments, is currently available in the United States, Norway, Denmark, and, as of late July, Germany.
Novo Nordisk's struggle to meet the surging demand for Wegovy in the United States has resulted in delays for the drug's launch across most of Europe. Despite increasing production capacity, the company's CEO admitted that it would be "quite some years" before they could fully satisfy the market. Novo Nordisk stated, "We are closely monitoring Wegovy demand and are working with regulators and providers to ensure people living with obesity can have access to and remain on treatment."
In March, the UK's National Institute for Health and Care Excellence (NICE) recommended Wegovy's use in adults with at least one weight-related condition and a body mass index of 35. However, this recommendation was limited to the National Health Service's (NHS) specialist weight management program and was suggested for a maximum duration of two years.
The cost of Wegovy in the UK remains unclear, with NICE yet to provide a comment on the matter. Novo Nordisk's statement indicated that the drug would be accessible both through the NHS weight management program and privately via registered healthcare professionals.
The pharmaceutical company did not disclose the quantity of supply allocated for the UK or the pricing structure for Wegovy in either treatment scenario. In the United States, the drug is priced as high as $1,350 per month.
The implications of the drug's availability through private healthcare professionals are still uncertain. Novo Nordisk stated, "As we expect supply to be constrained for the foreseeable future, a proportion of available supply will be allocated for use only within the NHS to allow healthcare professionals to implement NICE guidance."
Approximately 50,000 eligible patients in England could potentially be prescribed Wegovy through NHS specialist weight management services, according to an NHS spokesperson.
Despite global supply constraints, NHS England is taking steps to implement NICE guidance for weight management while also working to restore supplies of this class of drug for individuals with type 2 diabetes, the spokesperson added.
In June, the British government announced plans for a pilot program aimed at exploring the administration of new weekly weight-loss shots like Wegovy by general practitioners, although the launch date for Wegovy was still uncertain at that time.
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Drug Discoveries
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Junior doctors in England are starting their fifth round of strike action with no sign of a breakthrough in their bitter pay dispute with the government.
The doctors' union, the BMA, made headlines earlier this year when it said pay had fallen so far behind inflation that its members would be better off serving coffee than treating patients. The government described that as misleading and said the average junior doctor earns between £20 and £30 an hour.
In reality, that term - junior doctor - covers someone fresh out of medical school right up to those with a decade or more of experience. And pay is complicated, with salaries varying massively as medics move up grades when they become more skilled and start to specialise.
BBC News asked two junior doctors, at different stages of their careers, to show us their wage slips and explain exactly how much they earn.
The new starter
Dr Robert Gittings graduated from medical school in Liverpool after studying for a master's in infectious disease biology.
Last summer, he started his first, or FY1, year as a junior doctor in London and is currently working on the infectious diseases ward as part of his rotation - where doctors get experience in different types of medicine.
"In my hospital, we have a lot of tuberculosis patients, patients with uncontrolled HIV, and we also get pneumonias and, sometimes, we get a tropical infection coming in," he says.
Robert is paid a basic salary before tax of about £2,450 a month for a standard 40-hour week - or just over £14 an hour. Then there are additional roster hours - which are compulsory - taking his average working week to 48 hours.
Under what the government calls a "final offer", his pay will go up in October in two ways: a straight 6% pay rise and £1,250 permanently added to annual salaries - both backdated to April.
But that falls well short of the 35% increase for which the BMA has been asking to make up for years of below-inflation rises.
For Robert, the latest pay offer would be worth roughly £250 a month before tax.
He also receives extra payments each month:
- Another £1.04 an hour to cover the higher cost of living in London
- An extra £147 for night shifts - about £5 an hour in June before tax
- A fixed £122 a month as he has to work one in every five or six weekends
"Sometimes night shifts can be really busy," he says. "There have been times when I've had to manage a patient by myself who is deteriorating, and I have to do everything for them, just with advice over text message."
Junior doctors like Robert typically spend five or six years in medical school before starting their jobs.
He says he graduated with about £50,000 of debt including tuition fees and - in June - paid back £75 in student loans from his salary.
There are other deductions including £257 - or 9.8% of his wages - for a pension, with the NHS contributing 20.7% under the latest career average scheme, more than most private sector pensions.
In June, Robert took home a total of £2,164 after tax and deductions. That works out as a total annual salary of roughly £37,000.
He says he is now looking to take a year out to work abroad - probably in Australia. "I'm not confident the pay here is going to improve as much as I'd like it to," he says. "I would really quite strongly consider staying [there]."
The speciality registrar
Dr Kiran Rahim qualified from medical school in 2011 and now treats sick children as a paediatric registrar - one of the most experienced junior doctor grades.
"I was at work yesterday and it was really, really busy," she says. "I was managing A&E - so taking in all the paediatric referrals, all the sick kids who needed to be seen.
"And then managing the acute stay ward, making sure the children were getting their treatment, accessing and booking scans for them."
Kiran has taken three years out to have children herself, and is now working part-time while she looks after her young family, meaning her training - and her time as a junior doctor - has been "elongated".
For an average three-day week, she is paid a basic salary before tax of roughly £3,315 a month - or just under £28 an hour - which is the same rate as a full-time doctor. Like Robert, she also receives London weighting.
In July, she was paid another £292 for night shifts and £132 for working one weekend in every six or seven.
She says the "vast majority" of junior doctors at her level end up working extra unpaid hours before they can go home at the end of the day.
"I can't just leave a sick patient because it's unsafe, and it's not fair on the people who are already fighting fire on the next shift," she adds.
Kiran finished paying off her student loan this year, although she says - like other junior doctors - there are unavoidable costs which do not show up on her payslip.
She pays £433 a year to the GMC to be on the doctors' register. There are charges to be a member of the Royal College of Paediatrics and Child Health, and she has had to pay thousands of pounds in exam fees.
Plus there is the cost of personal indemnity insurance - just under £700 a year - to protect her in case she is sued for medical negligence.
In July, Kiran took home £2,159 after tax and deductions for a 27-hour working week. That would work out as a total annual salary of roughly £69,000 if she was full-time.
"Pay is important but so are all the other things that make you want to go to work," she says. "This is not the job I signed up to do 10 years ago and I have seen a decline in morale, in our working environment and in our working conditions."
The government says it has accepted the latest recommendations made by an independent pay review body and its most recent offer represents an 8.8% annual pay rise for the average junior doctor in England.
"Our award balances the need to keep inflation in check while recognising the important work they do," says Health Secretary Steve Barclay.
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Health Policy
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Funding promised to develop the social care workforce in England has been halved, the government has confirmed.
In 2021 the government pledged "at least" £500 million for reforms, to be spent on training places and technology over three years.
But that figure is now £250 million, according to the Department of Health.
The government said its reforms would give care "the status it deserves" but some organisations in the sector say they fall short of what is needed.
Measures outlined in the government's white paper on social care, published in December 2021, include the creation of a new Care Certificate qualification and funding for hundreds of thousands of training places.
The document also outlines plans to speed up digitising social care records and make better use of technology such as smart speakers and sensors.
The government has said its refreshed plan will bolster the workforce and help free up hospital beds.
But the money allocated to the reforms is now just half of what was put forward in 2021.
The white paper also promised to invest at least £150 million in digitisation across the sector, but the Department of Health and Social Care said the figure is now £100 million as £50 million has already been spent.
There has also been no mention of the previously announced £25 million to support unpaid carers or the £300 million mentioned in the white paper to integrate housing into local health and care strategies.
Social care minister Helen Whately said the package announced on Tuesday "focuses on recognising care with the status it deserves".
She said the reforms focused on the "better use of technology, the power of data and digital care records, and extra funding for councils - aiming to make a care system we can be proud of".
The Department for Health and Social Care insists that all the promised money will stay within social care and that it has yet to allocate the full budget.
But the King's Fund health think tank said the measures were "a dim shadow of the widescale reform to adult social care that this government came into office promising" while Age UK described them as not being "remotely enough to transform social care".
A report from Care England and the HfT care provider in March warned that adult social care was "on the precipice" when it came to costs.
The low level of pay for care staff was considered the biggest barrier to recruitment and retention, the report said.
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Health Policy
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Funding for drug treatment centers in Oregon, financed by the state's pioneering drug decriminalization policy, stood at over a quarter-billion dollars Friday as officials called for closer monitoring of where the money goes.
That need for oversight was demonstrated Wednesday when state officials terminated a $1.5 million grant agreement with a drug recovery nonprofit in Klamath Falls accused of failing to submit completed expenditure and data reports and buying a building for more than double the authorized amount.
That $1.5 million is just a drop in a huge bucket — $264.6 million has been allocated to date for recovery centers — and state officials have a massive responsibility to ensure the money does what it is supposed to: combatting drug use in a state with one of the nation's highest addiction rates.
Oregon's drug decriminalization had a rocky start after voters approved it in a 2020 ballot measure. Only a tiny number of people have accessed treatment services after being ticketed for possessing drugs, and funding to treatment providers was delayed.
But as of Friday, $184 million has been handed out to these behavioral health resource networks, or BHRNs, in a state of 42 million people.
To ensure things run smoothly, the Measure 110 Oversight and Accountability Council, responsible for overseeing addiction and recovery centers and the funds to support them, needs more staff, officials say. And the Oregon Health Authority needs more leverage to address bureaucratic and administrative barriers to oversight.
But a bill to provide all that remains stuck in the Senate, along with more than 100 other bills, because of a walkout by Republican senators that began on May 3 seeking to block Democratic initiatives on abortion rights, transgender care and gun safety.
“This proposed legislation is grounded in the fundamental principles vital to the success of Measure 110,” Monta Knudson, CEO of Bridges to Change, an addiction recovery organization based in Portland, told lawmakers.
The GOP stayaway casts doubt on the bill being passed, even though it had strong bipartisan support as it cleared the House.
Oregon's 2020 ballot measure marked the first time a U.S. state decriminalized hard drugs. It reframed the “war on drugs” to treatment instead of incarceration. Anyone caught with user amounts can call a hotline for help or face a maximum $100 fine. Tax revenues from Oregon's legal marijuana industry finance the treatment as well as harm reduction through needle exchanges and overdose medications.
But with so much money involved, opportunities for abuse are ripe.
The Measure 110 Oversight and Accountability Council voted Wednesday to terminate its $1.55 million grant agreement with a provider in Klamath Falls after it allegedly failed to submit completed expenditure and data reports.
“I don’t really have any confidence in this grantee to move forward with funds because we are already catching a lot of flak about Measure 110," council member Hubert Mathews, Jr. said at the meeting "And I think we need to have grantees that can follow the procedures to be able to do this work.”
Mathews and another council member, though, expressed surprised that no state officials visited Red is the Road to Wellness in person, or other BHRNs (pronounced “burns”).
“That’s kind of incredible," Mathews said. "I think we should be able to visit some of these BHRNs to see what they’re doing physically. That would probably help. I don’t know how that would happen. I think we need to have a process.”
Red is the Road to Wellness has already been provided with more than $1 million of its allocation, the health authority said. The health authority can recover those funds if it determines any was spent outside the scope of the grant, said health authority spokesman Tim Heider.
The grant included $290,500 to purchase a building, but instead Red is the Road to Wellness bought a property for $750,000 and failed to secure a state interest in the property as required by the health authority, Heider said.
William Barnes, the Klamath Falls outfit's executive director, said in a phone interview Thursday that meeting the health authority's reporting requirements is a challenge.
“The Measure 110 process has been a learning experience for everybody involved, including our organization," Barnes said. He said he had invited health authority staffers to visit his facility, but they never took him up on it.
Barnes said he spent $561,000 in grant funding for the purchase of the building, and improvements, with the remainder coming from outside sources. In a statement Friday, Barnes said the building will have eight apartments of recovery housing, a recovery drop-in center, employment office and a bakery offering on-the-job training.
Barnes said he'll appeal the termination while still continuing to serve marginalized communities of color.
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Drug Discoveries
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People in the UK are less likely to survive treatable conditions, such as breast cancer and stroke, than those in other rich nations, a study has found.
The review, by the King's Fund think tank, said the problem may be directly linked to the performance of the NHS.
It said below-average spending on the UK health service led to fewer staff and equipment than systems elsewhere.
But the study showed the NHS was very efficient within its budget, with less cash spent on admin than other nations.
The government says the NHS is one of the most efficiently run healthcare systems, and that investment is happening to further improve services.
Ahead of the 75th anniversary of the creation of the NHS next month, the think tank compared the UK's health service with the performance of 18 other health systems, including those in Europe as well as Japan, the US and Australia.
It found:
- Only the US had a worse record in terms of preventing death from treatable conditions
- The UK had one of the lowest levels of life expectancy - although the study acknowledged this would be affected by many factors, aside from the quality of NHS care
- The NHS has strikingly low levels of key clinical staff, with fewer doctors and nurses per head than most of its peers
- As well as one of the lowest number of hospital beds per capita
- The UK has less equipment relative to its population size: the US has five times as many scanners, for example, and Germany four times
But the think tank also found the UK had low levels of people avoiding medical care due to cost fears - just one in 10 of those questioned maintain there are major difficulties accessing NHS treatment.
The NHS also had the sixth-lowest spend on administration, with an outlay of less than 2% of the budget.
The review noted waiting lists for routine treatments, such as knee and hip replacements, were rising in many countries - with waiting times in the NHS around average.
For these reasons, it concluded the UK health service was neither a "leader nor a laggard".
But report author Siva Anandaciva said it was clear the the NHS had "sadly seen better days".
"While the UK stands out in removing most financial barriers to accessing healthcare and the NHS is run relatively efficiently, it trails behind its international cousins on some key markers of a good healthcare system.
"The pressures of the pandemic on our health service compounded the consequences of more than a decade of squeezed investment," he said
"This leaves the NHS delivering performance that is middling, at best, and the UK must do much more to reduce the number of people dying early from diseases such as heart disease and cancer."
However, Mr Anandaciva said the findings were not an argument for moving to a different funding model, adding there was little evidence any one particular approach to health funding was inherently better than another.
A Department of Health and Social Care spokesman said: "This report recognises the NHS is one of the most efficiently run healthcare systems and we are investing up to £14.1 billion to improve services and cut waiting lists, one of the government's top five priorities."
He said this was paying for new community diagnostic centres, while the number of staff working in the NHS was increasing.
The government is due to publish a workforce plan soon, which is expected to set out a big increase in training places for doctors and nurses.
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Global Health
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“Want to lose weight? Buy smaller plates.” “Mindfulness at work: a superpower to boost productivity.” “Leaving Facebook can make you happier.” That’s what the headlines and Ted Talks would have you believe. But are any of these psychological tricks – or life hacks, as they are often called these days – actually true? The truth is, we don’t know; and, in a very real sense, we can’t ever know, because of limitations that are inherent in the design of the relevant experiments – not just those on weight loss, mindfulness or social media, but just about all experiments in what we might call “lifestyle science”. That, at least, is the implication of a new study by a pair of Stanford psychologists, Nicholas Coles and Michael Frank. We’ll get to their work in a minute, but first I’d like to take you back to the German city of Mannheim in 1988.
It was here that psychologist Fritz Strack conducted a study that has since been cited almost 3,000 times and become a staple of psychology textbooks and New York Times bestsellers, including Daniel Kahneman’s Thinking, Fast and Slow. In the experiment, participants were given a cover story: that previous research using questionnaires had excluded participants who were unable to use their hands to fill in the form, and that this study would explore the feasibility of instead holding the pen in your mouth. Half the participants were asked to hold the pen in their teeth (which forced their mouth into a smile) and half in their lips (which forced their mouth into a neutral pout) while they viewed a selection of cartoon strips. Sure enough, the participants who were smiling when they saw the cartoons rated themselves as more amused than the participants who were pulling a neutral (if slightly odd) expression. Importantly, when they were asked afterwards whether they’d suspected anything fishy was going on, none of the participants showed any sign of realising that the pen-in-mouth cover story was simply a way to get them to smile. Strack seemed to have shown that – at least sometimes – our facial expressions determine our moods, rather than vice versa.
For the next couple of decades, Strack’s findings stood unchallenged. That is until 2011, when psychology unearthed its “replication crisis” and the Scheiße really hit the fan. The crisis started not with Strack’s work, but with a series of studies by Daryl J Bem showing that – among other things – participants showed better-than-chance performance when asked to guess which of two curtains was hiding a pornographic picture. Bem’s findings confronted researchers with a stark choice: either (a) seeing into the future is possible or (b) our criteria for evaluating psychology experiments are too lax. Unsurprisingly, psychologists agreed upon the second option, and started worrying about how many of the field’s long-established findings would hold up to the scrutiny of replication – that is, if we did the same experiment again, would we get the same result? Of course, being able to replicate experiments and obtain the same result is one of the fundamental tenets of science, but one to which – to our shame – we psychologists have long turned a blind eye.
The replication crisis wasn’t kind to Strack’s study. Two large-scale international replications – one in 2016 and one in 2022, with altogether about 6,000 participants – found that the mood boost from holding a pen between your teeth was, at best, infinitesimally small. How small? Well, when happiness is measured on a seven-point scale, the increase shown by the pen-in-teeth participants worked out at 0.04 – effectively zero. (When, last month, I put it to Strack that these findings undermined his conclusions, he simply pointed to a “considerable number of studies in which the effect was demonstrated”, though it wasn’t clear which particular studies he had in mind, or why their findings should override those of the two recent mega-studies.)
Once we begin digging deeper, though, the findings of the 2022 study get much more interesting – and start to cast light on issues beyond mere “replication”. For starters, the research team found that if you simply ask participants to smile, rather than tricking them into smiling, the mood boost they show is 10 times greater (though, as you’d expect, it’s still relatively modest in absolute terms; smiling is never going to cheer you up as much as winning the lottery, or watching your team win the Champions League). Most intriguingly, the happiness boost from smiling was biggest for participants who had correctly figured out that this was the hypothesis that the researchers were testing.
Of course, psychology researchers have long known that participants will often guess the experimenter’s hypothesis and – whether consciously or unconsciously – behave in a way that supports it (or, more rarely, undermines it; a kind of “screw you!” effect). It was these “demand characteristics” (like everything, researchers have a special name for the phenomenon) that Strack’s pen-in-the-mouth method was designed to overcome in the first place.
What has been unclear, however, is exactly why participants seem to work hand-in-glove with experimenters to produce the desired results. When a participant reports a higher happiness score after smiling rather than frowning, are they just pretending to be happier to please or help the experimenter, or are they actually happier? After all, as Nicholas Coles, lead author on the 2022 smiling mega-study, told me: “In medicine, placebo effects have been discussed for centuries in the context of things like pain relief.” It doesn’t seem particularly unlikely, he said, that “similar effects can occur in psychology, for instance, in the context of things like happiness interventions”. Much like patients whose symptoms improve after being given a placebo sugar pill, if you’re led to believe that smiling makes you feel happier, maybe it will.
This is exactly what Coles set out to investigate in his latest study. Half of the participants were told that the researchers expected to find that smiling would lead to increased happiness ratings compared with a neutral expression. The other half were told that the researchers expected to find no difference. Surprisingly, both groups gave higher happiness ratings after smiling than after adopting a neutral expression, although the effect was more pronounced for participants who’d been told to expect this pattern. This is not what you’d expect if participants were just trying to please the experimenter by producing the desired result.
To get to the bottom of these findings, Coles asked participants a couple of follow-up questions. First, he asked them to rate how motivated they were to support the experimenter’s hypothesis. He found – counter to all received wisdom about demand characteristics – that these ratings could not explain the main findings at all. That is, participants did not seem to be raising or lowering their happiness ratings to help the experimenter. Next, he asked participants to rate how much they believed in the idea that simply smiling makes you happier (which, by now, has pretty much become accepted folk wisdom). This time, he struck gold. Just as with a placebo pill, the more strongly you believe that smiling makes you happier, the more it does.
This got Coles wondering: how many “demand characteristics” findings in psychology research are the result not of participants giving experimenters a helping hand – which is what we’ve always thought – but of participants acting to confirm their own prior beliefs, the ones they brought with them to the experiment?
The answer, it turns out, is a lot. Poring through the literature, Coles unearthed almost 200 studies in which – just like in his own smiling study – researchers explored the effect of simply telling participants what the study hoped to find. It wasn’t possible for Coles to talk to the participants of these original studies – many of which are decades old – so instead he did the next best thing. First, he gave new participants potted descriptions of the studies, and what they hoped to find: “Listening to happy or sad music will make you feel the opposite emotion”, “Your aggression will fall after watching an aggressive film”, “Describing a country as ‘democratic’ will make you less likely to support military action against it”. He then asked them: “Supposing you were taking part in this study, how motivated would you be to help the experimenter get the expected result? And how much do you personally believe in the claim that the study is testing?”
The findings were clear: the results of the original experiments were retrospectively predicted by how much today’s participants personally believed in the claim being tested, but not by their motivation to help (or hinder) the experimenter.
In retrospect, this seems obvious. Of course if you think listening to sad music will cheer you up (perhaps because it has done so in the past), it’s likely that it will. But, in terms of the psychology literature, it’s difficult to overstate the extent to which this turns conventional wisdom on its head: every experimental psychologist is taught from day one that it’s vital not to let participants know what the experimenter is hoping to find, lest they oblige. But that was sheer vanity. It turns out that participants’ behaviour in experiments is shaped not by our hopes, but their beliefs.
Coles’s study hasn’t yet been peer-reviewed or published, just posted on PsyArXiv, a website where psychology researchers share their work in progress. That said, the idea that peer-reviewed and published equals true is exactly what caused the replication crisis in the first place. For example, the finding that participants can see into the future has been peer-reviewed and published (in Bem’s 2011 paper), but – unless our fundamental understanding of the physical universe is wrong – it’s not just untrue, but impossible.
But assuming Coles’s findings hold water, the implications for psychology research – and the “life hacks” that we’ve all been sold on the back of them – are catastrophic. The beliefs that participants bring to the experiment affect the results, and not just a little bit: Coles found that the average placebo effect (eg feeling amused because that’s what you expect the experiment to do) is just as powerful as the average real effect (eg feeling amused because the experimenter has told you a genuinely funny joke). It’s as if, in medicine, sugar-pill placebos – on average – worked just as well as the real thing.
Let’s backtrack for just a moment here to make sure we’re clear what we mean by an “experiment”. In medical research, the gold standard for experiments is the randomised double-anonymised placebo-control trial. Half of the participants (chosen at random) get the new would-be wonder drug, half get a placebo; and, crucially, neither the experimenters nor the participants themselves know who got what. In this way, medical experiments factor in placebo effects from the start. Indeed, in normal circumstances, no drug will be licensed for prescription until it has been shown to beat a placebo.
The majority of psychology experiments, however, don’t get anywhere near to this standard. The problem is that for many of the phenomena psychologists are interested in – particularly those with “real world” applications – no convincing placebo is possible.
Let’s say, for example, we want to know whether mindfulness meditation really makes you more productive at work. We run a study, and sure enough, our participants show higher productivity after doing the mindfulness course than before. But was it the mindfulness course that helped, or simply the participants’ expectation that the mindfulness course would help that made them work harder afterwards? The only way to tell would be to have a control group who – analogous to the placebo group in a drug trial – think they’re doing a mindfulness course, but aren’t. But how would that work? If you removed the mindfulness elements, it would be obvious to those participants that they were in the control group. The same is true for the supposed benefits of deleting your social media apps or using a smaller plate: unless we can come up with a convincing sham intervention (like sham acupuncture, where they put the needles in the wrong place) we can never hope to separate out the effect of the intervention itself from the effect of participants’ beliefs about it. Don’t get me wrong: none of this means that all psychology-based life hacks are mere bunkum. For all we know, some of them might work. The problem unearthed by Coles’s study is that – without proper control conditions – we will never know.
There is a silver lining, though you won’t hear it from the Ted Talkers with a book to sell. Given the power of our prior beliefs, the usefulness of any particular life hack in and of itself is often irrelevant: whether it’s using a smaller plate, deleting social media or practising mindfulness meditation, if you truly believe that something works then, for you at least, it probably will.
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Stress and Wellness
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WASHINGTON -- The Food and Drug Administration on Thursday said it has sent warning letters to dozens of retailers selling fruit- and candy-flavored disposable e-cigarettes, including the current best-selling brand, Elf Bar.
It’s the latest attempt by regulators to crack down on illegal disposable vapes that have poured into U.S. stores in recent years.
Last month, the FDA issued orders allowing customs officials to seize shipments of Elf Bar, Esco Bar and two other brands at U.S. ports. None of the products have received FDA authorization and they come in flavors like cotton candy, which regulators say can appeal to teenagers.
In the latest action, the FDA said it issued warnings to 189 convenience stories, vape shops and other retailers.
“We’re not going to stand by as bad actors are profiting off the sale of illegal products that are addicting our nation’s youth,” Brian King, the FDA’s tobacco center director, said in an interview. “Today’s action is just part of our long-standing efforts to address those products, particularly flavored disposable products.”
The FDA has tried for years to regulate the multibillion-dollar vaping industry, but separate data released by government researchers Thursday shows unauthorized e-cigarettes continue to launch.
The Centers for Disease Control Prevention analysis showed the number of e-cigarette brands in the U.S. grew from 184 in early 2020 to 269 by late 2022.
The rise coincided with the growing popularity of disposable e-cigarettes. The analysis showed disposables’ share of vaping sales more than doubled from 24.7% in early 2020 to nearly 52% by late last year.
Researchers from the CDC and a nonprofit, Truth Initiative, analyzed data from IRI, which collects sales records from convenience stores, gas stations and other retailers.
Elf Bar was the best-selling disposable in the U.S. and the third-best selling e-cigarette by late last year. Only the reusable e-cigarettes Vuse, from Reynolds American, and Juul had higher sales.
The FDA and CDC also cited Elf Bar in a separate report about thousands of calls to U.S. poison centers concerning e-cigarettes, mainly involving children under age 5.
When accidentally ingested, liquid nicotine can cause seizures, convulsions, vomiting and brain injury. Reports of nicotine poisoning have gone up and down over the past decade, but government scientists said calls increased more than 30% between last spring and March this year.
Brand information was not reported in 95% of cases, but when it was, Elf Bar was the most frequently named product.
Despite the missing data, FDA's King called the high number of reports involving Elf Bar a “canary in the coal mine.”
“What we want to do is nip things in the bud before they're allowed to expand even further,” King said.
Manufactured by a Chinese firm, iMiracle Shenzhen, Elf Bar is part of a wave of copycat e-cigarettes that have followed a path paved by Puff Bar, a popular brand of disposables that briefly racked up hundreds of millions in sales after regulators cracked down on older vaping products like Juul.
In early 2020, the FDA restricted flavors in cartridge-based reusable e-cigarettes like Juul to just menthol and tobacco, which are more popular with adults. But the flavor restriction didn’t apply to disposable e-cigarettes, which are thrown away after use.
After the FDA tried to force Puff Bar off the market, the company relaunched and said it was now using laboratory-made nicotine, which didn’t fall under FDA’s original oversight of tobacco-derived nicotine. Most disposable makers followed the same playbook.
Congress closed the loophole last year. Under the law, companies were supposed to remove their vapes from the market and file FDA applications, but new products continue to launch.
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The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
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Health Policy
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Everyone wants to stop opioid overdoses. But it’s unclear how a Republican-backed bill that passed the House last month with Democratic support would help.
Instead, it seems like the latest chapter in a failed drug war that hasn’t kept people safe. So it’s important to understand what the bill does — and doesn’t do — as the Senate considers it. The Biden administration has supported the measure, which was enacted on a temporary basis during Donald Trump’s presidency.
Called the HALT Fentanyl Act, it would permanently outlaw so-called “fentanyl-related substances” under the most restrictive federal drug control, Schedule I. That schedule contains drugs with no accepted medical use and high potential for abuse, according to the government. Keep in mind: cannabis is also on Schedule I, so the scheduling system isn't exactly a model of common sense (though President Joe Biden has ordered a review of cannabis’ Schedule I status and it might finally change). Notably, fentanyl itself is used across the country in hospitals for pain relief and is controlled under the less-restrictive Schedule II, which also contains substances with high abuse potential but also approved medical use.
The bill potentially bans substances that not only aren’t harmful, but could even be helpful.
The pending bill wouldn’t change fentanyl's status; rather, it would permanently place fentanyl-related substances into Schedule I. So what are they? They’re ones with chemical structures related to fentanyl, according to broad scientific criteria laid out in the bill. They’re defined on what’s called a class-wide basis, sweeping in scores of substances instead of outlawing them individually, thus making the government's job easier on the front end.
The class-wide measure could make sense (relatively, in the context of the drug war) if we knew that all the substances potentially captured by the bill would be harmful. But that’s not necessarily the case. The proposed law, which has been in effect temporarily since 2018, doesn’t require these substances to have similar effects to fentanyl. That matters because two substances being structurally similar doesn’t necessarily mean that their effects are similar. So the bill potentially bans substances that not only aren’t harmful, but could even be helpful, subjecting people to stiff prison terms for benign or beneficial drugs.
More than 150 groups including Human Rights Watch and the Drug Policy Alliance have spoken out against the measure, which they called “a radical departure from drug scheduling practices as it relies exclusively on chemical structure without accounting for pharmacological effect.” They also criticized the imposition of mandatory minimums and Schedule I research restrictions on unknown substances. Nonetheless, 74 Democrats joined 215 Republicans to pass it, 289-133.
And then there’s the question of what good the HALT Fentanyl Act would do even when it comes to potentially harmful substances. As I noted, the bill would make permanent a law that’s been temporarily in effect for several years; it’s currently set to expire next year. Yet, it’s unclear what the outlawing of these substances on a temporary basis has done to mitigate the opioid crisis, such that making the measure permanent would benefit the American people, who’ve continued to die from opioids in the hundreds of thousands.
An exchange over a failed amendment to the bill illustrates the point. The amendment, proposed by Rep. Brittany Pettersen, D-Colo., would have required the Department of Health and Human Services and the attorney general to certify that the act would reduce overdose deaths. After telling a wrenching story about her mother’s addiction, Pettersen said she cared deeply about the issue but that the bill as drafted wasn’t the answer.
Rep. Larry Bucshon, a Republican from Indiana who received an “F” grade from the National Organization for the Reform of Marijuana Laws, called Pettersen’s amendment a “poison pill” that would somehow let the Biden administration (which, remember, supports permanent class-wide scheduling) “indefinitely delay” such scheduling. The Republican also cited harrowing statistics on overdoses, noting that, in 2021, nearly 108,000 people died of them and 71,000 of those were from synthetic opioids including fentanyl or fentanyl-related substances.
But again — class-wide scheduling was in effect temporarily in 2021 and for years prior. How did it help?
The Senate and Biden should consider that question.
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Drug Discoveries
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Mums and dads notoriously have a hard time getting their children to eat enough vegetables.
But help is finally here, as scientists have revealed the surprising secret to getting kids to eat their veg.
Researchers from Brigham Young University found that children ate up to 52 per cent more peas and carrots when they was served with potato smiles.
However, there's an important caveat - the effect only applies when the potato smiles are served in the same bowl as the veg.
'Potatoes not only add nutrients, like potassium, directly to the plate, but they may also help encourage kids to explore other veggies that they're served alongside and thereby help them get closer to their overall nutrition needs,' said Professor Gene Ahlborn, lead author of the study.
In the US, dietary guidelines recommend that children aged between three and 18 eat around three cups of vegetables per day.
However, Professor Ahlborn points out that the average school child only eats one cup per day.
Meanwhile, a recent survey in the US found that half of all American children don't eat a single vegetable in day.
'That's why we wanted to learn more about how school meal offerings may influence kids' eating behavior and possibly encourage greater vegetable consumption,' he explained.
In the study, the researchers fed children a controlled meal consisting of chicken nuggets, two per cent milk, ketchup, apple sauce, mixed peas and carrots, and some form of potato or bread.
The children's meals were weighed before and after to see how the different presentations of the meal affected what they chose to eat.
In the control experiment, where a bread roll was served on the side, children ate 21.1g of vegetables with their meals.
And when the meal was served with potato smiley faces in a separate bowl from the veg, the researchers found that the amount of veg eaten actually decreased by 20 per cent.
However, when the smiles and veg were served in the same bowl, children ate 51 per cent more veg than when they were served separately.
While the study notes that this improvement is not enormous, they write that 'even small steps towards improving vegetable consumption are significant for enhancing nutrition intake.'
Professor Ahlborn also says that this trick could reduce food waste by making sure more veg gets eaten.
He adds: 'We want vegetables on school lunch trays to fuel kids' bodies - not fill the trash can.'
If you're trying to help your children eat more veg at home, you may be concerned that potato smiles are not the most healthy choice.
However, the study found that adding potato smiles to the meal only added 21 calories and 5g of fat, all of which is unsaturated.
Professor Ahlborn also tested the impact of other potato shapes on vegetable consumption by including seasoned potato squares.
However, the study found that the less-fun-shaped potatoes had less of an impact on how much veg the kids ate during the meal.
Served separately, the potato cubes slightly increased vegetable eating compared to the control with kids eating just over 2g more.
Yet when the potatoes were served in the same bowl the amount of peas and carrots eaten actually decreased to only 20.8g.
The authors say that the reason for this difference is unknown, but suggest it might be because potato smiles are more familiar to kids.
'Getting kids to eat their vegetables is always a challenge,' Professor Ahlborn joked.
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Nutrition Research
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The country's mental health is probably the worst it has ever been - with the cost-of-living crisis, aftermath of the Covid pandemic and global instability pushing people to the brink, the head of a major charity has warned.
Dr Sarah Hughes, who became chief executive of Mind in January, said the charity was really worried about the impact the cost-of-living crisis will have on people's mental health.
Speaking to the PA news agency in her first interview since taking over, Dr Hughes said that despite the nation's mental health suffering, the issue has fallen down the political agenda.
She warned that the pandemic, cost-of-living crisis and war in Ukraine and ensuing global instability could drive vulnerable people to suicide.
She added: 'We are really worried. This feels like a a bit of a perfect storm that we need to take hold of.
'We have got the recovery from the pandemic, we have got the cost of living crisis and we can't underestimate the impact of the war in Ukraine and global instability.
'All of these things contribute greatly to the vulnerability that we are all experiencing to a greater or lesser extent.
'What we know is after the financial crash in 2008 the number of people taking their own lives increased - we don't want that to happen again.'
When asked if mental health had fallen down the political agenda in recent years, Dr Hughes said: 'I absolutely think it has.
'I don't think it has fallen down the agenda for the public. But I have seen a slow down in the conversations that we are having with policy makers, a sort of sense 'we have been there we have done that we have already achieved the ambition to get parity'.
'But, of course, we know that's not quite the case because mental health was coming from an underinvested place, so any investment has just filled a previous gap.
'That is a misunderstanding we have to get over - the job hasn't been done and the mental health of the nation is probably worse than it has ever been.
'The Government can't afford for mental health to slip down its agenda, but I can understand why it might happen - the sight of ambulances waiting outside A&E is terribly frightening. But some of that is people trying to get help for their mental health as well.'
Dr Hughes said that services needed to get better at catching people before their mental health deteriorated.
She added: 'We need to be much better, much more agile about what we do for people who are coming for their first episode of mental health, picking people up at the first opportunity.
'We know we can stop someone going into mental health crisis by helping them resolve a benefits problem or legal advice for their housing.'
Dr Hughes also said children's services needed to be prioritised because young people were not immune to the impact of global crisis.
'Children's mental health today is the nation's mental health tomorrow. We have got to be better,' she said.
'What I know from talking to people who work with children and young people is they are deeply worried about the cost of living too. They are not immune from the global crisis, they are very much in the thick of it.
'We all know that children and young people are facing some of the biggest challenges in terms of their own mental health and trying to find their way in a world that was different pre-pandemic.
'Children are very resilient, let's acknowledge that. These kids are amazing. But we can't underestimate the impact on them.'
Her comments come after a recent National Audit Office (NAO) report found that millions of people with mental health problems are missing out on NHS treatment or face lengthy waits.
The NAO said that while the number of people getting care has increased overall to 4.5 million in England, some targets are not being met and do not even apply to the bulk of inpatient or community treatment.
An estimated 1.2 million people are on the waiting list for community-based NHS mental health services, with an estimated eight million more having mental health needs, but not yet in contact.
NHS England has said that mental health services will receive an additional £2.3 billion every year by 2023-24 to help transform services while providing support to more people than ever before.
But Dr Hughes said the report highlighted the 'dire straits' mental health services were in, with bed occupancy above safe levels, people waiting too long in A&Es for urgent mental health care and people reporting of poor experiences of care.
She said that it remained to be seen whether the new major conditions strategy, announced by the Government last month, was a dilution of the 10-year mental health plan promised last year.
She added: 'I think we were really set up for this ambitious 10-year plan, this idea we were going to work across departments and do some real deep thinking about how to create the conditions for good mental health across society but also look at the other end of treatment and care.
'We are struggling to see how the major conditions strategy will do the deep dive we need it to do.
'We understand on the one hand it states a principle they recognise mental health is a major condition, that's an important statement.
'But we think it's a bit of a missed opportunity to have parked that and gone for a major conditions strategy. But we are also open, we are not going to walk away from the conversations we are having.'
However, Dr Hughes said hoping for the best will not address the issues patients are facing trying to get treatment for their mental health problems.
She added: 'Many charities have given quite clear solutions across Government - income, benefits system, housing. These are the answers to the questions.
'Sadly, we can go around the houses about it, but the bottom line is that we know we can give people the best treatment they would ever have received in this country, and in some parts of the system they are getting the best psychiatric care anywhere in the world, but if you're sending them back to poor housing, for instance, that treatment is being undermined.
'So, our ability to move people through treatment and recovery and get them back to their lives is undermined.'
A Department of Health and Social Care spokesperson said: 'We are investing an extra £2.3 billion a year into mental health services, so that an additional two million people can get the support they need, including 345,000 more children and young people.
'We are also investing £150 million into schemes that address pressures on local urgent and emergency mental health care pathways, up to 100 new mental health ambulances to support people to be cared for closer to home, including alternatives to A&E and hospital admission such as crisis houses, safe havens and step-down services.
'There are currently 287 mental health support teams in place in around 4,700 schools and colleges across the country, offering support to children experiencing anxiety, depression, and other common mental health issues, and this will increase to almost 400 teams by April.'
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Mental Health Treatments
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New research may eventually help solve a mystery relevant to holiday drinkers. Scientists at the University of California Davis and elsewhere believe they’ve figured out why some people quickly develop headaches after drinking red wine but not other alcoholic beverages: too much of a particular flavonoid that mixes badly with alcohol. The team is already set to conduct a small clinical trial to further test their theory.
Alcohol can be a specific headache trigger for some people, while heavy drinking in general can induce them as well. But red wine headaches seem to be their own distinct phenomenon—one that’s eluded an easy explanation. Some experts theorize that it might be due to a surplus of histamine in the grape skins used to make red wine; others speculate that ample amounts of tannins or a type of preservative called sulfites in red wine are to blame. But the authors behind this current study, published Monday in Scientific Reports, have landed on a different culprit: the flavonoid quercetin.
Flavonoids are nutrients found in many plant-based foods, including chocolates and grapes. They may have potential health benefits, such as antioxidant and antimicrobial properties, and they help account for the color of red wine. The team theorized that flavonoids might also cause red wine headaches, based on another biological quirk related to alcohol.
Some people, especially those of Asian descent, are predisposed to flushed red skin and other symptoms after drinking relatively little alcohol. This is usually caused by having a variant of certain genes that help us metabolize alcohol. One of these genes is responsible for the enzyme ALDH2, which breaks down acetaldehyde, a toxic byproduct of alcohol. Without this enzyme, or a less functional version of it, acetaldehyde builds up in the body and makes people sick.
The team hypothesized that flavonoids could cause a similar issue with ALDH2 and acetaldehyde. In the lab, they found that a byproduct of quercetin was indeed able to inhibit the production of ALDH2. Based on how much quercetin is found in a typical red wine and how it breaks down in our blood, the team estimates that a standard glass should contain enough quercetin to inhibit ALDH2 production by around 37%.
“We postulate that when susceptible people consume wine with even modest amounts of quercetin, they develop headaches, particularly if they have a preexisting migraine or another primary headache condition,” said co-author Morris Levin, professor of neurology and director of the Headache Center at the UC San Francisco, in a statement from UC Davis.
These findings are far from definitive proof that quercetin causes red wine headaches. And it’s likely that this isn’t the only important piece of the puzzle, the team notes. Some people might have an added vulnerability to this condition, possibly because of how they respond to acetaldehyde or break down quercetin. And the researchers also point out that some red wines contain much more quercetin than others, due to differences in the wine-making process, such as being made with grapes that spend more time in the sun.
The team is now planning to put their theory to a real-world test. With a funding grant from the Wine Spectator Scholarship Foundation, the researchers will conduct a small trial that will compare how people respond to red wines high and low in quercetin.
“We think we are finally on the right track toward explaining this millennia-old mystery,” said Levin. “The next step is to test it scientifically on people who develop these headaches, so stay tuned.”
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Disease Research
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Story at a glance
- Long COVID is a broad term describing complication that can last weeks, months or even years.
- However, as time goes on, the chance of getting long COVID seems to be diminishing, new research suggests.
- The reasons include vaccination and prior cases of illness with COVID-19.
(NEXSTAR) – Nearly three years into the COVID-19 pandemic, we’ve learned a lot about the virus, and have developed vaccines and antiviral treatments that make the prospect of contracting the virus less deadly for most people. But one aspect of the virus that remains frustratingly mysterious, and scary to many, is the range of outcomes called “long COVID.”
Long COVID is a broad term describing complication that can last weeks, months or even years. Some people have shortness of breath, while others have damage to their senses of smell and taste. Some who suffer from long COVID experience debilitating fatigue and brain fog.
However, as time goes on, the chance of getting long COVID seems to be diminishing, new research suggests.
“The odds of having long COVID, we do see that rate is going down,” said Michael Gottlieb with Rush University Medical Center, who co-led a recent study on persistent COVID symptoms.
The study found people were more likely to suffer prolonged symptoms if they caught COVID in the “pre-delta period,” compared to the delta and omicron waves of 2021 and 2022. However, the difference has nothing to do with the variants. It has everything to do with vaccination and repeat infections.
“It is generally accepted that, on average, later infections with the same virus are going to be somewhat milder, and have somewhat less of a risk of causing long COVID symptoms,” agreed David Dowdy, an epidemiologist at Johns Hopkins Bloomberg School of Public Health.
Dowdy explained that on average – though there are exceptions – someone’s second or third COVID infection is less severe than their first. If you get over COVID in a few days while resting at home, you’re less likely to have issues that stick around for months. Whereas if you go to the ICU – with COVID-19 or any virus – you’re more likely to have a long road to recovery.
Repeat infection isn’t the only thing driving down the odds of catching long COVID. Vaccination plays a major role, research shows. People who get vaccinated, even if they experience a breakthrough infection, are less likely to have long COVID, according to the Centers for Disease Control and Prevention.
Gottlieb said his research also suggested vaccination reduces the risk of long COVID across variants.
“The odds are going down, but it’s not going down because of pure time. It’s going down because of things we’ve done,” said Gottlieb. “By getting vaccinated, it reduces that risk. And because more people have been vaccinated – or they have prior COVID, so they have some basic immunity in place – it reduces your longer term risk.”
Despite the odds trending in the right direction, many people are still suffering from a bout with COVID they had years ago. At least 65 million people globally are estimated to have suffered from long COVID, according to research published last month.
“There has definitely been a decrease in incidence of this complication over time, but because so many people have gotten COVID, there’s still a huge number of people suffering from prolonged symptoms,” said Paul Sax, the clinical director of infectious diseases at Brigham and Women’s Hospital who co-led the study with Gottlieb. “So there’s some good news and not-so-good news in that statistic.”
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Disease Research
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A new strain of Covid-19 that is circulating in the UK has been designated as a variant of interest by the World Health Organization, although the public health risk has been judged as low.
The variant, known as EG.5 or “Eris”, is related to an Omicron subvariant called XBB.1.9.2, and is growing in prevalence globally, with countries including the UK, China, and US among those affected.
However, the WHO suggested the variant does not pose a particular threat. “Based on the available evidence, the public health risk posed by EG.5 is evaluated as low at the global level,” the agency said, adding that the risk appeared to be on a par with other circulating variants of interest.
“While EG.5 has shown increased prevalence, growth advantage, and immune escape properties, there have been no reported changes in disease severity to date,” the WHO added.
Christina Pagel, professor of operational research at University College London, said that while the variant was growing in prevalence and appeared to be better at evading the immune system, allowing it to outcompete other variants, there was no evidence that it caused more severe disease.
“It will probably cause a wave of more cases and all the problems that brings – [such as] more hospitalisations and Long Covid– but [there is] no reason at the moment to think [that will be] worse than previous waves this year,” she said.
Pagel noted that waning immunity whether from vaccinations or previous infections may mean the wave of EG.5 took longer to peak and hence could be larger.
Prof Stephen Griffin, a virologist at the University of Leeds, added that while the prevalence of the variant was increasing relatively slowly in the UK, its infectiousness and ability to evade antibodies meant that the number of cases could grow more rapidly when schools return and people go back to work and university after the summer.
Prof John Edmunds, an infectious diseases expert at the London School of Hygiene and Tropical Medicine, said the new variant may well cause an an increase in incidence, but added: “Successive waves of Omicron sub-variants has been the pattern for the last 18 months now.”
The WHO listed a number of actions it recommended member states prioritise to better understand antibody escape and severity of EG.5, including monitoring for changes in indicators of severity.
Last week, the UK Health Security Agency (UKHSA) published an update that suggested EG.5, or more specifically its subvariant EG5.1, accounts for an estimated 15% of sequenced Covid-19 cases in England.
Dr Meera Chand, the deputy director of UKHSA, said the emergence of new variants was not unexpected.
“UKHSA continues to analyse available data relating to Sars-CoV-2 variants in the UK and abroad,” she said. “EG.5.1 was designated as a variant on 31 July 2023 due to continued growth internationally and presence in the UK, allowing us to monitor it through our routine surveillance processes.”
Chand added: “Vaccination remains our best defence against future Covid-19 waves, so it is still as important as ever that people come take up all the doses for which they are eligible as soon as possible.”
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Epidemics & Outbreaks
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At a company-wide meeting in October, Google CEO Sundar Pichai expressed concern and heartbreak over Iran’s deadly crackdown on human rights protests. “To our Iranian Googlers, know that you have our full support,” Pichai said, answering a question submitted by a staffer about the swelling revolt. The query had been upvoted by thousands of workers, according to four employees.Google by then had spun up a cross-company task force to focus on Iran, just as it had after Russia’s attack on Ukraine, the arrival of the pandemic, and other major events. Teams were endeavoring to keep services like Maps and Meet video chats accessible through government throttling in Iran. Demand for the company’s Outline virtual private network was growing to millions of Iranians seeking uncensored internet access. And security staffers reviewed and suspended a few popular Android apps in Iran that violated policies meant to keep users safe. On Google’s internal chat boards, workers celebrated Pichai’s acknowledgement and the company’s efforts. But at the same time, Google’s Iran response has frustrated some employees, rights groups, and US lawmakers. They want the company to deepen its support, including by opening up cloud computing and software development tools to people inside Iran to help protesters communicate securely and circumvent government internet firewalls.Some employees born in Iran point to Google’s aid in Ukraine as evidence that it is capable of doing more, and Microsoft’s Iran response has caused similar tensions with lawmakers, advocates, and some employees. A few of the tech workers unsatisfied by the industry’s contributions on Iran have now taken matters into their own hands.One Google engineer bought a server from a little-known provider to host a VPN to help his parents and other family in Iran stay in touch, he says. He followed a how-to guide that Iranian peers at Google and other companies compiled, and on a recent trip to Iran checked that his parents’ tablet could connect to the service. Other workers across North America and Europe are stealthily taking on more complex anti-censorship and anti-surveillance software projects that could help sustain the protests, according to 15 workers involved in or familiar with the volunteer activities.The recent wave of “Woman, Life, Freedom” protests in Iran began in September, following the death of 22-year-old woman Mahsa Amini, who also went by Jina, while in morality-police custody for allegedly wearing a hijab improperly. Iranian officials have blamed her death on prior medical problems and the violent protests on enemies including the US and domestic separatists. Iran’s foreign ministry did not respond to a request for comment. Security forces in the Islamic Republic have killed hundreds people, including by public hanging, and have arrested thousands in the crackdown, according to the group Human Rights Activists in Iran.The Biden administration quickly loosened US sanctions on Iran after the protests began, to allow companies to supply social media, mapping, and communication tools. In October, then-congressman Tom Malinowski and three other US lawmakers wrote to the CEOs of Google, Microsoft, and other big tech companies asking them to provide cloud and analytics capabilities. “Iranians are fearlessly risking their lives for their fundamental rights and dignity,” the letter said. “Your tools and services may be vital in their efforts to pursue these aspirations.”But in a previously unreported response, Google’s US public policy head Mark Isakowitz wrote back a month later saying that newly relaxed sanctions still had not authorized those activities, “unfortunately.” Isakowitz instead urged Congress to work with the Biden administration “to identify additional means of ensuring Iranians’ access to vital communication and information tools.”Google’s Iran response, like that of other tech giants concerned about sanctions and related financial risks, prompted side projects by employees to put their technical skills to use. Many of the workers involved declined to be named or provide complete details about their work out of fear of retaliation by their employers or Iran.The grassroots coding is all about “developing technology that they think can form a level playing field,” says Faraj Aalaei, one of the Silicon Valley community leaders funding and marshaling some of the projects. Overall, hundreds of volunteers from the tech-savvy Iranian diaspora are involved, says Aalaei, a longtime tech executive and now founding general partner of investment firm Candou Ventures.A priority is to develop software that could enable use of Elon Musk’s Starlink internet satellites in Iran to defeat web censorship without fear of being tracked by the government. Activists have brought hundreds of Starlink units into Iran, with some already operating, Aalaei says. Security experts have warned that users need to take precautions to avoid exposing their location.Among groups tackling that issue are four engineers who work at tech companies, including Google, who have begun meeting online to debate practical solutions and write software aimed at helping Starlink users hide themselves, one person involved says. The group aims to have a solution ready within weeks.The rallying within the Iranian-born tech community has an energy unlike ever before, because more members now support a regime change in Iran and the unrest has spread to a wider swath of the population, particularly women, several workers say. There also is recognition that government censorship helped stymie previous protests in the country.“Staying connected to the outside world is a lifeline for protesters inside,” says Shoresh Shafei, a data scientist who left Google a year ago. “The more we raise awareness about what's going on in the streets and prisons of Iran, the less likely the government is able to repeat what has happened in the past 40-plus years.”Tech workers have been not only inspired but also frustrated by the way the industry stepped up to help Ukrainians over the past year. That has included providing cash to humanitarian groups, and cybersecurity and cloud computing services to the Ukrainian government. “We want to be acknowledged and legitimized,” Shafei says. “The silence is deafening.”Google’s Ukraine response saw it and its employees donate over $45 million in a campaign it promoted several times on a company blog. For Iran, Google quietly matched donations in a worker-led internal fundraising campaign that ultimately directed about $375,000 to a foundation supporting internet access in Iran, three employees say. The company has remained silent about the Iranian government limiting some users to accessing the version of its search engine with the company’s SafeSearch feature activated, which human rights organization Miaan Group says hobbles access to protest-related web results because they can be gory and thus considered unsafe.Google spokesperson Shira Almeleh says that, as part of the industry group Global Network Initiative, the search giant has “stood with many companies in clearly expressing [its] deep concern about the ongoing violence and efforts to disrupt free expression.” Use of Google’s Outline VPN has surged tenfold in Iran since protests began, Almeleh says, and the company remains focused on legally permissible ways to assist Iranian citizens.In one previously unreported initiative that some Iranian tech workers view as emblematic of the caution at play, in October, after lobbying from employees, Microsoft allowed anyone to place calls to Iran on Skype for free to help families stay connected, according to two employees and posts on the company’s online help forum and social media. “#Skype has made it free to make international calls to Iran. I just called my family and it worked!” one Twitter user wrote at the time. But Microsoft did not publicly announce the promotion and then ended it after two days without public explanation, the two employees say. Microsoft declined to comment for this story. It provided a significant amount of free credit for cloud computing services to Iranian activists, but it is unclear if they will get more, two people involved in projects using them say. Tech companies have several reasons to be more deliberate about Iran than Ukraine. The geopolitics of a war that threatens Europe’s security and the domestic upheaval in Iran are very different, and not every Iranian immigrant working for a US tech company is supportive of the protests, adding to complexities for companies to weigh as they face the calls to wade into the latest social crisis. Companies also face legal uncertainties. The United States has blocked business with Iran for decades over its alleged support of Islamic terrorists and pursuit of nuclear weapons. Although the Biden administration loosened sanctions on social media and other tech tools, interpretations of those rules vary, and breaching sanctions can come with prison time and multimillion-dollar penalties. The Biden administration has repeatedly said it welcomes exemption requests from companies seeking permission to launch new services supporting internet freedom in Iran. With companies likely to stay cautious, the workers who have sprung into action include teams working on secure chat technology. One group of five, mostly European, engineers has met twice a week for the past three months to research enabling texting between devices, without need for the internet, while leveraging Tor and other data transfer protocols to ensure security, a person involved says.Others are upgrading an existing encrypted messaging system or writing a guide for using Meta’s WhatsApp through a proxy server that eludes government censors. A few engineers in Canada developed a website that helps a long march of protesters synchronize their chants, one source says. Not all tech workers are operating in stealth. Mahni Shayganfar, a machine learning engineer in Silicon Valley, says he posts on Instagram about the protests 30 times a day now, after barely ever sharing content on any topic before. He says if people become informed about Iranian culture, they might consider offering support. “The main thing we can do is be their voice,” he says of the protesters.
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Epidemics & Outbreaks
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The first patient to receive a spinal implant to treat advanced Parkinson’s disease has described experiencing “a rebirth” after the treatment allowed him to walk again without falling over.
Marc, 63, from Bordeaux, France, was diagnosed with the degenerative disease more than 20 years ago and had developed severe mobility problems, including balance impairments and freezing of gait. After receiving the implant, which aims to restore normal signalling to the leg muscles from the spine, he has been able to walk more normally and regained his independence.
“I practically could not walk any more without falling frequently, several times a day. In some situations, such as entering a lift, I’d trample on the spot, as though I was frozen there, you might say,” he said. “Right now, I’m not even afraid of the stairs any more. Every Sunday I go to the lake, and I walk around 6 kilometres [3.7 miles]. It’s incredible.”
The implant is yet to be tested in a full clinical trial. But the Swiss team, who have a longstanding programme to develop brain-machine interfaces to overcome paralysis, hope that their technology could offer an entirely new approach to treating movement deficits in those with Parkinson’s disease.
“It is impressive to see how by electrically stimulating the spinal cord in a targeted manner, in the same way as we have done with paraplegic patients, we can correct walking disorders caused by Parkinson’s disease,” said Jocelyne Bloch, neurosurgeon and professor at the CHUV Lausanne University hospital, who co-led the work.
Parkinson’s disease is caused by the progressive loss of dopamine-producing neurons. For about 90% of patients with advanced illness, this leads to difficulties with walking, including balance deficits and freezing of gait. Conventional treatments, such as the drug Levodopa, can improve symptoms but are unable to completely restore normal movement. The implant aims to overcome this by directly targeting the spinal area responsible for activating leg muscles during walking.
First, the team developed a personalised anatomical map of Marc’s spinal cord that identified the precise locations that were involved in signalling to the leg to move. Electrodes were then implanted at these locations, allowing stimulation to be delivered directly into the spine.
The patient wears a movement sensor on each leg and when walking is initiated the implant automatically switches on and begins delivering pulses of stimulation to the spinal neurons. The aim is to correct abnormal signals that are sent from the brain, down the spine, to the legs in order to restore normal movement. “At no point is [the patient] controlled by the machine,” said Prof Eduardo Martin Moraud, of Lausanne University hospital. “It’s just enhancing his capacity to walk.”
The study, published in Nature Medicine, found that the implant improved walking and balance deficits and when Marc’s walking was analysed it more closely resembled that of healthy controls than that of other Parkinson’s patients. Marc also reported significant improvements in his quality of life.
The authors said a full clinical trial was needed to demonstrate clinical efficacy and have enrolled a further six patients to assess whether the apparent benefits are replicated. “At this stage it’s a proof of concept,” said Prof Grégoire Courtine, a neuroscientist at EPFL, who co-led the work. “Of course it’s not tomorrow, it will be at least five years of development and testing.”
Prof Karunesh Ganguly, a neurologist at University of California San Francisco, who was not involved in the work, said: “This study describes a new approach for modulating the spinal cord in order to improve gait in Parkinson’s disease [and the] treatment can also potentially address freezing of gait, which is currently hard to treat. It will be exciting to see how this generalises to a larger population of patients.”
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Medical Innovations
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Thirty years ago, kidney stones were considered a disease of the middle-aged white man. Now doctors are increasingly seeing a different kind of patient suffering from the extremely painful condition, especially during summer.
Kidney stones, hard deposits of minerals and salts that can get caught in the urinary tract, are now occurring in younger people, particularly among teenage girls, emerging data shows.
Experts aren’t sure why more children and teens are developing the condition, but they speculate that a combination of factors are to blame, including diets high in ultraprocessed foods, increased use of antibiotics early in life and climate change causing more cases of dehydration.
Doctors who spoke to NBC News said they see more kids with kidney stones in the summer than any other season.
Kidney stones is a metabolic disorder, also known as nephrolithiasis, that occurs when minerals such as calcium, oxalate and phosphorus accumulate in urine and form hard yellowish crystals as small as a grain of sand or as large as a golf ball in severe cases. Some stones make their way out the urinary tract with no issue, but others can get stuck, blocking the flow of urine and causing severe pain and bleeding.
In recent years, hospitals across the country have opened pediatric “stone clinics” to keep up with demand, where children can meet with urologists, nephrologists and nutritionists to get the care they need to treat and prevent future kidney stones.
Kidney stones in adults are linked to conditions such as metabolic syndrome, obesity, hypertension and diabetes.
"In children, we’re not seeing that," said Dr. Gregory Tasian, a pediatric urologist at Children’s Hospital of Philadelphia. "They’re otherwise healthy and simply come in with their first kidney stone for unclear reasons.”
Much of the nephrolithiasis research in children in the U.S. has been led by Tasian and his colleagues and is focused on finding the cause. "Clearly something has changed in our environment that is causing this rapid shift,” he said.
About 10% of people in the U.S. will have a kidney stone at some point in their lives, according to the National Kidney Foundation. Stones can be found in children as young as 5 years old.
Chloe Carroll, now 14, was only 8 years old when she found blood in her urine during a dance recital. Doctors diagnosed her first kidney stone — a surprise for a young athlete with no underlying medical conditions.
Less than a year later, she was struck with a second stone. At age 11, she developed another — all three stones required surgical removal.
“It’s still nerve-wracking to have to go through it again and again,” Carroll, now 14, said through tears as she recalled the fear of undergoing surgery. “But I know it’s a part of life, and I have to keep moving forward.”
How many children develop kidney stones?
Kidney stones aren't common in children, although the rate is unclear because most research has focused on adults.
One estimate comes from a 2016 study Tasian led that included nearly 153,000 adults and children in South Carolina who received emergency, inpatient or surgical care for nephrolithiasis.
The research, published in the Clinical Journal of the American Society of Nephrology, found that the annual incidence of kidney stone disease rose 16% from 1997 to 2012, with 15- to 19-year-olds experiencing the greatest increase. Within this age group, kidney stone incidence was 52% higher among girls and women. The disease became more common in men beginning at age 25.
Overall, the risk of kidney stone disease doubled during childhood for boys and girls, while women saw a 45% increase of risk in their lifetime over the 16-year study period. Black adults and children in the study also developed kidney stones at greater rates than whites.
Similar trends have been reported in other studies, including one conducted in Olmsted County, Minnesota, which found that the kidney stone incidence rate among children ages 12-17 increased 6% a year from 1984 to 2008.
Is diet linked to kidney stones?
Experts believe that kids’ worsening diets may play a role.
High amounts of sodium from potato chips, sandwich meats, sports drinks and packaged meals can force extra minerals into the urine that can clump into kidney stones. It's especially likely if a child doesn’t drink enough water or drinks too many sweetened beverages high in fructose corn syrup.
It’s like trying to dissolve sugar into a nearly empty cup of coffee, said Dr. David Chu, a pediatric urologist at the Ann & Robert H. Lurie Children’s Hospital of Chicago who conducts research with Tasian.
Hotter summers cause more kidney stones
The more hot and humid it is, the more you sweat and less you urinate, allowing minerals to bond in the kidneys and urinary tract. Children are especially vulnerable to heat.
Dr. Christina Carpenter, interim chief of pediatric urology at the New York-Presbyterian Morgan Stanley Children’s Hospital, said she has already been treating more children with kidney stones in the summer.
Studies have found that the number of people seeking medical care for kidney stones increases as daily mean temperatures rise. Other research shows that the southeastern U.S. — known as the “kidney stone belt” — has as much as a 50% higher prevalence of kidney stone disease than the Northwest.
One 2008 study predicted the “belt” will inevitably expand upward, with the fraction of the U.S. population living in “high-risk zones” growing from 40% in 2000 to 70% by 2095.
An antibiotic link to kidney stones
Antibiotics may alter the gut microbiome in a way that favors kidney stone development, Tasian said.
In 2018, Tasian’s team found that people who took any of five commonly prescribed oral antibiotics were associated with a 1.3- to 2.3-fold increase in the odds of developing kidney stones. The risk decreased over time, but remained high for up to five years after taking the medication — and was greatest when given at earlier ages.
Because many antibiotics are prescribed unnecessarily in the U.S., Tasian called it a “leading theory” for the increase in children developing kidney stones.
The earlier a person develops kidney stones, the more time they have to develop a more severe form of the disease and long-term health issues associated with it, Tasian said. Some of the consequences include loss of kidney function, decreased bone mineral density that could lead to fractures, and higher risk of heart disease in adulthood.
Children who develop a stone have about a 50% chance of developing another one within five to seven years, according to the National Kidney Foundation.
Each stone that passes through the urinary tract increases their risk of developing a ureteral stricture, which is the narrowing of the tube that drains urine from the kidneys into the bladder, Carpenter said.
When this happens, kids may need to undergo invasive surgery to fix it.
The trend is also worrisome because there’s limited evidence about how to best treat children with kidney stone disease, experts say.
Symptoms of kidney stones
According to the National Institute of Diabetes and Digestive and Kidney Disease symptoms include:
- Sharp pains around the back, lower abdomen and groin.
- Pink, brown or red blood in the urine.
- A constant need to urinate.
- Cloudy or foul-smelling urine.
- Irritability, especially in younger children.
Some children may not experience any symptoms. However, symptoms can sometimes be “more nonspecific” in kids, particularly younger ones, said Carpenter, so they might complain about stomach aches, rather than back pain or nausea, for example.
To avoid kidney stones
Drink plenty of water, especially during warmer months, experts say.
Not sure you’re drinking enough? Make sure your urine resembles a light lemonade color, Carpenter said. If it’s darker, hydrate more.
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Disease Research
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Bone cows, specially bred in mad cow-free Australia, are being used instead of human donors for dental and medical bone grafts.
While bovine grafts have been tested for spinal fusion, foot reconstructions and to fix skull traumas, the Australian versions are predominantly used in dental work to strengthen degraded jaws before tooth implants.
Dental bone grafts in the past required the use of bone donated from the bodies of people who gave consent while alive or from the patient themselves.
But now synthetic bones as well as xenografts – bone from animals including pigs or cattle – can often be used instead. Cow bones have become the most commonly used, but the next evolution is set to be artificial 3D-printed products.
Scott Davis, federal president of the Australian Dental Association, said people were “more comfortable” with bovine products than human, and they had been shown to work.
Australian cattle are used because they have no history of bovine spongiform encephalopathy (mad cow disease).
“With the main product, Bio-Oss, it’s acceptable to donate blood with the Red Cross if you’ve had a graft with that,” he said. “It’s one of the few where people can continue to donate. It’s from a select herd of Australian cattle that have been thoroughly tested.”
These cattle undergo regular health checks and they are sent to certified slaughterhouses. The material is sent overseas – for example, to Switzerland – for high-temperature treatments, cleaning and sterilisation, before it is sent back.
It is then used to create a scaffold around which a patient’s own bone will grow so there is enough material to support a titanium implant, to which a crown is attached.
“The periodontist or surgeon will recommend [bovine bone],” Davis said.
“It has a long track record of success and hundreds of published articles. The way it’s heat treated means it reabsorbs less than fresh bone – it shrinks less.
“Australia’s a safe market because of the TGA. The only materials you can use are definitely biologically safe.”
A xenograft is a type of xenotransplantation, a field that has been rapidly developing to use parts of animals for human transplants, amid a shortage that was exacerbated by the pandemic.
Xenotransplantation is the use of tissues, organs or cells from animals to treat humans. The cells are genetically modified so the human body accepts them.
The former prime minister Kevin Rudd had his faulty heart valve replaced with one from a cow. Animal pancreases can be used to produce insulin. There is ongoing research into using kangaroo tendons – which are much stronger than human tendons – to repair human anterior cruciate ligaments.
The world’s second human recipient of a pig heart died this month, nearly six weeks after the procedure.
In August a pig kidney was transplanted into a brain-dead human. It worked normally for two months in the body of a man who had donated his body for the experiment, then was removed and the body was returned to his family.
Prof Toby Coates, transplantation director at Royal Adelaide hospital, said success could help overcome the shortage in donor kidneys and provide hope for more than 15,000 Australians on dialysis.
Australia had a ban on xenotransplantation clinical research imposed in 2005 but it was lifted five years later.
Animal rights organisations including the RSPCA are opposed to xenotransplantation and the genetic manipulation that can accompany it. “However, where xenotransplantation occurs, mandatory welfare standards must be monitored and enforced to ensure a good quality of life,” the RSPCA says.
Humane Research Australia refers to xenotransplantation as “trading in spare parts”.
Davis said work is afoot to 3D print synthetic materials to rebuild bones, which will be particularly attractive to vegans and adherents to some religions.
“The challenge is making it bioactive, that is, inspire ourselves to actively be recruited and generate new bone,” Davis said. “It’s essentially largely experimental, but that is the future.”
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Medical Innovations
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Martha Bebinger/WBUR
toggle caption
Dr. Rebecca Rogers practices primary care at the Cambridge Health Alliance in Somerville, Mass. During a recent appointment, she went over hydration tips with her patient Luciano Gomes, who works in construction.
Martha Bebinger/WBUR
Dr. Rebecca Rogers practices primary care at the Cambridge Health Alliance in Somerville, Mass. During a recent appointment, she went over hydration tips with her patient Luciano Gomes, who works in construction.
Martha Bebinger/WBUR
Earlier this summer, an important email popped up in the inboxes of a small group of health care workers north of Boston. The email warned them that local temperatures were rising into the 80s.
An 80-plus degree day is not sizzling by Phoenix standards. It wasn't even high enough to trigger an official heat warning for the wider public.
But research has shown that those temperatures, coming so early in June, would drive up the number of heat-related hospital visits and deaths across the Boston region.
The health risks of heat don't fall equally across the populace. But most patients at this particular clinic, Cambridge Health Alliance in Somerville, MA could be vulnerable.
And the health impacts of heat don't occur consistently throughout the summer. A sudden heat surge, especially if it happens early in what scientists call the heat season, can be especially dangerous.
"People are quite vulnerable because their bodies haven't yet adjusted to heat," said Dr. Rebecca Rogers, a primary care physician at the clinic.
The targeted email alert that the doctors and nurses got that day are part of a pilot project run by the non-profit Climate Central and Harvard University's Center for Climate, Health and the Global Environment, or C-CHANGE.
Medical clinicians who are receiving the alerts are based at 12 community-based clinics in seven states: California, Massachusetts, North Carolina, Oregon, Pennsylvania, Texas and Wisconsin.
For each location, the first email alert of the season was triggered when local temperatures reached the 90th percentile. In a suburb of Portland, Oregon, that happened on May 14th during a springtime heat wave. In Houston, that occurred in early June.
A second email alert went out when forecasts indicated the thermometer would reach the 95th percentile. For Rogers, that email arrived on July 6th, when the high hit 87 degrees.
The emails help remind Rogers and other clinicians to focus on patients who are particularly vulnerable to heat. That includes outdoor workers, individuals who are older, or patients with heart disease, diabetes or kidney disease.
Other at-risk groups include youth athletes and people who can't afford air conditioning, or who don't have stable housing. Heat has been linked to complications during a pregnancy as well.
"Heat can be dangerous to all of us," said Dr. Caleb Dresser, the director of health care solutions at C-CHANGE. "But the impacts are incredibly uneven based on who you are, where you live and what type of resources you have."
"This is not your grandmother's heat"
The pilot aims to remind clinicians to start talking to their patients about how to protect themselves on dangerously hot days, which are happening more frequently because of climate change. Heat is already the leading cause of death in the U.S. from natural hazards, Dresser said.
"What we're trying to say is 'you really need to go into heat mode now,'" said Andrew Pershing, the vice president for science at Climate Central, with a recognition that "it's going to be more dangerous for folks in your community who are more stressed."
"This is not your grandmother's heat," said Ashley Ward, who directs the Heat Policy Innovation Hub at Duke University. "The heat regime that we are seeing now is not what we experienced 10 or 20 years ago. So we have to accept that our environment has changed. This might very well be the coolest summer for the rest of our lives."
Candid talk about heat risks in the exam room
The alerts bumped heat to the forefront of Dr. Rogers' conversations with patients. She makes time to ask each person whether they can cool off at home and at work.
That's how she learned that one of her patients, Luciano Gomes, works in construction.
"If you were getting too hot at work and maybe starting to feel sick, do you know some things to look out for?" Rogers asked Gomes.
"No," said Gomes slowly, shaking his head.
Rogers told Gomes about early signs of heat exhaustion: dizziness, weakness, or profuse sweating. She handed Gomes some tip sheets that arrived along with the email alerts.
They included information about how to avoid heat exhaustion and dehydration, as well as specific guidance for patients with asthma, chronic obstructive pulmonary disease (COPD), dementia, diabetes, multiple sclerosis and mental health concerns.
Rogers pointed out a color chart that ranges from pale yellow to dark gold. It's a sort of hydration barometer, based on the color of one's urine.
"So if your pee is dark like this during the day when you're at work," she told Gomes, "it probably means you need to drink more water."
Gomes nodded. "This is more than you were expecting to talk about when you came to the doctor today, I think," she said with a laugh.
During this visit, an interpreter translated the visit and information into Portuguese for Gomes, who is from Brazil. He's quite familiar with heat. But for Dr. Rogers, he now had questions about the best ways to stay hydrated.
"Because here I've been addicted to soda," Gomes told Rogers through the interpreter. "I'm trying to watch out for that and change to sparkling water. But I don't have much knowledge on how much I can take of it?"
"As long as it doesn't have sugar it's totally good," Rogers said.
Now Rogers creates heat mitigation plans with each of her high-risk patients.
But she still has medical questions that the research can't yet address. For example: If patients take medications that make them urinate more often, could that lead to dehydration when it's hot? So should she reduce their doses during the warmest weeks or months? And if so, how much? But research has yielded no firm answers to those questions.
Dealing with heat at home and outside, day or night
Deidre Alessio, a nurse at Cambridge Health Alliance, also receives the email alerts. She has a number of patients who sleep on the streets or in tents, and search for places to cool off during the day.
Alessio recently looked for an online directory of cooling centers in communities around Greater Boston, and couldn't find one.
"Getting these alerts make me realize that I need to do more homework on the cities and towns where my patients live," she said, "and help them find transportation to a cooling center."
Some heat-related health problems can set in overnight if the body can't cool down. That's why clinicians may recommend putting an air conditioner in the bedroom, if a patient can only afford one unit. But for patients who can't afford any air conditioning at all, finding resources can be hard.
Alessio and Rogers pay special attention to patients who live in neighborhoods that are heat islands, with little to no shade or natural surfaces. Heat islands can experience day and nighttime temperatures that are significantly warmer, compared to the general Boston area on which the alerts are based.
Dr. Gaurab Basu, another colleague who is getting the alerts, talks to patients about issues that may not seem related to cooling and hydration. He routinely asks patients about their social connections and whether they live alone.
"I'm really concerned about folks who are lonely or isolated," said Basu, mentioning research findings from a deadly heat wave in Chicago in 1995. "One of the major variables in whether people survived was whether they had other people they could turn to."
An intervention limited to the "heat season"
For now, Basu, Rogers and Alessio are only addressing heat risks with the patients they see during what's become known as the "heat season," which begins in late spring and can extend beyond the official months of summer.
They realize they may be missing high risk patients with appointments at cooler times of year.
Most clinics and hospitals don't have heat alerts built into electronic medical records, don't filter patients based on heat vulnerability, and don't have systems in place to send heat warnings to some or all of their patients.
"I would love to see health care institutions get the resources to staff the appropriate outreach," said Basu, who also co-directs the Center for Health Equity, Advocacy and Education at Cambridge Health Alliance.
"But hospital systems are still really strained by COVID and staffing issues."
This pilot program is an excellent start, and could benefit by including pharmacists as well, says Kristie Ebi, who leads the Center for Global Health and the Environment at the University of Washington.
Ebi has studied early heat warning systems for 25 years. She says one problem is that too many people don't take heat warnings seriously. In a survey of Americans who experienced heat waves in four cities, only about half of residents took precautions to avoid harm to their health.
"We need more behavioral health research," she said, "to really understand how to motivate people who don't perceive themselves to be at risk, to take action."
For Ebi and other researchers, the call to action is not just to protect individual health, but to address the root cause of rising temperatures: climate change.
"We'll be dealing with increased exposure to heat for the rest of our lives," said Dresser. "To address the factors that put people at risk during heat waves we have to move away from fossil fuels so that climate change doesn't get as bad as it could."
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Global Health
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Iran Supreme Leader Ayatollah Ali Khamenei called for the death penalty for whoever poisoned hundreds of schoolgirls – saying if the string of incidents are deliberate it would be an "unforgivable crime."
"If the poisoning of students is proven, those behind this crime should be sentenced to capital punishment and there will be no amnesty for them," Khamenei said of the poisonings, according to a CBS News report Monday.
The comments come as Iranians officials in recent weeks have begun to acknowledge the poisonings, which started last year and have caused hundreds of schoolgirls across the country to fall ill.
The attacks have so far affected over 50 schools and more than 400 schoolgirls in 21 provinces across Iran, with some politicians placing blame on religious extremist groups opposed to girls' education.
However, little information is known about how the poisonings happened or whether they were deliberate, and Iran has no previous history of religious extremists targeting female education.
Iranian Interior Minister Ahmad Vahidi has alluded to authorities gathering "suspicious samples" from some of the schools, though he did not elaborate on what was found and instead urged the public to remain calm while accusing enemies of the regime of attempting to spread fear.
Meanwhile, parents have taken to social media to post photos of schoolgirls in emergency rooms with IVs in their arms, with the girls complaining of headaches, heart palpitations, shortness of breath, nausea, vertigo and feeling lethargic. Others have described smelling tangerines, chlorine or cleaning agents.
"A very bad smell suddenly spread, I got dizzy and I fell to the ground," one schoolgirl recounted, according to CBS.
Reports of attacks continued over the weekend, with one student complaining she "felt nausea and intense pain in the chest" and that her "legs were numb" after a suspected attack.
One emergency doctor at a hospital in the western city of Borujerd, where one of the suspected attacks took place, said that "most of the students suffered symptoms such as headaches, respiratory problems, lethargy, nausea and hypotension."
The suspected attacks also come amid months of protests over the death in police custody of Mahsa Amini, who was arrested for being found in violation of the country's head covering laws. Some of those protests have been joined by schoolgirls, with New York-based Iranian-American activist Masih Alinejad saying the girls were now "paying the price" for their outspoken behavior.
"Now the girls of Iran are paying the price for fighting against the compulsory hijab and have been poisoned by the government," Alinejad said on Twitter.
Maryam Rajavi, the president-elect of the National Council of Resistance of Iran, took aim at Khamenei's response on social media Monday, arguing the supreme leader is attempting to pass blame for the poisonings.
"Belatedly, Khamenei has woken up and is looking for others to blame for poisoning schoolgirls in fear of an uprising," Rajavi said. "But there's no one to blame other than himself and the agencies and elements under his command. Otherwise, Khamenei must accept a visit by an international investigative mission which we asked the UN to form from Day 1. In the meantime, we must step up our protests and demonstrations."
Authorities have sought to assure parents that they are taking the matter seriously, with Iranian Education Minister Yousef Nouri saying on state television Sunday that they fully understand the parents' concerns and are following up the issue seriously.
Meanwhile, Grand Ayatollah Abdollah Javadi Amoli called on officials to "solve the problem as quickly as possible ...to reassure the nation."
"It is frightening to note that the origin of the poisoning of students has not yet been determined," he said.
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Epidemics & Outbreaks
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NHS must modernise or die, says Labour as it reveals major plan
The NHS must “modernise or die”, Labour has said, as it pledged to double the number of diagnostic scanners in hospitals to give tens of thousands of patients faster access to life-saving treatment.
Wes Streeting, the shadow health secretary, said his party would save the health service from an “existential crisis” that had left people unable to rely on it in emergencies.
Sir Keir Starmer, the Labour leader, hailed a “seismic” victory in the Rutherglen & Hamilton West by-election in Scotland on Friday, with the party achieving a higher-than-expected 20.4 percentage point swing from the SNP.
The scale of the victory would be enough to give Labour 40 seats in Scotland if it were replicated at the general election, ending the SNP’s decade-long dominance over Scottish politics and putting Starmer on course for No 10.
In an interview with The Times, Streeting issues a direct appeal to “decent, longstanding Conservatives” to turn to Labour. “We say to all those decent and disaffected Conservative supporters you have a home in Labour,” he said. “The NHS is in the grip of an existential crisis and unless it modernises and reforms, it will die ... I’m never going to pretend that the NHS today, which is failing patients and failing staff, is the NHS that we want it to be or anything like the founding promise that the NHS was established with 75 years ago.”
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He said that Labour would spend £171 million a year over the next parliament on new MRI and CT scanners equipped with artificial intelligence technology. The pledge would be funded by scrapping non-dom tax status.
Britain is near the bottom of rich-world league tables for scanning capacity, below countries such as Slovakia and Greece, with little more than 1,000 MRI and CT scanners. Doubling this would put Britain at similar levels to Germany or Spain.
Streeting said that long delays for diagnosis meant “the difference between life and death” for some patients, and that speeding this up through new kit would save lives by spotting diseases such as cancer earlier.
Describing himself as a “walking, talking case study”, Streeting described how his own kidney cancer was picked up early during tests for kidney stones, meaning treatment now gives him an “excellent” prognosis. “It breaks my heart to think there will be people being diagnosed at [less treatable stages] simply because the NHS couldn’t reach them in time,” he said.
A quarter of people wait more than six weeks for diagnostic tests, against a 1 per cent target, with 1.6 million people awaiting checks. There are a record 7.6 million people awaiting routine care, and previous estimates have suggested that about 25,000 people in the queue will turn out to have cancer.
“I have no doubt on those NHS waiting lists for elective treatment will be undiagnosed cancer and that sends chills through my bones,” Streeting said. “If you can diagnose faster, you can get people treated more quickly, which is often far less expensive and leads to better outcomes, which is good for the patient and for the taxpayer.”
His comments come before the start tomorrow of Labour’s conference in Liverpool, which has been buoyed by the by-election result in Scotland.
• Wes Streeting: ‘Tories in hock to crackpots and conspiracy theorists’
Starmer’s aides are increasingly confident that they will achieve significant gains north of the border at the expense of the SNP, making it much easier to win an overall majority in Westminster.
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The party is drawing up plans to focus on more SNP seats than previously, with resources expected to be diverted from Labour’s headquarters in London. Party strategists believe that up to double the previous target of 20 seats is possible after Rutherglen.
The Labour leader, on a visit to the constituency, described the result as a “big step in the right direction”, saying that the Labour’s campaign had “blown the doors off”, adding: “But we accept this humbly, this is a step on the journey.”
Labour’s opportunity was highlighted on Friday by polling by the Tony Blair Foundation, which indicated that about a third of SNP supporters now say that getting rid of the Tory government in Westminster is their first priority.
Labour’s candidate in Rutherglen & Hamilton West, Michael Shanks, won 17,845 votes, with 8,399 for his closest rival, the SNP’s Katy Loudon. The Tories and Lib Dems lost their deposits. The former SNP MP, Margaret Ferrier, was ousted for breaching lockdown rules.
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Health Policy
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On Nov. 22, three FDA inspectors arrived at the sprawling Intas Pharmaceuticals plant south of Ahmedabad, India, and found hundreds of trash bags full of shredded documents tossed into a garbage truck. Over the next 10 days, the inspectors assessed what looked like a systematic effort to conceal quality problems at the plant, which provided more than half of the U.S. supply of generic cisplatin and carboplatin, two cheap drugs used to treat as many as 500,000 new cancer cases every year.
Seven months later, doctors and their patients are facing the unimaginable: In California, Virginia, and everywhere in between, they are being forced into grim contemplation of untested rationing plans for breast, cervical, bladder, ovarian, lung, testicular, and other cancers. Their decisions are likely to result in preventable deaths.
Cisplatin and carboplatin are among scores of drugs in shortage, including 12 other cancer drugs, attention-deficit/hyperactivity disorder pills, blood thinners, and antibiotics. Covid-hangover supply chain issues and limited FDA oversight are part of the problem, but the main cause, experts agree, is the underlying weakness of the generic drug industry. Made mostly overseas, these old but crucial drugs are often sold at a loss or for little profit. Domestic manufacturers have little interest in making them, setting their sights instead on high-priced drugs with plump profit margins.
The problem isn’t new, and that’s particularly infuriating to many clinicians. President Joe Biden, whose son Beau died of an aggressive brain cancer, has focused his Cancer Moonshot on discovering cures — undoubtedly expensive ones. Indeed, existing brand-name cancer drugs often cost tens of thousands of dollars a year.
But what about the thousands of patients today who can’t get a drug like cisplatin, approved by the FDA in 1978 and costing as little as $6 a dose?
“It’s just insane,” said Mark Ratain, a cancer doctor and pharmacologist at the University of Chicago. “Your roof is caving in, but you want to build a basketball court in the backyard because your wife is pregnant with twin boys and you want them to be NBA stars when they grow up?”
“It’s just a travesty that this is the level of health care in the United States of America right now,” said Stephen Divers, an oncologist in Hot Springs, Arkansas, who in recent weeks has had to delay or change treatment for numerous bladder, breast, and ovarian cancer patients because his clinic cannot find enough cisplatin and carboplatin. Results from a survey of academic cancer centers released June 7 found 93% couldn’t find enough carboplatin and 70% had cisplatin shortages.
“All day, in between patients, we hold staff meetings trying to figure this out,” said Bonny Moore, an oncologist in Fredericksburg, Virginia. “It’s the most nauseous I’ve ever felt. Our office stayed open during covid; we never had to stop treating patients. We got them vaccinated, kept them safe, and now I can’t get them a $10 drug.”
The 10 cancer clinicians KFF Health News interviewed for this story said that, given current shortages, they prioritize patients who can be cured over later-stage patients, in whom the drugs generally can only slow the disease, and for whom alternatives — though sometimes less effective and often with more side effects — are available. But some doctors are even rationing doses intended to cure.
Isabella McDonald, then a junior at Utah Valley University, was diagnosed in April with a rare, often fatal bone cancer, whose sole treatment for young adults includes the drug methotrexate. When Isabella’s second cycle of treatment began June 5, clinicians advised that she would be getting less than the full dose because of a methotrexate shortage, said her father, Brent.
“They don’t think it will have a negative impact on her treatment, but as far as I am aware, there isn’t any scientific basis to make that conclusion,” he said. “As you can imagine, when they gave us such low odds of her beating this cancer, it feels like we want to give it everything we can and not something short of the standard.”
Brent McDonald stressed that he didn’t blame the staffers at Intermountain Health who take care of Isabella. The family — his other daughter, Cate, made a TikTok video about her sister’s plight — were simply stunned at such a basic flaw in the health care system.
At Moore’s practice, in Virginia, clinicians gave 60% of the optimal dose of carboplatin to some uterine cancer patients during the week of May 16, then shifted to 80% after a small shipment came in the following week. The doctors had to omit carboplatin from normal combination treatments for patients with recurrent disease, she said.
On June 2, Moore and her colleagues were glued to their drug distributor’s website, anxious as teenagers waiting for Taylor Swift tickets to go on sale — only with mortal consequences at stake.
She later emailed KFF Health News: “Carboplatin did NOT come back in stock today. Neither did cisplatin.”
Doses remained at 80%, she said. Things hadn’t changed 10 days later.
Generics Manufacturers Are Pulling Out
The causes of shortages are well established. Everyone wants to pay less, and the middlemen who procure and distribute generics keep driving down wholesale prices. The average net price of generic drugs fell by more than half between 2016 and 2022, according to research by Anthony Sardella, a business professor at Washington University in St. Louis.
As generics manufacturers compete to win sales contracts with the big buyers, including wholesale purchasers Vizient and Premier, their profits sink. Some are going out of business. Akorn, which made 75 common generics, went bankrupt and closed in February. Israeli generics giant Teva, which has a portfolio of 3,600 medicines, announced May 18 it was shifting to brand-name drugs and “high-value generics.” Lannett Co., with about 120 generics, announced a Chapter 11 reorganization amid declining revenue. Other companies are in trouble too, said David Gaugh, interim CEO of the Association for Accessible Medicines, the leading generics trade group.
The generics industry used to lose money on about a third of the drugs it produced, but now it’s more like half, Gaugh said. So when a company stops making a drug, others do not necessarily step up, he said. Officials at Fresenius Kabi and Pfizer said they have increased their carboplatin production since March, but not enough to end the shortage. On June 2, FDA Commissioner Robert Califf announced the agency had given emergency authorization for Chinese-made cisplatin to enter the U.S. market, but the impact of the move wasn’t immediately clear.
Cisplatin and carboplatin are made in special production lines under sterile conditions, and expanding or changing the lines requires FDA approval. Bargain-basement prices have pushed production overseas, where it’s harder for the FDA to track quality standards. The Intas plant inspection was a relative rarity in India, where the FDA in 2022 reportedly inspected only 3% of sites that make drugs for the U.S. market. Sardella, the Washington University professor, testified last month that a quarter of all U.S. drug prescriptions are filled by companies that received FDA warning letters in the past 26 months. And pharmaceutical industry product recalls are at their highest level in 18 years, reflecting fragile supply conditions.
The FDA listed 137 drugs in shortage as of June 13, including many essential medicines made by few companies.
Intas voluntarily shut down its Ahmedabad plant after the FDA inspection, and the agency posted its shocking inspection report in January. Accord Healthcare, the U.S. subsidiary of Intas, said in mid-June it had no date for restarting production.
Asked why it waited two months after its inspection to announce the cisplatin shortage, given that Intas supplied more than half the U.S. market for the drug, the FDA said via email that it doesn’t list a drug in shortage until it has “confirmed that overall market demand is not being met.”
Prices for carboplatin, cisplatin, and other drugs have skyrocketed on the so-called gray market, where speculators sell medicines they snapped up in anticipation of shortages. A 600-milligram bottle of carboplatin, normally available for $30, was going for $185 in early May and $345 a week later, said Richard Scanlon, the pharmacist at Moore’s clinic.
“It’s hard to have these conversations with patients — ‘I have your dose for this cycle, but not sure about next cycle,’” said Mark Einstein, chair of the Department of Obstetrics, Gynecology and Reproductive Health at Rutgers New Jersey Medical School.
Should Government Step In?
Despite a drug shortage task force and numerous congressional hearings, progress has been slow at best. The 2020 CARES Act gave the FDA the power to require companies to have contingency plans enabling them to respond to shortages, but the agency has not yet implemented guidance to enforce the provisions.
As a result, neither Accord nor other cisplatin makers had a response plan in place when Intas’ plant was shut down, said Soumi Saha, senior vice president of government affairs for Premier, which arranges wholesale drug purchases for more than 4,400 hospitals and health systems.
Premier understood in December that the shutdown endangered the U.S. supply of cisplatin and carboplatin, but it also didn’t issue an immediate alarm, she said. “It’s a fine balance,” she said. “You don’t want to create panic-buying or hoarding.”
More lasting solutions are under discussion. Sardella and others have proposed government subsidies to get U.S. generics plants running full time. Their capacity is now half-idle. If federal agencies like the Centers for Medicare & Medicaid Services paid more for more safely and efficiently produced drugs, it would promote a more stable supply chain, he said.
“At a certain point the system needs to recognize there’s a high cost to low-cost drugs,” said Allan Coukell, senior vice president for public policy at Civica Rx, a nonprofit funded by health systems, foundations, and the federal government that provides about 80 drugs to hospitals in its network. Civica is building a $140 million factory near Petersburg, Virginia, that will produce dozens more, Coukell said.
Ratain and his University of Chicago colleague Satyajit Kosuri recently called for the creation of a strategic inventory buffer for generic medications, something like the Strategic Petroleum Reserve, set up in 1975 in response to the OPEC oil crisis.
In fact, Ratain reckons, selling a quarter-million barrels of oil would probably generate enough cash to make and store two years’ worth of carboplatin and cisplatin.
“It would almost literally be a drop in the bucket.”
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Drug Discoveries
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By Steven Reinberg
HealthDay Reporter
THURSDAY, Oct. 19, 2023 (HealthDay News) -- Think twice about ordering that double cheeseburger, salami on rye or juicy T-bone.
Just two servings of red meat a week -- processed or unprocessed -- can increase your risk of type 2 diabetes by 62%, according to a new study.
"A modest but statistically significant increase in risk was seen with even two servings of red meat per week, and risk continued to increase with higher intakes," said lead author Xiao Gu, a postdoctoral research fellow at Harvard's T.H. Chan School of Public Health in Boston. "Our findings suggest that replacing red meat with healthy plant-based protein sources, such as nuts and legumes, or modest intakes of dairy foods, would reduce the risk of diabetes."
The study can't prove that eating red meat causes type 2 diabetes, but there appears to be a link.
And a serving of meat is likely smaller than you might suspect.
One serving of unprocessed red meat is about 3 ounces of pork, beef or lamb; a serving of processed red meat is about 1 ounce of bacon or 2 ounces of hot dog, sausage, salami, bologna or other processed red meats, Gu said.
Red meat is usually high in saturated fat and low in polyunsaturated fat, Gu said.
"Studies have shown that saturated fat can reduce beta cell function and insulin sensitivity, which results in type 2 diabetes," he explained.
"Red meat also has a high content of heme iron, which increases oxidative stress and insulin resistance and impairs beta cell function through its by-product of nitric oxide compounds," Gu said. "For processed red meats, there is also a high content of nitrates and their byproducts, which promote cell dysfunction and insulin resistance."
For the study, Gu and his colleagues collected data on nearly 217,000 participants from the Nurses’ Health Study and the Health Professionals Follow-up Study.
Their diets were assessed with food questionnaires for up to 36 years. During this time, more than 22,000 participants developed type 2 diabetes.
People who ate the most red meat had a 62% higher risk for type 2 diabetes, compared with those who ate the least.
Continued
Every added daily serving of processed red meat was associated with a 46% higher risk and every added daily serving of unprocessed red meat with a 24% increased risk, Gu's team found.
They estimate that replacing one daily serving of red meat with another protein like nuts or legumes could lower the risk for type 2 diabetes by 30%. Substituting a serving of dairy, meanwhile, might lower the risk by 22%, researchers said.
These findings support recommendations to limit red meat and instead choose plant protein or modest amounts of dairy foods, Gu said. Plant-based proteins, such as nuts and legumes, are among the healthiest protein sources, he said.
"Prevention of diabetes is important because this disease is itself a serious burden, and it also is a major risk factor for cardiovascular and kidney disease, cancer and dementia," he said.
Diabetes rates are increasing rapidly in the United States and worldwide, which is a red flag that rates of many other serious conditions will follow, Gu said.
"Our findings strongly support that adoption of this dietary strategy will help reduce an individual's risk of developing type 2 diabetes and its consequences, which will ultimately improve the health and well-being of people worldwide," he said. "Also, replacement of red meat with healthy plant protein sources would help reduce greenhouse gas emissions and climate change, along with other environmental benefits."
A physician who reviewed the findings noted that obesity and other factors play a significant role in type 2 diabetes.
"Obesity is a common indicator of patients with diabetes," said Dr. Alisha Oropallo, a vascular surgeon at Northwell Health in New Hyde Park, N.Y. "As patients reduce their weight, they also reduce complications associated with type 2 diabetes."
Part of reducing the risk for type 2 diabetes is improving one's lifestyle, which means adopting a healthy diet and exercising, Oropallo said. Part of improving your diet is limiting how much red meat you eat. Red meat consumption may be a marker of other unhealthy behaviors that lead to type 2 diabetes, she explained.
Continued
Oropallo noted that red meat can promote inflammation, which can lead to some of the worst consequences of type 2 diabetes.
"I tend to focus on really the patients that are almost terminal," Oropallo said. "They have diabetes, but they also have suffered from repercussions with diabetes, for instance, amputations, foot ulcers and wounds that won't heal."
Oropallo counsels her patients to eat more nuts, legumes, soy, vegetables and whole grains.
"You can look at other alternative sources of protein, like fish, chicken, soy, even certain types of vegetables have high protein and mushrooms and beans have high protein," she said. "Whole grains, too, have a lot of protein in them. So breads and other alternatives can substitute for red meat."
The findings were published Oct. 19 in the American Journal of Clinical Nutrition.
More information
For more on type 2 diabetes, see the American Diabetes Association.
SOURCES: Xiao Gu, PhD, postdoctoral research fellow, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston; Alisha Oropallo, MD, vascular surgeon, Northwell Health, New York City; American Journal of Clinical Nutrition, Oct. 19, 2023
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Nutrition Research
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It can be alarming to find a lump in your breast. But understanding the next steps can arm you with important knowledge.
In the WebMD webinar "What to Do When You Find a Lump," Stephanie Bernik, MD, explained the steps you should take. She talked about breast changes that need to be checked, health conditions other than breast cancer that might be the cause, whether breast self-exams are useful, and more.Â
Bernik is the chief of breast service at Mount Sinai West in New York and associate professor of surgery at the Icahn School of Medicine at Mount Sinai.
âIf you find a mass, don't panic. There are so many things that can be benign (non-cancerous), especially in people who are menstruating,â says Bernik. âBut certainly don't ignore a finding.â
Poll Questions
Some lifestyle habits can reduce your exposure to estrogen. High levels of estrogen are linked to an increased risk of breast cancer and other health conditions.Â
A poll of webinar viewers found that 40% reduce their estrogen exposure with regular exercise. Thatâs followed by 27% who avoid estrogen-increasing hormone-replacement therapy (HRT).Â
Question: I limit my exposure to estrogen by:
- Getting regular exercise: 40%
- Avoiding HRT: 27%
- Reducing fat in my diet: 20%
- Drinking little or no alcohol: 11%
Another webinar poll asked about known risks for breast cancer. Being female was a breast cancer risk for 41% of viewers, compared to over 30% who have breast cancer in their family history.Â
Question: My breast cancer risks include:
- Being female: 41%
- Family history: 32%
- Starting periods early: 13%
- Being postmenopausal and taking hormone therapy: 7%
- Starting menopause late: 4%
Whatâs a Breast Self-Exam?
Itâs a way to check your breasts for changes. While it used to be more popular, doctors now warn against its overuse.
âThe problem we have found with self-breast exams is that people tend to feel too much,â says Bernik.Â
âThat creates a false positive. For example, if you feel something but the doctors don't see anything, you may have to get surgery to have a tissue diagnosis.â
While itâs important to be aware of any change in your breasts, itâs also good to understand that youâll feel the fat areas in your breasts during a self-exam as well. These may not be dangerous lumps. Feeling too much can create unneeded anxiousness for you.
âWe say you should sweep your breasts in the shower. Make sure you're not feeling anything obvious. If you do feel something, you can't ignore it,â she says.
When to See Your Doctor About a Lump
If you find a breast mass and youâve been through menopause, call your doctor and schedule an exam.Â
âMost cancers will be in postmenopausal women,â says Bernik. âBut just because you're young, it doesn't mean you can't get cancer.â
If you havenât been through menopause, wait to see if the lump is still there after your next period. If it doesnât go away, see your doctor.
Viewer Questions
How do breast implants affect breast cancer risk?
Whatâs the link between stress and breast cancer?
How does breast reduction surgery affect breast cancer risk?
Implants can make some breast tissue unclear when you have a mammogram. With implants, even if theyâre silicone, it's suggested you have more mammograms. You should be adding an MRI at least every 3 years in addition to the screening mammogram and/or an ultrasound if you're 40 or older.
Several years ago, we had textured implants that were mostly silicone. They were used because they really held their shape. While it was rare, they were linked to lymphoma. We donât use those implants anymore. But we also donât rush to take them out unless thereâs a reason. If there is, then those implants are removed and replaced with different ones.
Stress can increase your risk of breast cancer, as it causes inflammatory reactions in your body. On a microscopic level, those factors affect cells, which raises your risk of cancer. Stress isnât good for your body, not just in terms of breast cancer, but for every organ system.
You want to lead a healthy lifestyle by eating a nutritious diet, exercising, trying to keep alcohol to a minimum, and lowering your stress. All of these help lower your risk of cancer.
Nothing eliminates your risk of breast cancer. But if you have a genetic risk of it, you might have a prophylactic mastectomy. This is surgery that can remove a lot of your breast tissue. Through that, we can lower your risk by 90%, which is lower than the general population.Â
How do you know if youâre a BRCA carrier?
Does having an aunt with breast cancer increase your risk?
Why are women more likely to develop breast cancer as they age?
We screen a lot more people for BRCA than we used to because the cost of the genetic tests has gone down. You can do screening for BRCA for about $250.Â
Some people get the test just to know if they carry the mutation or not. But in general, the screening is recommended if you have:
- Triple-negative cancer yourself
- Male breast cancer in your family
- A history of breast and ovarian cancer
- Several relatives whoâve had breast cancer
In terms of your cancer risk related to your family history, we like to do a little probing. We ask about other cancers in your family on your fatherâs and motherâs side.
Just because you don't have a first-degree relative with cancer, it doesn't mean you donât have a risk. You need to dive more into your genetics.Â
Cancers can skip a generation. So you can have a mother who didn't have breast cancer, but sheâs a carrier. She may have three sisters, your aunts, with breast cancer. You have to look at the whole story.
People are more likely to develop breast cancer as they age. Thatâs because as you age, you're at a higher risk of all sorts of cancers. This is because your cells are older.Â
In your body, you have repair tools. There are always breaks in your DNA, but your body tends to fix those. If your body fails to fix a break in your DNA, that can cause cancer. As you age, there are more of these breaks in your DNA because your cells are older and not functioning as well.
Is there a best or worst time in your cycle to have a mammogram?
Should you get an ultrasound annually with a mammogram if you have dense breasts?Â
Should you have mammograms as long as you live?
We don't usually time mammograms to your cycle. But the best time to get a mammogram would probably be on days 7 to 14 of your cycle. It's hard to predict that because cycles can sometimes have something that throws them off. So people tend to schedule mammograms at any point in their cycle.
If you have dense breasts, your ultrasound and mammogram recommendations will vary a little bit based on what state youâre in. Some states will put a statement on the mammogram if there's dense breast tissue. Then, you have to speak to your doctor to see if extra screening is needed.
If you have dense breast tissue, some states automatically add an ultrasound. But it does vary, so always read your mammogram. If it says âheterogeneously denseâ anywhere on your mammogram, you should ask for an ultrasound as well.
If youâre expected to live more than 5 years, breast surgeons suggest we continue to screen you for breast cancer. Guidelines say you can stop at 75. But people are living much longer than that. These large-scale guidelines look at the general population and not at the person as an individual.
Even if the guidelines say you donât need screening, you should consider doing it. Even if youâre 85. If youâre still healthy, you should continue getting screened.
Watch a replay of the WebMD webinar "What to Do When You Find a Lump."
Watch other free WebMD webinars by leading experts on a variety of health topics.
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Women’s Health
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A newly declassified U.S. intelligence report states that there's no evidence linking the start of the COVID-19 pandemic to research or biosafety incidents at the Wuhan Institute of Virology, an institute located near the site of the first reported outbreak of the novel coronavirus.
The new report, publicly released on Friday (June 23) evening, comes from the office of Avril Haines, the Director of National Intelligence. The 10-page document summarizes the U.S. intelligence community's understanding of the research capabilities and actions of the Wuhan Institute of Virology (WIV) leading up to and in the early days of the COVID-19 pandemic.
"This report does not address the merits of the two most likely pandemic origins hypotheses" — that SARS-CoV-2, the virus that causes COVID-19, spilled over from animals to humans or that the virus "leaked" from a laboratory, the document reads. However, the report does throw water on the notion that actions taken by WIV researchers somehow sparked the coronavirus pandemic.
Prior to the pandemic, WIV researchers did work with coronaviruses but none that could plausibly be precursors to SARS-CoV-2, the report states. The same goes for researchers associated with China's People's Liberation Army, who sometimes use WIV facilities for virology and vaccine-related work and have collaborated with WIV staff on public health initiatives of this nature.
WIV's research on coronaviruses involved genetic analyses and sampling viruses from animals, such as bats. But again, there's "no indication" that the institute possessed any samples of SARS-CoV-2 or a potential precursor prior to the pandemic.
"Information available to the IC [intelligence community] indicates that the WIV first possessed SARS-CoV-2 in late December 2019, when WIV researchers isolated and identified the virus from samples from patients diagnosed with pneumonia of unknown causes," the report states.
There is also no "direct evidence" that a research-related incident involving WIV personnel occurred before the pandemic and could have sparked the global outbreak, the report notes. That said, WIV personnel "probably did not use adequate biosafety precautions at least some of the time" prior to the pandemic, and the lab had been working to improve some of its biosafety measures, equipment and training practices prior to the outbreak's start.
As part of their research, WIV staff have genetically engineered coronaviruses using "common laboratory practices," but there's no indication that the institute has done such research with SARS-CoV-2, a closely related precursor, or a "backbone" virus that is closely related enough to SARS-CoV-2 to have been the source of the pandemic.
In addition to probing the research conducted at WIV, the report focused on several cases of mild illness among WIV researchers that occurred in fall 2019. These illnesses involved some symptoms consistent with COVID-19 and some unrelated symptoms. The intelligence community has concluded that the employees' illnesses neither support nor refute either of the pandemic origin hypotheses, in part, because the reported symptoms may have resulted from other conditions, such as allergies or the common cold.
At this time, U.S. intelligence agencies are split as to whether they favor the spillover or lab leak hypothesis, but five have concluded that the former scenario is the most likely, the report notes. Two agencies — the Department of Energy and the Federal Bureau of Investigation — have supported the lab leak theory, while two more have said they're unable to determine the precise origin of the pandemic.
Still, "all agencies continue to assess that both a natural and laboratory-associated origin remain plausible hypotheses to explain the first human infection." But crucially, all agencies have concluded that SARS-CoV-2 was not developed as a biological weapon, the report notes.
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Nicoletta Lanese is the health channel editor at Live Science and was previously a news editor and staff writer at the site. She holds a graduate certificate in science communication from UC Santa Cruz and degrees in neuroscience and dance from the University of Florida. Her work has appeared in The Scientist, Science News, the Mercury News, Mongabay and Stanford Medicine Magazine, among other outlets. Based in NYC, she also remains heavily involved in dance and performs in local choreographers' work.
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Epidemics & Outbreaks
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NHS leaders and ministers will meet in Downing Street on Wednesday to discuss planning for winter.
The summit will involve the prime minister, health secretary and NHS England boss Amanda Pritchard.
The focus will be on what else the NHS needs to help it through the winter.
With a record number of people on the hospital waiting list, the threat of continued strikes by doctors and long waits for emergency care, concern is growing over how the NHS will cope.
The event comes after the launch of the winter flu and Covid vaccination campaign earlier this week.
An extra 5,000 hospital beds are already in the process of being opened - increasing capacity by about 5%.
And there will be at least 10,000 "virtual" hospital beds, where doctors provide remote monitoring of patients - who would otherwise have to be admitted to hospital - in their homes.
These have been used in recent years for patients with conditions such as respiratory infections and heart problems.
'The best minds'
Quicker discharge arrangements to get patients out of hospital when they are medically fit to leave are also being promised, through the use of what have been dubbed "care traffic control centres".
These centres bring together the NHS, community, housing and charity teams to help co-ordinate support for those patients who need help once they leave hospital.
Speaking ahead of the meeting - which will include senior doctors - Prime Minister Rishi Sunak said he wanted to bring together "the best minds" to plan for winter.
He said there was one shared aim - protecting patients and making sure they get the care they need this winter.
Sarah-Jane Marsh, NHS England's director of urgent and emergency care, who will be attending, said the winter would be "challenging", but added the NHS had been doing its best to get ready by working on plans since the start of the summer.
Sir Julian Hartley, of NHS Providers, said it was essential a solution was found to the pay dispute with junior doctors and consultants - both will take part in strike action next week and again in October.
"It is acting as a drag anchor," he said.
He also said more needed to be done to reform social care despite the initiatives that were being tried this winter.
He said the lack of access to social care would have an "enormous" effect on the NHS in terms of the ability of hospitals to discharge patients quickly.
One solution put forward by the Institute for Public Policy Research (IPPR) think tank is providing free personal care for the elderly and frail, as happens in Scotland.
It said funding support for daily tasks such as washing, dressing and eating, would be a better option than introducing the £86,000 cap on care costs, which is planned for 2025.
It added the move would keep people living independently and reduce reliance on the NHS, but conceded tax rises may be needed to cover the £5bn-a-year cost.
At the moment personal care is means tested, so only the poorest receive financial support. The IPPR said more money would be needed to be spent on health and care anyway, given the ageing population.
It said funding free personal care would be the "smart investment" that in the long term would help to limit the cost to the NHS.
It estimates the move would lead to another 232,000 people requiring support, on top of the 400,000 already receiving it.
It would also help break down the division between social care, which is run by councils, and the NHS, the think tank said.
To further integrate services, it says a network of neighbourhood health and care hubs should be created to help co-ordinate services such as social care, community NHS support, hospital outpatients service and mental health care.
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Health Policy
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Sir Patrick Vallance, the UK government’s chief scientific adviser throughout Covid, has been giving evidence to the inquiry into the pandemic on Monday. Here is what we have learned so far.
Scientists worried about ‘Eat out to help out’
Vallance was asked about the summer 2020 discount scheme run by Rishi Sunak’s Treasury to encourage people to go to restaurants and cafes – and whether concerns were raised.
Vallance said the plan “completely reversed” earlier advice to reduce mixing between households, and that it would clearly increase infection levels.
The inquiry was shown written evidence from Sunak who said: “I do not recall any concerns about the scheme being expressed during ministerial discussions”, including ones attended by Vallance and by Prof Chris Whitty, the chief medical officer for England.
Vallance said: “I think it would have been very obvious to anyone that this would inevitably cause an increase in transmission risk, and I think that would have been known by ministers.”
Andrew O’Connor KC, counsel to the inquiry, said: “And Mr Sunak?” Vallance replied: “I can’t recall which meetings he was in, but I’d be very surprised if any minister didn’t understand that these openings carried risk.”
Boris Johnson is not great at science
It was, Vallance said with heartfelt understatement, “difficult at times” to get the then-prime minister to fully absorb concepts central to Covid, such as how lockdowns can flatten infection rate curves.
Boris Johnson last studied science at the age of 15 and “would be the first to admit it wasn’t his forte”, and he had the habit of pretending to misunderstand things to test out whether an alternative could be true, Vallance explained.
Extracts from Vallance’s contemporaneous diary showed Johnson found it “a real struggle” to understand some graphs. One entry said the prime minister was “bamboozled” by modelling, while another said Johnson would fail to understand ideas he had had put to him six hours earlier.
This was not an issue just for the UK. Vallance recalled being on a group call with scientific advisers from various countries, when one said their leader could not understand exponential curves, “and the entire phone call burst into laughter because it was true in every country”.
UK ‘should have gone into lockdown earlier’
Vallance said that while Johnson first announced a lockdown on 23 March 2020, it had been clear to him by the weekend of 14-15 March that action was needed.
Data that weekend showed “there were many more cases, it was far more widespread and was accelerating faster than anyone had expected”, he said, adding: “This was an occasion when I think it’s clear that we should have gone earlier.”
Vallance explained: “I thinkthat weekend there was in principle a decision that all of these measures would be needed. And I think it would have been sensible to have got on and done those as quickly as possible.”
Vallance was reprimanded after calling for lockdown
The inquiry heard that Chris Wormald, who was and remains the top civil servant at the health department and is tipped to be the next cabinet secretary, was “incandescent” with anger after Vallance used a ministerial meeting in mid-March to call for swift action.
Mark Sedwill, the then cabinet secretary, was also annoyed, Vallance said.
After hearing this was the case, Vallance asked Wormald why. “He said it was the manner of raising it in the meeting rather than the substance; that he was concerned that I’d sort of thrown it into a ministerial meeting, whereas it should have gone through due process. But I stand by the fact that I think it was the right thing to say at the time.”
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Epidemics & Outbreaks
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State and local health departments across the U.S found out in June they'd be losing the final two years of a $1 billion investment to strengthen the ranks of people who track and try to prevent sexually transmitted diseases — especially the rapid increase of syphilis cases.
The fallout was quick.
Nevada, which saw a 44 percentage-point jump in congenital syphilis from 2021 to 2022, was supposed to get more than $10 million to bolster its STD program budget. Instead, the state's STD prevention budget fell by more than 75%, reducing its capacity to respond to syphilis, according to Dawn Cribb at the Nevada Division of Public and Behavioral Health.
Several states told The Associated Press the loss of funding is affecting efforts to expand their disease intervention workforce. These are people who do contact tracing and outreach and are key in stopping the spread of syphilis, which reached a low point in the U.S. in 2000 but has increased almost every year since. In 2021, there were 176,713 cases — up 31% from the prior year.
"It was devastating, really, because we had worked so hard to shore up our workforce and also implement new activities," said Sam Burgess, the STD/HIV program director for the Louisiana Department of Health.
His state was slated to receive more than $14 million overall, but instead got $8.6 million to stretch until January 2026. "And we're still scrambling to try to figure out how we can plug some of those funding gaps," he said.
While men who have sex with men are disproportionately impacted by syphilis, the U.S. Centers for Disease Control and Prevention and health officials across the country also point to the increase in pregnant women who are passing syphilis to their babies. It can cause serious health issues for infants, including blindness and bone damage, or lead to stillbirths. In 2021, there were 77.9 cases of congenital syphilis per 100,000 live births.
Disease intervention specialists often link infected mothers and their partners with care for syphilis, which has mild symptoms for adults, like fever and sores. Doing so in a timely manner can prevent congenital syphilis. The specialists also can help pregnant patients find prenatal care.
"When you have a mother who didn't know (she had syphilis), it can be very emotional trying to explain ... it could have been prevented if we could have caught it before," said Deneshun Graves, a public health investigator with the Houston Health Department.
The Houston Health Department is in the midst of what it calls a "rapid community outreach response" because syphilis cases increased by 128% among women from 2019 to 2022, and congenital syphilis cases went from 16 in 2019 to 151 in 2021.
Its STD/HIV bureau was set to receive a total of $10.7 million from the federal grant but will end up with about 75% of that.
The department has used the money to hire disease intervention specialists and epidemiologists — including Graves. But Lupita Thornton, a public health investigator manager, said she could use "double of everything," and had planned to bring down the caseload for her investigators by hiring even more people.
It would help Graves, who deals with more than 70 cases at a time.
"You got people that don't want to go in and get treatment. You have people that don't want to answer the phone, so you got to continue to call," Graves said.
Mississippi is also seeing an increase in congenital syphilis cases, which a recently published study showed rose tenfold between 2016 and 2022. Health officials said a combination of funding shortages and poor access to prenatal care compounds their ability to stop the spread of syphilis.
The Mississippi State Department of Health was supposed to get more than $9 million in federal grant money over five years to expand its disease intervention workforce. Agency head Dr. Dan Edney said one of his top priorities now is finding money from other parts of the state's health budget.
Arizona has the highest rate of congenital syphilis in the nation: 232.3 cases per 100,000 live births. The federal money helped the state Department of Health Services clear out a backlog of several thousand non-syphilis STD investigations that had been stalled for years, said Rebecca Scranton, the deputy bureau chief of infectious disease and services.
"We were finally at the point where we were able to breathe again," Scranton said, "and start really kind of tackling it."
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Epidemics & Outbreaks
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- Novo Nordisk said Thursday that its blockbuster weight-loss drug Wegovy could receive expanded approval from the U.S. Food and Drug Administration within six months.
- Chief Financial Officer Karsten Munk Knudsen said the company had received priority review in its application for approval of Wegovy as a treatment for reducing the risk of cardiovascular disease.
- A greenlight from the health agency could potentially boost the insurance coverage prospects of the highly sought-after drug.
Novo Nordisk said Thursday that its blockbuster weight-loss drug Wegovy could receive expanded approval from the U.S. Food and Drug Administration within six months.
Chief Financial Officer Karsten Munk Knudsen told CNBC that the Danish pharmaceutical company had received priority review in its application for approval of Wegovy as a treatment for reducing the risk of cardiovascular disease.
A greenlight from the health agency could potentially boost the insurance coverage prospects of the highly sought-after drug.
"I would say from today, [the outcome will be] less than six months," Knudsen told CNBC's Julianna Tatelbaum on "Street Signs."
Earlier Thursday, Novo Nordisk in its third-quarter earnings announced plans to get expanded approval from the FDA, but shared no timeline. It also reported record profits and sales for the period on the back of the runaway success of its obesity drug.
Late-stage trial data in August showed that Wegovy reduced the risk of major cardiovascular events such as heart attacks or strokes by 20%, compared with a placebo.
"The SELECT study is, in an obese population with established cardiovascular disease, does Wegovy reduce cardiovascular risk? And the answer is, yes it does, by 20%," Knudsen said Thursday.
The findings provided an added boost for the company's stock, which has been on the up this year. Shares were 1.5% higher Thursday morning following its earning's report; over the year to date, shares are almost 45% higher.
Knudsen said the company will present a detailed copy of the trial findings in approximately 10 days, after which the FDA will have six months to provide its verdict.
He added that approval would expand the use cases of the drug, bolstering the chances of insurance companies paying for the treatment. Some insurers have so far been reluctant to cover the drug — which has a U.S. list price of $1,350 a month — solely for weight-loss purposes.
"The pricing of the products are also a reflection of the value that they give to society," Knudsen said.
"So the more data we are able to generate, whether it's on cardiovascular disease or chronic kidney disease or other comorbidities, that is of course part of the overall value story when we discuss with payers and insurers."
However, even with approval, supply shortages could continue to hamper rollout of the drug. Knudsen said Thursday that the company is continuing to ramp up production.
"I can promise you coming into next year that we're significantly scaling Wegovy supply," he said.
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Drug Discoveries
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Popular AI tool ChatGPT flubbed nearly 75% of questions about prescription drugs — with some responses causing potential harm to users, according to a new study.
For the other 29 questions, the responses either did not directly address the question, were inaccurate or incomplete, according to LIU’s researchers, who presented the findings during the American Study of Health-System Pharmacists meeting in Anaheim, Calif., which began Dec. 3 and runs through Dec. 7.
“Healthcare professionals and patients should be cautious about using ChatGPT as an authoritative source for medication-related information,” said Sara Grossman, an associate professor of pharmacy practice at LIU and the leader of the study.
Grossman and her team pointed to a query about the relationship between the COVID-19 antiviral Paxlovid and the blood-pressure lowering medication verapamil as an example.
When asked if there’s a drug interaction between Paxlovid and verapamil, ChatGPT responded that there were no reported interactions for this combination of drugs, per LIU.
“In reality, these medications have the potential to interact with one another, and combined use may result in excessive lowering of blood pressure,” Grossman said. “Without knowledge of this interaction, a patient may suffer from an unwanted and preventable side effect.”
The Post has sought comment from LIU and OpenAI.
LIU’s researchers asked ChatGPT to provide references with each of its responses for verification purposes.
Only eight of 39 replies included references.
All of the references were “non-existent,” LIU reported — proving ChatGPT may not be the go-to resource for medication-related questions.
OpenAI’s usage policies denote that its technologies should not be used to “tell someone that they have or do not have a certain health condition, or providing instructions on how to cure or treat a health condition.”
The guidelines also warned: “OpenAI’s models are not fine-tuned to provide medical information. You should never use our models to provide diagnostic or treatment services for serious medical conditions.”
However, since ChatGPT’s debut in November 2022, it has been groundbreaking for the development of AI and in unrelated fields — including medicine.
In June, the chatbot outperformed human candidates in a mock obstetrics and gynecology exam — even excelling in areas like empathetic communication and exhibiting specialist knowledge.
ChatGPT scored an average of 77.2% on the ob-gyn specialist exam, while human candidates only eked out a 73.7% average, a study from the National University of Singapore revealed.
ChaptGPT also took an average of just under three minutes to complete each station, well under the 10-minute time limit, the study noted.
That same month, a study from medical journal JAMA Network suggested that ChatGPT is considered more caring and empathetic than human doctors.
JAMA’s researchers randomly selected 195 exchanges on the Reddit forum r/AskDocs.
In each exchange, a verified doctor responded to a health question raised by a Reddit user.
Then, the same questions were posted to ChatGPT.
The results won’t make a doctor too happy: ChatGPT gave better answers 78.6% of the time, JAMA found. Its responses were also lengthier and more comprehensive in most instances.
Perhaps most damningly, the chatbot gave the most empathetic response nearly 10 times more often than the humans.
Doctors weren’t sweating for too long, though, as just two months later ChatGPT was tapped for yet another medical-related study — and spewed out cancer treatment regimens that contained a “potentially dangerous” mixture of correct and false information.
In August, researchers at Brigham and Women’s Hospital, a brand of Harvard Medical School, prompted OpenAI’s popular chatbot to provide treatment advice that aligned with guidelines established by the National Comprehensive Cancer Network.
While all of ChatGPT’s outputs “included at least 1 NCCN-concordant treatment,” about 34% also contained an incorrect treatment recommendation, the study found.
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Drug Discoveries
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An entirely preventable condition leaving Indigenous children with severe and irreversible heart damage may be spread due to a reservoir of bacteria in the throat that causes no symptoms in the host, Australian researchers have found.
It is a discovery that will likely have implications for rheumatic heart disease (RHD) prevention and vaccine development, infectious diseases physicians say.
RHD is a chronic and severe disease affecting disadvantaged areas of low- and middle-income countries. Australia has one of the highest reported rates of RHD in the world, where it is only found in remote Indigenous communities plagued by social disadvantage.
In those communities, RHD overwhelmingly affects children, many of whom have endured open-heart surgery.
RHD is caused by infection with the highly contagious group A streptococcus bacterium, which causes the common “strep throat” and can also cause skin infections. Most people experience strep throat as children and receive fast treatment with antibiotics.
Yet Indigenous children living in remote communities may experience repeated, chronic infections with strep A due to overcrowding, poverty and difficulty accessing healthcare. These repeated, untreated infections can cause acute rheumatic fever, an inflammatory disease.
This fever can lead to the irreversible heart damage known as RHD. Without open-heart surgery to repair or replace the damaged heart valves, clots can form and sufferers may die from stroke or heart failure.
In a bid to understand why Australia has struggled to reduce rates of RHD, researchers led by the Doherty Institute in Melbourne analysed the genetic makeup of hundreds of strep A bacterial samples in a freezer, collected between 2003 and 2005 by Dr Malcolm MacDonald.
MacDonald visited Aboriginal households across three remote Northern Territory communities every four weeks, looking for strep A by taking swabs from the skin and throats of householders, including those with no symptoms.
“But what wasn’t available at that time was whole genome sequencing, which is what we’ve now done,” said Prof Steven Tong, an infectious diseases physician at the Doherty Institute.
“We’ve gone back to the freezers, pulled out all the isolates of the bacteria that Malcolm collected decades ago and looked at the whole DNA sequence of each of these germs.”
Researchers believe skin-to-skin transmission of strep A is an important factor in disease spread in Aboriginal communities, with overcrowded living conditions exacerbating this spread, so treating skin disease is a focus of prevention along with treating anyone with a sore throat.
But the genome sequencing revealed the strep A bacteria found in the throats of those who reported no symptoms was the same isolate as that found in people with skin infections and symptomatic disease.
Dr Michael Marks, an associate professor in infectious diseases at the London School of Hygiene & Tropical Medicine, said a “key question” with RHD has “been the extent to which transmission occurs between infections in the throat and the skin, and what is driving transmission overall in communities where this infection is a serious problem”.
He said the study by Tong and his peers revealed “both skin and throat infections appeared to lead to onward spread of the bacteria, but there were about twice as many infections seeming to be linked to a throat infection suggesting that these infections are playing a key role”.
“Importantly, these throat infections were asymptomatic, which suggests that if we only target individuals with symptoms of strep throat, then we will miss a lot of people who have infection and who can spread the bacteria to others,” Marks said.
In 2015–19, there were 1,325 new RHD diagnoses among Indigenous Australians, the Australian Institute of Health and Welfare reported, with more than half of those in people aged under 25. The disease killed 400 people in the same period.
Prof Andrew Steer, a paediatric infectious diseases physician at the Royal Children’s hospital in Melbourne, is working on a vaccine for strep A and said the findings “tell us that we need to measure asymptomatic throat colonisation of strep A in the vaccine trials”.
“As time has gone by, and as living conditions and access to medicine improved, the disease has shifted from being a global disease to being a disease in disadvantaged populations in low- and middle-income countries,” Steer said.
“And as the disease in the US, Europe and the eastern seaboard of Australia began to disappear, so did efforts around vaccine development,” he said.
“It’s only really now, I think partly thanks to efforts led by Australians, that there’s been a revived, renewed, rejuvenated effort to develop a vaccine for rheumatic heart disease.”
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Vaccine Development
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A long-anticipated government report on the origins of Covid-19 offered new details on the U.S. intelligence community’s findings but did not state definitively whether the source of the coronavirus was exposure to an infected animal or an event at a laboratory.
“All agencies continue to assess that both a natural and laboratory-associated origin remain plausible hypotheses to explain the first human infection,” the Office of the Director of National Intelligence said Friday in a 10-page declassified report.
The report laid out divisions within the Intelligence Community, some of which were previously acknowledged.
While the National Intelligence Council and four unnamed agencies assessed that natural exposure to an infected animal was the most likely scenario for the first human infection, the Department of Energy and FBI’s assessment was that a laboratory-associated incident was more likely the cause.
Meanwhile, the CIA and an unidentified agency “remain unable to determine the precise origin of the COVID-19 pandemic, as both hypotheses rely on significant assumptions or face challenges with conflicting reporting,” the report states.
“Almost all” intelligence agencies agreed that the virus wasn’t genetically engineered, and all agencies agreed that Covid was not manufactured as a biological weapon.
Additionally, the report said “most” agencies also agreed that the virus was not laboratory-adapted -- more specifically, that the virus had not sustained natural, random mutations via human-enabled processes in the lab.
The report shed light on the Wuhan Institute of Virology, which has been at the center of a hypothesis that the virus escaped from a lab and began infecting people or was transmitted to humans from an animal.
It described how between 2017 and 2019 the lab funded, and some of its personnel conducted, research in collaboration with the People’s Liberation Army to boost China’s knowledge of pathogens and early disease warning capabilities for the military’s defensive and biosecurity needs.
Some of the research conducted by the People’s Liberation Army and the lab “included work with several viruses, including coronaviruses, but no known viruses that could plausibly be a progenitor of" Covid, the report said.
The report also said that while the lab and military collaborated on vaccines and therapeutics relevant to coronaviruses, “this work was intended for public health needs” and the coronaviruses known to be used were “too distantly related” to have led to the virus causing Covid-19.
The intelligence community in March expanded its inquiry into Covid-19, by examining whether the first human infection with the virus was the result of natural exposure to an infected animal or a lab-linked incident, according to Friday’s report.
In 2021, a U.S. intelligence report identified three researchers at the Wuhan institute who sought treatment at a hospital after falling ill in November 2019 -- providing inconclusive, circumstantial evidence that appeared to bolster a hypothesis that the virus may have spread to humans after escaping from the lab.
The report released on Friday notes that several researchers were sick in fall 2019 and that some of their symptoms were "consistent with but not diagnostic of COVID-19," suggesting that they could have had a cold or allergies, and that their illness alone "neither supports nor refutes either hypothesis of the pandemic’s origins."
The Intelligence Community was not aware of a particular biosafety incident that might have caused the pandemic, the report said, while noting that some of the lab's researchers "probably did not use adequate biosafety precautions at least some of the time prior to the pandemic in handling SARS-like coronaviruses," which increased the risk of potential exposure to viruses.
Parts of the lab were inspected in 2020, revealing overdue updates to old equipment, and needs for additional disinfectant equipment and improved ventilation systems, but the report cautioned that the timing of these findings were "not necessarily indicative" of the lab's biosafety status before the outbreak.
Congress passed legislation earlier this year requiring the intelligence community to declassify information relating to potential links between the Wuhan Institute of Virology and the pandemic’s origins.
Liu Pengyu, a spokesperson for the Chinese Embassy in Washington, said in a statement Friday that the U.S. "has issued similar reports before."
"The US should stop rehashing the 'lab leak' narrative, stop smearing China and stop politicizing origins-tracing issue," Liu said.
A spokesman for the White House National Security Council said the report’s release reflects a commitment from President Joe Biden “to declassify and share as much information as possible related to the origins of COVID-19, while protecting sources and methods.” The spokesman added that “getting to the bottom of the origins” of Covid remains a top priority for the president.
House Intelligence Committee chair Mike Turner of Ohio and Rep. Brad Wenstrup, who chairs the Select Subcommittee on the Coronavirus Pandemic, called the declassified report "a promising step toward full transparency."
“Everyone deserves to know the truth,” the two GOP lawmakers said in a statement, adding that their committees “will continue to investigate the origins of COVID-19 and the information obtained today will help to further its investigation.”
In the Senate, Intelligence Committee chair Mark Warner pointed the finger at Beijing for the uncertainty that still surrounds the early days of the coronavirus.
“Basic concepts that we take for granted in our democracy, like accountability and transparency, are totally anathema to China’s Communist Party. As a result, we may never learn the true origins of the global pandemic that resulted millions of lost lives and livelihoods,” Warner, D-Va., said in a statement.
The Chinese government has maintained that it’s “always been open and transparent” about Covid.
Biden administration officials have also voiced their frustration with China in conducting Covid investigations.
FBI Director Christopher Wray said in a Fox News interview this year that the Chinese government had been doing “its best to try to thwart and obfuscate the work here, the work that we’re doing, the work that our U.S. government and close foreign partners are doing, and that’s unfortunate for everybody.”
The Chinese Embassy did not respond at the time to Wray's remarks.
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Epidemics & Outbreaks
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Nicola Bulley had been "looking forward to the future" before her disappearance, her partner has told her inquest.
Paul Ansell said there had been concerns about her drinking and she had a "blip" over Christmas but was back to herself by January.
The inquest heard the family called 999 with worries about her welfare.
On the call-out Dr Theresa Levy said the 45-year-old appeared to be intoxicated but did not wish to engage.
Ms Bulley went missing on a dog walk in St Michael's on Wyre, Lancashire, on 27 January, prompting a major search.
Her body was found in the River Wyre more than three weeks later.
Dr Levy said she worked alongside a mental health crisis service, who were called on 10 January to the mother-of-two's home address.
The doctor confirmed to the coroner this was following Ms Bulley telling her sister about not wishing to engage with her children and "not wishing to be here".
Describing the encounter as "brief", Dr Levy said in a review of the service provided to the Bulley family, it was found she had been in receipt of the crisis service even though she "did not wholly meet the criteria".
Mr Ansell, giving evidence, said she had a "blip" over the Christmas period but in January she was back to herself.
He said: "She had a good day the day before [she went missing], came home full of beans, excited with work, with the meetings she had and plans for the year."
Dr James Adeley, senior coroner for Lancashire, asked Mr Ansell if Ms Bulley had any suicidal thoughts.
Mr Ansell replied: "There were a couple of throwaway comments during the blip period but nothing that gave me any concern."
He broke down in tears during his evidence and had to leave the room.
Mr Ansell said: "She was an incredible mum."
"Nikki was a quiet person who enjoyed the simple side of life. She was a very private person and kept herself to herself," he said.
Ms Bulley's younger sister Louise Cunningham told Preston Coroner's Court she "always had things under her control".
She said her sister was "very much a planner" as the "busy mum" and juggled a career and family life.
Ms Cunningham also said there was a "blip" in her sister's mental state in the month before her death but "she was back on the HRT medication in January and back to work and back to the normal Nikki".
Ms Cunningham said her sister was drinking more heavily over that period.
'Low mood and anxiety'
However, she added: "She's never confided in me about any suicidal thoughts."
Ms Bulley vanished while walking her dog by the river after dropping off her daughters, aged six and nine, at school.
Her dog was found shortly afterwards and her mobile phone was discovered on a bench overlooking the water - still connected to a work conference call.
Lancashire Police came under fire after revealing Ms Bulley's struggles with alcohol and perimenopause.
Ms Bulley's former GP told the hearing there was "nothing" in her medical records to suggest she wanted to self-harm.
Dr Rebecca Gray said she had been receiving treatment for "low mood and anxiety" since December 2018, later telling of headaches, fatigue and lack of sleep.
Ms Bulley had been receiving HRT for the menopause since summer 2021, the inquest heard.
She had revisited the surgery, for symptoms including increased anxiety and headaches, and by late 2022 was reporting trouble with sleep.
The GP said Ms Bulley attended a walk-in centre on 11 January after a fall, complaining of increased drowsiness and vomiting.
She was sent to Accident & Emergency where a CT scan came back normal.
On Monday the inquest heard from Home Office pathologist Dr Alison Armour who conducted the post-mortem examination on Ms Bulley.
She said she concluded she died of drowning and there was no evidence she had been harmed before she fell into the water.
Dr Armour also told senior coroner Dr Adeley Ms Bulley had not been drinking before her death.
The inquest also heard from various passers-by who saw Ms Bulley in the village on the morning she disappeared.
One said she looked "absolutely idyllic", while another described her as "not happy" but "not sad".
- If you're affected by any of the issues raised in this article you can find support at BBC Action Line
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Mental Health Treatments
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3D folding of the genome: Theoretical model helps explain how cell identity is preserved when cells divide
Every cell in the human body contains the same genetic instructions, encoded in its DNA. However, out of about 30,000 genes, each cell expresses only those genes that it needs to become a nerve cell, immune cell, or any of the other hundreds of cell types in the body.
Each cell's fate is largely determined by chemical modifications to the proteins that decorate its DNA; these modification in turn control which genes get turned on or off. When cells copy their DNA to divide, however, they lose half of these modifications, leaving the question: How do cells maintain the memory of what kind of cell they are supposed to be?
A new MIT study proposes a theoretical model that helps explain how these memories are passed from generation to generation when cells divide. The research team suggests that within each cell's nucleus, the 3D folding pattern of its genome determines which parts of the genome will be marked by these chemical modifications.
After a cell copies its DNA, the marks are partially lost, but the 3D folding allows each daughter cell to easily restore the chemical marks needed to maintain its identity. And each time a cell divides, chemical marks allow a cell to restore its 3D folding of its genome. This way, by juggling the memory between 3D folding and the marks, the memory can be preserved over hundreds of cell divisions.
"A key aspect of how cell types differ is that different genes are turned on or off. It's very difficult to transform one cell type to another because these states are very committed," says Jeremy Owen Ph.D., the lead author of the study. "What we have done in this work is develop a simple model that highlights qualitative features of the chemical systems inside cells and how they need to work in order to make memories of gene expression stable."
Leonid Mirny, a professor in MIT's Institute for Medical Engineering and Science and the Department of Physics, is the senior author of the paper, which appears in Science. Former MIT postdoc Dino Osmanović is also an author of the study.
Maintaining memory
Within the cell nucleus, DNA is wrapped around proteins called histones, forming a densely packed structure known as chromatin. Histones can display a variety of modifications that help control which genes are expressed in a given cell. These modifications generate "epigenetic memory," which helps a cell to maintain its cell type. However, how this memory is passed on to daughter cells is somewhat of a mystery.
Previous work by Mirny's lab has shown that the 3D structure of folded chromosomes is partly determined by these epigenetic modifications, or marks. In particular, they found that certain chromatin regions, with marks telling cells not to read a particular segment of DNA, attract each other and form dense clumps called heterochromatin, which are difficult for the cell to access.
In their new study, Mirny and his colleagues wanted to answer the question of how those epigenetic marks are maintained from generation to generation. They developed a computational model of a polymer with a few marked regions, and saw that these marked regions collapse into each other, forming a dense clump. Then they studied how these marks are lost and gained.
When a cell copies its DNA to divide it between two daughter cells, each copy gets about half of the epigenetic marks. The cell then needs to restore the lost marks before the DNA is passed to the daughter cells, and the way chromosomes were folded serves as a blueprint for where these remaining marks should go.
These modifications are added by specialized enzymes known as "reader-writer" enzymes. Each of these enzymes is specific for a certain mark, and once they "read" existing marks, they "write" additional marks at nearby locations. If the chromatin is already folded into a 3D shape, marks will accumulate in regions that already had modifications inherited from the parent cell.
"There are several lines of evidence that suggest that the spreading can happen in 3D, meaning if there are two parts that are near each other in space, even if they're not adjacent along the DNA, then spreading can happen from one to another," Owen says. "That is how the 3D structure can influence the spreading of these marks."
This process is analogous to the spread of infectious disease, as the more contacts that a chromatin region has with other regions, the more likely it is to be modified, just as an individual who is susceptible to a particular disease is more likely to become infected as their number of contacts increases. In this analogy, dense regions of heterochromatin are like cities where people have many social interactions, while the rest of the genome is comparable to sparsely populated rural areas.
"That essentially means that the marks will be everywhere in the dense region and will be very sparse anywhere outside it," Mirny says.
The new model suggests possible parallels between epigenetic memories stored in a folded polymer and memories stored in a neural network, he adds. Patterns of marks can be thought of as analogous to the patterns of connections formed between neurons that fire together in a neural network.
"Broadly this suggests that akin to the way neural networks are able to do very complex information processing, the epigenetic memory mechanism we described may be able to process information, not only store it," he says.
Epigenetic erosion
While this model appeared to offer a good explanation for how epigenetic memory can be maintained, the researchers found that eventually, reader-writer enzyme activity would lead to the entire genome being covered in epigenetic modifications. When they altered the model to make the enzyme weaker, it didn't cover enough of the genome and memories were lost in a few cell generations.
To get the model to more accurately account for the preservation of epigenetic marks, the researchers added another element: limiting the amount of reader-writer enzyme available. They found that if the amount of enzyme was kept between 0.1 and 1 percent of the number of histones (a percentage based on estimates of the actual abundance of these enzymes), their model cells could accurately maintain their epigenetic memory for up to hundreds of generations, depending on the complexity of the epigenetic pattern.
It is already known that cells begin to lose their epigenetic memory as they age, and the researchers now plan to study whether the process they described in this paper might play a role in epigenetic erosion and loss of cell identity. They also plan to model a disease called progeria, in which cells have a genetic mutation that leads to loss of heterochromatin. People with this disease experience accelerated aging.
"The mechanistic link between these mutations and the epigenetic changes that eventually happen is not well understood," Owen says. "It would be great to use a model like ours where there are dynamic marks, together with polymer dynamics, to try and explain that."
The researchers also hope to work with collaborators to experimentally test some of the predictions of their model, which could be done by altering the level of reader-writer enzymes in living cells and measuring the effect on epigenetic memory.
Journal information: Science
Provided by Massachusetts Institute of Technology
This story is republished courtesy of MIT News (web.mit.edu/newsoffice/), a popular site that covers news about MIT research, innovation and teaching.
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Medical Innovations
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Sharon Hartley considered herself a fairly average drinker. She had followed a similar pattern to that of other people she knew in their mid-40s – teenage drinking that continued at university and in her 20s, then drinking at home in her 30s and 40s. “It crept up on me and I got to 44 and I thought: when was it deemed normal to be drinking a bottle of wine a night? And maybe opening it a bit earlier – not at 8pm, when the children have gone to bed, but 5pm, when you’re making dinner for the family.”She didn’t consider herself to be addicted to alcohol, but says: “I knew my relationship with alcohol wasn’t going in a good direction.”Hartley, now 49, had tried dry January, and sober October – the month-long campaigns that encourage people to cut out alcohol – but would be looking forward to the following month, when she could “drink my body weight in rosé”, she says. “I knew in order to experience a life without alcohol, I had to take a longer break.”She decided on a 90-day challenge, starting on a Monday in 2018, with a raging hangover, on the first day her children were back to school. “It had been another really boozy summer and I thought: today it starts.”It was hard at first, because drinking had become such a habit. “But then, step by step, something weird started to happen. Instantly, I started to feel better because I wasn’t waking up feeling below par every day. I used to brag that I didn’t get hangovers, but I think because of the frequency of my drinking, I lived in a constant state of hangover.”She took a selfie of herself that first day, and then another each week, watching her face deflate, the blotches on her skin disappear, the whites of her eyes become clearer. “The benefits that came with that 90-day break have led me to say I will never drink again, and that removing booze from my life has been the best thing I’ve ever done.”An estimated 17% of adults in the UK are taking part in dry January this year, and now may be the point where you have given up, or are counting the days until the end of the month. But just maybe you are considering extending your abstinence into February, and beyond, after discovering the joys of sobriety after years of drinking.Joanne Midgley, 61, had done a few month-long alcohol-free challenges, just to have a bit of a break from the amount she and her husband were drinking at home, before going back to drinking almost immediately.“Normally, I would have been waiting for the first of February, and had all the lovely gins lined up, ready to go again,” she says. Last year was different. She had partly been influenced by posts about being sober on social media and in newspaper articles, and her mindset shifted. “I thought, I’ll just do another month.” For Midgley, giving up completely has been easier than trying to moderate her drinking.People have felt sorry for her, she says. “But it’s not about loss for me, it’s about what I’ve gained,” she explains. “Don’t feel sorry for me; I feel sorry for you. I was that person when I was drinking who was gutted if somebody turned up and they were on antibiotics or they were pregnant.” Midgley has lost weight, and has more energy – and more friends, after joining some local sober groups Bee Sober and Sober Butterfly Collective. “My days are longer; my world got bigger.” Now she can drive to the other side of the city, rather than having to plan how to get back after a drink or – more likely – just remaining near home.‘A lot of my health issues cleared up’ … Kate BeavisKate Beavis, 50, a menopause awareness campaigner, also gave up drinking after her second attempt at dry January, in 2015, with a loosely held thought that she would try to continue it for a year. “I didn’t think I would last, but I felt so much better. A lot of my health issues cleared up. I now realise some of my menopause symptoms got better. I felt so much more able to look after my family and run my business, and that helped drive me forward with not drinking.”She says she sleeps better, has more energy and motivation, and finds it easier to control her mood. Her back pain eased, simply because she wasn’t sitting on the sofa drinking several glasses of wine every night, which had become a reward for getting the kids to bed – something “very normal for lots of people, particularly women”. When it got to the end of the year, people assumed she would have a celebratory New Year’s Eve drink. “It would’ve been pretty stupid. If you gave up smoking for a year, you wouldn’t have a celebratory cigarette. So then I just carried on.”To begin with, she says, it could be tricky to go out with friends. “People used to give me a lot of grief: ‘Why aren’t you drinking. You’re so boring.’ Which I did not expect, but it’s probably more about them than me.”People still ask her why she doesn’t drink. “That can get quite annoying. I could be pregnant, it could be for religious reasons, I could have a health condition, I could be an alcoholic – it’s quite invasive to ask. Still, people are fascinated by it.”For James, who is in his mid-50s, what finally convinced him to ditch the booze was waking up hungover after a workplace Christmas party. He had been a social drinker, and also drank at home three or four nights a week. “It was beginning to affect my health – just getting out of bed was harder,” he says.Having stopped drinking, James loves not having hangovers. “You feel brighter, more alert, especially in the mornings.” He has noticed how much time he has – drinking seemed to take up more hours than it should, either thinking about the experience or recovering from it. He uses the time thus released for pursuing hobbies. “The main thing it’s made me realise is it’s so endemic in British culture – people drink all the time and you see, when you stop doing it, how ridiculous it is. But when somebody says: ‘I don’t drink,’ people are still aghast.”‘It’s like rocket fuel, it’s life-changing’ …Andy Garwood. Photograph: Jim Higham/Sussex Sport PhotographySince Andy Garwood, who is also in his mid-50s, gave up drinking alcohol – he was a daily drinker, knocking back gin and tonic at home after a day running his construction business – he has changed his life. He has become a sober coach, helping others to give up alcohol, and has done triathlons and climbed mountains. “You think you’re giving something up, but you gain so much,” he says. “All these ailments I told myself were just about getting old, back pains, miraculously cleared up. It’s like rocket fuel, it’s life-changing.”People Andy’s age are the nation’s biggest drinkers – the 55 to 75 age group, with the second-biggest consumers belonging to the group below, 35 to 55. Several factors lie behind this, according to Richard Piper, the chief executive of Alcohol Change, a charity that campaigns to reduce alcohol harm. One is life stage: drinking usually starts as a social activity when people are in their teens or 20s. After that, many people will have children and drink at home, where they will often drink more or more regularly, and perhaps start earlier in the day. On top of this, there are generational cohorts whose members share similar characteristics, not just their age. Members of some cohorts “just drink more – and the group currently 55 to 75 is the heaviest-drinking cohort we’ve ever seen. The cohort of 35 to 55 is second.”The historical trend, Piper says, is that generations tend to react to each other. “That’s what’s happening – younger people are drinking less. That’s a reaction against the two cohorts above them. There’s a sort of natural rejection of our parents’ choices.”Societal shifts in the past few decades have contributed to higher alcohol consumption in those older cohorts. Women started drinking more, and people started drinking at home. Supermarkets made alcohol easily available, and affordable.We also know far more about the harm alcohol causes, he points out – younger people may recognise this, but so do increasing numbers of older people. “People are asking: ‘Why am I doing this? I’m not getting a lot out of this, and I’m doing it by habit, not by choice,’” says Piper. There are inequalities within this – he says it tends to be women, rather than men, who are cutting down or giving up, and it tends to be “wealthier, more wellbeing-conscious parts of the population, whereas working-class populations and communities are not, at the same level, exposed to those kind of messages, or are finding it harder to make the change. We’re not clear yet what’s leading to the problem.” There are also racial inequalities, he says, which his organisation is researching.Mark stopped drinking two years ago; he was, he says, an addict. He used alcohol and cocaine to self-medicate his low self-esteem, lack of confidence, childhood trauma and then a stressful job in finance. “Alcohol in the City is a common theme,” he says. He had stints in rehab, and says it was easier to come off cocaine than alcohol. “Friends drank. The worst part was walking into a supermarket and seeing alcohol. Over time, that did lessen because I realised how much I’d gained by not drinking, and the possibility that I would lose everything if I started again.”Counselling helped in terms of the issues that had led to the drinking and drug-taking; his wife was a big support, he got a dog, met new people. “I feel much more comfortable in myself, therefore I don’t need alcohol. I’m happy now. I’ve never been happy before.”For Michael, who says he was “a functioning alcoholic”, drinking never seemed a big problem. He hadn’t been excessively drunk since he was a teenager, and got up at 5.30am every day to exercise, but the daily consumption of beer and wine was adding up. “You kid yourself that it’s fine,” he says.In 2020, when Michael was in his late 40s, he stopped, and still feels great about it more than two years later. “I would never touch it again, which feels bonkers to me, because I could never have seen myself doing that,” he says. “I would have understood the reasons why I should stop, but I wouldn’t be able to relate to that frame of mind to be able to be free of it.” His mental health has improved and he lost weight and to begin with he used an app that showed him how much money he was saving.At one point, Michael started to microdose with magic mushrooms to fill some of what alcohol was doing for him. “They seemed to break the pattern of behaviour and habit, and probably there is a human need, I think, not to get inebriated but to change how you feel about reality. I was looking for other ways to enjoy myself, I guess.”Others haven’t taken quite such an extreme step – James realised he had to give some advance thought to what he would order at the pub, to make it easier not to slip back into ordering a pint of lager (for him, it used to be soda with ice, but now alcohol-free beer is better, and more widely available).“I had a preconception that a life without alcohol meant it would be boring, miserable,” says Sharon Hartley. “You could never socialise. How could you navigate a wedding, birthday, any sort of celebration without a glass in your hand?” Each time she went to one of those events, it got easier. “I started to enjoy new hobbies, meeting new friends. There’s a whole sober world that I didn’t know was there, this amazing community of other people. It’s lifted the lid on my world. I now have a confidence that I thought came from alcohol, but it turns out I never needed it. It makes you braver, it makes you try new things.”She went back to working in broadcasting, and presents her own show on BBC Radio Lancashire, as well as hosting a podcast, Over the Influence, about life alcohol-free. “You don’t have to say: ‘I’m an alcoholic’ in order to reassess your relationship with alcohol. There are people that just drink on a weekend, people that have a glass of wine every night, people that are binge drinkers, but they want to change.”Most of the people who listen to her shows and join her wider online community are over 40. “People that don’t drink are classed as boring, but after 30 years of drinking, I think drinking becomes quite boring. It gets to the point where you think: ‘Is this it?’ I just wanted to jump off that hangover hamster wheel of hell.” It was only meant to be a brief break from the booze, she says. “But the longer I went, the easier it got, the more positive changes came into my life. I totally and utterly fell in love with sobriety.”
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Stress and Wellness
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Issued on: 26/01/2023 - 17:16 Screenshot of a video published on January 26 showing Jajarm Aluminum Factory, 9 km east of Jajarm City, Iran emitting heavy smoke after burning mazut instead of gas to run its machinery. © Observers In Iran, most households rely on natural gas for their heating and hot water. But amid a cold snap and gas shortages, the population has been paralysed by sub-zero temperatures in many regions around the country. These gas shortages have not only led to widespread power cuts, but also severe air pollution from burning low-grade heavy fuel oil, known as mazut, to make up the difference. Despite denials from authorities, the FRANCE 24 Observers team found evidence that this fuel oil is partially responsible for the “unbreathable” air in some Iranian cities. The lack of natural gas for power plants in Iran has another side effect beyond the cold and darkness across Iran. It has polluted the air with toxic elements. Faced with massive shortages, Iranian authorities are running the engines in the power plants to generate as much electricity as possible by burning "mazut", a polluting, cheap and low-grade heavy fuel oil.>> Read more on The Observers: Amid gas shortages and blackouts, a harsh winter is fueling discontent in IranHowever, many Iranian officials have vehemently denied burning mazut. Dariush Gollizadeh, one of the deputies of the Department of Environment, said on October 9, 2022, "We do not plan to burn mazut in the power plants this year." And Parviz Sarvari, a member of Tehran City Council, said on December 16, 2022, "The power plants are not burning mazut in Tehran province". فردیس جاده ملارد نیروگاه منتظر قائممازوت سوزی وحشتناک و سرطانزا#آلودگی_هوا pic.twitter.com/vqtVuFy2Jy— Iranworkers (@iranworkers) January 25, 2023 Heavy smoke rises from the Qaem Power Plant, as a result of the burning of mazut. The Qaem power plant is located in the city of Fardis, 40 km west of Tehran. ‘Almost all power plants seem to be burning only mazut’Termeh (not her real name) is an environmental expert in Tehran. She explains that the smoke that makes the air in Iranian cities "unbreathable" comes in part from the power plants that burn mazut, despite authorities’ denial.The authorities deny it, but peak air pollution levels in southern Tehran and many other cities near power plants show that mazut is being burned there. In recent years, some power plants sometimes burned mazut when they did not have enough gas, but this year almost all power plants seem to be burning only mazut without interruption. The poor air quality this year is another indication of this.The higher PM2.5 and PM10 levels in the air can have no other cause than the burning of mazut [Editor’s note: PM2.5 and PM10 are air pollutants that can endanger human health when present at high levels in the air. The tiny particles reduce visibility and make the air appear cloudy when levels are elevated]. The last day of clean air quality in Tehran was March 28, 2022. According to a study by Tehran University, at least 40,000 Iranians die each year as a result of PM2.5 pollution. Contrary to the authorities' claims, FRANCE 24's Observers team was able to find evidence of the massive use of mazut in Iran's numerous power plants, as Termeh and other Iranian environmentalists suspected, based on satellite images and data.Mazut is known to create dense white smoke when it burns, while the vaporisation that occurs when natural gas is burned appears almost invisible.The difference is clear when comparing satellite images of Iran's power plant vents in January 2023 – when they were accused of burning mazut – and in the summer of 2022.In the summer of 2022, no traces of white smoke can be seen above the power plant's chimneys, but in January 2023, dense white smoke is visible in satellite imagery. The photos above show the Mashhad power plant in north-eastern Iran. The picture on the right was in October 2022, and the one on the left was in January 2023. In January 2023, heavy smoke from mazut can be seen from the satellite photo. The photos below show the Iranshahr power plant in south-eastern Iran. The photo on the right was taken last summer and the photo on the left in January 2023. The heavy smoke visible in January 2023 is the result of the burning of mazut in this power plant. © Observers / Sentinel ‘This is the result of decades of mismanagement in all sectors of this country’Termeh continued:"The burning of mazut in this large of a quantity has a significant impact on the environment. When mazut is burnt, the power plants release fine particulate matters that are very dangerous to all living things.Mazut contains significant amounts of sulphur and releases toxic sulphur dioxide into the air when burnt. These toxic chemicals aren't only dangerous to humans, animals and plants, but also cause acid rain. And unfortunately we don't know how big the problem really is, because there are no comprehensive studies on this for the whole of Iran. We have only some random measurements of pollution from the burning of mazut. According to one study, for example, the concentration of sulphur dioxide in the air in Isfahan reaches 1200 ppm within 24 hours when the power plant in Isfahan burns mazut, while the norm is 50 ppm." The photos above show a power plant in southeast Tehran. The photo on the right was taken in December 2022. Dense white smoke can be seen on the satellite images, as compared to the image on the left, taken in October 2022. The photos below show the Isfahan power plant in central Iran. The photo on the left was taken last summer, and the one on the right in January 2023. The heavy smoke in the photo on the left is the result of the burning of mazut in this power plant. © Observers / Airbus The FRANCE 24 Observers team also looked at data from satellite detectors capable of measuring sulphur dioxide levels in the air. We compared the presence of sulphur dioxide over cities in Iran in the summer of 2022 and January 2023. The satellite image on the right was taken last summer, and the image on the left was taken in January 2023. Both images show the northern and central regions of Iran. The red in these images indicates the higher concentration of sulphur dioxide in the air. The concentration was much higher this January in the images taken over cities like Tehran, Semnan, Qazvin, Mashhad and Isfahan. © Observers Sentinel The thick layer of air pollution over Tehran and many other cities is making people sick. Walking on the streets is difficult, any physical activity is unbearable, coughing, headaches and nausea are just some of the short-term effects. Cancer and many other long-term and more serious health problems are also inevitable. And this is the result of decades of mismanagement in all sectors of this country, which cannot be reversed by some limited changes.To solve the problem of air pollution in Iran requires a new approach to energy production, a move towards clean energy sources, and this change of course requires opening up to the outside world, foreign investment and foreign technology. This will not happen in Iran unless there is political change.‘The gas and energy shortages will not only continue, but will worsen over time’Economic journalist Reza Gheibi explains the lack of gas production in Iran:Iranian households consume more than 700 million cubic metres of natural gas per day, while production is 850 million cubic metres. This means that power plants and many other industries that consume gas are without power. Production in many factories is at a standstill because they have no gas, or they burn mazut.When factories stop working, there are fewer products on the market, and that means prices will continue to rise. The horizon is also gloomier. Since, on the one hand, there is no money to maintain and modernise the systems and, on the other hand, consumption is increasing, the gas and energy shortages will not only continue, but will worsen over time. To change this situation, Iran needs more than 80 billion euros, according to estimates by Iranian officials.
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Epidemics & Outbreaks
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Research into predicting and monitoring Parkinson's disease using the Apple Watch is now sufficiently advanced that the FDA has been clearing apps for doctors and patients.
The ability of the Apple Watch to take periodic health measurements has transformed medical research in many fields. Back in 2015, Apple's Jeff Williams announced the then-new ResearchKit tool, specifically for helping track data — including for researchers working on Parkinson's.
Now according to medical journal Stat, there is "unmistakable progress in the odyssey that brought the [Parkinson's] tracking technology to people's wrists."
Stat interviewed neurologists, app developers, patients, and also both current and former Apple staff. There remains no cure for Parkinson's disease as yet, but active, continuous monitoring has become available.
"Physicians are missing the tools that they need to quantify these symptoms throughout the patient's day," Deidre Caldbeck, a senior director of Apple Watch and Health product marketing, told Stat.
"I still don't think we've even scratched a fraction of what the potential could be," Ray Dorsey, a neurologist and researcher at the University of Rochester, said to the publication. "I think we're going to rapidly get to a point where these tools are going to identify people who are at high risk for developing Parkinson's disease."
Dorsey worked on the first study of Parkinson's using Apple devices back in 2015. He says that the technology could now help get people diagnosed sooner.
Since the start of 2023, the US Food and Drug Administration has cleared three separate apps that each track typical symptoms. They each present the data in ways that can inform patients and their doctors.
Specifically, they monitor tremors and dyskinesia, involuntary movements. The former is an effect of Parkinson's, while the latter is a typical side effect from medication.
Continuous health monitoring on Apple Watch
The developer of one such app, StrivePD, told Stat that this tracking can help with the "frustrating, mundane, tedious decisions that a patient has to make all the time."
Having a continuous record of health monitoring with the Apple Watch obviously means that doctors can get a better overall picture than they can from occasional examinations. However, in the case of Parkinson's, Stat says that it's more useful having such monitoring because such examinations can be counter-productive.
"I always tell my residents the hospital is the perfect place to get the wrong impression about Parkinson's tremor," Bastiaan R. Bloem, a neurologist and professor at Radboud University Medical Center in the Netherlands, told the publication.
This is because it's been observed that people's symptoms may not be typical when they are in a clinical setting. Consequently, monitoring over time is going to be more accurate — and also make the process easier for both patient and doctor.
"Hopefully that can help the medical community understand if the treatments are working, maybe they can adjust them, they can look at symptom tracking and management," Apple's Caldbeck said. "It's just one less thing for the patient to have to deal with and to worry about because the physician can hopefully just monitor it remotely."
ResearchKit is an Apple tool made to help developers get consistent, reliable health data from Apple Watch wearers. Owners of Apple Watch have to elect to join any particular study, and can do so via the company's Apple Research app.
Separately, Apple has at times offered a grant to buy Apple Watches to qualifying ResearchKit projects.
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Disease Research
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NHS professionals and privacy activists continue to voice strong concerns over Palantir’s bid for a £480mn NHS England data contract. The contract, which will be used to create a Federated Data Platform (FDP) able to collect and share reams of patient information between hospital trusts and integrated care systems, is set to be awarded in September.
The first procurement exercise for the contract was announced in January and has since rejected bids from other UK businesses, including a consortium comprised of Voror Health Technologies, Eclipse, and Black Pear, solidifying Palantir’s bid as the clear favourite. NHS England had already been using the Colorado-based company’s software, known as Foundry, for its Covid-19 vaccination program, which has given Palantir what is known as the ‘incumbent’s advantage’.
This has raised alarm over possible privacy breaches and questions regarding the legality of the procurement not only amongst NHS professionals but also privacy and technology advocates.
Palantir’s advantage
In procurement law, the ‘incumbent’s advantage’ refers to the upper hand an existing supplier may have over newcomers. Having been used to a great extent during lockdown, Palantir’s software has already proven itself as a reliable contender.
But Dr Marcus Baw, a Yorkshire GP and health IT specialist, is one of many NHS professionals concerned about the nature of the contract. He said:
“Procurement law is there in order to prevent this kind of backroom deal and lobbying going on. They’ve schmoozed their way in and that’s not good for value, for money, for the taxpayer.”
Unfair and uncompetitive?
Incumbency advantage has been a hot topic of debate for those concerned with procurement law due to the unfair and anti-competitive advantage it can create.
A 2019 OECD paper, submitted for the 18th Global Forum on Competition, revealed small and medium-sized enterprises only account for 45% of the value of public contracts, and showed the number of public tenders with only one bid had increased from 17% to 30% between 2006 and 2016.
However, this is not the only issue with Palantir. In fact, much of the concern comes from the company’s involvement with the US Department of Defence, Air Force, and FBI, in counter-terrorism, intelligence, and defence efforts. Palantir was co-founded by Peter Thiel, one of Silicon Valley’s few high-profile Donald Trump supporters.
According to Dr Baw: “[Palantir] are primarily providers of spyware technology for governments, and that means that their default position is to do whatever they’re told by the government – that’s not an appropriate operating system for something that contains healthcare data.”
Vague about ‘what the thing does’
Since announcing the FDP the government has said the data will be used to make NHS processes faster and more accessible, including reducing the time spent chasing referrals, scheduling appointments, and waiting for test results.
With that said, not much else is known about the ways the data collected will be used.
Dr Baw said: “[The government] told us that they’re going to spend £480 million on a thing, but they haven’t actually got into any detail about what the thing does. They have made vague suggestions, usually in response to what was in the papers that week.”
This raises a lot of questions regarding the boundaries between the government and the health data gathered by hospitals and local practices.
“I’m a medical doctor and people tell me things in strict confidence, that’s one of the fundamental principles of medicine, it’s in the Hippocratic oath,” explained Dr Baw. “It’s a very dangerous precedent to start saying that certain elements of that data are up for grabs.”
Controversial data requests
In late 2016, the government found itself in hot water following a memorandum of understanding outlining arrangements for the Home Office to make data disclosure requests to NHS Digital, in order to track down immigration offenders.
Despite a 2018 House of Commons report categorising this move as “entirely inappropriate”, and emphasising that health data should only be “shared for law enforcement purposes in the case of serious crime”, privacy advocates still refer to this scandal as an example of how governments can easily overstep important boundaries.
Cori Crider, the director of Foxglove, a non-profit technology advocacy group, said: “NHS insiders have warned [us] this system is a huge waste of money, is a dangerous power grab by central government over health data, and will lock Palantir’s monopoly into the NHS for good.”
Dr Baw believes if the fears are justified it could lead to a lower standard of care being delivered to patients in England: “People’s healthcare is going to be potentially worse because we have allowed government to break the doctor-patient relationship.”
Questionable priorities
A further consideration is that a large amount of money is being allocated to this contract at a time when NHS staff continue to protest for better pay and working conditions, putting into question the government’s priorities.
Crider commented: “The NHS is in crisis. Decades of underinvestment and stagnant staff pay have put the service on its knees — it’s baffling that officials now want to blow half a billion pounds on a Palantir database.
“Officials should pause the FDP process and consult patients and experts on alternatives that use health data better, for the good of the NHS and us all.”
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Health Policy
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By Michelle Fay Cortez
After more than three years, the global Covid emergency is officially over. Yet it’s still killing at least one person every four minutes and questions on how to deal with the virus remain unanswered, putting vulnerable people and under-vaccinated countries at risk.
After more than three years, the global Covid emergency is officially over. Yet it’s still killing at least one person every four minutes and questions on how to deal with the virus remain unanswered, putting vulnerable people and under-vaccinated countries at risk.
A key question is how to handle a virus that’s become less threatening to most but remains wildly dangerous to a slice of the population. That slice is much bigger than many realize: Covid is still a leading killer, the third-biggest in the US last year behind heart disease and cancer. Unlike with other common causes of death such as smoking and traffic accidents that led to safety laws, though, politicians aren’t pushing for ways to reduce the harm, such as mandated vaccinations or masking in closed spaces.
“The general desire in the world is to move beyond the pandemic and put Covid behind us, but we can’t put our heads in the sand,” said Ziyad Al-Aly, director of the Clinical Epidemiology Center at the Veterans Affairs St. Louis Health Care System in Missouri. “Covid still infects and kills a lot of people. We have the means to reduce that burden.”
Even before the World Health Organization declared earlier this month that Covid no longer constitutes an emergency, most governments had already relaxed lockdowns and guidelines. After spending heavily in earlier phases of the pandemic, global leaders have dialed back efforts and are reluctant to pursue preventative measures for which the public no longer has much patience.
Meanwhile, the infection that caused at least 20 million deaths worldwide continues to evolve, leaving the elderly and those with pre-existing conditions at the mercy of luck, uneven access to medicine and little protection from others without face masks or recent vaccinations.
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Why No Long-Term Plan?
A global, long-term plan to protect the vulnerable and to keep a resurgence at bay hasn’t materialized, partly because of how difficult it is to forge any consensus around Covid. From the start, polarized political discourse overshadowed official guidelines on masking and vaccinations.
Even in developed countries where the vaccine became available in less than a year into the pandemic, many people refused to take it. Lack of immunization led to more than 300,00 excess American deaths, or one out of every two from Covid, throughout 2021. Globally, it could have saved half a million more, studies show.
“We know that politicizing public health is one of the tragedies of the pandemic,” Al-Aly said. “Political leaders leveraged their responses not only to advance public health but to advance their own narrative and drum up support for themselves.”
Global coordination has also been hampered by politics. China’s refusal to allow independent experts unfettered access to a wet market thought to be a crucible for Covid or to the Wuhan Institute of Virology added to diplomatic tension and mistrust. Today, Chinese representatives aren’t participating in many global preparation efforts, said Linfa Wang, a virologist and director of the emerging infectious diseases program at Duke-NUS Medical School in Singapore.
“It’s hindering academic collaboration, and China/US collaboration is almost zero,” Wang said. “With these two superpowers, if they don’t collaborate, how can we say the world is ready for the next disease?”
A waning sense of emergency has also meant the surge of investment in Covid vaccines and therapeutics has also cooled. While companies including Moderna Inc and Pfizer Inc are still updating their shots, trying to make them easier to manufacture and store, many of the hundreds of novel approaches that were initially conceived have fallen by the wayside.
In the US, experts are due to meet in June to advise on what strain of the virus vaccines should target for the remainder of the year. Those vaccines will only launch in the fall, with just 100 million doses expected in the US according to Moderna’s estimates, far less than in previous years.
Why Is This a Problem?
Long Covid, estimated to affect around 10% of infected people, is considered one of the biggest post-pandemic medical challenges. The economic costs are also significant.
In the US, long Covid was estimated to cost around $50 billion a year in lost salaries as of late 2022. In the UK, the Institute for Fiscal Studies last year estimated that about one in 10 people with long Covid have to stop working as a result. The number of people with those symptoms, including brain fog, breathing difficulties and fatigue, are rising even as infections are decreasing.
It’s particularly scary for high-risk people, who’ve had to return to work and public spaces where masks are sparse and the dangers are invisible. A family wedding can still turn into a super-spreader event, and a flight can be catastrophic.
Epidemiologist Steffanie Strathdee is painfully aware of this. Her husband Tom survived a drug-resistant infection with a rare superbug in 2016, but was left with scarred lungs and other medical issues. They understood the potential risk if he contracted Covid, so they were vigilant, limiting travel through the pandemic. Both were fully vaccinated and avid maskers.
But a recent visit to their son in Canada led to an infection. In the hospital, where Tom was treated with acute respiratory distress, she was taken aback by how cavalier some younger staff were about contracting Covid as they considered themselves low-risk, even though they could transmit it to patients.
“It’s not mild for everybody and we know repeated exposures increase your risk,” said Strathdee, also associate dean of Global Health Sciences at the University of California, San Diego.
While people with active health issues may know to take precautions, some will learn that they’re vulnerable only after an infection lands them in the hospital. Repeated bouts can add to damage, and that applies to everyone, not just those with pre-existing conditions.
What Should We Be Doing?
The silver lining is that the world now has vaccines and better treatments. Tests can uncover infections in minutes, and new outbreaks can be quickly spotted.
Health experts say immunization is the best way to protect against it. Only about 16% of Americans have gotten a bivalent booster, according to Pfizer Inc., compared with almost 70% vaccinated in the first inoculation drive. Increased out-of-pocket costs and vaccine fatigue could cause uptake rates to fall further. Longer term, the hope is that innovative new shots or nasal sprays will provide better protection.
There are other improvements that could help, ranging from ventilation and air quality testing to better masks. There needs to be more investment in surveillance systems so threats can be caught early, experts said.
The US is also planning to spend $5 billion on a new project aimed at developing advanced vaccines and treatments for coronaviruses in concert with drugmakers. The goal is to make medicines available quickly as the virus mutates, so the targeted strain isn’t ebbing when they hit the market.
“Even if governments are tired, we have to face the reality that the virus is still evolving,” said Duke-NUS’s Wang.
--With assistance from Kevin Dharmawan.
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Epidemics & Outbreaks
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"It would be much better if I was out there than in here," said Roger.
The 69-year-old looked wistfully across Newport from the window next to his bed at the Royal Gwent Hospital.
He has been here for three weeks after being admitted with an infection.
But although he is now well enough to leave and desperate to do so - he can't.
"I've still got a smile on my face, but I'm feeling a bit down," he said.
"I haven't got the foggiest when I'll be able to go home. I'm keeping my fingers crossed... because it will make a big difference."
Roger has cerebral palsy and the impact of his recent illness means he needs extra care to be arranged before he can safely go home.
Until then, he's stuck in a ward with no televisions. He watches whatever he can find on his phone.
Roger is not alone.
"At least a quarter of patients in our care of the elderly beds are in a similar position," explained Helen Price, a senior nurse at the hospital.
"It is very much a waiting game for that care to be available," she said.
Hospitals in Wales are fuller than ever, according to the latest statistics.
In the final week of January more than 95% of all acute beds in the Welsh NHS were occupied, which is the highest figure ever recorded.
These delays are having an impact not just on individual patients and staff, but the work of the entire health board.
Paul Underwood, who manages urgent care in Aneurin Bevan University Health Board, said there are well over 350 patients medically fit enough to leave hospital.
"Roughly a third of patients do not need to be accommodated on those sites and that's extremely difficult," he said.
These logjams are often beyond the control of the NHS, with social care largely the responsibility of local authorities.
But whatever the cause, the impact on the health service is massive with hospitals fuller than ever.
For every patient like Roger waiting to leave, there are many more waiting for a bed to become available.
On the day of my visit, there are only two acute beds free across the entire health board. Yet patients keep piling in.
At the Grange University Hospital in Cwmbran, six miles north of the Royal Gwent, I witness the impact in one of the busiest emergency departments in Wales.
At mid-morning the waiting room is already full, as are most of the department's beds or trolleys. There are 68 patients here in total.
Frances Evans, 85, from Tredegar, is one of them. She is being assessed for a chest injury.But the day before, she had spent eight hours in the back of an ambulance outside the department.
"I was in the ambulance from 10 in the morning until six in the evening in the evening," she said. "And I had to come back and forth for the tests, it was really full."
Frances believes the NHS "has a lot too much to do" and that "some people abuse the system".
But I'm struck that staff say this morning is "relatively pleasant" compared to much of what they have experienced over the course of the winter.
'You feel like crying'
Lead nurse Claire Parks said there have been days with more than 200 patients in the department, which she describes as "record-breaking numbers".
"The festive period was some of the worst I've seen in 25 years in emergency care," she said, adding that some patients were "waiting in chairs" for days.
"When you walk away you do feel like crying because you're not giving the quality of care that you want."
A Welsh government spokesperson said: "We are doing everything we can to help health boards improve flow through the healthcare system, including investing record amounts in health and care services.
"This winter we have secured more than 600 extra community beds and social care packages to help move people out of hospital to get care closer to home, and are working to deliver even more."
The importance of having spare capacity is made abundantly clear when a car screeches up to the A&E's front door.
In the passenger seat is a mother who has just given birth. Paramedics, nurses and doctors rush to help.
Within seconds, mother and baby are taken in Resus [short for Resuscitation], the part of A&E set aside for patients needing the most urgent care.
"That's a good example of why we always need capacity because we don't know what's around the corner," said Dr Owain Chandler, a consultant in the department.
"The danger would have been that there are times when we would have had to bring them into Resus without a cubicle ready, looking around to see who is the least unwell patient we can pull out... and doing that on the hoof."
But the outcome today is a happy one.
A few hours later I meet baby William on the maternity ward, along with his parents Andrea and Adam Sheppard as they are preparing to go home.
"There was no lack of anything from the staff," said Adam.
"The paramedic was there and soon there were four or five others at the door... plenty of staff to help."
Andrea agreed that there were "no problems", adding with a broad smile that "the baby is perfect."
The family will be forever grateful for the staff's willingness to go above and beyond despite relentless pressure.
A ray of light, perhaps, in what has arguably been the NHS's darkest winter.
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Health Policy
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Now that the US Department of Energy has concluded the SARS-CoV-2 virus that spawned the COVID pandemic most likely came from a lab, focus is back on where pandemics come from and how best to prepare.
At the height of the H5N1 bird-flu scare back in 2006, there was a common expression among top flu experts I spoke with: “the back-door pandemic.”
While many here and around the world were so worried about a bird-flu virus that was killing millions of birds but very few people, others were predicting another virus would come in “the back door” when we were least expecting it and cause the next pandemic.
In other words, public-health experts had bad aim when it came to predicting which virus would infect us on a grand scale — and the unfortunate tendency to couple this misdirection with excessive fearmongering.
In fact, the pandemic that followed, namely 2009’s H1N1 swine flu, was mild. Though this swine flu infected more than 60 million people in America, it only killed around 12,000 here, a very low number by pandemic standards. It was not the back-door pandemic the hype had us fearing.
COVID was and is that pandemic. No one predicted it — indeed few scientists were talking about coronaviruses at all. SARS and MERS had alarmed public-health experts, but only briefly, and most of our attention remained on influenza.
And too few people were talking about the possibility of a lab leak despite ongoing manipulations of novel viruses.
Somehow COVID didn’t teach us our pandemic radar is faulty. Instead, scientists and journalists are using the ferocity of this pandemic to try to scare us that some specific bug (like H5N1) or other will cause the next one — and we are pandemic deniers if we don’t acknowledge this.
But the fact is we don’t know and should admit it.
Center for Infectious Disease Research and Policy chief Michael Osterholm is a top epidemiologist more levelheaded than most experts. He told me that though H5N1 has been spreading to more and more species, the number of human infections has declined over the past few years; it doesn’t appear to be improving its facility to pass human to human.
Peter Palese, Mt. Sinai School of Medicine chair of microbiology and one of the world’s top influenza experts, agreed that the chance of an imminent bird-flu pandemic is small. But we need to help ensure that by culling and vaccinating more and more birds while increasing our surveillance and stockpiling our own vaccines just in case.
I agree with both but feel strongly that fear is not our best approach.
This applies to norovirus too — the winter flu, which is highly contagious and has sparked recent outbreaks in America, the United Kingdom and elsewhere. But outbreaks are self-limited, and it has very low death rates, generally fewer than 800 per year.
Norovirus will not be our next pandemic. There are many strains out there, but there are no sea changes.
The widely popular HBO show “The Last of Us,” which depicts a fungal pandemic devastating society, has contributed to concerns over fungal outbreaks.
But Dr. George Thompson, University of California, Davis, School of Medicine professor and one of the world’s experts on fungal infections, told me this scenario is very unlikely.
One bug, Candida auris, has been spreading especially among the immunocompromised. Though this yeast has shown drug resistance, is sometimes difficult to identify and causes outbreaks in health-care settings, its spread is still quite limited, Thompson said.
The biggest threat to us remains a bioengineered animal pathogen that’s helped to skip the obstacles of requisite mutations before it can become widespread.
The very gain-of-function research that manipulates viruses or bacteria and induces mutations to teach us how to be protected or to provide treatments or vaccines in advance can create the exact path to harm that we fear.
This is what happened with H5N1 in 2012, when Ron Fouchier and colleagues in the Netherlands used genetic engineering and serial infections of ferrets (which spread viruses similar to the way humans do) to create a mutant bird-flu virus that spread among ferrets through the air.
Those experiments led to a temporary moratorium on such research with H5N1. But work manipulating coronaviruses continued. Palese feels that this gain-of-function research is sometimes worth the risk, especially in the United States, where the experiments can and should be highly monitored.
Unfortunately, it may take only one rogue scientist to prove Palese wrong — if COVID hasn’t already done so.
Marc Siegel, MD, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Health and a Fox News medical analyst.
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Epidemics & Outbreaks
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If you think migraines timed to your menstrual cycle are just something you have to suffer through month after month, think again.
âMenstrual migraine is a common phenomenon and there are very useful treatments to make this a more comfortable time,â says Huma U. Sheikh, MD, a headache specialist and CEO of New York Neurology Medicine.
How can I tell if itâs menstrual migraine?
If your migraine starts anywhere from 2 days before your period to 3 days after, you have menstrual migraine. But you can also get migraines at other times, like when youâre ovulating, Sheikh says.
Menstrual migraine attacks tend to be more severe and last longer. And youâre typically more sensitive to light around this time than with other migraine attacks.
If there seems to be a connection between migraine attacks and your menstrual cycle, hormones are the likely cause. âUsing a headache diary or app can be helpful in determining if thereâs a clear pattern,â Sheikh says.
Why do I get a migraine during my period?
Itâs all about hormones. âDuring the course of a normal cycle, your estrogen levels rise until about day 14 of your cycle,â says Steven A. Rabin, MD, a gynecologist in Burbank, CA. Thatâs when you start to ovulate and make more progesterone.
Around day 27 or 28, both hormones drop back down to a normal level. âThe sudden drop of estrogen can trigger a migraine headache for many women,â Rabin says.
What helps with menstrual migraine?
There are lots of ways to manage and treat your menstrual migraines. These include mini-preventive treatment, acute treatment, and hormonal treatment.
Mini-preventive treatment
You can sometimes stop menstrual migraine attacks before they start or lessen how severe they are with prevention techniques.
âThis is called mini-prophylaxis or mini-prevention, or taking daily or regular medication around the time of your menstrual cycle,â Sheikh says.
One option is taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or fenoprofen calcium (Nalfon) two times a day for 5-7 days. Do this 2-3 days before your period starts and throughout.
Another option is estrogen supplementation. You can use a pill, vaginal gel, or patch before and during your period to stop the natural estrogen dip that triggers migraine.
âWe give patients a very low dose of plant-derived natural estradiol,â Rabin says. It comes in the form of a prescription patch. Every month, you put the patch on your skin about 1 day before your migraine typically comes on.
âItâs important to track your cycle and find this day so you can get what I call the estrogen parachute, which prevents your estrogen levels from falling off a cliff and triggering the migraine,â Rabin says. You wear it about 3-4 days, then take it off.
Other mini-prevention techniques include taking magnesium starting on day 15 of your cycle and taking triptan medication two times a day throughout your period.
Acute treatment
If youâre in the middle of a menstrual migraine attack, you can take medicine to ease the pain. Itâs most effective if you take it early.
Your doctor may recommend a fast-acting triptan or selective serotonin receptor agonist. Most triptans are pills. Some are available as injections under the skin or as nasal sprays and powder.
Options include:
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Sumatriptan (Imitrex, Tosymra)
- Zolmitriptan (Zomig)
Your doctor might also suggest taking an NSAID with the triptan. Taking a multitreatment approach may help, too, Sheikh says. For example, you take a pain reliever while also using a heating pad to manage other period symptoms.
CGRP (calcitonin gene-related peptide) antagonists are another option. CGRP is a molecule involved in causing migraine pain. CGRP antagonists block the effects of CGRP. They include rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy).
Continuous prevention
If youâve tried other methods and they donât work, or if your period is irregular, your doctor may recommend continuous preventive treatment.
One type of continuous prevention is taking birth control pills without breaking for a monthly period. Instead of taking a placebo pill for 7 days, you keep taking active pills. This keeps your hormones from dropping and triggering migraine. You can also do this with a vaginal ring. After you take the ring out, put a new one in right away instead of waiting until your period is over.
Your doctor may recommend medication that changes hormone levels, like leuprolide (Lupron). Or they may suggest using the lowest possible dose of estrogen in your hormonal contraception.
Botox is a good option, too. Itâs FDA approved for migraine and works by blocking pain signals in the nerves. It can take time to work, so you may need more than one treatment. Your doctor may prescribe this if other preventive treatments donât work.
Neuromodulation treatments can be used during an attack or to prevent one. They send signals to your brain and nervous system using electrical or magnetic waves or heat to calm brain activity. Some are portable; others are surgically implanted.
What should I avoid?
You can manage your pain better by avoiding triggers or things that make you feel worse. Try keeping a migraine diary to identify triggers and sensitivities. Alcohol, dehydration, and stress are common ones. Heat and light may also make you feel worse.
Avoid alcohol around your period. Try to drink 1.5-2 liters of water every day. If you have light sensitivity or heat sensitivity, try staying in a cool, dark room.
Can lifestyle choices help menstrual migraine?
âRegular exercise and a healthy diet have been shown to reduce overall menstrual symptoms and can help with migraine attacks,â Sheikh says. A good, consistent sleep schedule can also help. Try limiting coffee and energy drinks if they cause problems with your sleep.
Learn to manage stress better. Try relaxation techniques. âYoga and mindfulness can be a really helpful tool to help regulate your hormones and make this time easier,â Sheikh says.
Which menstrual migraine treatment is right for me?
Your doctor can help you decide which options are best for you. It may be a combination of strategies, including mini-prevention, acute treatment, and lifestyle changes. Or they may recommend continuous birth control.
âYou have many useful options and most of them are safe,â Sheikh says. But everyoneâs different and it depends on many factors. âItâs important to take an individual approach,â she says.
Show Sources
Photo Credit: Stockbyte / Getty Images
SOURCES:Â
Steven A. Rabin, MD, gynecologist, Burbank, CA.
Huma U Sheikh, MD, New York Neurology Medicine.
American Migraine Foundation: âMenstrual Migraine Treatment,â "Botox for Migraine,â âNeuromodulation for migraine treatment: An overview,â "ORAL AND INTRANASAL TRIPTANS FOR MIGRAINE."
Cleveland Clinic: âMenstrual Migraines (Hormone Headaches).â
Johns Hopkins Medicine: âHeadaches and Women: What Do Hormones Have to Do With It?â
American Migraine Foundation.
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Women’s Health
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The French doctor admitted he didn't have the training or knowledge to treat trans patients - as experts say there's no need for a trans woman to visit a gynaecologist at all.
"I only treat real women" - that's what French gynaecologist Victor Acharian told a 26-year-old transgender woman he refused to treat in his clinic in the south-west of the country recently.
The transgender woman, accompanied by her boyfriend, went to a gynaecological appointment when, after minutes of waiting, the secretary told her that the doctor had refused to see her.
"I told her that I'm not competent, but I can guide you. I can refer you to services that can take better care of you. But after I said that, things went south," gynaecologist Victor Acharian told Euronews.
"I thought I was being honest when I said it wasn't my speciality. I don't know how to treat them and I don't mind being called ignorant," he added.
"You're transphobic!" the young woman reportedly shouted as she left the consulting room. According to the gynaecologist, the patient began to insult his secretary, reacting violently to the refusal.
The woman's partner, still in shock, left a comment on the clinic's Google reviews complaining about what had happened.
The doctor replied with a message addressed to a "gentleman", claiming that he treated "real women".
He justified himself by saying that he had "no skills to treat men, even if they have shaved their beards and come to tell my secretary that they have become women".
He also asked the woman to take it upon herself to tell other transgender people that they were not welcome in his clinic.
After the incident, the patient was reported to be in a 'black hole' and still in 'shock', according to the French press.
Dr Acharian admits he lashed out with the online comments, but says his reasoning for not seeing the patient is still justified, and highlights an underlying problem for medical professionals.
"I reacted spontaneously, out of anger, and I felt I'd been unfairly attacked. I reacted with very clumsy words that may have offended. I'm well aware of that, I've expressed my regrets on several occasions," said Acharian.
"Now the situation has got out of hand, but the problem remains – these people need medical attention," he added.
But the controversy is raging in France, and transgender rights organisations from across Europe have come to the patient's defence.
"It is brutal to deny the right to health, it is a universal right that all citizens have," Mar Cambrollé, president of the Trans Platform Federation in Spain, told Euronews.
‘A cavity is not a classic vagina’
Although gynaecology is still associated with specialised care for women, it's not that simple anymore.
Doctors claim that a lack of knowledge makes it difficult for them to treat transgender people, while 50% of transgender people cancel or delay their medical appointments to avoid discrimination, according to the latest report published by Doctors of the World in collaboration with the Spanish Federation of Lesbians, Gays, Transsexuals and Bisexuals.
"Just because it's a cavity doesn't mean it's a classic vagina," Acharian explains, admitting his lack of knowledge about transgender patients. The doctor claims that this person was the first transgender woman he had seen in his thirty years of practice.
The challenge for medicine is to find new ways of dealing with changing social norms, as transgender people are still under-represented in medical curricula - but the story is changing.
Since September 2021, a conglomerate of three French universities started providing training for trans healthcare. The aim is for medical professionals to develop an understanding of transgender people's healthcare.
Béatrice Denaes, co-president of the association Trans-Santé France, pointed out in a French medical newspaper that doctors who are 'competent, caring and willing' to treat trans people are still rare, and that she receives 'many emails from desperate transgender people'.
Acharian echoed the desperation the community may feel - stating that the lack of follow-up by the medical establishment may leave some transgender people "on their own, wandering for health care".
‘More and more’ trans people
All this at a time when the number of transition requests is on the rise.
For 2020 in France, around 3,300 people were recognised by the health insurance scheme as having a long-term condition for "gender dysphoria", ten times more than in 2013, according to a report submitted in January 2022 to France’s Ministry of Health.
"As more and more transgender patients are coming, it is the responsibility of the country's health authorities to be aware of this and to take them into account so that they can deal with this problem," Pernille Ravn, a member of the European Society of Gynaecology and a gynaecologist at Odense University Hospital in Denmark, told Euronews.
"There is no recommendation for a transgender woman to have regular gynaecological check-ups, unless she has a surgical problem related to the operation, because she doesn't have a uterus or a cervix," she added.
However, Ravn said that transgender women can have issues related to their surgery that require some kind of gynaecological assessment, so it's important to have specialists with knowledge in this area.
All the reports suggest that health professionals will one day have to treat transgender people.
Without proper training, these professionals "run the risk of adopting inappropriate attitudes that are not necessarily transphobic in intent - but have the same negative effects".
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Medical Innovations
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A young woman with a severe skin condition spent almost four years on a waiting list to see an NHS dermatologist in person.
Charlotte Brown, 31, from Edinburgh, was first diagnosed with psoriasis in 2017 and referred for light therapy in 2019.
It wasn't until September this year that she began treatment.
Psoriasis is a chronic condition that causes inflammation on the body that forms flaky patches of skin and scales.
Symptoms range from mild to severe and can have a huge impact on someone's life.
"It's exacerbated by stress, so when you are in that endless cycle of not knowing when you are going to next get treatment it does get frustrating and it can make you feel quite vulnerable, especially because it is a very visible condition," Charlotte told BBC Scotland News.
"If you don't have the time to sit and put creams on, it gets dried out really fast and that's when it starts to break and bleed."
Although delays to Charlotte's treatment were exacerbated by Covid, it has not been uncommon in recent years for patients to face long waits to see a dermatologist.
Data released by Public Health Scotland revealed that more that 8,000 people had joined the waiting list for a dermatology outpatient appointment in the three months to June - and that list had grown by more than any other NHS specialty.
It comes as statistics showed that NHS waiting lists in Scotland have grown to a record high, with more than 670,000 names in the queue to see a specialist for non-urgent care in the latest quarter - including more than 500,000 waits for an outpatient appointment.
The Scottish government has a national standard whereby 95% of new outpatients should wait no longer than 12 weeks from referral to being seen.
However, waiting times have been growing since the pandemic with hospitals struggling to free up beds and create additional capacity.
Scottish ministers pledged to spend an additional £100m a year to bring down the longest waits - and there has been a slight reduction in the number of people waiting over two years for an outpatient appointment - but a growing number waited over 18 months for inpatient treatment in hospital.
Cardiology, dermatology and neurology were the specialisms with the highest increase in waits for a new outpatient appointment last year.
Although Charlotte was able to speak with a dermatologist via Whatsapp during her wait, she says the delay to begin treatment and see a consultant in person meant that her condition went from manageable to severe.
She says her psoriasis began with just a couple of small patches on her body, but it has now spread across most of her arms, legs, back and face.
"Sometimes you just want to be out in a bar with your friends and not have people come up and point or ask if it is contagious. You want to be out and about having a normal life," she added.
Prof Colin Fleming, a consultant dermatologist at NHS Tayside, told BBC Scotland News it was hard for many dermatology services to "recover lost ground since the pandemic" partly because the services had to concentrate on skin cancer.
"This has meant that many NHS dermatology services have maintained reasonably short waiting times for cancer detection and treatment but many life-altering conditions, such as eczema or psoriasis, now have long waits to be seen," he said.
It is for these life-altering but not life-threatening conditions that some patients are now turning to private health to get treatment for.
In 2020, Karen McLeod noticed a growing lump on her forehead.
After getting referred by her GP to see a dermatologist, Karen was told the lump was a lipoma - a non-cancerous lump that is not typically removed by the NHS.
However, the lump continued to grow until it ran from her hairline down to the middle of her forehead.
"I feel really down about it, looking at my pictures and other people have commented now," she said.
"I always try to hide it, but it really does have a big impact on me."
Karen was told it was highly unlikely she could get the lipoma removed on the NHS as it would be considered a cosmetic procedure despite it having a "huge impact" on her daily life.
She felt she had no choice but to pay £800 at a private clinic in Glasgow to get the lump removed.
"I just feel I work hard, I pay my taxes like everybody else, and obviously that contributes to the NHS and it would be nice just to have a wee bit back," she said.
Dr Cormac Convery, who was a GP for over a decade before taking up work at a private clinic in Glasgow, said he increasingly sees patients who have "serious life-changing differences" that they can't get treated on the NHS.
"They withdraw from society, they stop working and it just has a massively detrimental effect on their quality of life and it is more of those people who we end up seeing," he said.
Owners at the Ever Clinic say their service began as more cosmetic-focused, but they quickly pivoted resources as it became clear there was a high demand for minor surgery from patients who couldn't get NHS treatment or faced years-long waits.
The most common treatments include removing lipomas, rhinophymas and moles - procedures which cost £800, £3,495 and £275 respectively.
"Transparency is the critical thing," Dr Convery said.
"Many of our patients have engaged with the NHS and have received some sort of attention but it's just the timely delivery of that care that is not supportive of that patient's need, and when we go to years waiting for that treatment it's just not workable for the average individual."
The Scottish government said there were "unacceptable waits" in some specialities but that it was determined to ensure people receive the treatment they need as soon as possible.
A spokesman said: "The first minister has announced new annual funding of £100m to help reduce inpatient and day-case waiting lists by an estimated 100,000 patients over the next three years.
"We are working with NHS Boards to reduce long waits, which have been exacerbated by the impacts of the global pandemic. This includes targets to address long waits and delivery of the commitments in our £1 billion NHS Recovery Plan to support an increase in inpatient, day-case, and outpatient activity.
"Two National Treatment Centres opened this year in Fife and Highland, with two further centres opening soon in Forth Valley and the Golden Jubilee, providing additional protected capacity for patients across Scotland."
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Disease Research
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Bacteria-containing dust found at day care centers could put children at a higher risk of asthma, a new study from the European Respiratory Society suggests.
In the study, the researchers collected dust samples from 103 different day care facilities in Paris, France.
Then they analyzed the samples in a lab to identify the bacteria found in each one.
The researchers also asked the parents of 515 children to disclose whether the children experienced any wheezing or other respiratory issues.
Of the four types of bacteria found, one of them — which included Streptococcus and Lactococcus — was linked to a higher risk of wheezing.
That's often a precursor to asthma in children under 3 years old, the journal entry noted.
The average age of the children in the tested day care centers was 2 years old.
The findings were presented at the European Respiratory Society International Congress in Milan, Italy, by Dr. Annabelle Bédard, a researcher at Inserm (the French National Institute of Health and Medical Research) in Paris, France.
"We find mixtures of different bacteria and other microbes living everywhere — outside, inside our homes, on our skin and even inside our bodies," Bédard said in her presentation. "These communities of bacteria, known as microbiota, can have beneficial or harmful effects on our health."
She added, "Young children will come into contact with the bacteria living in day care centers via their skin and mouths and by breathing them in. So, we might expect this exposure to have an impact on children's developing lungs via the different microbiota that arise in children's airway, gut or skin."
These findings highlight the need to further investigate indoor air quality at day care centers, Bédard said.
"We now need to understand what factors influence this bacterial community — for example, how the rooms are cleaned and ventilated, and indoor air quality," she said.
"This, along with future findings from other studies, could help us understand how to improve conditions and inform public health strategies for preventing chronic respiratory diseases, such as asthma, in children."
The researchers plan to follow the health of the children in the study to determine which develop asthma as they grow older.
Dr. Steven Abelowitz, founder and medical director of Coastal Kids Pediatrics in California and also medical director of Pediatric Associates, was not involved in the study but reviewed the findings.
He noted that some of the bacteria found in the study are quite common, while others are less common.
"We still have a great deal to learn about these complex bacteria types and how our bodies respond to them."
"Per the study, at least two of the types of bacteria (Streptococcus and Lactococcus) — which were the second most common bacteria they found — showed an association of a higher risk of wheezing in the study," Abelowitz told Fox News Digital.
"We still have a great deal to learn about these complex bacteria types and how our bodies respond to them."
While wheezing can be a sign or symptom of asthma, the doctor noted that’s not always the case.
"It really depends on how frequent and severe the wheezing is, as well as if there is a family history of allergies, asthma and eczema," he said. "Some studies have even shown that day care attendance in early childhood has been observed to be inversely associated with wheezing and asthma."
To minimize the risk of wheezing and other lung issues in kids who are attending day care facilities, Abelowitz recommended that all rooms be kept clean and well-ventilated, and that indoor air quality is consistently monitored.
Abelowitz reiterated the need for more studies to explore these "complex communities of bacteria" and their potential association with long-term lung issues for children.
He added, "From a pediatrician’s standpoint, it's more important to choose childcare programs with low child-to-teacher ratios, small group sizes, well-trained staff, age-appropriate curriculum and a safe, positive environment."
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Disease Research
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Inside the heads of people who are always late, as explained by stick figures.
Everyone knows a person like this or is one themselves!
I woke up this morning to a text. It was a link:
I got to reading. And as it turns out, according to the article, late people are actually the best people ever.They're optimistic and hopeful:
"People who are continuously late are actually just more optimistic. They believe they can fit more tasks into a limited amount of time more than other people and thrive when they're multitasking. Simply put, they're fundamentally hopeful."
They're big-thinking:
"People who are habitually late don't sweat over the small stuff, they concentrate on the big picture and see the future as full of infinite possibilities."
Late people just get it:
"People with a tendency for tardiness like to stop and smell the roses…life was never meant to be planned down to the last detail. Remaining excessively attached to timetables signifies an inability to enjoy the moment."
By the end of the article, I had never felt prouder to be a chronically late person.
But also, what the hell is going on? Late people are the worst. It's the quality I like least in myself. And I'm not late because I like to smell the roses or because I can see the big picture or because the future is full of infinite possibilities. I'm late because I'm insane.
So I thought about this for a minute, and I think I figured out what's going on. The issue is that there are two kinds of lateness:
1. OK lateness. This is when the late person being late does not negatively impact anyone else — like being late to a group hangout or a party. Things can start on time and proceed as normal with or without the late person being there yet.
2. Not-OK lateness. This is when the late person being late does negatively impact others — like being late to a two-person dinner or meeting or anything else that simply can't start until the late party arrives.
John Haltiwanger's Elite Daily article is (I hope) talking mostly about OK lateness. In which case, sure, maybe those people are the best, who knows.
But if you read the comment section under Haltiwanger's article, people are furious with him for portraying lateness in a positive light. And that's because they're thinking about the far less excusable not-OK lateness.
1. OK lateness. This is when the late person being late does not negatively impact anyone else — like being late to a group hangout or a party. Things can start on time and proceed as normal with or without the late person being there yet.
2. Not-OK lateness. This is when the late person being late does negatively impact others — like being late to a two-person dinner or meeting or anything else that simply can't start until the late party arrives.
John Haltiwanger's Elite Daily article is (I hope) talking mostly about OK lateness. In which case, sure, maybe those people are the best, who knows.
But if you read the comment section under Haltiwanger's article, people are furious with him for portraying lateness in a positive light. And that's because they're thinking about the far less excusable not-OK lateness.
All of this has kind of left me with no choice but to take a quick nine-hour break from working on a gargantuan SpaceX post to discuss not-OK late people.
When it comes to people who are chronically not-OK late, I think there are two subgroups:
Group 1: Those who don't feel bad or wrong about it. These people are assholes.
Group 2: Those who feel terrible and self-loathing about it. These people have problems.
Group 1 is simple. They think they're a little more special than everyone else, like the zero-remorse narcissist at the top of Haltiwanger's article. They're unappealing. Not much else to discuss here.
Punctual people think all not-OK late people are in Group 1 (as the comments on this post will show) — because they're assuming all late people are sane people.
When a sane person thinks a certain kind of behavior is fine, they do it. When they think it's wrong, they don't do it. So to a punctual person — one who shows up on time because they believe showing up late is the wrong thing to do — someone who's chronically late must be an asshole who thinks being late is OK.
But that's misunderstanding the entire second group, who, despite being consistently late, usually detest the concept of making other people wait. Let call them CLIPs (Chronically Late Insane Persons).
While both groups of not-OK late people end up regularly frustrating others, a reliable way to identify a Group 2 CLIP is a bizarre compulsion to defeat themselves — some deep inner drive to inexplicably miss the beginning of movies, endure psychotic stress running to catch the train, crush their own reputation at work, etc., etc. As much as they may hurt others, they usually hurt themselves even more.
I spent around 15% of my youth standing on some sidewalk alone, angrily kicking rocks, because yet again, all the other kids had gotten picked up and I was still waiting for my mom. When she finally arrived, instead of being able to have a pleasant conversation with her, I'd get into the car seething. She always felt terrible. She has problems.
My sister once missed an early morning flight, so they rescheduled her for the following morning. She managed to miss that one too, so they put her on a flight five hours later. Killing time during the long layover, she got distracted on a long phone call and missed that flight too. She has problems.
I've been a CLIP my whole life. I've made a bunch of friends mad at me, I've embarrassed myself again and again in professional situations, and I've run a cumulative marathon through airport terminals.
When I'm late, it's often the same story, something like this:
I'll be meeting someone, maybe a professional contact, at, say, a coffee place at 3:00. When I lay out my schedule for the day, I'll have the perfect plan. I'll leave early, arrive early, and get there around 2:45. That takes all the stress out of the situation, and that's ideal because non-stressful commutes are one of my favorite things. It'll be great — I'll stroll out, put on a podcast, and head to the subway. Once I'm off the subway, with time to spare, I'll take a few minutes to peruse storefronts, grab a lemonade from a street vendor, and enjoy New York. It'll be such a joy to look up at the architecture, listen to the sounds, and feel the swell of people rushing by — oh magnificent city!
All I have to do is be off the subway by 2:45. To do that, I need to be on the subway by 2:25, so I decide to be safe and get to the subway by 2:15. So I have to leave my apartment by 2:07 or earlier, and I'm set. What a plan.
Here's how it'll play out (if you're new to WBW, you're advised to check this out before proceeding):
Making plans on time.
Maybe some procrastination.
Avoiding the issues.
Arguing over avoiding the issues.
Some dawdling.
Some more dawdling.
And some lingering.
And some more lingering.
Is this dragging my feet?
This is dragging my feet.
This is becoming a problem.
This is feeling uncomfortable.
This IS uncomfortable.
This IS a problem.
But I’m cool.
So cool.
Ice cold like a fighter pilot.
I’m a chillin’.
Now worries my way.
Not thinking about it.
Positive thoughts.
Positive action... well now.
It will all workout.
Maybe I’m gonna be late.
I’m gonna be late.
Oopsie.
And that’s the traffic.
It’s the traffics fault.
This map is broken.
Perfect timing on being late. Nailed it.
CLIPs are strange people. I'm sure each CLIP is insane in their own special way, and to understand how they work, you'll usually have to get to some dark inner psychology.
For me, it's some mix of these three odd traits:
1. I'm late because I'm in denial about how time works.
The propensity of CLIPs to underestimate how long things take comes out of some habitual delusional optimism. Usually what happens is, of all the times the CLIP has done a certain activity or commute, what they remember is that one time things went the quickest. And that amount of time is what sticks in their head as how long that thing takes. I don't think there's anything that will get me to internalize that packing for a weeklong trip takes 20 minutes. In my head, it's eternally a five-minute task. You just take out the bag, throw some clothes in it, throw your toiletries in, zip it up, and done. Five minutes. The empirical data that shows that there are actually a lot of little things to think about when you pack and that it takes 20 minutes every time is irrelevant. Packing is clearly a five-minute task. As I type this, that's what I believe.
2. I'm late because I have a weird aversion to changing circumstances.
Not sure what the deal is with this, but something in me is strangely appalled by the idea of transitioning from what I'm currently doing to doing something else. When I'm at home working, I hate when there's something on my schedule that I have to stop everything for to go outside and do. It's not that I hate the activity — once I'm there I'm often pleased to be there — it's an irrational resistance to the transition. The positive side of this is it usually means I'm highly present when I finally do haul my ass somewhere, and I'm often among the last to leave.
3. Finally, I'm late because I'm mad at myself.
There's a pretty strong correlation here — the worse I feel about my productivity so far that day, the more likely I am to be late. When I'm pleased with how I've lived the day so far, the Rational Decision-Maker has a much easier time taking control of the wheel. I feel like an adult, so it's easy to act like an adult. But times when the monkey had his way with me all day, when the time rolls around that I need to stop working and head out somewhere, I can't believe that this is all I've gotten done. So my brain throws a little tantrum, refusing to accept the regrettable circumstances, and stages a self-flagellating protest, saying, "NO. This cannot be the situation. Nope. You didn't do what you were supposed to do, and now you'll sit here and get more done, even if it makes you late.”
So yeah, that's why I'm late. Because I have problems.
Don't excuse the CLIPs in your life — it's not OK, and they need to fix it. But remember: It's not about you. They have problems.
This article originally appeared on 04.07.16
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Stress and Wellness
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In posts on two Facebook forums, GP Survival and Resilient GP, family doctors write anonymously, revealing their concerns about how hard they sometimes find it to get an ambulance to attend to a sick patient – and the risks that can pose.
“I ended up in the back of a police car with sirens going with a stranger who’d had a probable stroke on the street. Category 2 ambulance hadn’t come after 45 minutes so flagged down a cop car. They bundled us in.
“Emergency department full of waiting ambulances unable to unload and I eventually left him in the very capable hands of the stroke team. Terrifying how broken our system is and how many people had likely just walked past him before I spotted him from my car.
“With so many ambulance issues, I’d hate to think of someone in my village left with no support in a similar situation.”
“Our emergency care practitioner called an ambulance at 6pm on Wednesday 6 July. Very elderly gentleman. Off legs, urinary symptoms, not eating/drinking. Guess when crew arrived? This morning, Friday 8 July, around 10am – 40 hours [later]. And the ECP had to wait 35 minutes just for 999 call to be answered!”
“I recently complained [to the local ambulance service] for first time ever when ambulance refused to take a very sick patient of mine into hospital that I’d assessed over the phone because ‘her obs are normal’. They weren’t but even if they had been the reliance on these alone, ignoring the medical background, the family history and my history was just wrong.
“I then had to go out and see her, re-call 999 (with many hours additional delay) and she died after a few days in hospital.”
“I had a situation recently where I had to make the decision to put someone having an MI [myocardial infarction heart attack] into the car and drove to A&E. It was a neighbour. The husband knocked on my door after they were told the ambulance would be over an hour. They knew I was a GP and so asked for help.
“I dithered because all I could think of was her arresting en route but realised that could happen at home too. It was a huge risk to take but thankfully it ended as well as it could.”
“This is an increasingly common scenario. Three potential MIs in surgery recently. One put in GP’s car after no show from ambulance, next drove self (not recommended and against my advice) and third taken by wife to A&E.
“We used to have ambulance response time of under 10 minutes. But that was before lockdown.”
“I had a neighbour [suffer an] aortic abdominal aneurysm. Told it will be six to seven hours. Family drove him instead. Sadly he died from ruptured AAA.”
“We had this happen on a Friday at work. Elderly lady walked in with central crushing chest pain. After three hours of waiting for ambulance, two members of staff took her in their car. Very difficult situation to know what to do.”
“Took woman who’d come off bike, knocked herself out and ripped her ear and hurt her leg to hospital. She came to quickly and could stand but I thought she’d broken her hip.
“Freezing cold. Ambulance was going to be three hours. She had broken her hip.”
“Just tried to get an ambulance for my partner’s elderly mother who’s 89 and probably had a stroke. Husband rang 999 to be told no ambulances available. Then I rang the GP who said the same and told us to get a private one.
“What the hell is going on when you can’t get an emergency ambulance? We’ve had to get a private one.”
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Health Policy
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Severely injured war hero Martyn Compton admits he would struggle to cope without his loyal wife’s “enduring love”.
Michelle stayed by his side after he suffered severe burns to three-quarters of his body in a Taliban attack in Afghanistan, supporting him through 17 years of gruelling rehabilitation and more than 1,000 operations – including 100 to his face alone.
Through everything – including the tragic loss of their newborn twins – their love endured.
And so, to mark their inspirational bond, the veteran, 39, is in training to propose to Michelle all over again on their 15th anniversary – from 18,000ft up Mount Everest.
The dad-of-two says: “They say love conquers all and we are proof of that. “Michelle is my rock, someone who has literally got me through everything, and the words ‘soul mate’ aren’t enough to describe what she means to me.”
Martyn was a lance corporal in the Army when his armoured vehicle was torn apart by a roadside bomb in Helmand province in 2006, killing three comrades.
A rocket-propelled grenade then exploded nearby, showering him with flames and shrapnel. Martyn said: “I came as close to death as it’s possible to and survived that day.”
He was so gravely injured he “died” four times in Afghanistan, was in a coma for 12 weeks and was told he would never walk again.
Yet even after her gave her the choice, Michelle, 42, refused to leave him – saying she loved him, no matter what.
They wed in July 2008, less than two years after the attack, with Martyn determined to walk on their big day.
He managed it after gruelling physiotherapy and says: “I went to Afghanistan as one person and I came back as another. It didn’t change the love we had for one another.”
Their life together has been filled with amazing highs and terrible lows.
Tragedy struck again when they lost newborn twins Harry and Freya on their first wedding anniversary.
But they happily went on to have Archie, 12, and Coral, 10 – who, Martyn says, help him to cope with life by not seeing him any differently, like Michelle.
As he recovered, Martyn, who has left the Army, became firm pals with Prince Harry, who he served with in the Household Cavalry, and his brother Prince William.
Martyn and Michelle were even invited to William and Kate’s wedding in 2011.
Martyn reveals: “Michelle and I were sandwiched between David and Victoria Beckham and Elton John – it was surreal.
“Prince Harry smiled and waved, and whispered ‘Hello, Compo!’ Then Elton struck up a conversation before the ceremony. I remember saying, ‘I love your socks’ – he had a flamboyant, brightly coloured pair on. So he pulled up his trousers to show me better.”
Martyn still suffers PTSD from the Helmand attack and his injuries are so bad that he will need surgery for the rest of his life. His most recent op – on his lower eyelid – was just weeks ago.
He admits: “I still hate the operations, they don’t get any easier.”
Martyn says he sometimes he finds it difficult when people stare but he knows he has done some amazing things since his life-changing injury.
He adds: “I have served my country and while that is a part of my former life it has made me stronger, very grateful for what I have got.”
And having already beaten incredible odds, he is busying himself with Everest training ready to tackle his latest challenge.
Martyn, from Kent, is joining other veterans on the Pilgrim Bandits charity venture – including ex-Gurkha Hari Budha Magar, who aims to be the first above-the-knee double amputee to reach the summit.
Despite Martyn’s fragile skin not being able to maintain body heat in freezing temperatures, he will brave the treacherous Khumbu Icefall so he can call Michelle at 18,000ft to ask if she will renew her vows with him.
He says: “You never fully leave behind what has happened. But you can live a new life – albeit one different from the one you thought you were going to have. And in some ways it’s even better than before, as you know what you so nearly didn’t have.”
The brave dad credits facing his challenges with helping his mental health and he wants to show others they can achieve almost anything.
And it is clear that, for Martyn, his love for Michelle is what motivates him.
He adds: “I was determined to walk at my wedding. To now be climbing Everest is incredible.
“Our relationship is against the odds, our beautiful children are against the odds – and me being here at all is against the odds. So while this is a huge challenge for me, it is also a challenge I know I can face and conquer.
“I’m climbing in memory of veterans who are no longer with us, for families who have lost their babies.
“And also I’m climbing in celebration of enduring love.”
■ You can donate to Martyn’s campaign to climb Mount Everest at justgiving.com
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Mental Health Treatments
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Only half the recommended number of medical staff were on duty at the O2 Brixton Academy on the night of a crush at the south-west London venue.
Industry guidelines suggest there should have been medical cover of at least 10 people, including a paramedic and a nurse.
After two insiders approached the BBC, the medical cover provider confirmed only five people were working when the crush happened in December.
No paramedics or nurses were present.
Rebecca Ikumelo, 33, and security guard Gaby Hutchinson, 23, died in hospital following the crowd surge on 15 December 2022, at the concert by Afrobeats artist Asake.
The medical provider, Collingwood Services Ltd, said it was "fully confident" its team had "responded speedily, efficiently and with best practice".
We approached the venue operator, Academy Music Group (AMG), for comment. It said it was unable to respond to specific questions, citing the police investigation into what happened.
Two whistleblowers who regularly work for Collingwood Services Ltd at Brixton told BBC Radio 4's File on 4 programme that medical cover at the south London gig had been "inadequate".
Neither of them was there when the crush happened, but one said he had spoken to colleagues who were.
The insiders told us that of the five people working for Collingwood at the venue, none had a paramedic qualification.
"[They] had two student paramedics, so they're basically unqualified," said one whistleblower. "They have to be supervised by a paramedic, not by anybody of a lower grade. They didn't have appropriate supervision."
To become a paramedic, you need to pass an approved Health and Care Professions Council (HCPC) course - which often means studying for three years to degree level.
Two of the three others working that night, say the insiders, were so-called "FREC 3s" - with a Level 3 certificate in First Response Emergency Care. They would normally have done a five-day course to learn skills for medical and trauma situations in pre-hospital settings.
We approached Collingwood Services Ltd who confirmed there had been five trained medical staff in attendance on site on the evening of 15 December. It said two of those had been first responders - which is a generic term which can cover a variety of competency levels.
The company also said there were two third-year student paramedics - working as lower grade emergency medical technicians (EMTs). The fifth person, said Collingwood, was also an EMT.
EMT is also a generic term which can cover different levels of competency in both the NHS and private medical sector. It is not a regulated qualification.
We asked the company to further clarify what qualifications the five Brixton staff held, but it refused to say - stating merely that "all staff present were qualified to carry out the scope of practice they were contracted to perform."
It also confirmed that "no member of staff was contracted to provide paramedic level duties at the event."
In addition, Collingwood told us a further team of three trained medical staff arrived at the Academy by 23:00 and were in attendance until 02:30.
Police have previously said they were called by venue staff at about 21:30.
London Ambulance Service says it was asked to attend at 22:06 - and that its staff treated 10 patients at the scene, eight of whom were transferred to hospital.
If you have any personal experience of the issues raised by this investigation, please email the File on 4 team at fileon4@bbc.co.uk
For a sold out, 5,000-strong audience gig at Brixton - such as the Asake show - industry-standard guidance suggests there should have been at least 10 people with medical training on duty.
That's double the number who were there when the crush happened.
Concert organisers across the UK use several tools to work out appropriate staffing levels.
They are likely to look back to similar events to judge what staff might be needed. File on 4 has previously reported that the Asake concert had been classed as "high risk" by Academy operator AMG.
The Purple Guide is based on guidance formerly published by the Health and Safety Executive - and while it was originally drawn up for outdoor live events, it is now also used as a benchmark for indoor ones too.
The guide says events with between 3,000 and 10,000 attendees should have:
- one or two paramedics or Emergency Care Practitioners
- one or two nurses or Emergency Nurse Practitioners
- six first aiders/first responders for the first 3,000 attendees - then one more for every additional 1,000
The following should also be considered:
- doctor
- rapid response vehicle
- ambulance(s) and crew for on-site service and transfers to hospital
Both our whistleblowers said previous concerts at the Brixton Academy - before the Asake gig - also had not had enough Collingwood medical staff on duty.
"Very often they would just tell you the extra staff were running late," one told us, "but they would never turn up."
Collingwood also provides medical cover at another London venue run by AMG - the O2 Academy Islington.
One of the insiders sent us photos, taken since the Brixton crush, of out-of-date medical supplies which, he said, he had been expected to use at Islington.
They include:
- a paediatric resuscitator bag and tubing - use-by date March 2019
- nasopharyngeal airway tubes (that fit down the nose and throat) - use-by date January and June 2022
- oxygen masks - use-by date August 2022
- a defibrillator which should have been safety tested by September 2022
"I feel ashamed to be working for this organisation," he said. "If we had a Brixton-style incident at this venue [O2 Academy Islington] then I would not be able to operate effectively and people's lives would be at risk."
The whistleblowers told us they had both complained to Collingwood managers about inadequate staffing levels and training - and medical supplies being out of date.
Collingwood Services Ltd did not comment on those allegations when approached by the BBC.
In its statement, the company said it had conducted its own internal investigation and was fully confident that its team had "responded speedily, efficiently and with best practice" on the night of the Brixton crush.
"We believe strongly that the swift action and skill of medical staff, emergency services and others who assisted... were instrumental in avoiding further serious injuries or loss of life," it said.
"We are in full support of the investigation into the causes of the events of 15 December and welcome any outcomes of the ensuing report which would stop similar tragedies happening in the future."
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Epidemics & Outbreaks
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The U.S. spends huge amounts of money on health care that does little or nothing to help patients, and may even harm them. In Colorado, a new analysis shows that the number of tests and treatments conducted for which the risks and costs exceed the benefits has barely budged despite a decade-long attempt to tamp down on such care.
The state — including the government, insurers, and patients themselves — spent $134 million last year on what is called low-value care, according to the report by the Center for Improving Value in Health Care, a Denver nonprofit that collects billing data from health plans across Colorado. The top low-value items in terms of spending in each of the past three years were prescriptions for opiates, prescriptions for multiple antipsychotics, and screenings for vitamin D deficiency, according to the analysis.
Nationwide, those treatments raise costs, lead to health complications, and interfere with more appropriate care. But the structure of the U.S. health system, which rewards doctors for providing more care rather than the right care, has made it difficult to stop such waste. Even in places that have reduced or eliminated the financial incentive for additional testing, such as Los Angeles County, low-value care remains a problem.
And when patients are told by physicians or health plans that tests or treatments aren’t needed, they often question whether they are being denied care.
While some highly motivated clinicians have championed effective interventions at their own hospitals or clinics, those efforts have barely moved the needle on low-value care. Of the $3 trillion spent each year on health care in the U.S., 10% to 30% consists of this low-value care, according to multiple estimates.
“There’s a culture of ‘more is better,’” said Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design. “And ‘more is better’ is very hard to overcome.”
To conduct its study, the Center for Improving Value in Health Care used a calculator developed by Fendrick and others that quantifies spending for services identified as low-value care by the Choosing Wisely campaign, a collaborative effort of the American Board of Internal Medicine Foundation and now more than 80 medical specialty societies.
Fendrick said the $134 million tallied in the report represents just “a small piece of the universe of no- and low-value care” in Colorado. The calculator tracks only the 58 services that developers were most confident reflected low-value care and does not include the costs of the cascade of care that often follows. Every dollar spent on prostate cancer testing in men over 70, for example, results in $6 in follow-up tests and treatments, according to an analysis published in JAMA Network Open in 2022.
In 2013, Children’s Hospital Colorado learned it had the second-highest rate of CT abdominal scans — a low-value service — among U.S. children’s hospitals, with about 45% of kids coming to the emergency room with abdominal pain getting the imaging. Research had shown that those scans were not helpful in most cases and exposed the children to unnecessary radiation.
Digging into the problem, clinicians there found that if ER physicians could not find the appendix on an ultrasound, they swiftly ordered a CT scan.
New protocols implemented in 2016 have surgeons come to the ER to evaluate the patient before a CT scan is ordered. The surgeons and emergency doctors can then decide whether the child is at high risk of appendicitis and needs to be admitted, or at low risk and can be sent home. Within two years, the hospital cut its rate of CT scans on children with abdominal pain to 10%, with no increase in complications.
“One of the hardest things to do in this work is to align financial incentives,” said Lalit Bajaj, an emergency physician at Children’s Colorado who championed the effort, “because in our health care system, we get paid for what we do.”
Cutting CT scans meant less revenue. But Children’s Colorado worked with an insurance plan to create an incentive program. If the hospital could hold down the rate of high-cost imaging, saving the health plan money, it could earn a bonus from the insurer at the end of the year that would partly offset the lost revenue.
But Bajaj said it’s tough for doctors to deal with patient expectations for testing or treatment. “It’s not a great feeling for a parent to come in and I tell them how to support their child through the illness,” Bajaj said. “They don’t really feel like they got testing done. ‘Did they really evaluate my child?’”
That was a major hurdle in treating kids with bronchiolitis. That respiratory condition, most often caused by a virus, sends thousands of kids every winter to the ER at Children’s, where unneeded chest X-rays were often ordered.
“The data was telling us that they really didn’t provide any change in care,” Bajaj said. “What they did was add unnecessary expense.”
Too often, doctors reading the X-rays mistakenly thought they saw a bacterial infection and prescribed antibiotics. They would also prescribe bronchodilators, like albuterol, they thought would help the kids breathe easier. But studies have shown those medicines don’t relieve bronchiolitis.
Bajaj and his colleagues implemented new protocols in 2015 to educate parents on the condition, how to manage symptoms until kids get better, and why imaging or medication is unlikely to help.
“These are hard concepts for folks,” Bajaj said. Parents want to feel their child has been fully evaluated when they come to the ER, especially since they are often footing more of the bill.
The hospital reduced its X-ray rate from 40% in the 17 months before the new protocols to 29% in the 17 months after implementation, according to Bajaj. The use of bronchodilators dropped from 36% to 22%.
Part of the secret of Children’s success is that they “brand” their interventions. The hospital’s quality improvement team gathers staff members from various disciplines to brainstorm ways to reduce low-value care and assign a catchy slogan to the effort: “Image gently” for appendicitis or “Rest is best” for bronchiolitis.
“And then we get T-shirts made. We get mouse pads and water bottles made,” Bajaj said. “People really do enjoy T-shirts.”
In California, the Los Angeles County Department of Health Services, one of the largest safety-net health systems in the country, typically receives a fixed dollar amount for each person it covers regardless of how many services it provides. But the staff found that 90% of patients undergoing cataract surgery were getting extensive preoperative testing, a low-value service. In other health systems, that would normally reflect a do-more-to-get-paid-more scenario.
“That wasn’t the case here in LA County. Doctors didn’t make more money,” said John Mafi, an associate professor of medicine at UCLA. “It suggests that there’s many other factors other than finances that can be in play.”
As quality improvement staffers at the county health system looked into the reasons, they found the system had instituted a protocol requiring an X-ray, electrocardiograms, and a full set of laboratory tests before the surgery. A records review showed those extra tests weren’t identifying problems that would interfere with an operation, but they did often lead to unnecessary follow-up visits. An anomaly on an EKG might lead to a referral to a cardiologist, and since there was often a backlog of patients waiting for cardiology visits, the surgery could be delayed for months.
In response, the health system developed new guidelines for preoperative screenings and relied on a nurse trained in quality improvement to advise surgeons when preoperative testing was warranted. The initiative drove down the rates of chest X-rays, EKGs, and lab tests by two-thirds, with no increase in adverse events.
The initiative lost money in its first year because of high startup costs. But over three years, it resulted in modest savings of about $60,000.
“A fee-for-service-driven health system where they make more money if they order more tests, they would have lost money,” Mafi said, because they make a profit on each test.
Even though the savings were minimal, patients got needed surgeries faster and did not face a further cascade of unnecessary testing and treatment.
Fendrick said some hospitals make more money providing all those tests in preparation for cataract surgery than they do from the surgeries themselves.
“These are older people. They get EKGs, they get chest X-rays, and they get bloodwork,” he said. “Some people need those things, but many don’t.”
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Health Policy
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For over nine months, Delayne Ivanowski of Kirkwood, Missouri, kept a secret from her dad that ended up saving his life.
Delayne Ivanowski, a 25-year-old nurse at Mercy Hospital in St. Louis, donated her kidney to her dad John Ivanowski, who told his daughter for months that he did not want her to be his donor.
"I told her, I'm not taking your kidney,'" John Ivanowski, 60, told ABC News. "I told her that flat out."
John Ivanowski was diagnosed two years ago with IgA nephropathy, a type of kidney disease that can lead to kidney failure, according to the National Institutes of Health.
The disease ultimately led John Ivanowski to be on dialysis for four to five hours, four days a week, a quality of life that his daughter said was not right for him.
"He likes to walk my dog and run with my dog and he wants to do all this stuff, but now he's hooked up to a machine," she told ABC News. "I don't think that's any way that anybody should have to live."
Delayne Ivanowski said while her dad on dialysis, she made the decision to try to donate her kidney to him, despite his opposition. She said she knew that without her becoming a living donor for her dad, he could wait years to find a donor.
"I was like, 'I'm going to do it. I don't care how mad he is at me. I don't care if he kicks me out of the house or hates me or doesn't say a word to me for the rest of my life,'" she said. "At least he'll be living a good life and not hooked up to a machine."
Without Delayne Ivanowski's intervention to donate her own kidney, John Ivanowski could have remained on the transplant waiting list for several years, according to his doctor, Dr. Jason Wellen, kidney and pancreas transplant surgical director at the Washington University & Barnes-Jewish Transplant Center.
"There are over 100,000 people in the country right now waiting for a kidney transplant," Wellen told ABC News. "The one way we can get people transplanted within a few months is if they come to us with a living donor."
Wellen added that, as a father of three, he understood John Ivanowski's concern for his own daughter, but said living donors face no additional medical risks.
"We spend a tremendous amount of energy and resources and effort to work on every person that comes forward as a living donor," he said. "To the point that we feel extremely comfortable knowing that if we approve for them donation, that they'll have no higher risk for the rest of their life of renal failure or any other medical issues."
John Ivanowski said his opposition to his daughter donating one of her kidneys to him came from not wanting anything to happen to her, now or in the future. He said he was especially concerned after losing his son, Delayne Ivanowski's only sibling, to neuroblastoma, a type of cancer, nearly 16 years ago.
"I thought, I lost my boy and if anything happened to Delayne, I don't know what I would do," he said. "It was a big concern."
Knowing her dad's opposition and concerns, Delayne Ivanowski went through the months-long process of getting approved to be her dad's kidney donor in secret, even while living at home with him and her mom.
The secret mission, she said, included dozens of phone calls with social workers, doctors and nurses out of hearing range of her dad, as well as undergoing blood work and countless medical tests, often at the same clinic as her dad, all without him knowing.
John Ivanowski said he had no idea what his daughter was up to, but does remember getting the life-changing phone call last August that the transplant team had found him a donor.
"They called me at work and said, 'We've got an anonymous donor,' and I about dropped the phone and thought are you kidding me?," he recalled. "People can be on the [kidney waiting] list for five, six, seven, eight years and go through dialysis for that long, and I just couldn't believe it."
On the day of the transplant, Feb. 16, the team at Washington University & Barnes-Jewish Transplant Center took special precautions to make sure John Ivanowski would not see his daughter, according to Wellen.
"We had to figure out how to put them in separate areas of the pre-op area and how to make it so they didn't see each other in the post-op area and make sure that they were in different parts of the floor until she was ready to let him know that she was the donor," Wellen said. "It took a lot of teamwork and effort behind-the-scenes to respect her request to make sure that he didn't know it was her."
After a successful transplant surgery, during which the father and daughter were in side-by-side operating rooms, Delayne Ivanowski and her dad recovered in rooms just steps away from each other on the same floor.
The day after the surgery, John Ivanowski learned his anonymous donor was his daughter when she walked into his room wearing a hospital gown.
"I knew right away," he said. "I was upset. I was just in shock. I looked at my wife and was like, 'Are you kidding me?'"
A video Delayne Ivanowski posted of the moment she walked into her dad's room has gone viral on TikTok, garnering hundreds of thousands of views.
John Ivanowski -- who will be on anti-rejection medication for the rest of his life, but no longer needs dialysis -- said the shock and anger have since subsided, saying, "I wouldn't change a thing. I feel so much better."
Delayne Ivanowski, who should have no lasting side effects or complications from the transplant, said she also wouldn't change anything about the way she helped her dad, saying, "I'm not good at being told no."
She said she hopes her family's story helps raise awareness of the need for organ donation. Over 104,000 people are currently on the waiting list in the United States for a lifesaving organ transplant, according to UNOS.
"If anything, I've saved one life and hopefully I can, with awareness and other things, save other lives by encouraging people to become donors or to take that next step and go get the testing done to become a match," said Delayne Ivanowski. "It hurts, but all the pain is worth it in the end, I think."
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Medical Innovations
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Dozens of Scottish patients are travelling to Lithuania for private healthcare because they cannot face long waits on the NHS, an investigation has found.
The BBC probe found that 10 patients per month were travelling to a clinic in Kaunas, with hundreds more turning to the private sector at home, for routine procedures they would otherwise face waiting more than a year for.
There are currently 625,000 patients on waiting lists in Scotland, the highest figure on record, and equivalent to one person in nine of the general population.
Despite Humza Yousaf, the Health Secretary running to become First Minister, pledging to end long waits as part of his NHS recovery plan, lists have continued to spiral, according to an independent Audit Scotland report last month.
A poll commissioned by BBC Scotland found that more than one in five adults said they or a member of their family had paid for private healthcare in the previous 12 months.
The documentary also reported that some children are waiting up to three times longer for spinal surgery than pre-pandemic, with nursing shortages a major factor.
'Lays bare Humza Yousaf’s inept stewardship'
“These figures are a shameful reflection of the SNP’s mismanagement of Scotland’s NHS,” Sandesh Gulhane, health spokesman for the Scottish Tories, said.
“The fact that so many people feel compelled to pay for private treatment – when in many cases they can scarcely afford it – should shame ministers who have failed to properly resource our health service.
“This lays bare Humza Yousaf’s inept stewardship, but also the dire workforce planning of successive SNP health secretaries, over the last 16 years, which has left our health service desperately short of the frontline medical staff required to meet patient demand.”
Of those who the poll found had used the private sector for treatment, 73 per cent said they would have preferred to use the NHS.
Linda Fyfe, from South Ayrshire, was among those to travel to Lithuania for a hip replacement she was told she would have to wait between 12 and 18 months for on the NHS.
She and others have travelled to Eastern Europe as it is cheaper to get procedures there than privately in the UK.
While the SNP has said it will not introduce further charging in the NHS, 62 per cent said they would back the introduction of a £10 fee for those who missed GP appointments. Just 24 per cent were opposed to the idea, the poll found.
Mr Yousaf said: "I don't want anybody to look at any options other than the NHS. I am committed to make a significant dent into the backlog but I've also got to be really upfront that it will take time."
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Health Policy
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Dozens of home care companies in England fear collapse because invoices are going unpaid by councils and the NHS.
Hundreds of millions of pounds in unpaid bills are threatening parts of a care industry already stretched by a recruitment crisis and rising wages, according to research by the Institute of Health and Social Care Management (IHSCM).
One company, which has 60 care workers, said it had stopped working with the council or people funded by the NHS because “there is a high risk of financial failure because you can’t pay the payroll”.
Caroline Southgate, the managing director of the Doris Jones care agency, said: “If they don’t address this they are never going to address their discharge problem in the NHS. We have had people die and have been chasing the NHS for a year and a half for the money.”
More than one in five home care providers surveyed said they feared the collapse of their business in the next six months because of unpaid bills.
More than £679m owed to care providers in England has been outstanding for more than 30 days, the IHSCM estimates, of which £567m relates to delayed payments by local authorities and £112m is to do with delayed payments from NHS integrated care boards for continuing healthcare services. More than 60% of respondents said they had at least one or more invoice still unpaid after six months.
Adam Purnell, the director of social care at the IHSCM, said: “These findings are indicative of a deeply concerning trend that cannot be ignored. The impact of delayed payments goes far beyond mere statistics; it cripples care providers who are already facing immense challenges from insurance costs, rising energy bills and workforce shortages.”
There are 152,000 social care vacancies in England, figures show, despite rising demand from an ageing population with increasingly specialised care needs.
Jane Townson, the director of the Homecare Association, said: “Late payment of invoices by NHS integrated care boards and local authorities is a serious issue, threatening the financial viability of home care providers. Some have spent months fighting for thousands of pounds owed for care delivered, being pushed from pillar to post without resolution. There is no possible excuse for this.”
A spokesperson for the Local Government Association, which represents councils, said: “Councils continue to work closely with adult social care providers in the private and not-for-profit sector and are acutely aware of the financial pressures they are under. Councils do all they can to avoid exacerbating those pressures.
“Processing payments at the scale that councils do means there are inevitably complexities which can sometimes cause delays, such as when required information in an invoice is not given. A vast majority of payments made by local authorities are correct and on time. Councils have absolutely no deliberate intention to pay late.”
NHS England was approached for comment.
The cashflow problems threaten to lengthen the extensive waiting lists for social care. Despite an improvement since the pandemic, 430,000 people were waiting to access care at the end of March, resulting in the continued deterioration of the health and wellbeing of thousands of people awaiting assessments.
The shortage of social care creates blockages in the NHS. About 12,000 people in England await discharge from hospital beds they no longer need, NHS data shows, with access to care at home a major problem.
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Health Policy
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Surgeons have performed the world's first ever whole-eye transplant, a feat hailed as a breakthrough despite the patient not yet regaining his sight.
Doctors "never expected it to work at all", patient Aaron James said, but the eye has shown signs of health, such as functioning blood vessels and a promising retina.
It has been six months since the 21-hour surgery, performed during a partial face transplant in New York, but the surgeon who led the procedure said Mr James, 46, may yet see out of his left eye again.
Warning: This article contains a graphic picture of the patient
"I don't think anyone can claim that he will see. But by the same token, they can't claim that he will not see," Dr Eduardo Rodriguez said.
"The mere fact that we transplanted an eye is a huge step forward, something that for centuries has been thought about, but it's never been performed."
Mr James, a military veteran from Arkansas, survived a work-related high-voltage electrical accident that destroyed the left side of his face, his nose, his mouth and his left eye in June 2021.
He said he knew he might not regain his vision, but he had hoped that surgeons could "learn something to help the next person".
"Hopefully this opens up a new path," he said.
"It feels good. I still don't have any movement in it yet. My eyelid, I can't blink yet. But I'm getting sensation now," he added.
Until now, doctors have only been able to transplant the cornea, the clear front layer of the eye.
Read more:
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Drug that could prevent breast cancer to be offered to nearly 300,000 women
Initially, doctors were just planning to include the eyeball as part of the face transplant for cosmetic reasons, Dr Rodriguez said.
"If some form of vision restoration occurred, it would be wonderful, but... the goal was for us to perform the technical operation," Dr Rodriquez said, adding they aimed to have the eyeball survive.
"At this point, I think we're pretty happy with the result that we were able to achieve with a very technically demanding operation."
Mr James's eye will continue to be monitored, but right now it is not communicating with the brain through the optic nerve.
To encourage connection between the donor and recipient optic nerves, surgeons harvested adult stem cells and injected them into the optic nerve during the transplant, hoping they would replace damaged cells.
Transplantation of a viable eye opens many new possibilities, Dr Rodriguez said, even if sight is not restored in this case.
Other research teams are developing ways to connect nerve networks in the brain to sightless eyes through insertion of electrodes, for example, to allow vision, he said.
"If we can work with other scientists that are working on other methods of restoring vision or restoring images to the visual cortex, I think we're one step closer," he added.
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Medical Innovations
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A four-day junior doctors' strike across England is expected to be the most disruptive in the NHS's history.
British Medical Association (BMA) members in planned and emergency care will walk out at 07:00 BST on Tuesday.
More than a quarter of million of appointments and operations could be cancelled, and some hospitals say up to half of planned treatment is affected.
The NHS's national medical director said it will be "the most disruptive industrial action in NHS history".
Prof Sir Stephen Powis said health leaders were concerned about the potential impact on patients and services, and cancer patients are among those whose treatment will be delayed.
Mental health services and some GP surgeries are also expected to be impacted, while the NHS said it will prioritise keeping critical care, maternity, neonatal care, and trauma operations running.
Between 250,000 and 350,000 appointments and operations could be cancelled, according to estimates from senior NHS figures.
An estimated 86,000 staff will strike, but the timing is as important as its scale - it immediately follows the bank holiday Easter weekend, a period when the NHS already faces increased demand and greater staff absence.
The British Medical Association (BMA) said there were plans to pull doctors off picket lines if lives were in immediate danger.
Under trade union laws, life-and-limb cover must be provided.
The junior doctors' approach contrasts with recent strikes by nurses and ambulance workers, which saw unions agree to exempt certain emergency services.
The patients left in limbo
Dr Paul Turnbull, 61, from Hampshire, who is an occupational health doctor, needs a prosthetic femur bone implanted in his leg.
His operation has been cancelled twice - once in December, because he developed deep vein thrombosis, and the second time because of the first junior doctors' strike. The operation is now due to take place on 18 April, after the four-day strike.
He has limited mobility and is unable to work.
"As a doctor, I don't believe doctors should strike. I think our first responsibility is to our patients and I think using patients as pawns in a dispute with the government is not something we should be doing."
Neuroscientist Dr Camilla Hill, 42, from Nottingham, has also been affected. She has had two knee operations cancelled because of the junior doctors' strikes - one this week and one back in March. She now has a third date scheduled for 25 April.
She has been unable to do some of her favourite hobbies, which include hiking and sailing, in part because of the pain in her knees.
"I feel really frustrated. It's messed me about, it's messed about my employer, it's messed about my husband - and it's messed about his employer as well. It's not just the patient whose operation is cancelled that's impacted, it's everybody around them."
Junior doctors are demanding a 35% increase in pay, to compensate for 15 years of below-inflation wage increases.
But the government has said the pay demand is unrealistic, pointing to the deal other health unions have recommended to their members - which includes a 5% pay rise and one-off payment of at least £1,655.
During last month's three-day walkout by junior doctors, more than 175,000 treatments and appointments were cancelled.
Hospital bosses have said the impending walkout has been even more difficult to manage, since it lasts 24 hours longer and comes after the four-day Easter weekend.
More than 40% of the medical workforce are classed as junior doctors, with two-thirds of them members of the BMA.
The NHS has said patients who have had appointments affected will be told beforehand. Those needing emergency care are being advised to seek treatment as normal, but less urgent cases should use the 111 service.
'Stretched to our limits' - junior doctors
Rabiat is in her third year of junior training, working in a hospital in the south east of England.
She is planning on striking this week, saying it is as much about safety as it is pay.
"It's quite a common thing that junior doctors are left alone with wards of patients to look after, with their seniors having gone down to A&E or an acute assessment area, for example.
"We feel really left out and unsupported. Not because our seniors don't want to support us, but because we are all stretched to our limits.
"I really hope that the strikes will make the government realise that this is really having a big impact on junior doctors - and the whole of the NHS - and more actually needs to be done.
"We don't feel as though we are being listened to."
Matthew Taylor, chief executive of the NHS Confederation, which represents service providers, said it was "depressing that there seems to be no movement at all from the two sides of this dispute" and called for the conciliation service Acas to oversee talks.
He told the BBC the strike's impact will be "enormous", adding: "Those services are stretched and there's no question there will be a risk to patient safety, there will be a risk to patient dignity because we're unable to provide the kind of care we want."
Miriam Deakin, director of policy and strategy at NHS Providers, which represents hospital trusts, told the BBC that health leaders were "deeply worried" about the impact on patient care and safety.
She told BBC Radio 4's World At One there would be "extreme pressure on critical life-preserving services", and called for both sides to "step back from the brink".
The BMA has accused the government of refusing to negotiate, and union leaders have said they are ready to cancel the strike if an improved pay offer is made, signalling it could accept a smaller rise.
The organisation's co-chair, Dr Vivek Trevedi, told the BBC striking doctors would return to work in the event of a major incident, but said the government had not formally requested an agreed list of circumstances in which the action would be paused.
The Department of Health and Social Care (DHSC) declined to comment on the call for Acas to intervene, but said it was working with NHS England to put in place contingency plans to protect patient safety.
Additional reporting by Sean Seddon.
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Health Policy
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Anyone in the U.K. who has tried to book an NHS medical appointment of late will know just how much of an ordeal it can be, with median waiting times for consultant-led elective care (i.e. pre-planned clinical treatment) currently sitting at around 14.6 weeks in England. This has led to a spike in people turning to the private medical sector, a trend some argue heralds the start of a two-tier healthcare system where those with financial means effectively pay to fast-track their treatment.
One such company is Scan.com, a London-based medical imaging startup that connects patients with scanning centers, covering MRI, ultrasound, CT, and X-ray. The company today announced it has raised $12 million in a Series A round of funding, as it looks to build on its recent U.S. launch.
Waiting times
The problem, according to Scan.com, is that even if a patient is able to book a doctor’s appointment in the first place (a procedure that is becoming increasingly difficult in itself in the U.K.), the subsequent referral process to get an appropriate scan can take several months, after which they may have to wait even longer to receive the results.
Scan.com has partnered with hundreds of scanning centers to enable individuals to access medical imaging services with or without a GP’s referral, with user-friendly reports replete with clickable diagrams delivered within a week.
To use Scan.com’s online referral system, users pay up-front to secure their scan, and then they are booked in for a virtual consultation with a clinician within 48 hours.
Prices vary based on a number of factors such as location and the type of scan required, but rough ball-park figures run anywhere from £180 to £395 or more, and includes the consultation, the scan, and all the follow-on reports.
If a scan identifies a serious problem, the patient enters Scan.com’s “urgent findings pathway,” where a clinical team contacts the patient and their doctor to explain the results and offer guidance on what to do next.
But the ability to bypass a GP (general practitioner) and self-refer for a medical scan surely could lead to all manner of time-wasting endeavors — what if a patient doesn’t actually need a scan?
“Our clinical team offers consultations and guidance to all patients once they’ve booked, which is a core part of the service we offer,” Scan.com CEO Charlie Bullock explained to TechCrunch. “Their time is included in our scan pricing, which is why we take payment at the point of booking. During the consultation, the clinician can amend the scan type, add or amend body parts, and ensure the scan is both safe and medically justified for the patient’s needs.”
Bullock added that if the clinician determines that there is no justification for the scan, Scan.com refunds the full cost and provides guidance on what the patient should do next. “This happens in around 3% of cases,” Bullock said.
But most patients who are at the stage of thinking about scans are likely to have had some medical assessments already that suggest some a scan might be needed to get to the root of their problems, and a large chunk of the target user-base are simply looking to circumvent the lengthy waiting times currently encumbering the NHS.
“Patients may choose to self-refer for imaging for a variety of reasons, but one of the core factors is speed,” Bullock said. “Some patients may have already seen a GP, physiotherapist, or other healthcare provider, but have reached a bottleneck in their healthcare pathway due to long waiting times. They may know what scan they need, and in many cases have been informed of the waiting time, and they choose to come to us to access the next steps faster.”
In truth, there are numerous scenarios that may require a service such as that provided by Scan.com. Some people might have general concerns and want a preventative screening without taking up the time of a primary healthcare provider, and Scan.com offers full-body MRI scans for such cases.
“Family history or lifestyle factors that could lead to disease can be investigated and checked in this way,” Bullock said.
Also, more than 10,000 women under the age of 50 are diagnosed with breast cancer in the U.K. each year, while the country’s national screening program only starts from the age of 50. As such, Scan.com is gearing up to launch early mammogram screenings later this year targeting women under the age of 50 specifically.
“We aim to fill that gap to speed up access to treatment,” Bullock added.
The story so far
Scan.com was founded some five years ago by clinicians Khalid Latief and Jasper Nissim who had grown exasperated by “inefficiencies” in organizing diagnostics for their patients. Launching initially as a side-project, the duo brought on board CEO Charlie Bullock, COO Oliver Knight, and front-end designer Joe Daniels as co-founders in 2019, bootstrapping their way through to 2021 before going full-time and raising some £4.2 million ($5.2 million) in seed funding from investors including Monzo co-founder Tom Blomfield.
Today, Scan.com claims around 30 employees across the U.K. and U.S., having launched its product Stateside two months ago.
“We ramped up to $1 million in annualised revenue in the first five weeks in the U.S. following this launch,” Bullock said.
So far, Scan.com has been piloting its service in Georgia, and the company is looking to expand to five more states to “cement ourselves as the leading diagnostic imaging platform in the U.S.,” Bullock said. “We also know there is significant opportunity within Europe, but with language barriers and more varied healthcare systems, our focus is the U.S. and U.K. for the time being.”
With another $12 million in the bank, Scan.com is well-financed to continue its U.S. expansion and also extend its service offering to include the likes of DEXA scans, echocardiograms, and the aforementioned mammograms, while also pursuing enterprise contracts across digital health providers, employee benefit platforms, among other industry organizations.
“Medical imaging covers such a variety of modalities that our focus is to launch as many of these as we can,” Bullock said. “Alongside scans, we also want to design pathways to add value for our patients, such as guided injections for pain relief, or adding in-vitro testing and pathology solutions to our preventative screenings to make them more comprehensive.”
Scan.com’s Series A round was co-led by Oxford Capital, Aviva Ventures, YZR Capital, Triple Point Ventures and Simplyhealth Ventures, with participation from Forefront Venture Partners.
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Medical Innovations
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The number of people in Scotland whose death was caused by alcohol has risen again to the highest level in 14 years.
The latest figures from National Records of Scotland (NRS) show 1,276 people died from conditions caused by alcohol in 2022.
This was 31 (2%) more than the previous year, which was the highest number since 2008.
Male deaths - which were unchanged at 836 - again accounted for about two thirds of alcohol-specific deaths.
Female deaths increased by 31 to 440.
Daniel Burns, head of vital events statistics at NRS, said: "Looking at the long-term trend the number of deaths from alcohol-specific causes fell between 2006 and 2012 but has risen since and is now about the same as 2010 levels.
"In 2022, the average age at death for females from an alcohol-specific cause was 58.7 years and for males it was 60.0 years."
The rate of mortality from alcohol-specific causes was 22.9 deaths per 100,000 people in 2022, up from 22.3 the previous year. NRS said it did not consider the rise to be "statistically significant".
The alcohol death rate was 4.3 times higher in Scotland's most deprived areas than it was in the least deprived, though NRS said the "equality gap" has narrowed.
In comparison, there were 1.8 times more deaths of any cause in the most deprived areas than in the least deprived.
Alcohol-specific deaths were also higher than drug deaths in 2022, after figures released last week showed the number of drug deaths in Scotland had gone down for the first time in five years.
The NHS Greater Glasgow and Clyde health board area - the largest in the country - recorded the highest number of deaths with 326, followed by NHS Lanarkshire with 200 and NHS Lothian - which includes Edinburgh - with 153.
The majority of deaths logged alcoholic liver disease as an underlying cause of death - 778 in total.
Drugs and Alcohol Policy Minister Elena Whitham said more work is required to reduce alcohol-related harm.
"Every life lost is a tragedy and my sympathy goes to all those affected by the loss of a loved one through alcohol," she said.
"While we will need to better understand the reasons for this increase in deaths, I will do all I can to reduce alcohol-related harm.
"We will continue to work closely with Alcohol and Drug Partnerships (ADPs) and the third sector to address this public health priority, backed by substantial investment."
Scotland became the first country in the world to introduce minimum unit pricing (MUP) for alcohol, initially set at 50p, in May 2018.
A Scottish government-funded study published in March suggested the scheme's introduction in Scotland had led to fewer alcohol-related deaths and hospital admissions compared to England.
A Public Health Scotland evaluation published in June said MUP "had a positive impact on health outcomes, including addressing alcohol-related health inequalities" but warned it had a limited impact on the most harmful drinkers.
Minimum pricing
Alcohol Focus Scotland said the third consecutive increase in alcohol-related deaths was "completely unacceptable".
The organisation's deputy chief executive Laura Mahon said the death toll would be higher without the MUP, but she called for it to be increased to 65p "to help save many more lives".
She added: "The Scottish government must deliver on the commitments made in the 2018 alcohol strategy.
"This includes a strong focus on preventing people from developing alcohol problems in the first place alongside urgent action to combat the 40% reduction in access to specialist alcohol services over the last decade."
The call for MUP to be increased was echoed by the Scottish Health Action on Alcohol Problems.
Chairman Dr Alastair MacGilchrist said the government "must address the wider availability and marketing of alcohol, in order to tackle the inescapable exposure to alcohol experienced by children and other vulnerable groups, such as people in recovery".
Scottish Conservative health spokesperson Sandesh Gulhane said MUP was "simply not working", adding: "It is increasingly proving to be a blunt instrument to tackle a complex problem."
Scottish Labour said the effect on the country's most deprived communities was "a national scandal".
Public health spokesperson Carol Mochan said: "The SNP's failure on public health is costing lives and devastating the poorest communities - we urgently need a comprehensive plan to support treatment services and ensure those struggling with alcohol can get the help they need."
Scottish Liberal Democrat leader Alex Cole-Hamilton accused ministers of cutting funding to drug and alcohol partnerships.
"The Scottish government have been asleep at the wheel," he said.
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Epidemics & Outbreaks
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Visualizing fungal infections deep in living host tissue reveals proline metabolism facilitates virulence
An international team of scientists, led by researchers from the Department of Molecular Biosciences, The Wenner-Gren Institute, SciLifeLab, Stockholm University has published in PLoS Pathogens the first successful application of two-photon intravital microscopy (IVM) to image the dynamics of fungal infections in the kidney of a living host. The study reveals that the opportunistic human fungal pathogen Candida albicans requires the ability to metabolize proline, an amino acid obtained from the host, to mount virulent infections.
Candida albicans has recently been listed as one of four "critical priority" fungal pathogens by the World Health Organization (WHO). A defining feature of C. albicans is that it is a commensal organism that thrives in symbiosis along with other components of the human microflora, and is normally well-tolerated. However, when humans experience health challenges that negatively affect the immune system, C. albicans can cause bloodstream infections that are lethal unless aggressively treated.
During infection, C. albicans cells are known to switch morphologies from ovoid yeast-like to elongated filamentous hyphal cells, a process linked to the capacity of this fungi to grow as a pathogen. Although proline has long been known to trigger hyphal growth, it has been recently discovered that C. albicans can use proline as a main source of energy. Proline breakdown takes place in the mitochondria, the powerhouse of the cell.
The investigating team now reports that proline is an important source of energy in other pathogenic Candida species, including the multidrug resistant C. auris, an emerging health threat and also a WHO critical priority fungal pathogen. The lead author of this study, Dr. Fitz Gerald S. Silao, explains, "In fungal cells possessing mitochondria equipped with a full complement of energy conserving respiratory complexes, the catabolism of proline generates almost as much chemical energy (ATP) as does the catabolism of the energy-rich sugar glucose."
The collaborating groups provided access to a multitude of infection models, including artificial skin, co-culture with immune cells, survival in whole human blood and two model host systems. The results consistently showed that strains unable to metabolize proline exhibit significantly reduced virulence properties and a clearly diminished capacity to undergo morphological transitions. These observations provide novel insights implicating proline metabolism as a key determinant of pathogenic fungal growth.
Proline, one of the 20 naturally occurring amino acids in the body, is enriched in extracellular matrix proteins such as collagen, and as such is readily available when connective tissue is broken down at sites of infection, or when a host becomes vulnerable as a result of cancerous growth or upon the onset of sarcopenia. Strikingly, genetic dissection of the Proline UTilization (PUT) pathway and of the control mechanisms governing proline use led to the discovery that proline is toxic to cells unable to catabolize it. This latter finding was unexpected, and further work is needed to solve the mystery and underlying mechanism of its toxicity.
The kidney is the primary organ affected during bloodstream infections by C. albicans, and it is imperative to understand why. To obtain answers, the team initially applied a mouse model of infection, which remains invaluable for this kind of work, and found that C. albicans cells lacking the capacity to utilize proline were less invasive and virulent. Notably, mice infected with fungal cells unable to catabolize proline, e.g., cells lacking the Put2 enzyme (1-pyrroline-5-carboxylate (P5C) dehydrogenase), showed milder illness or no symptoms at all.
Next, state-of-the-art 2-photon intravital microscopy (IVM) was used to visualize, in real-time, the invasion of C. albicans cells deep in the cortex of the kidneys inside a living host. In contrast to native wild-type cells, the Put2-deficient cells (put2-/-) failed to form hyphae in kidneys. It should be recognized that imaging the initial stages of an ongoing infection is very challenging due to many factors, such as the small size and scarcity of the fungal cells and the continuous motions associated with vital and life-sustaining processes in living hosts.
"The utilization of engineered reporter strains and differential staining techniques enabled us to swiftly spot fungal outgrowth deep in the tissue. IVM is really a game-changer as it allows the imaging of a dynamic process in organs in their intact physiological context and at depths unachievable with conventional fluorescence or confocal microscopy," says Dr. Christiane Peuckert, Head of the IntraVital Microscopy Facility-Stockholm University (IVMSU) and co-corresponding author of the paper.
As the senior author of this study Professor Per O. Ljungdahl explains, "The kidney is a major hub for proline metabolism, which makes our data congruent to known processes linked to kidney function and make this work even more interesting. Our future research will focus on creating sets of reporter strains to directly assess and visualize proline utilization in the kidney. We will also extend the application of IVM to other Candida species to determine whether a tailored proline metabolic network tuned to the mammalian host environment is a common and key feature of important opportunistic human fungal pathogens that are of growing concern to human health."
More information: Fitz Gerald S. Silao et al, Proline catabolism is a key factor facilitating Candida albicans pathogenicity, PLoS Pathogens (2023). DOI: 10.1371/journal.ppat.1011677
Journal information: PLoS Pathogens
Provided by Stockholm University
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Disease Research
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A coroner has found neglect contributed to a baby's death at the hospital where he was born.
Jasper Brooks died at the Darent Valley Hospital in Kent on 15 April 2021.
The coroner found gross failures by midwives and consultants at the hospital and says Jasper's death was "wholly avoidable".
The Dartford and Gravesham NHS Trust says: "We are committed to learning from our mistakes to ensure no family has to go through this again."
It added: "We are very sorry for the devastating impact this has had on the Brooks family.
"We have already taken significant action to improve our practices and will commit to implementing the additional recommendation from the inquest."
Jasper was a second child for Jim and Phoebe Brooks. Their first, Oscar, had also been born at the Darent Valley Hospital.
On that occasion, the family had received good, prompt care after Phoebe had suffered a placental abruption - a serious condition in which the placenta starts to come away from the inside of the womb wall.
That complication was the reason Phoebe was booked in to have an elective Caesarean section to deliver Jasper. But in April 2021 those plans changed overnight.
A check-up found Phoebe had raised blood pressure. She was told to remain in hospital and that the C-section would happen the following morning - nine days earlier than planned - when there were more staff on duty.
Jasper's parents say the midwives caring for Phoebe repeatedly failed to listen to her and Jim's concerns - that she was shaking violently, feeling sick, and thought she was bleeding internally.
"We felt like an inconvenience - no-one wanted to deal with me that night," Phoebe says. "The doctor didn't want to do my C-section, the midwife that's meant to be looking after me, she just doesn't really care.
"I remember saying clearly to her, 'my whole body is shaking - something's happening, and no-one's taking the time to listen to what I'm saying or listen in on my baby'."
Phoebe went into labour naturally, before the C-section could take place.
At the inquest hearing, midwife Jennifer Davis was accused by the family's barrister, Richard Baker KC, of "failing to act on signs of blood loss, failing to determine if Phoebe was in active labour, and failing to call a senior doctor when necessary".
Ms Davis told the inquest that she had been traumatised by the case.
"I thought, on the night, I was giving the best care I could," she said. "Everything I did that night wasn't done with any intent to harm."
Prior to baby Jasper's birth, staff struggled to find the unborn baby's heartbeat and did not spot that Phoebe was about to deliver.
"His whole body was born all at once," Phoebe says, "I looked down and he was just so white. And then all of a sudden it was like, panic. One of the midwives picked up the baby and started rubbing him and was like, 'come on baby, come on baby'.
"Then I thought, 'he's going to cry, he's going to cry. Why is baby not crying?'"
Jasper was born without a heartbeat, so a resuscitation team was called. But during the inquest, the family learned that further errors were made because the correct people failed to attend the resuscitation.
There was no consultant neonatologist on site - a doctor with expertise in looking after newborn infants or those born prematurely. Intubation, the process of placing a breathing tube into the windpipe - which should only take a few minutes - did not occur for 18 minutes. There was also a delay in administering adrenaline to try to stimulate Jasper's heart.
Twenty-seven minutes after Jasper was born, and with a heartbeat still not evident, a consultant told Jim and Phoebe they were going to stop working on their son.
"We were just in complete shock, 'how has this happened?'," says Phoebe. "I reached out and touched him, and basically his heartbeat came in, and then, all of a sudden, they were like, 'we've got a heartbeat'.
"They went from calling time - they're going to end life, and end resuscitation - to he's got a normal heartbeat."
The newborn was taken away for tests, but shortly afterwards a doctor returned and told the family further treatment would be futile because Jasper was very ill.
The family asked if he could be moved to another hospital for more specialised care - the possibility of which had already been mentioned - but were now told there would be no point.
National guidelines state the decision to end care should be made by a multidisciplinary team comprising at least two consultants - not just a single doctor, the family later learned.
"We did not agree with the plan they made," says Phoebe. "We asked if there's any other options, and we were told, 'no. You're going to go into monkey room [bereavement suite] and Jasper's going to die'.
"I remember holding him, uncontrollably crying, and just trying to treasure that moment with our son while we're waiting for him to die. But he kept taking another breath and another breath."
The longer Jasper lived, the more his parents were keen further treatment be offered. They were finally given permission to feed him when Jasper was 12 hours old.
Rather than dying within minutes, as his parents had been told he would, Jasper died on 15 April 2021, having lived for 23 hours.
"It was a complete shambles," says Jim, a director at a construction company. "He lived for a day," adds Phoebe, who works as a personal assistant.
"We wanted a lifetime with him, which was taken away from us because of how that hospital treated me in labour and how they treated him."
Inquiries into poor maternity care have already been held in Morecambe Bay, Shrewsbury and Telford, and East Kent, with a review ongoing in Nottingham.
But such are the concerns about care in many other units that some campaigners now argue that a national inquiry is needed, not reviews into individual trusts.
Rhiannon Davies lost her daughter at the Shrewsbury and Telford Hospital Trust in 2009. Her complaints led to the Ockenden report on safety and standards - the largest inquiry of its kind in the history of the NHS.
"We still hear of the same mistakes being made - and often, they are basic errors, but they are catastrophic in terms of their impact," Ms Davies, who has written to the health secretary asking for a wider inquiry, says.
"It's fair to say what we've tried so far hasn't worked. Neither has increased investment and greater public awareness of maternity risk. We need a national inquiry resulting in national measures that can properly protect people from avoidable harm and death."
Since Jasper's death, Phoebe and Jim have had a daughter, Primrose, a sister for Oscar.
But when asked, they say they have three children, not two.
"He will always be part of the family," says Jim.
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Women’s Health
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Nationwide lockdowns in the UK during the pandemic were a “failure” of public health policy as they were not considered a last resort, an epidemiology expert has said.
Giving evidence at the Covid-19 public inquiry on Monday, Prof Mark Woolhouse of the University of Edinburgh – a member of the Scientific Pandemic Influenza Group on Modelling (SPI-M-O) – said the group failed to adequately assess the negative consequences of a nationwide lockdown.
“The harms of the social distancing measures – particularly lockdown, the economic harms, the educational harms, the harms to access to healthcare, the harms to societal wellbeing … just the way we all function … mental health – were not included in any of the work that SPI-M-O did and, as far as I could tell, no one else was doing it either,” Woolhouse told the inquiry.
“I take the view that it would have been very helpful if the government said explicitly: ‘We don’t want to go into lockdown. What’s your advice? How can we both minimise the health burden and stay out of lockdown?’ And we could have given a lot of advice and all the other things you could do other than lockdown.
“The question of how to avoid lockdown was never asked of us and I find that extraordinary.”
Woolhouse, who specialises in infectious diseases and epidemiology, also criticised the phrase “going early, going hard”, used by the UK’s then chief scientific adviser, Sir Patrick Vallance, in regard to the rapid implementation of a strict lockdown, claiming that in the circumstances of the coronavirus pandemic it would not have been effective, as completely eradicating the virus was not an option at that time.
He added: “I remember Patrick [Vallance] and others repeated it several times: ‘Go hard, go early and go wider than you would have.’ Now that, for me, is a good maxim in a particular situation where your strategic objective is to eradicate the virus – you’re going to try and clear it out completely. That’s what was done with Sars in 2003.
“I did not think from very early on that eradicating the virus was even the remotest possibility. In which case this ‘go hard, go early, go wide’ is going to mean severe restrictions,” Woolhouse said. “I was always interested from early on in trying to find a sustainable intervention and so my maxim is, ‘If you go early, you don’t have to go so hard.’”
Although Woolhouse told the inquiry that he supported lockdown at the time, with hindsight he questioned whether the measures were entirely necessary, before adding that lockdown was “a failure of public health policy”.
He added: “I think it’s fair to describe lockdown not as a public health policy, but as a failure of public health policy. [Lockdown] is what you do when all those other things you know you can do haven’t worked, it’s a last resort and it should always be that in my view.”
The inquiry continues.
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Health Policy
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NEW YORK (AP) — The patients’ eyes were painfully inflamed. They could sense light but could see almost nothing else. A doctor called one case the worst eye infection he’d ever seen.
It was the beginning of a national outbreak caused by an extremely worrisome bacteria — one that some say heralds an era in which antibiotics no longer work and seemingly routine infections get horribly out of hand.
At last count, 58 Americans in 13 states have been infected, including at least one who died and at least five who suffered permanent vision loss. All have been linked to tainted eyedrops, leading to a recall.
READ MORE: This researcher builds ‘cool stuff for blind people.’ He’s also trying to help transform society
Experts marvel at how disease detectives pieced together the case: Patients were scattered across the country. The illnesses occurred over the span of months. The infections were found in different parts of the body — in the blood of some patients, in the lungs of others.
But scientists also shudder, because they have long worried common bacteria will evolve so that antibiotics no longer work against them.
“This really shows us that it’s not something theoretical and in the future. It’s here,” said Dr. Luis Ostrosky, an infectious diseases expert at the University of Texas Health Science Center at Houston.
This account is drawn from phone and email interviews with U.S. disease investigators, health officials in three states and regulators in the U.S. and India.
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The investigation started in May in Los Angeles County, California. A patient who’d recently been to an ophthalmologist came in with a bad eye infection. A month later, local health officials got a second report. Another bad eye infection, same eye doctor.
Two more cases were reported in the county before the summer was over. The patients’ eyes were inflamed with heavy yellow pus that obscured most of the pupil. Among the four, two had complete vision loss in the affected eye.
The hospital that reported the first infection determined it was caused by a bacteria called Pseudomonas aeruginosa. The institution, which was equipped to do advanced genetic testing, quickly realized the bacteria had a rare gene that protected it from the effects of commonly used antibiotics.
It was an early break for investigators, said Kelsey OYong, of the Los Angeles County Department of Public Health.
OYong and her colleagues knew they were dealing with a scary germ, and they notified the Centers for Disease Control and Prevention.
Pseudomonas infections are not new. Drug-resistant strains of the bacteria cause more than 30,000 infections annually among hospitalized patients in the U.S. and more than 2,500 deaths, the CDC said. It can spread through contaminated hands or medical equipment, and is particularly dangerous to fragile patients who have catheters or are on breathing machines.
But the California infections were in patients’ eyes, not more common spots like the blood and lungs. Also, the lab analysis determined the infections were caused by a Pseudomonas germ that could resist just about every antibiotic.
The only thing that worked was a newer antibiotic called cefiderocol, administered by IV.
Over the summer, Pseudomonas outbreaks were seen at long-term care facilities in two other states.
In Connecticut, the first case was in June. Eventually, the bacteria was found in 25 patients from five nursing homes in different parts of the state, said Christopher Boyle, a spokesperson for Connecticut’s health department.
In Davis County, Utah, north of Salt Lake City, the first of six cases was reported to the CDC in August. While the patients had the bacteria, none actually got sick, said Sarah Willardson of the Davis County Health Department.
L.A. County health investigators thought the cases there might be due to some kind of equipment contamination at the eye doctor’s office.
But that suspicion faded in early October, when genetic testing showed the clusters in California, Connecticut and Utah were all caused by the same bacteria strain — a version of the germ that hadn’t been seen anywhere before.
“That made us start thinking that this was some kind of a product,” said Maroya Walters, the CDC official supervising the investigation.
As the year went on, other reports of drug-resistant Pseudomonas came in, including a Washington man who died with a bloodstream infection.
Given the initial cluster at the California ophthalmologist’s office, investigators suspected an eye care product was the culprit, though that hypothesis was complicated by the fact that the infections at the long-term care facilities were mainly found in the lungs.
But it wasn’t impossible. Tear ducts drain into the nasal cavity, which leads to the lungs and could provide a path to deep inside the body.
In early November, investigators determined most of the infected Connecticut patients had been given artificial tears, though it wasn’t clear who had been given which brand.
Then, on Nov. 9, a Florida hospital contacted the CDC to report bad eye infections connected to an outpatient clinic. A check of artificial tears brands used in Connecticut, Florida and Utah pointed to one common product: EzriCare Artificial Tears, an over-the-counter product marketed in the U.S. by New Jersey-based EzriCare LLC and made in India by Global Pharma Healthcare.
The Pseudomonas bacteria is “pretty much everywhere” in India and the drug-resistant germ is common in many hospitals, said Dr. Gagandeep Kang, who studies microbes in the Christian Medical College in the same state as Global Pharma’s factory.
In January, genetic sequencing confirmed the Florida cases were caused by the same bacteria strain as the clusters in California, Connecticut and Utah. On Jan. 20, the CDC urged doctors to avoid recommending the EzriCare product.
There was no recall or widespread public notice, however. Investigators had strong circumstantial evidence pointing toward the EzriCare drops, but didn’t get more conclusive proof until more than a week later after testing found the bacteria in seven open bottles of EzriCare Artificial Tears in Connecticut and New Jersey.
In early February, CDC officials issued a public health alert and the FDA recalled the EzriCare eyedrops and Delsam Pharma’s Artificial Tears, another product made by Global Pharma. Last week, the recall was expanded to include Delsam Pharma’s Artificial Eye Ointment.
Global Pharma didn’t respond to emailed requests for comment.
A month before the first recall, the FDA blocked imports of Global Pharma products.
FDA spokesperson Audra Harrison said the U.S. import ban was “unrelated to the outbreak,” and was instead based on the company’s “inadequate response” to a records request and problems with its manufacturing procedures. She wouldn’t say what those problems were.
The subsequent recall, she said, was recommended due to lack of microbial testing and issues with the product’s formulation and packaging.
The FDA, tasked with assuring the safety of drug products shipped to the U.S., has long struggled to inspect facilities in China and India that account for the vast majority of raw materials used in American medicines. A search of FDA’s online inspection database shows no records of agency staff visiting the plant.
Indian drug inspectors visited the plant and the country’s drug controller asked Global Pharma to stop making all products related to treating eye disorders until they finish their investigation, said P.V. Vijayalakshmi, the drug controller for southern Tamil Nadu state.
Ostrosky, the University of Texas expert, called the U.S. investigation “a public health victory” saying it shows that fighting drug-resistant bacteria requires international collaboration and investment. But he also said the case is disheartening.
An infection that’s usually easy to treat with common antibiotic eyedrops “has become an infection that can be deadly and has pretty much no treatment except one IV antibiotic,” he said.
Pseudomonas now joins a growing list of bugs — including bacteria that cause urinary tract infections — that are getting increasingly difficult to treat, Ostrosky added.
“It’s like a wave coming for us,” he said.
AP writers Matthew Perrone in Washington and Aniruddha Ghosal in New Delhi contributed.
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Epidemics & Outbreaks
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Britain is suffering the worst flu season for a decade with pressures on A&E leading to hundreds of deaths, new figures have revealed.Flu admissions stood at 8.3 per 100,000 people in the week to January 1, down from 14.8 the previous week which was the highest level in at least a decade, according to the UK Health Security Agency (UKHSA).Despite the drop, the rate is still running above any point in the previous four winters, with hospital admissions 50 per cent higher in the week before Christmas than in 2017-18.Admissions continue to be highest among the oldest age groups, at 61.8 per 100,000 for people 85 and over and 31.8 for 75-84 year-olds. The graph shows the weekly hospital admissions per 100,000 people for Covid (red) and flu (blue). UK Health Security Agency surveillance figures showed Covid admissions feel from 12 to 11 per 100,000 people, while admissions fell to 8 per 100,000 in the week to January 1 NHS data shows 995 people, on average, infected with Covid were admitted to hospitals across England in the week to January 2. The figures suggest that the number of people seeking NHS care due to the virus, on average, peaked on December 23 (1,154) and has been trending downwards since The flu-nami has swept across the NHS in England, the latest round of health service data shows, with over 3,800 admissions for the virus on December 23. Graph shows the number of beds on wards taken up by those with flu (red) and the number of beds occupied due to the virus in critical care (blue) NHS England data today showed that an average of 63,000 staff were off work every day in the week to Christmas (red line). Around 8,000 of the absences were due to Covid (blue line) Ambulance handover delays peaked on December 19 with more than 3,000 patients forced to wait over an hour in the back of an emergency vehicle, unable to be offloaded to a hospital bedThe country is on course for its deadliest season since the swine flu outbreak in 2010-11, according to The Times.The severe wave of flu has fuelled weekly deaths reaching the highest levels for almost two years, with an overall figure of 14,530 in the week to December 23.It comes as Covid hospital admissions have plateaued ahead of another expected wave fuelled by 'the Kraken' variant, figures suggest.NHS stats show virus pressures peaked in mid-December, when XBB-1.5 first started to be detected across Britain, and have been falling ever since. Flu admissions also plunged during the last week of 2022.Experts hope both drops are genuine, with ailing hospitals currently being battered by a 'twindemic' that has sparked calls for a return of pandemic-era restrictions like face masks and mass testing. But officials admit the downturn could be a blip caused by reporting delays over the Christmas period. The massive strain on the NHS, triggered by staff shortages and record levels of bed-blockers as well as Covid and flu, has led to a surge in excess deaths, analysts fear. Almost 15,000 people died in England and Wales in the week before Christmas when the pressures across the health service were described as being their most intense. Fatalities were around a fifth higher than typically seen at the time of year before the pandemic.The Royal College of Emergency Medicine (RCEM) warned the spike in deaths are 'undoubtedly' linked to record delays for urgent care.NHS data shows 995 people, on average, infected with Covid were admitted to hospitals across England in the week to January 2.The figures suggest that the number of people seeking NHS care due to the virus, on average, peaked on December 23 (1,154) and has been trending downwards since.The numbers include patients who aren't actually ill with the virus and incidentally tested positive. On top of this, weekly UK Health Security Agency (UKHSA) surveillance figures showed Covid admissions feel from 12 to 11 per 100,000 people.Rates for Covid admissions were highest among the elderly, at 131 per 100,000 for over-85s and 52 per 100,000 for those aged 75 to 84.Separate UKHSA data, also published today, suggest that influenza admissions have fallen drastically over the festive period.Hospitalisations for influenza soared to the highest level seen in a decade in the week before Christmas, with 15 admissions per 100,000 people. But admissions nearly halved in the week to January 1, hitting 8 per 100,000.Flu hospitalisations continue to be highest among the oldest age groups, at 62 per 100,000 for people aged 85 and over and 32 per 100,000 for 75- to 84-year-olds.Despite the drop, health chiefs warn that the rate is still running above any point in the previous four winters.And there can often be a slight reduction in recorded levels of hospital activity over the festive period, which this winter included the weekend of December 24 and 25 followed by bank holidays on both December 26 and 27.So the latest data might have been affected by some hospitals not returning a full set of figures, together with 'reporting delays and bank holidays over Christmas and New Year', the UKHSA said.But there may also have been a temporary reduction in the transmission of viruses due to 'reductions in social contact rates over the holiday', with fewer people travelling and many communal buildings closed, the agency said. Figures from the Sanger Institute, one of the UK's largest Covid surveillance centres, shows 4 per cent of cases in the week to December 17 were caused by XBB.1.5 (shown in purple, bottom right corner) December 17 marked the first time XBB.1.5 was listed on the institute's virus dashboard, which is updated weeklySteve Russell, the health service's director of vaccinations and screening, said the NHS had delivered almost 20million flu jabs to around four in five over-65s. It means 13million have not come forward for the vaccine. But flu admissions 'continue to be very high' so it 'remains vital' that anyone eligible — including pregnant women and children aged two and three — who have not had their flu jab book one as soon as possible.UKHSA chief executive Dame Jenny Harries said there had been a 'dramatic increase' in the number of flu admissions before Christmas, but they have started to fall in recent days.She said: 'I urge all those eligible to come forward for their free flu vaccination, which is the best way to protect yourself from serious illness.'Uptake of the flu vaccine is particularly low in children aged two and three, so if your child is eligible, please urgently take up the offer.'Covid also continues to circulate at high levels and anyone eligible for a booster who has yet to take it up should come forward.'Dame Jenny added: 'Try to stay home when unwell and if you do have to go out, wearing a face covering can help prevent germs spreading to other people. Don't visit vulnerable people if you're unwell.' In response to the surge in seasonal viruses and in a plea to reduce pressure on the NHS, health chiefs issued fresh calls for ill Britons to stay off work if they are unwell and wear a mask if they must go outside. Children who are sick and have a fever should stay home from school, UKHSA bosses said.Other gloomier experts have gone even further amid record pressures on the NHS an the emergence of Omicron sub-variant XBB.1.5, which has been labelled the most contagious strain yet by World Health Organization officials. Some scientists urged people to work from home where possible, reduce their social contacts and wear masks in crowded places, even if they are not ill. But a group of Tory MPs and scientists have dismissed these calls, however. They warned that the NHS's annual winter crisis can't be used as an 'excuse to reintroduce Covid-era restrictions'.
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Epidemics & Outbreaks
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When you were a teenager, your parents probably warned you once or twice not to get a tattoo or go to sketchy parties just because your friends do it. A new study shows that the influence of friends – for good and for well, mischief – extends into our older years, as well.
The study, published Wednesday in the journal Epidemiology and Psychiatric Sciences, found that friendships in older adults were associated with some instances of better physical health and health behaviors, as well as better mental health across the board.
The study authors analyzed surveys from nearly 13,000 over-50-year-olds who participated in the Health and Retirement Study, a nationally representative panel study. They looked at 35 different health and psychological outcomes, and how those were linked with the quality of the respondents' friendships.
While many previous studies have connected having good friends with particular health benefits, this is the largest and most comprehensive study done to date, according to study co-author William Chopik, an associate professor of psychology at Michigan State University.
"Friendships are often the first relationships of choice that we have in our lives," he said. Because of that, he says, he and his colleagues wanted to "tell everybody, everything we can about it."
Chopik and his coauthors found that those who had high-quality friendships actually lived longer. Study participants took the survey three times over eight years and those with the good friends were 24% less likely to die during that time.
Having good friends was also associated with a whole lot of positive health behaviors and benefits, like a 9% increase in likelihood to exercise, a 17% reduced risk of depression, and a 19% lower likelihood of having a stroke, among other findings.
If you're wondering if you have the kinds of friendships that can help you live longer, it might help to know that the authors defined high-quality friendships by analyzing three categories: number of friends, number of interactions with friends, and feeling supported and happy around your friends.
The dangers of loneliness have become more and more apparent in recent years as one in four older people now experience social isolation worldwide, which carries higher risks of stroke, anxiety, dementia, depression, suicide, and more, according to the World Health Organization.
"We need different people," says Rosemary Blieszner, a professor emerita of human development and family science at Virginia Tech who was not involved with the new study. "We need the emotional satisfaction of feeling close to people, and feeling like you belong to a group, and to have your self-worth reinforced, and to share interests with others."
Unlike co-workers, or family members, we get to choose our friends freely. Think of the stress you might feel looking forward to a big family gathering (even if you love them!) versus the relaxation and belly laughs you might share with a group of your closest buds at a birthday party or gabbing over coffee with your best friend from childhood.
But those peer pressure effects of friendship that your mom warned you about as a teenager? They appear to still exist in your later years, too. Those individuals in the study with the best friendships were also more likely to smoke and drink heavily.
"I will say it's not like they're smoking a pack a day," said Chopik. "When you look at older adults, they kind of mellow out in terms of how much they drink and how much they smoke. So it's really kind of a small difference, but we do find it."
Mysteriously, Chopik adds, even taking those negative health behaviors into consideration, the cohort still lived longer and were happier than those whose friendships weren't as strong. "It could be that they imbibe a little bit, but then they have all these positive things that counteract that and then they end up living longer," he says.
The results are consistent with a lot of other research that has demonstrated the importance of close relationships for health, says Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University who had no role in the study.
And, at the same time she says it's also been shown before that peers "can also influence riskier behaviors. Our relationships can be very powerful influences on our health ... for good or for bad."
Holt-Lunstad, who also serves as founding scientific chair and board member of the U.S. Foundation for Social Connection, says the comprehensive nature of the study goes to show how interconnected our health is with the people around us.
"A lot of things can cluster, like people who are more socially connected are more physically active, and they can also have more of a sense of meaning and purpose in their life. That can lead them to take better care of themselves and take less risk, because they have people who depend on them, or are encouraging them and looking out for them."
Still she adds, she hopes this doesn't encourage people to smoke or drink heavily just because they have friends.
The large scale of this study confirms the important role of friendships in health, says Blieszner: "You can generalize these results with great confidence to the population as a whole."
But she says to take the results about particular behaviors, like smoking and drinking, with a grain of salt. Though she says the study's research methods are sound, "that area does need further research."
She notes these kinds of individual behavioral questions are better answered with smaller studies that can track people's daily activities in real time, rather than asking people to remember their alcohol consumption over a long-term period.
Blieszner has seen, however, that negative health behaviors often cluster in certain communities, geographically, meaning that friends and other social connections can certainly influence negative behaviors as well as positive ones.
Chopik, the study co-author, noted that he hopes his future work at the Close Relationships Lab at Michigan State will dig deeper into these granular details about friendship, particularly how to best make and foster friends at all the various points in our lives.
"There's an under-appreciation of friendships historically, not just in the research literature, but also just in general society. There's often an exclusive focus on romantic relationships and marriages," he said.
But the nature of friendships seem like a potent public health opportunity. "The fact that you can make new friends and you can invest in friendships you have, and you can add as many friends as you want, and it can improve a lot of different parts of your life."
So don't skip your Friendsgiving get-together this year, and be sure to include a toast to your health!
Maggie Mertens is a freelance journalist in Seattle who writes about gender, culture, health, and sports.
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Mental Health Treatments
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are causing poor air quality in the northeastern U.S., posing a health danger to millions of people. Experts say the air is especially harmful for more vulnerable populations, including older people and those with lung or heart issues.
The best thing to do to protect yourself? Stay inside and take other precautionary steps to limit your exposure, experts say.
"The particulate matter that's in this haze is significant because it does irritate the bronchioles, or the small tubes that go down into your lungs and connect to the alveoli, which are the sacs that allow you to breathe," Dr. Bob Lahita, director of the Institute for Autoimmune and Rheumatic Disease at St. Joseph's Health, told CBS News. "That gets irritated in people without asthma, but if you have asthma, chronic obstructive pulmonary disease, congestive heart failure or anything that involves your lungs or even your heart, you should stay indoors."
While indoors, keep all windows and doors shut, according to AirNow, a government-run site on air quality data.
AirNow's guide on reducing smoke exposure also advises not to contribute to indoor air pollution either.
"Do not burn candles or use gas, propane, woodburning stoves, fireplaces or aerosol sprays," the guide reads. "Do not fry or broil meat, smoke tobacco products or vacuum. All of these can increase air pollution indoors."
Does wearing a mask help with air pollution? What types of masks are best?
If you need to be outside, experts advise wearing a mask.
N95 masks are the best option to reduce your exposure to pollutants, according to Lahita, but if you don't have those, surgical masks or even a scarf is better than nothing.
"Put a scarf over your nose and mouth so that the particulate matter does not go into your lungs," he says.
To avoid both large and small particles, the United States Environmental Protection Agency says dust masks aren't enough.
"Paper 'comfort' or 'dust' masks - the kinds you commonly can buy at the hardware store - are designed to trap large particles, such as sawdust," the EPA's website reads. "These masks generally will not protect your lungs from the fine particles in smoke."
Do air purifiers help with smoke?
Using a portable air cleaner can reduce indoor air pollution, according to AirNow.
"Make sure it is sized for the room and that it does not make ozone, which is a harmful air pollutant," the orginzation advises.
Dr. David Hill, a pulmonologist in Waterbury, Connecticut, and a member of the American Lung Association's National Board of Directors, told the Associated Press that people, especially those with underlying lung or heart disease, "should consider investing in in air purifiers for their homes."
Do air conditioners bring in unhealthy outside air?
If you have filters on your home HVAC system, Hill suggests making sure they're up to date and high quality.
Hill also recommends running the air conditioning on a recirculation setting to prevent any outside air coming in.
You can also recirculate the air in your car if you need to drive anywhere.
"Reduce smoke in your vehicle by closing the windows and vents and running the air conditioner in recirculate mode," AirNow's guide says.
But experts say to use common sense and keep any eye on air quality data for your area to avoid leaving your home in particularly polluted times.
"Take it easier during smoky times to reduce how much smoke you inhale. If it looks or smells smoky outside, avoid strenuous activities such as mowing the lawn or going for a run," the guide adds. "Smoke levels can change a lot during the day, so wait until air quality is better before you are active outdoors."
Vladimir Duthiers, Anne-Marie Green and The Associated Press contributed to this report.
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Epidemics & Outbreaks
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Fungal infections are becoming more common in the United States, but unlike illnesses caused by bacteria or viruses, there’s no vaccine to protect against a fungal threat.
While scientists aren’t worried that a fungal infection like the one seen in HBO’s “The Last of Us” will wipe out humanity, the infections are certainly a cause for concern.
Fungi cause a wide range of illnesses in people, from irritating athlete's foot to life-threatening bloodstream infections.
In the U.S., fungal infections are responsible for more than 75,000 hospitalizations and nearly 9 million outpatient visits each year, according to the Centers for Disease Control and Prevention. In 2021, around 7,200 people died from fungal diseases. These numbers, the CDC said, are likely an underestimate.
One type of fungus, Candida auris, can be resistant to all of the drugs used to treat it, and is particularly dangerous for hospitalized and nursing home patients. The fungus was first identified in Japan in 2009 and has since been found in over 30 countries, including the U.S., the CDC said.
Climate change also threatens to make several infection-causing fungi more widespread: The fungus that causes Valley fever thrives in hot, dry soil, and the fungus that causes an illness called histoplasmosis prefers high humidity.
Despite the growing threat, there are currently no licensed vaccines — in the U.S. or abroad — to prevent fungal infections.
"These are the most important infectious diseases that you have not heard of," said Karen Norris, an immunologist and vaccine expert at the University of Georgia. "A vaccine has the potential to move forward and protect a large swath of individuals."
Fatal fungal infections
Norris said that the ultimate goal would be to develop a single vaccine that protects against all fungal infections.
But a "pan-fungal" vaccine is incredibly challenging to make.
That’s because, she said, unlike the Covid vaccines, which target a single pathogen — the SARS-CoV-2 virus — a fungal vaccine would ideally protect against the wide spectrum of fungi in existence, each biologically different from the next.
For now, Norris and her team have decided to focus on the three fungi responsible for the vast majority of fatal fungal infections in the U.S.:
- Aspergillus, a common mold that can cause an infection in the lungs and sinuses that can later spread to other parts of the body.
- Candida, particularly Candida auris, a type of yeast that can cause serious blood infections, particularly in people in health care settings.
- Pneumocystis, which can cause pneumonia.
In preclinical trials, the experimental vaccine developed by Norris and her team was shown to generate antifungal antibodies in animals, including rhesus macaques. With funding support, the researchers could start and finish the human vaccine trials within the next five years, she said.
In Arizona, researchers are focused on a vaccine to prevent Valley fever, a lung infection caused by the fungus Coccidioides. The fungus, typically found in the hot, dry soils of the Southwest, is an "emerging threat," Norris said, because climate change is expanding its range.
So far, the vaccine has been shown to be effective in dogs, said John Galgiani, the director of the Valley Fever Center for Excellence at the University of Arizona College of Medicine.
Little urgency, lack of funding
While experts know which fungi are best to target, vaccine development has been slow, mostly due to a lack of funding, said Galgiani, who is working to start a trial in humans for the Valley fever vaccine.
Many in public and private spaces don’t see fungal vaccines as a "critical unmet need," he said. Respiratory viruses, such as the ones that cause Covid, the flu or measles, infect millions of people and lead to thousands of hospitalizations worldwide each year, he said. The viruses can be deadly for anyone, in any part of the world, he said, illustrating the need for vaccines to prevent those diseases.
By comparison, hundreds of species of fungi can cause illness in people, but the most common ones — such as those that infect the skin and nails, or cause vaginal yeast infections or athlete’s foot — are non-life-threatening, according to Galgiani.
Additionally, severe cases are sporadic across the U.S., he said.
Valley fever, for example, is usually limited to the Southern and Western regions of the U.S. and are usually serious for people with weakened immune systems. Most people breathe in Aspergillus every day without getting sick, but it can be life-threatening for people with cystic fibrosis or asthma. Candida auris infections have been mostly limited to health care settings, and pose the biggest threat to very sick patients.
“As a risk-benefit investment proposal, it fails,” Galgiani said of developing a vaccine. “You would not put your retirement investment into this.” He said it could take eight years before a fungal vaccine is made available in the U.S.
But as awareness of climate change’s impact on fungal infections grows, funding support could grow and there could be a fungal vaccine developed sooner, Norris said.
In response to growing public health concerns about severe and life-threatening fungal diseases, the National Institutes of Health in September released a framework for how the U.S. could create a vaccine for Valley fever in the next 10 years.
Last October, the World Health Organization released its first-ever list of fungi that pose the greatest threat to public health, calling for more research into 19 fungal diseases.
Dr. Andrew Limper, a pulmonologist at the Mayo Clinic in Rochester, Minnesota, said that there are a handful of oral treatments for most mild to moderate fungal infections. Depending on the fungus, he said, people may need to take the medications for three to six months to clear the infection from their system. The drugs can come with side effects, including headache, stomach pain, vomiting and diarrhea.
People with strong immune systems oftentimes will recover with medication, but fungal infections, particularly those that affect lungs, can leave scarring, he said.
In severe cases, some people may need to take intravenous medications, such as Amphotericin B, he said.
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Vaccine Development
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EMBARGOED FOR RELEASE UNTIL 4 PM ET, August 09, 2023
Long-Term Use of Certain Acid Reflux Drugs Linked to Higher Risk of Dementia
MINNEAPOLIS – People who take acid reflux medications called proton pump inhibitors for four-and-a-half years or more may have a higher risk of dementia compared to people who do not take these medications, according to new research published in the August 9, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study only looked at prescription medications. Over-the-counter medications were excluded. This study does not prove that acid reflux drugs cause dementia; it only shows an association. Acid reflux is when stomach acid flows into the esophagus, usually after a meal or when lying down. People with acid reflux may experience heartburn and ulcers. People with frequent acid reflux may develop gastroesophageal reflux disease, or GERD, which can lead to cancer of the esophagus. Proton pump inhibitors reduce stomach acid by targeting the enzymes in the stomach lining that produce that acid. “Proton pump inhibitors are a useful tool to help control acid reflux, however long-term use has been linked in previous studies to a higher risk of stroke, bone fractures and chronic kidney disease,” said study author Kamakshi Lakshminarayan, MBBS, PhD, of the University of Minnesota School of Public Health in Minneapolis, and a member of the American Academy of Neurology. “Still, some people take these drugs regularly, so we examined if they are linked to a higher risk of dementia. While we did not find a link with short-term use, we did find a higher risk of dementia associated with long-term use of these drugs.” The study included 5,712 people, age 45 and older, who did not have dementia at the start of the study. They had an average age of 75. Researchers determined if participants took acid reflux drugs by reviewing their medications during study visits and during yearly phone calls. Of the participants, 1,490 people, or 26%, had taken the drugs. Participants were then divided into four groups based on whether they had taken the drugs and for how long, as follows: people who did not take the drugs; those who took the drugs for up to 2.8 years; those who took them for 2.8 to 4.4 years; and people who took them for more than 4.4 years. Participants were then followed for a median duration of 5.5 years. During this time, 585 people, or 10%, developed dementia. Of the 4,222 people who did not take the drugs, 415 people developed dementia, or 19 cases per 1,000 person-years. Person-years represent both the number of people in the study and the amount of time each person spends in the study. Of the 497 people who took the drugs for more than 4.4 years, 58 people developed dementia, or 24 cases per 1,000 person years. After adjusting for factors such as age, sex and race, as well as health-related factors such as high blood pressure and diabetes, researchers found people who had been taking acid reflux drugs for more than 4.4 years had a 33% higher risk of developing dementia than people who never took the drugs. Researchers did not find a higher risk of dementia for people who took the drugs for fewer than 4.4 years. “More research is needed to confirm our findings and explore reasons for the possible link between long-term proton pump inhibitor use and a higher risk of dementia,” said Lakshminarayan. “While there are various ways to treat acid reflux, such as taking antacids, maintaining a healthy weight, and avoiding late meals and certain foods, different approaches may not work for everyone. It is important that people taking these medications speak with their doctor before making any changes, to discuss the best treatment for them, and because stopping these drugs abruptly may result in worse symptoms.” A limitation of the study was that participants were asked once a year about medication use, so researchers estimated use between annual check-ins. If participants stopped and restarted acid reflux drugs in between check-ins, estimation of their use may have been inaccurate. The authors were also unable to assess if participants took over the counter acid reflux drugs. The study was supported by the National Institutes of Health, including the National Heart, Lung, and Blood Institute. Learn more about dementia at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram. When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.
The American Academy of Neurology is the world's largest association of neurologists and neuroscience professionals, with 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, concussion, Parkinson's disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, LinkedIn, Instagram and YouTube.
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Disease Research
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Unlike humans, zebrafish can completely regenerate their hearts after injury. They owe this ability to the interaction between their nervous and immune systems, as researchers led by Suphansa Sawamiphak from the Max Delbrück Center now report in the journal Developmental Cell.
Each year, more than 300,000 people in Germany have a myocardial infarction -- the technical term for heart attack. The number of people surviving a heart attack has increased significantly, but this severe cardiac event causes irreparable damage to their hearts. A heart attack occurs when blood vessels that supply blood and oxygen to the heart muscle become blocked, causing part of the heart muscle tissue to die. This damage is permanent because the human heart has no ability to grow new heart muscle cells. Instead, connective tissue cells known as fibroblasts migrate into the damaged area of the heart muscle. They form scar tissue that weakens the pumping power of the heart. Previous attempts to use stem cells to treat infarction-damaged hearts have not been very successful.
The team led by Dr. Suphansa Sawamiphak, head of the Cardiovascular-Hematopoietic Interaction Lab at the Max Delbrück Center, is looking at the process from a different angle. "We know that both signals from the autonomic nervous system and the immune system play a pivotal role in scarring and regeneration," says Sawamiphak. "So it stands to reason that the communication between the autonomic nervous and immune systems determines whether heart muscle scarring will occur or whether the heart muscle can recover." It is also known that macrophages play a role in both processes. But how is this decision made?
To address this question, the researchers are studying zebrafish larvae. The fish can be easily modified and are also optically transparent, making internal processes easy to observe in the living organism. "Plus, they can fully regenerate their heart after an injury," says Onur Apaydin, first author of the study published in "Developmental Cell."
Signaling for regeneration
The researchers used zebrafish larvae whose heart muscle cells produce a fluorescent substance, making it easy to detect them under a microscope. They then induced an injury similar to a myocardial infarction in the larval hearts and blocked several receptors on the surface of the macrophages. The result was that adrenergic signals from the autonomic nervous system determined whether the macrophages multiplied and migrated into the damaged site. These signals also played an important role in regenerating heart muscle tissue.
In the next step, the researchers engineered genetically modified zebrafish in which the adrenergic signal reached the macrophages but could not be transmitted from the receptor into the cell's interior. "This showed that signal transmission is crucial for heart regeneration," says Apaydin. If signaling is interrupted, the scarring process is triggered instead.
"Our findings indicate that this is a key regulator of crosstalk between the nervous and immune systems," says Apaydin. When macrophages are activated by the adrenergic signals of the autonomic nervous system, they in turn communicate with fibroblasts. Fibroblasts that promote regeneration alter the extracellular matrix at the damaged site. This ultimately creates a microenvironment conducive to the growth of blood and lymph vessels and to the development of new heart vessels. If, on the other hand, the signal is blocked, fibroblasts infiltrate the site and cause scarring -- similar to what occurs in the human heart after a heart attack.
"We next want to examine in detail how signaling differs between zebrafish and humans," says Sawamiphak. "This will help us understand why heart muscle tissue is unable to regenerate in humans." The team also hopes to identify potential targets for influencing the interaction between the nervous and immune systems in a way that promotes the regeneration of heart muscle tissue and the maintenance of heart function in heart attack patients.
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Materials provided by Max Delbrück Center for Molecular Medicine in the Helmholtz Association. Note: Content may be edited for style and length.
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Disease Research
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Matt Hancock is at the centre of a furious row over the Government's handling of the pandemic following a bombshell leak of more than 100,000 WhatsApp messages.
A tranche of Covid-era messages from the former Health Secretary and other top ministers have been made public after he shared them with journalist Isabel Oakeshott who helped him write his pandemic memoir.
Today, Mr Hancock furiously disputed the "distorted account" of key decisions, with his spokesman claiming the reports in Telegraph had been "spun to fit an anti-lockdown agenda".
"It is outrageous that this distorted account of the pandemic is being pushed with partial leaks, spun to fit an anti-lockdown agenda, which would have cost hundreds of thousands of lives if followed," the spokesman said.
"What the messages do show is a lot of people working hard to save lives."
The leak throws Covid decision-making back into the spotlight, with a string of explosive allegations about care home policy and availability of tests.
Further allegations are expected in the coming days covering what is said to be an often casual approach that officials took over decisions such as shutting schools, face mask policy and testing.
Here are the key claims from more than 100,000 leaked messages.
Advice on care home testing was 'ignored'
The most controversial exchanges centres on testing in care homes at the height of the first Covid wave, when the virus ripped through vulnerable residents.
The leaked WhatsApps allege Mr Hancock did not accept advice from Chief Medical Officer Chris Whitty that there should be testing for “all going into care homes” in April 2020. Mr Hancock fiercely disputes that he ignored clinical guidance.
On April 14, messages between Mr Hancock and one of his aides, Allan Nixon, discussed this advice ahead of the publication of new Covid guidance, which made testing mandatory only for people coming into care homes from hospitals.
Later that day, Mr Hancock allegedly removed this commitment to test everyone going into care homes from the community.
At 6.23pm, Mr Nixon sent a message saying: “Just to check: officials are saying your steer is to *remove* the commitment to testing on admission to care homes *from the community*, but *keep* commitment to testing on admission to care homes *from hospital*. Is that right?”
Soon after, he messaged again: “Update: we can say in the doc that it’s our ambition to test everyone going into a care home from the community where care homes want (‘in the comings weeks’ is the suggested timeframe I’ve been told).”
Mr Hancock responded: “Tell me if I’m wrong but I would rather leave it out and just commit to test & isolate ALL going into care from hospital. I do not think the community commitment adds anything and it muddies the waters.”
The former Health Secretary fiercely denied suggestions that he ignore clinical guidance - and accused the Telegraph of removing a key part of the message where Mr Nixon said: "I wasn't in testing mtg".
A spokesman said the removal changed the context, adding: "It demonstrates there was a meeting at which advice on deliverability was given.
"By omitting this, the messages imply Matt simply overruled clinical advice. That is categorically untrue.
"He went as far as was possible, as fast as possible, to expand testing and save lives. This story categorically shows that the right place for this analysis of what happened in the pandemic is in the inquiry.”
Ex-Health Minister Lord Bethell said the decision was taken due to a lack of testing capacity and insisted "we wanted to test everyone who went into social care".
He told the Today programme that Mr Hancock "changed his view because there was an operational meeting to talk about how you were actually going to test people and how many actual tests we had".
He added: "The reality was there was a very, very limited number of those tests... The thing that held us back was not a dispute about the clinical advice. It was simply the operational ability to deliver tests."
New admissions to care homes from the community did not have to undergo mandatory tests until August 2020. Between April 17 and August 13, some 17,678 people died of Covid in care homes in England.
In 2021, Mr Hancock told the Health and Social Care Committee that “the strongest route of the virus into care homes, unfortunately, is community transmission, so it was staff testing that was most important thing for keeping people safe in care homes”.
Hancock expressed concerns that care home testing could hit capacity
Mr Hancock was pushing hard to meet his ambitious target for 100,000 tests a day by the end of April 2020.
Messages published by the Telegraph show he agreed to prioritise testing in care homes that month - but expressed concern that it could hamper the ability to hit the target.
An official allegedly told him: "Asymptomatic testing sub is reading. Top recommendation is: That you agree to: Prioritise testing of asymptomatic staff and residents in care homes where an outbreak has been recorded within the past 14 days.
"We estimate this will result in 60,000 tests being carried out across 2000 care homes in the next 10 days.
Mr Hancock replied: "This is ok so long as it does not get in the way of actually fulfilling the capacity in testing."
Hancock warned by minister that care home Covid rules were ‘inhumane’
The-then Social Care Minister Helen Whately told Mr Hancock that the extremely strict rules governing care home visits were "inhumane".
The messages from October 2020, published by the Telegraph, show Ms Whately warned him against preventing “husbands seeing wives” as the country was put into tiered lockdowns, with tougher rules in places where the virus was spiralling.
Care homes were closed to visitors in March 2020 and tight restrictions remained in most places until July 2021, meaning many vulnerable people went months without seeing their loved ones.
“I’m hearing there’s pressure to ban care home visiting in tier 2 as well as tier 3. Can you help? I really oppose that,” Ms Whately wrote.
“Where care homes have Covid secure visiting we should be allowing it. To prevent husbands seeing wives because they happen to live in care homes for months and months is inhumane.”
In January 2021, she told Mr Hancock that the Government needed to have a visiting policy "given risks of lives lost through old people just giving up as well as Covid ...and expectation that vaccine = safe to visit.”
But Mr Hancock allegedly replied: “Yes on visiting but only after a few weeks."
Covid test couriered to Jacob Rees-Mogg's child during backlog
Another tranche of messages suggests Mr Hancock's aide helped top Tory Jacob Rees-Mogg get a test for one of his kids during a major testing backlog in September 2020.
An aide messaged Mr Hancock to say: "The lab lost JRM’s child’s test, so we’ve got a courier going to their family home tonight, child will take the test, and courier will take it straight to the lab. Should have result tomorrow am."
There were reports of a backlog of 185,000 tests waiting to be processed on September 11 2020.
Mr Rees-Mogg was approached for comment.
Hancock allegedly met 100,000 daily tests target by counting tests despatched but might never be processed
The messages repeatedly underline Mr Hancock's obsession with hitting his target of 100,000 Covid tests a day by the end of April 2020.
The Government initially struggled to build up testing capacity during the early days of the pandemic as experts around the globe battled to come up with effective tests for the virus.
Mr Hancock was warned by Lord Bethell in mid-April that the ambitious target was unlikely to be met and aides pushed for more supplies from companies like Amazon and Boots.
Lord Bethell said Amazon had more kits that could be sent out by the deadline, and Mr Hancock replied: "If only 20% are being returned then we can send many many many more out."
Lord Bethell replied: "That's true. since they count from the moment they're sent. i'll prod nicely. can you pls prod too."
Other messages with aides show the push for these tests, with Mr Hancock becoming concerned that the figure could be too high.
"IT WILL BE OVER 120,000," he said. "So we should be very very careful that the statos [statisticians] don't accidentally make us look flaky."
Minister claimed system working after 100-mile round trip for test
Then-Care Minister Helen Whately suggested the testing system was "definitely working" when she managed to get a test "just" 50 miles from her home.
She made the 100-mile round trip to get tested in September 2020.
She told Mr Hancock: “Good news from my mystery shopping of our testing system - by repeat visits to testing app as advised have got test for XXXX[redacted] (who is isolating with XXXX) just 50 miles from home."
No one thinks testing is working well, says George Osborne
Former Tory Chancellor George Osborne told Mr Hancock that no one believed his mass testing scheme was going well, the messages claim.
An exchange in November 2020 shows Mr Hancock kicking off over his ex-colleagues comments on the radio where he urged Boris Johnson to make testing his “absolute number one priority”.
“What was this for?” Mr Hancock messaged Mr Osborne.
Mr Osborne replied: “Trying to spread the responsibility from you to Number 10 – I’ve said it before.”
Mr Hancock retorted: “Ok but mass testing is going v well – I fear this looks like you asked for me to be overruled…”
“No one thinks testing is going well, Matt,” Mr Osborne replied, and said he had gone private after waiting three weeks for test results.
Mr Hancock said: “Hmm I don’t think this is right but I can see where you’re coming from.”
Another exchange allegedly shows Mr Hancock pleading with Mr Osborne, who was then editing the Evening Standard to "call in a favour" to promote thousands of spare testing slots.
What does Matt Hancock say?
A spokesperson for Matt Hancock said: "It is outrageous that this distorted account of the pandemic is being pushed with partial leaks, spun to fit an anti-lockdown agenda, which would have cost hundreds of thousands of lives if followed. What the messages do show is a lot of people working hard to save lives.
"The full documents have already all been made available to the inquiry, which is the proper place for an objective assessment, so true lessons can be learned.
"Those who argue there shouldn't have been a lockdown ignore the fact that half-a-million people would have died had we not locked down. And for those saying we should never lock down again, imagine if a disease killed half those infected, and half the population were going to get infected - as is happening right now with avian flu in birds. If that disease were in humans, of course we’d want to lockdown.
"The story spun on care homes is completely wrong. What the messages show is that Mr Hancock pushed for testing of those going into care homes when that testing was available.
"Instead of spinning and leaks we need the full, comprehensive inquiry, to ensure we are as well prepared as we can be for the next pandemic, whenever it comes.
"The Telegraph story is wrong, based on partial, spun leaks - and they did not approach Matt before publication."
What are others saying?
Labour’s Wes Streeting said: “The claim that the Government threw a ‘protective ring’ around care homes during Covid has proven to be a sham.
"They ignored the Chief Medical Officer and people died. How many lives could have been saved?”
Lindsay Jackson of Covid-19 Bereaved Families for Justice said: "The failure to protect care homes led to thousands of unnecessary deaths, like my mum's and meant hospitals became even more overwhelmed and even longer lockdowns were required to prevent further loss of life.
"The consequences of this could not be more horrific and there needs to be an immediate and serious police investigation in parallel with the inquiry.”
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Epidemics & Outbreaks
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Surgeons have performed the world's first transplant of an entire human eye, an extraordinary addition to a face transplant — although it's far too soon to know if the man will ever see through his new left eye.
An accident with high-voltage power lines destroyed most of Aaron James' face and one eye. His right eye still works. But surgeons at NYU Langone Health hoped replacing the missing one would yield better cosmetic results for his new face, because it would support the transplanted eye socket and lid.
The NYU team announced Thursday that so far, it's doing just that. James is recovering well from the dual transplant last May, and the donated eye looks remarkably healthy.
"It feels good. I still don't have any movement in it yet. My eyelid, I can't blink yet. But I'm getting sensation now," James told The Associated Press as doctors examined his progress recently.
"You got to start somewhere, there's got to be a first person somewhere," said James, 46, of Hot Springs, Arkansas. "Maybe you'll learn something from it that will help the next person."
Today, transplants of the cornea — the clear tissue in front of the eye — are common to treat certain types of vision loss. But transplanting the whole eye — the eyeball, its blood supply and the critical optic nerve that must connect it to the brain — is considered a moonshot in the quest to cure blindness.
Whatever happens next, James' surgery offers scientists an unprecedented window into how the human eye tries to heal.
"We're not claiming that we are going to restore sight," said Dr. Eduardo Rodriguez, NYU's plastic surgery chief, who led the transplant. "But there's no doubt in my mind we are one step closer."
Some specialists had feared the eye would quickly shrivel like a raisin. Instead, when Rodriguez propped open James' left eyelid last month, the donated hazel-colored eye was as plump and full of fluid as his own blue eye. Doctors see good blood flow and no sign of rejection.
Now researchers have begun analyzing scans of James' brain that detected some puzzling signals from that all-important but injured optic nerve.
One scientist who has long studied how to make eye transplants a reality called the surgery exciting.
"It's an amazing validation" of animal experiments that have kept transplanted eyes alive, said Dr. Jeffrey Goldberg, chair of ophthalmology at Stanford University.
The hurdle is how to regrow the optic nerve, although animal studies are making strides, Goldberg said. He praised the NYU team's "audacity" in even aiming for optic nerve repair and said he hopes the transplant will spur more research.
"We're really on the precipice of being able to do this," Goldberg said.
James was working for a power line company in June 2021 when he was shocked by a live wire. He nearly died. Ultimately, he lost his left arm, requiring a prosthetic. His damaged left eye was so painful it had to be removed. Multiple reconstructive surgeries couldn't repair extensive facial injuries including his missing nose and lips.
James pushed through physical therapy until he was strong enough to escort his daughter Allie to a high school homecoming ceremony, wearing a face mask and eye patch. Still, he required breathing and feeding tubes, and he longed to smell, taste and eat solid food again.
"In his mind and his heart, it's him — so I didn't care that, you know, he didn't have a nose. But I did care that it bothered him," said his wife, Meagan James.
Face transplants remain rare and risky. James' is only the 19th in the United States, the fifth Rodriguez has performed. The eye experiment added even more complexity. But James figured he'd be no worse off if the donated eye failed.
Three months after James was placed on the national transplant waiting list, a matching donor was found. Kidneys, a liver and pancreas from the donor, a man in his 30s, saved three other people.
During James' 21-hour operation, surgeons added another experimental twist: When they spliced together the donated optic nerve to what remained of James' original, they injected special stem cells from the donor in hopes of spurring its repair.
Last month, tingles heralded healing facial nerves. James can't yet open the eyelid and wears a patch to protect it. But as Rodriguez pushed on the closed eye, James felt a sensation — although on his nose rather than his eyelid, presumably until slow-growing nerves get reoriented. The surgeon also detected subtle movements beginning in muscles around the eye.
Then came a closer look. NYU ophthalmologist Dr. Vaidehi Dedania ran a battery of tests. She found expected damage in the light-sensing retina in the back of the eye. But she said it appears to have enough special cells called photoreceptors to do the job of converting light to electrical signals, one step in creating vision.
Normally, the optic nerve then would send those signals to the brain to be interpreted. James' optic nerve clearly hasn't healed. Yet when light was flashed into the donated eye during an MRI, the scan recorded some sort of brain signaling.
That both excited and baffled researchers, although it wasn't the right type for vision and may simply be a fluke, cautioned Dr. Steven Galetta, NYU's neurology chair. Only time and more study may tell.
As for James, "we're just taking it one day at a time," he said.
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Medical Innovations
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Scotland’s crisis-hit NHS is to begin a “programme of reparations” to Jamaica and Africa in a bid to “make amends” for a hospital’s slavery links dating from the eighteenth century.
An NHS Lothian report found that, in today’s money, the Royal Infirmary of Edinburgh had profited by almost £40 million from slavery, including through ownership of a small Caribbean slave plantation, left to it in a surgeon’s will in 1750.
It claimed that Scotland’s historic healthcare system had been “part funded by slavery” and that the hospital had been “built on and sustained by the horrific enslavement and cruel exploitation of enslaved peoples”.
While the reparations are not expected to involve direct repayment of the £39.1 million, the NHS Lothian board is expected to approve a series of measures on Wednesday designed to redress its part in a “crime against humanity”.
It is proposed that these will include NHS Lothian and its official charity making a formal apology to people of African descent, commissioning artwork dedicated to victims of slavery and signing an agreement aimed at improving health in modern-day Jamaica.
An advisory group set up by NHS Lothian claimed that the measures would “help to eliminate systemic discrimination and racism in Scotland” and “make amends for past wrongs”.
However, the timing of the announcement and the priority given to the work was questioned, with the Scottish NHS facing an unprecedented crisis that is set to deepen in coming months.
It is expected that the work would be funded from “existing departmental budgets and staffing”, meaning it will swallow up resources that could have been used for healthcare.
Sue Webber, the Scottish Tory MSP, said “eyebrows are bound to be raised” by the report, which was placed higher on the agenda for the board meeting than discussions on preparing for winter and NHS Lothian’s poor recent performance.
She added: “With Scotland’s NHS stretched beyond breaking point under the SNP, the public will rightly question why NHS Lothian are expending scarce resources on this matter – especially when they see it comes above ‘winter planning’ on the agenda.”
‘Reaffirm human worth’
Across Scotland, more than a quarter of cancer patients are waiting for longer than the two-month target to begin treatment, from an initial referral.
At the modern-day Royal Infirmary, which has moved twice since it was given the slavery plantation 273 years ago, 47.7 per cent of patients, 1,174 people, waited longer than a target of four hours in its A&E in the week ending Sept 10.
Of these, 324 waited longer than eight hours and 121 were stuck for more than 12 hours.
Research backed by the health board, set up in its current form in 2001, found that the Royal Infirmary had been left the Red Hill Penn estate, in south-eastern Jamaica, in 1750 in the will of a surgeon, Archibald Kerr.
The bequest included 39 slaves, and the report said that over the next 143 years, “generations of enslaved people” would provide “a considerable amount of wealth for the infirmary” in rental income.
Research has also identified donations the hospital received from individuals who profited from slavery.
The report claimed that implementing the recommendations would lead to better care and treatment, in part because they would “reaffirm human worth” of the “successive generations of people who are the victims of slavery”.
However, the claim was dismissed by an NHS Scotland insider, who said they would do nothing to address severe challenges the healthcare system is currently facing.
“It seems extraordinary that this is being treated as a major priority at a time that the basic healthcare needs of the public are simply not being met,” the staff member said.
“A huge amount of time and money has clearly gone into this already and every aspect of the recommendations will mean even more being wasted on things other than looking after people.
“These resources would be far better used trying to work out how to properly serve our patients, regardless of anyone’s race or background.”
‘This work is vital’
The research work was funded by NHS Lothian’s charity. Calum Campbell, the chief executive of NHS Lothian, said that “tackling racial inequality and racism” was “a core part of what NHS Lothian does”.
He added: “This helps us contribute to a health and care system where everyone in Lothian lives longer, healthier lives, with better outcomes from the care and treatment we provide and where everyone who works with and for us has better experiences.
“This work is vital to delivering this ambition.”
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Health Policy
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Laura Santhanam
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Millions of Americans are estimated to live with chronic hepatitis C. Incidents of new infections have more than doubled since 2013, and for decades, stigma has played an outsized role in determining access to testing and treatment.
The Centers for Disease Control has now expanded federal guidelines around testing to include infants who may have been exposed to the blood-borne virus. According to some estimates, as many as 40 percent of people who have hepatitis C are unaware of their infection, which can lead to liver cancer, cirrhosis, liver failure and untimely death if left untreated. The Biden administration has a goal of eliminating hepatitis C in the U.S. by 2030.
To gain a better understanding of how widespread hepatitis C is nationwide, the CDC in recent years has broadened recommendations for who should get tested for the disease. In 2020, the agency recommended screening all adults age 18 or older at least once in their lifetime, as well as testing for the virus during pregnancy since it can be transmitted in utero and at birth.
On Oct. 31, the CDC updated that recommendation to include infants between ages 2 and 6 months, an effort to connect families with more resources and slow the virus’ spread. If testing reveals an active infection, the agency urges parents to continue to retest their children, consult with their pediatrician and monitor the virus until age 3, when the child will be old enough to receive antiviral medication.
“If recommendations are implemented, more perinatally infected children will be identified and linked to care,” according to the CDC’s report. “This approach would increase the chances of timely treatment and subsequent cure that can mitigate the consequences from chronic hepatitis C and limit further transmission.”
Universal testing could ease stigma around hepatitis C interventions, improve access to treatment and slow the spread of the deadly virus, experts say.
Kareena Wasserman, 33, told the PBS NewsHour that many health care providers have a long way to go to overcome stigma around hepatitis C infections and offer patients the help they need. The mother of two, who ran the 2022 Chicago Marathon while eight weeks pregnant, said she was returning from a business trip later that year when her obstetrician called her with concerning news about her blood test results. As Wasserman sat in an airport, her doctor told her she had tested positive for hepatitis C and that she needed to seek care from a specialist.
“‘I can’t talk to you anymore about this,’” Wasserman recalled her doctor saying.
Her physician’s phoned-in follow-up and lack of knowledge about how to proceed scared her. Left “bawling my eyes out,” Wasserman said she spiraled about how this infection could have originated and struggled with the news of her diagnosis alongside her husband – together and alone. While Wasserman said she wanted to avoid “throwing my OB under the bus,” she said, “I felt like my OB didn’t believe I didn’t know where this came from.”
Historically, hepatitis C infections were linked to unsanitary practices in blood transfusions, particularly among baby boomers. In more recent years, infections were often associated with injection drug use, which can increase spread when people share needles and lack safe needle exchange programs. But given historically insufficient testing, experts say past U.S. estimates of hepatitis C likely underrepresented how many people have the virus. Testing also slowed during the pandemic.
A decade ago, researchers developed an antiviral medication that bears virtually no side effects and is effective in nearly all patients. This treatment, however, has remained difficult to access, particularly in communities where people may be most vulnerable to the disease. At the same time, stigma around being infected with hepatitis C has translated to policies that withhold cures from people who are sick, heightening the risk of more infections.
READ MORE: Hepatitis C is ‘not something you wish on anybody.’ Biden has a plan to end it
For years, testing protocols meant a patient often needed to visit their doctor’s office or a clinic multiple times before receiving a diagnosis, sometimes paying out of pocket. Those hurdles prevented many people from completing their testing or finding out if they were sick, meaning their illness also went unchecked and spread further.
Reception of the CDC’s testing recommendations has been slow-moving, even during a race against time to reduce infections, said Dr. Lynn Yee, an obstetrician and gynecologist at Northwestern University and associate chief of maternal-fetal medicine for research. There, Yee works with pediatrician Dr. Ravi Jhaveri to ramp up efforts to connect pregnant people who may have been exposed to hepatitis C with tests and, if needed, therapeutics to cure them, preventing the virus’ spread to their infant.
“We’re finding pregnant people with hepatitis C who were previously unknown, and yet, the standard of care is still to treat after pregnancy,” Yee said.
Wasserman began working with Yee a few weeks after learning of her diagnosis. During their first meeting, Wasserman said her head was “swirling” with the risks she and her fetus faced. She asked Yee if she needed to abort the pregnancy and was terrified about what this infection meant for her family.
During her third trimester, Wasserman said she took an antiviral medication to cure her hepatitis C infection. By the time her daughter was born, she tested negative for the infection.
For years, Jhaveri said he has followed up with pediatric patients who were exposed to hepatitis C. He said these updated CDC recommendations that build on universal testing for pregnant people and support infant testing “will make it easier.”
“If our goal is elimination of hepatitis C, our goal should really be to identify, treat and cure as many patients as possible, no matter how old they are or what background they have,” Jhaveri said. “We’re taking an important step toward elimination.”
Wasserman urges fellow patients to get tested for hepatitis C, particularly those who are trying to get pregnant. And she wants health care providers to “watch your stereotypes” and practice medicine while “being sympathetic and understanding.”
“If your patient tests for a high-risk thing and needs to see a specialist, talk through that,” Wasserman said, preferably in-person rather than over the phone. No matter what, she said, people should not feel like they have to hide their illness from others or feel ashamed.
“I want more women to understand that this isn’t something you have to face alone,” Wasserman said. “That’s something my husband and I had to do.”
Laura Santhanam is the Health Reporter and Coordinating Producer for Polling for the PBS NewsHour, where she has also worked as the Data Producer. Follow @LauraSanthanam
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Disease Research
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Was the Johnson government unprepared for Covid because it was distracted by Brexit? Was the virus itself caused by a lab leak? Did lockdowns do more harm than good? Are face masks a conspiracy? If the 2020s are indivisible from the pandemic, Covid offers endlessly fertile territory for the decade’s culture wars. They look irrational written down – what does remoaning have to do with face masks? – yet somehow we understand the faultlines, and how they connect, at a gut level.
Yet the public inquiry into the government’s handling of Covid, which opened on Tuesday in a neutral-looking building near Paddington, west London, with only the most sober-minded spectators still attending by Thursday – and without even a desultory anti-vax protest outside to liven anything up – kept insisting on one inconvenient, unarguable point. Governing isn’t about binary arguments in primary colours. The discourse may drown out reality but it can’t make it go away, and there bad decisions still cost lives and good ones still need homework.
This is the resilience and preparedness module of the Covid inquiry, tracking back to 2018, when Public Health England called attention to a “gap in strategy focusing on infectious diseases”; to 2016, when Exercise Alice wargamed what would happen had Middle East respiratory syndrome (Mers) taken on pandemic dimensions; to 2002, when the strategy void was first identified. The most neutral, factual language – “new, continuous cough”, “asymptomatic transmission”, “replication rate” – grabs you by the throat and drags you straight back to the shadowy, almost hallucinogenic state of March 2020, when every aspect of normal life, from a sneeze to a stranger, became freighted and ominous.
We pored over country comparisons back then, looking for clues about how to react, how seriously to take the disease, what the future might look like two weeks hence. But it seems that, certainly at the level of government, we weren’t looking at the right countries, and we didn’t start looking soon enough. Prof David Heymann talked about why the mortality rates in certain Asian countries – Japan, Korea, Singapore – were lower than those in Europe. Those countries learned more from, variously, the Sars outbreak 20 years ago and Mers in 2015, and had better surge capacity in hospitals, and superior contact tracing, in both directions – that is, who the infected patient might have transmitted to, and who they had likely been infected by. This enabled “precision lockdowns”, which are “good basic epidemiology”, Heymann said.
Kate Blackwell KC drew the inquiry’s attention to that table-top exercise in 2016, which specifically recommended that someone draw up a briefing paper on South Korea’s policy post-Mers and whether it had any lessons for the UK. Did Heymann know whether that had ever happened? He did not, unfortunately. We can work on the assumption that if it did, nobody read it; our contact tracing got demonstrably worse when Covid hit – previously, it was conducted at a local level, which is a high-trust environment. When it was centralised during the pandemic, that trust was watered down.
Probably the starkest evidence, from a political perspective, came from Prof Sir Michael Marmot: he was pressed on the state of healthcare immediately before Covid hit, and how much impact hospital capacity and staff shortages had on it. Most of the health differences we see are not attributable to healthcare, but to the underlying health of the population. “It’s hard to overstate how important this is: we used, as a country, to expect health to improve year on year. That’s what the history of the 20th century led us to expect,” he told the inquiry. That improvement slowed dramatically, in 2010, more in the UK than in any other country except Iceland and the United States. Furthermore, health inequalities got bigger; people in the most deprived decile saw a decline in life expectancy, in every region except London.
Neither Covid nor life after it, including the hundreds of thousands missing from the workforce, are comprehensible without looking squarely at what austerity has done to society. Even if the Conservatives hadn’t kept the NHS on a shoestring, even if we hadn’t had half the ICU capacity of Italy and France, the decisive factor would still have been this simple thing that we knew all along: the belt-tightening that Cameron sold as blitz spirit, and his successors have continued, was callous. People became ill and died as a result of it.
But even if the Covid inquiry has a galvanising effect, and reminds us of the value of compassion and competence in politics, that is not its purpose. David Alexander, professor of risk and disaster reduction at University College London, told the inquiry: “The bottom line is: do you think the British government within the limits of its competency keeps the public safe? My answer to that is no, or not sufficiently.” This painstaking exercise, which will take years, is not designed to pin the blame squarely on one administration, one prime minister. It’s not there to justify lockdowns or regret that Brexit eclipsed everything else. It exists for the one thing we don’t want to think about: the next pandemic.
Zoe Williams is a Guardian columnist
On Wednesday 5 July, join Zoe Williams and a panel of leading thinkers for a livestreamed discussion on the ideas that can make our economies fairer. Book tickets here
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Epidemics & Outbreaks
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For decades, the go-to treatments for cancer have been chemotherapy, radiation and surgery — but a fourth option is showing promising results.
Immunotherapy — which some experts are calling the "fourth pillar" of cancer treatments — is a relatively new approach that taps into the power of the patient’s immune system to fight the disease.
"If we look historically at how we treated cancer, primarily for most of the 20th century and the early part of the 21st century, cancer care was either surgery to cut it out, radiation to burn it or chemotherapy to poison it," Dr. Michael Zinner, CEO and executive medical director at Miami Cancer Institute, which is part of Baptist Health South Florida, told Fox News Digital via email.
"And then, around 20 to 25 years ago, we began to have targeted therapies," Zinner said.
"We figured out that certain cancers have certain mechanisms that we can target with a specific drug, having zero side effects."
That targeted therapy eventually led to personalized cancer care, he said, and then to the "next great development."
Immunotherapy had been in development for 40 to 50 years, Zinner said — "and finally it has now blossomed."
"We’ve gone from surgery, to radiation, to chemotherapy, to targeted therapy, and now immunotherapy to use the body's own cells and immune system to turn on the cancer, which is a foreign substance."
How immunotherapy works
In cancer patients, the immune system is generally dormant, explained Julian Adams, PhD, chief science officer of Stand Up to Cancer (SU2C) in Boston, Massachusetts.
"Immunotherapy awakens the body’s immune system, which then targets cancer," he told Fox News Digital in an email.
Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, said the idea is that cancer "makes itself invisible to the immune system, which is looking for foreign invaders to eliminate."
Immunotherapy then "lights up" the cancer up to be identified by the immune system for destruction, he said.
There are two main ways that immunotherapy accomplishes this, Siegel said.
The first is through the use of "checkpoint inhibitors," which are targeted treatments that block the proteins that keep the immune system from fighting cancer cells.
"Checkpoint inhibitors stop the cancer from doing its disappearing act," Siegel noted.
The second type of immunotherapy targets mutated or abnormal proteins on the surface of the tumor, which are often involved in its growth, the doctor said.
"Historically, cancer care was either surgery to cut it out, radiation to burn it or chemotherapy to poison it."
This includes CAR-T cell therapy, which involves removing immune cells called T cells from the patient’s body, altering them in a lab to make them fight cancer more effectively — and then putting the cells back into the patient’s body.
Beyond treatment, immunotherapy is also used in the application of cancer vaccines, Adams noted, which are emerging as a way to treat patients in remission or post-surgery to keep the cancer from coming back.
Immunotherapy in action
Stand Up to Cancer has supported research into both types of immunotherapy, Adams said.
In one clinical trial, rectal cancer patients who recently received a promising immunotherapy drug had a 100% response rate.
"All 18 patients in the trial had their cancer disappear, without the need for the standard treatments of radiation, surgery or chemotherapy," he told Fox News Digital.
"The cancer has not returned in any of the patients, some of whom have been cancer-free for up to two years."
In another trial supported by SU2C, pediatric cancer researchers developed a CAR T-cell therapy to treat B-cell acute lymphoblastic leukemia, which is a blood and bone marrow cancer, in children and young adults.
Outside of trials, an increasing number of patients are receiving immunotherapy in place of or in combination with chemotherapy and radiation.
Anthony Hall, 71, was diagnosed with stage 3 lung cancer in 2022, as his daughter, Erin LeMaster, told Fox News Digital.
The Ohio father and grandfather started chemotherapy and radiation in September 2022 for an eight-week period, receiving a total of 12 treatments.
"He had responded well to the chemo and radiation with very minimal side effects," LeMaster said.
Then in November 2022, Hall started immunotherapy — with a drug called Imfinzi, a prescription medicine used to treat lung cancer.
"He had a very positive experience with the immunotherapy," LeMaster told Fox News Digital. "He had no side effects at all, besides fatigue at times after treatment."
"It caused no hair loss, no food aversion and no sensitivity to skin like the chemotherapy caused," she added. "It was much easier on his body."
The doctor told Hall’s family that side effects for chemo and immunotherapy are typically mild in older men.
"It caused no hair loss, no food aversion and no sensitivity to skin like the chemotherapy caused. It was much easier on his body."
Hall received CT scans every three months, which showed that his cancer was responding to the treatment.
His last CT scan in October, however, revealed some growth of his original mass.
"So, per his oncologist, he will not receive this type of immunotherapy in the future," LeMaster said.
Hall is currently waiting for biopsy results to come up with a plan for further treatment, and he will likely need another round of chemotherapy and radiation.
"He may need surgery to remove the mass depending on biopsy results," LeMaster said.
Immunotherapy vs. chemotherapy
With chemotherapy, Adams said, the treatment can initially eliminate cancer cells, but resistance can eventually develop.
"In certain cancers, immunotherapy can provide long-term, durable remissions," he said.
Some cancers — such as melanoma, lung and bladder — are "very responsive" to immunotherapy, according to Adams.
"Others, such as pancreatic and colon, remain ‘cold’ and poorly responsive," he said.
For certain tumors, including kidney and melanoma, immunotherapy has replaced chemo, Adams noted.
"However, in other tumors, such as with lung cancer, a combination of chemo and immunotherapy can be used effectively."
In terms of side effects, chemo generally causes gastrointestinal side effects like nausea and diarrhea, Adams noted.
Immunotherapy, on the other hand, can lead to certain autoimmune side effects.
"Generally, both modalities can be managed with supportive care," he said.
Future of immunotherapy
In the cancer care landscape, immunotherapy is still fairly young — only about 15 years old, Adams pointed out.
"We should expect even better and more advances in this field to treat cancers," said Adams.
Immunotherapy is primarily used for blood cancers, but experts say it is moving in the direction of treating solid tumors.
Siegel pointed out that new immunotherapies are evolving and developing all the time, adding that artificial intelligence will likely play a role in its development.
"Right now, cellular therapy is pretty much only designed for liquid tumors – blood cancers like multiple myeloma, lymphoma and leukemia," Zinner said.
"We’re moving into immunotherapy and cellular therapy for solid tumors like breast cancer, pancreas cancer and colon cancer."
"We’re not quite there yet, but we’re moving in that direction."
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Medical Innovations
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Five years after medical cannabis was legalised, the government still hasn't funded clinical trials that could see it being used on the NHS, Sky News has been told.
The Home Office reclassified the drug in 2018 to allow specialist doctors to prescribe the drug under tight controls.
But a year later the NHS watchdog NICE warned doctors that they shouldn't prescribe the drug to the eight million patients with chronic pain, because it said there weren't enough good quality clinical trials.
Despite the evidence gap, the National Institute for Health Research has now revealed that it hasn't funded any studies on the safety and efficacy of cannabis since the law was changed.
It means legalisation has made little difference to patients who can't afford a private prescription.
Chad Martin pays a clinic around £300 a month for a supply of medical-grade cannabis to ease the pain from arthritis in his hands.
He told Sky News: "I am fortunate to be able to afford the drug. Others can't."
He had been offered opioid painkillers by his GP, but rejected treatment because they can be addictive and have serious side effects.
Since he started using cannabis in a dose-regulated inhaler, the pain and inflammation in his hands have reduced and he has returned to work.
"It's been really great actually," he said.
"When the weather changes, arthritis can affect you regardless, but cannabis has worked way better than anything else I've taken in the past."
He said having it prescribed gave him greater confidence in what he was taking than buying it illegally on the street.
Not all patients respond so well to the drug. And the Home Office warns regular use of cannabis can lead to dependence and mental health problems.
To try and provide more robust evidence on the use of the drug, Celadon Pharmaceuticals is now starting the first clinical trial of its kind in 5,000 patients with chronic pain.
It grows cannabis plants in special chambers, where light, humidity, temperature and nutrients can be precisely controlled to produce flower buds containing predictable amounts of active compounds.
Unlike other cannabis medicines, Celadon's plants contain the psycho-active chemical THC, though at levels too low to cause a high.
James Short, the company's co-founder, said of all the businesses he had set up in his career, Celadon had been the hardest.
"We are a pharma company, not a cannabis company," he said.
"We've got to try and get away from the stigma. When I first got involved in the business I was nervous to even talk about it with friends.
"But our job is not to get people high. It's to give them a better quality of life."
Medical cannabis is still controlled by the Home Office as a narcotic.
But for it to be prescribed, it also has to be regulated as a medicine.
"It's been hard to get them to work together because the regulation wasn't really baked in correctly," said Mr Short.
As part of the trial, patients are given ground cannabis buds in a special inhaler that only dispenses the prescribed dose.
The trial has been approved by the Medicines and Healthcare products Regulatory Agency (MHRA) and the NHS Research Ethics Committee.
Approval followed a preliminary study on 500 patients, which showed that cannabis reduced the need for opioid painkillers and improved sleep.
Read more:
Medicinal cannabis 'safe and effective' pain relief method for cancer patients
Families urge government to fund medical cannabis research
But it's far from clear whether even the larger trial will convince medical authorities.
Dr Alan Fayaz, an NHS consultant and a spokesperson for the British Pain Society, said there's plenty of real-world evidence from patients that cannabis works, but doctors are right to be cautious.
"In the aftermath of what happened with opioids the medical community is understandably a little bit sceptical about introducing a new drug without really robust evidence," he said.
"The opioid epidemic has perhaps done cannabis a bit of a disservice because it's tainted ground."
He said changing the law before there was good clinical evidence of benefit and safety had been detrimental.
"It creates this bizarre two-tiered system which actually doesn't advantage the patients on the NHS and it doesn't really advantage the patients in the private sector either.
"I think what we need is the research to be able to identify the role cannabis will play."
The Home Office said it had asked its expert advisers to assess whether there are any barriers to conducting research on the medical effects of cannabis.
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Drug Discoveries
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