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As the Covid inquiry kicks off oral hearings today, we will once again debate what exactly happened in 2020 and 2021, and who is ultimately responsible for the decisions made. The government has already started to close in on scientists and point the finger at them for the poor response in the early stages of the pandemic. The prime minister, Rishi Sunak, has said it was a mistake to “empower scientists” and the BMJ pointed to the former health secretary Matt Hancock making “science the fall guy” in the blame game over what went wrong. But it’s vital that the inquiry separates out what were scientific questions, that independent advisers and academics could provide data and input on, and what were leadership decisions. Policy measures such as closing gyms or schools or play parks, or the introduction of mandatory face coverings, were conveyed as “scientific” decisions, but they weren’t. Scientists could present the probable risks and benefits of certain policy options, but the final decision didn’t lie with them. For example, when considering whether to close gyms, a scientific question would be: “What is the risk of transmission within a gym setting? How many would become severely ill and need hospitalisation, and how many would die?” That type of analysis, as well as guidance on measures to reduce transmission in that setting, could be given, along with an assessment of how certain we were about the knowledge. This is what Covid-19 advisory group members were tasked with. For scientists, the challenge was filling in the puzzle pieces about Sars-CoV-2, from how transmissible it was, and risks of transmission in various settings, to the hospitalisation rate and burden on healthcare services. And, of course, modelling possible future scenarios. Certainly, we can evaluate how well they performed these tasks, and whether their data and predictions were reasonable given the situation. In terms of the response itself, public health scientists, including myself, had our own ideas for what the best approach would be (including learning from other countries that had had earlier waves of Covid-19) and these were presented to ministers in the form of briefings and papers – just as with any other area of policy, from defence to the economy. The pandemic brought a new immediacy to scientific advice, but it didn’t fundamentally change the job of elected politicians, which was to balance these multiple streams of advice, and decide what the next stage of the response would be. Another political decision was over whether face masks should be mandatory for children in primary schools. Again public health scientists can answer, “What’s the risk of transmission within a primary school classroom?” and “How effective are face coverings if used appropriately at reducing transmission?” But this was balanced against the advice from child psychologists who provided evidence on the impact of face coverings on emotional and speech development, especially for young children with special needs, and with input from headteachers on the practical challenges of implementing mandates. Ministers then had to decide whether to introduce these, and if the benefits outweighed the costs. What’s particularly surprising is when government ministers such as Sunak, when he was chancellor, chose not to take any scientific advice at all in policy decisions, such as in the launch of “Eat Out to Help Out”. In this scheme, the public were encouraged and actively subsidised to spend money in one of the riskiest settings for transmission: indoor hospitality. They were led to believe it was safe, even though scientists could clearly predict this would lead to onwards transmission and would probably undo the progress made in bringing case incidence down going into autumn. If scientific advice had been considered more thoroughly, then other approaches with similar economic benefits might have been used, such as expanded outdoor dining, takeaways and deliveries, and local vouchers and support schemes. The Covid inquiry starting point should be that government has a responsibility to ensure that its citizens are “safe enough” from risks that it can manage. We expect the water from our taps to be clean and not give us cholera, the food in shops not to poison us, and our roads to have speed limits and traffic rules to prevent accidents. This came to the forefront in the Covid-19 response: governments were expected to protect their populations and parse the question of “how safe is safe enough”. There was no perfect path through the pandemic as various countries struggled with waves of hospitalisations and high death tolls. Government ministers had to make rapid decisions, and countries that did better in terms of health and economic measures (such as Denmark, Norway, Japan, South Korea and New Zealand) seriously considered the trade-offs, and made judgments with strong and competent leadership. There was no way that life could continue as it did before Sars-CoV-2 – some action had to be taken. Scientists did their best to rapidly collect data about a new pathogen, analyse it and provide factual advice to governments on the risks that Covid-19 posed to human health, healthcare services and economic stability. They also could suggest various public health solutions to the challenge, but what leaders decided to do with that advice in terms of policy was 100% political. Scientific advice can provide data on the risks and benefits of closing schools or gyms or of “doing nothing”, but no scientist ever had the executive power to make policy decisions. This was the responsibility of elected officials. And knowing my academic colleagues, none of us would have wanted that power either. Prof Devi Sridhar is chair of global public health at the University of Edinburgh
Epidemics & Outbreaks
By Jacqueline Rosenthal, MD, as told to Keri Wiginton Multiple sclerosis (MS) affects everyone in a different way. But letâs talk a little bit about the differences we see between racial and ethnic groups when it comes to diagnosis, symptoms, and treatment. Iâll preface that by saying we need a lot more research in this area. What weâve seen in the clinic, and what the literature shows, is that Black people with MS donât do as well. What I mean by that is their disease is more aggressive from the start. For example, they have more spinal cord involvement, which is often tied to disability. Relapses also tend to be more frequent and severe in this group. And Black people living with MS are less likely to have a complete recovery between attacks. Those with relapsing-remitting MS also tend to advance to progressive MS faster than other groups. We also see more severe disease in the Hispanic population. This may be partly due to how MS affects this group. We see more involvement with the optic nerve and spinal cord. And whenever your vision and spinal cord are involved, youâre more likely to have disability.  That leads into the question of why. How much of this difference is caused by biology? How much is due to outside factors? Many MS specialists would lay heavy blame on the social and economic disadvantages that certain groups face. But we donât know the exact cause of these disparities. Even if we donât have all the answers, there are ways we can better understand and overcome challenges to care. Racial and Ethnic Disparities in Multiple Sclerosis We know that Black people with MS are diagnosed later in their disease course. Thereâs also a difference in prescribing patterns, with a lot of minority groups going untreated. And when they do get care, theyâre often undertreated. For example, Black people living with MS are less likely to start off with the aggressive treatment they need. This might lead to poorer health outcomes. And people who belong to minority groups generally face more barriers to care. Some of these hurdles include less access to health insurance, more financial hardships, and transportation troubles. All these things limit oneâs ability to see a neurologist or MS specialist early. And we do see that Black people living with MS are less likely to get into a comprehensive MS center right away. And by the time they get there, they have more disability. Misinformation, Medical Mistrust, and Stigma There are other reasons why MS may get missed in certain groups. That includes the faulty idea that people with this disease tend to look a certain way. I would argue that most MS specialists know people of any race or gender can get this disease. But some people still see it as an illness that mostly affects young white women. Unfortunately, that misconception remains even among some health care providers. And even though treatment for MS has gotten a lot better, thereâs still a stigma around being sick. There may also be cultural differences in how people think about chronic disease or neurological problems. Then you dive into the mistrust of the medical community. This delays diagnosis and treatment. Multiple Sclerosis Treatment Fears Disease-modifying therapies (DMTs) are the treatment of choice for people with relapsing-remitting MS. These drugs change how the immune system works. And theyâve been shown to lessen the chances of relapse and slow the progression of MS. Itâs best to start DMTs early in the disease course. But I sometimes see people with relapsing-remitting MS who want to try a drug-free approach at first. This happens among all racial and ethnic groups, but the topic might come up a little more often in people from the Hispanic and Black communities. I try to combat any treatment worries with education. Though, it can take time to put people at ease. Maybe we donât start on a medication after the first visit. But maybe by the second one, we can get to an understanding of the importance of disease-modifying treatment. Green Flags When Looking for Doctors You can live a full life with MS. But until thereâs a cure, youâll need medical care for the rest of your life. Because Iâm a minority, I know that some people may feel more comfortable with me right off the bat. But itâs important for doctors and people with MS to build a relationship based on trust. How do you know when a partnership is right? Listen to your gut. You should get the feeling that itâs OK to ask your doctor lots of questions. And you should feel like you leave each visit with a better understanding of whatâs going on with your body. I canât tell you how many people I see â who are referrals â whoâve had MS for years and donât really have a good grasp of the illness theyâre living with. On one hand, your doctor should go over the medications used to try to slow the disease itself. But you also need to cover how to manage symptoms caused by MS. These are all the things that will help you get through your day so you can go to work, hang out with friends and family, and stay involved in your community. If your quality of life and overall well-being arenât discussed, then Iâd say thatâs a problem. And maybe thatâs not the right doctor for you. Learn as Much as You Can Ask your doctor to explain what MS is. Learn how it affects your body, what symptoms you may get, and what your treatment choices are. Knowledge helps you advocate for yourself and make better-informed decisions. Keep in mind that learning about MS is a process. That first visit is always a shock. Some things register and some things may not. But if you know more about your MS â what type you have, where your lesions are â youâll know what questions or topics to bring up at your next visit. And take advantage of all of your MS resources. There are often ways to gain access to treatment even if you donât have health insurance or you have trouble paying for care or getting to your appointments. For example, you can get help for transportation or copay assistance for medication. While youâll need to be selective in your search, there are also good MS resources online. I encourage people to look at the websites of the National Multiple Sclerosis Society or the Multiple Sclerosis Association of America. Anything that ends in .edu or .org is usually safe. I donât think enough people know this kind of help is out there. But if the MS and health care communities can spread that education a bit more, that may help to address some of these disparities and inequities that weâre seeing. Show Sources SOURCE: Photo Credit: James Pauls / Getty Images Jacqueline Rosenthal, MD, neurologist, Andrew C. Carlos Multiple Sclerosis Institute, Shepherd Center, Atlanta.Â
Disease Research
At least 500 prisoners are on hunger strike inside a Bahraini prison primarily used to detain prisoners of conscience, refusing food in protest at their detention conditions. Detainees began refusing food on 7 August, and increasing numbers have joined since. Sayed Alwadaei, at the Bahrain Institute for Rights and Democracy (Bird) and a former inmate at Jau prison, said: “This is probably one of the most powerful strikes that has ever happened inside the Bahraini prison system; the scale of it is overwhelming.” According to a statement from the inmates released through the outlawed Al-Wefaq opposition party, the hunger strike includes demands for increased time outside their cells, currently limited to an hour a day, prayers in congregation at the prison mosque, changes to constraints on family visits, improvements to education facilities and access to proper medical care. “These are not frivolous demands, but necessary ones required for human life,” the prisoners added. The tiny Gulf island of Bahrain, population 1.5 million, has one of the highest incarceration rates per capita in the Middle East. An estimated 3,800 people are behind bars, of which Bird estimates that 1,200 are prisoners of conscience. Since pro-democracy protests against the ruling Al Khalifa family swept Bahrain in 2011, a large number of people connected with demonstrations have been incarcerated. The government has launched sweeping crackdowns on activists, civil society and opposition political groups, including banning two political parties. Most of the 1,200 political prisoners held in Bahrain are in Jau prison. Former inmates such as Alwadaei say political prisoners are housed in separate blocks and subjected to especially harsh treatment. Prominent political prisoners, including the veteran human rights defender Abdulhadi al-Khawaja, are among the hunger strikers in Jau. His daughter, the activist Maryam al-Khawaja, said her father, who has been incarcerated since 2011, launched his own hunger strike to demand adequate medical treatment for a heart condition, after he was denied an appointment with a cardiologist on 11 occasions. She said her father believed he had been singled out for additional punishment after demanding that prisoners received proper medical attention. The lack of medical care, she said, was putting his life at risk. “He has a heart arrhythmia and he is at risk of a heart attack or a stroke at any time. We believe my father needs urgent surgery to install a pacemaker.” Prisoners say denial of medical treatment, use of punitive solitary confinement and abuse are common. The family of Ahmed Jaafar Mohamed Ali, a dissident extradited from Serbia to Bahrain last year in contravention of a ruling by the European court of human rights because of fears he would be tortured in Bahrain, said he had joined the hunger strike. His family say that after Ali demanded to see the duty officer at Jau on 15 August, the officer arrived and instructed other guards to pepper spray Ali in the face. He was then bound, with his arms behind his back and on his legs, before being taken to solitary confinement. The national communication centre of Bahrain told the Guardian after publication: “The government of Bahrain is committed to protecting human rights and ensuring that international standards are met for all dealings with inmates at its reform and rehabilitation facilities”, and repeatedly asserted there were no prisoners of conscience held within its system. Officers and other employees at Jau prison “are fully committed to dealing with inmates in accordance to the law,” it added. The office of Bahrain’s interior ministry ombudsman said it had conducted investigations to “ensure the inmates obtain all their rights, whether from health care, visits or contact with their families, and are not being subjected to ill-treatment”. Maryam al-Khawaja pointed to the broad international assistance received by Bahraini authorities from abroad, including Britain. The UK prime minister, Rishi Sunak, met the crown prince of Bahrain, Salman Bin Hamad Al Khalifa, in July. Britain also increased funding to the Bahraini interior ministry and security bodies to £1.8m last year through its opaque Gulf strategy fund. She said: “The ruling family know they are incredibly dependent on their western allies … in many ways they [the allies] have enabled the Bahraini regime to stay in power.”
Global Health
SummaryJacobabad in Pakistan hits 51 Celsius (124 Fahrenheit)Women especially vulnerable to extreme heat - studiesPregnant women at even higher risk, scientists warnWIDER IMAGE photo essay:JACOBABAD, Pakistan, June 14 (Reuters) - Heavily pregnant Sonari toils under the burning sun in fields dotted with bright yellow melons in Jacobabad, which last month became the hottest city on Earth.Her 17-year-old neighbour Waderi, who gave birth a few weeks ago, is back working in temperatures that can exceed 50 Celsius (122 Fahrenheit), with her newborn lying on a blanket in the shade nearby so she can feed him when he cries."When the heat is coming and we're pregnant, we feel stressed," said Sonari, who is in her mid-20s.Register now for FREE unlimited access to Reuters.comThese women in southern Pakistan and millions like them around the world are at the searing edge of climate change.Pregnant women exposed to heat for prolonged periods of time have a higher risk of suffering complications, an analysis of 70 studies conducted since the mid-1990s on the issue found.For every 1 degree Celsius in temperature rise, the number of stillbirths and premature deliveries increases by about 5%, according to the meta-analysis, which was carried out by several research institutions globally and published in the British Medical Journal in September 2020.Cecilia Sorensen, director of the Global Consortium on Climate and Health Education at Columbia University, said the unfolding impact of global warming on the health of women was "highly underdocumented", partly because extreme heat tended to exacerbate other conditions."We're not associating health impacts on women and often times it's because we're not collecting data on it," she said. "And often women in poverty are not seeking medical care.""Heat is a super big deal for pregnant women."Women are especially vulnerable to rising temperatures in poor countries on the frontlines of climate change because many have little choice but to work through their pregnancies and soon after giving birth, according to interviews with more than a dozen female residents in the Jacobabad area as well as half a dozen development and human rights experts.Further adding to the risks, women in socially conservative Pakistan - and many other places - typically cook the family meals over hot stoves or open fires, often in cramped rooms with no ventilation or cooling."If you're inside cooking next to a hot open fire you have that burden of that heat in addition to the ambient heat which makes things that much more dangerous," Sorensen added.EXTREME HUMID HEAT EVENTSSouth Asia has suffered unseasonably hot temperatures in recent months. An extreme heatwave that scorched Pakistan and India in April was 30 times more likely to happen due to climate change, according to scientists at World Weather Attribution, an international research collaboration. Global temperatures have risen by about 1.2 degrees Celsius above pre-industrial levels. read more As temperatures continue rising, extreme heatwaves are only expected to increase.Jacobabad's roughly 200,000 residents are well aware of their reputation as one of the world's hottest cities."If we go to hell, we'll take a blanket," is a common joke told in the area.Few places are more punishing. Last month, temperatures hit 51 Celsius (124 Fahrenheit) on May 14, which local meteorological officials was highly unusual for that time of year. Tropical rains can also conspire with warm winds from the Arabian Sea to drive up humidity later in the year.The more humid it is, the harder it is for people to cool down via sweating. Such conditions are measured by "wet bulb temperatures," taken by a thermometer wrapped in a wet cloth. Wet bulb temperatures of 35C or higher are considered the limit to human survival.Jacobabad has crossed that threshold at least twice since 2010, according to regional weather data. And, globally, such "extreme humid heat events" have more than doubled in frequency in the last four decades, according to a May 2020 study in the journal Science.Sonari, who is in her 20s, and Waderi work alongside about a dozen other women, several of them pregnant, in the melon fields about 10 km from Jacobabad's centre.They begin work each day at 6 a.m. with a short afternoon break for housework and cooking before returning to the field to work until sundown. They describe leg pains, fainting episodes and discomfort while breastfeeding."It feels like no one sees them, no one cares about them," aid worker Liza Khan said more broadly about the plight facing many women in Jacobabad and the wider Sindh region which straddles the border of Pakistan and India.Razia, 25, and her six-month-old daughter Tamanna, sit in front of a fan to cool off during a heatwave, in Jacobabad, Pakistan, May 15, 2022. Last month Jacobabad became the hottest city on Earth. Women are especially vulnerable to rising temperatures in poor countries on the frontlines of climate change because many have little choice but to work through their pregnancies and soon after giving birth, according to interviews with more than a dozen female residents in the Jacobabad area as well as half a dozen development and human rights experts. REUTERS/Akhtar Soomro Khan's phone rings constantly as she drives to one of three heatstroke response centres she has helped set up in recent weeks as part of her work with a non-profit group called the Community Development Foundation.With a finance degree, Khan has lived in cooler cities across Pakistan but returned to her hometown because she wanted to be a voice for women in the conservative area."Nowadays I'm working 24/7," said the 22-year-old, adding that her organization was finding the impact of extreme heat increasingly intertwining with other social and health issues affecting women.GRAPHIC-Scorching South Asia: https://tmsnrt.rs/3MGhxINTHE FRONTLINES OF SUFFERINGThe harsh conditions facing many women were brought into tragic focus on May 14, the day temperatures in Jacobabad hit 51 C, making it the world's hottest city at that time.Nazia, a young mother of five, was preparing lunch for her visiting cousins. But with no air conditioning or fan in her kitchen, she collapsed and was taken to a nearby hospital, where she was pronounced dead from a suspected heat strokeDistrict health officials did not answer requests for comment about Jacobabad's record of heat-related deaths in recent years, or more specifically about Nazia's case.Her body was taken the following day to her ancestral village to be buried and her children, the youngest a one-year old who was still breastfeeding, regularly cry for their mother, a relative said.Widespread poverty and frequent power cuts mean many people can't afford or use air conditioning or at times even a fan to cool down.Potential strategies recommended by experts include providing clean-energy stoves to replace open-fire cooking, offering women's medical and social services during early morning or evening hours when it is cooler and replacing tin roofs with cooler material in white to reflect solar radiation away from the home.Climate Change Minister Sherry Rehman told Reuters that women were likely bear the brunt of rising temperatures as they continued to scorch the country, adding that climate change policies in the future needed to address the specific needs of women."A megatrend like climate change ... poses a significant threat to the well-being of unempowered women in rural areas and urban slums," she added. "Pakistani women, especially on the margins, will be impacted the most."Some in Jacobabad find it galling that Pakistan is responsible for just a fraction of the greenhouse gases released in the industrial era and now warming the atmosphere."We are not contributing to the worsening, but we are on the frontlines as far as suffering is concerned," said Hafeez Siyal, the city's deputy commissioner.NO WATER, NO POWER, WE PRAYIn a residential neighbourhood of the city, a donkey-drawn cart stacked with blue plastic jerrycans stops near the entrance to warren-like lanes leading to a cluster of homes. The cart's driver runs back and forth delivering 20-litre containers of water from one of a few dozen private pumps around the city.Most residents of Jacobabad rely on such water deliveries, which can cost between a fifth and an eighth of a household's meagre income. Still, it's often not enough, and some families are forced to ration.For young mother Razia, the sound of her six-month-old Tamanna crying in the afternoon heat was enough to persuade her to pour some of her precious water over the baby. She then sat Tamanna in front of a fan, and the child was visibly calmer, playing with her mother's scarf.Local officials said water shortages were partly due to electricity cuts, which mean water cannot be filtered and sent via pipes throughout the city. There are also severe water shortages across Sindh, with climate change minister Rehman flagging shortfalls of up to 60% of what is needed in the province's key dams and canals.Rubina, Razia's neighbour, fried onions and okra over an open fire, explaining she usually felt dizzy in the heat and tried to soak herself in water each time she cooked to prevent herself from fainting.There was not always enough water to do so, though."Most of the time, it ends before it's time to buy more and we must wait," Rubina said as she closely supervised her children and grandchildren sharing a cup of water. "On the hot days with no water, no electricity we wake up and the only thing we do is pray to God."($1 = 197.6000 Pakistani rupees)Register now for FREE unlimited access to Reuters.comCharlotte Greenfield reported from Jacobabad and Gloria Dickie from London; Editing by Mike Collett-White, Katy Daigle and Pravin CharOur Standards: The Thomson Reuters Trust Principles.
Global Health
Thereâs a lot to think about when you find out that you have autosomal dominant polycystic kidney disease (ADPKD). When do you start treatment? Will your daily life change? How will it affect your kids? That last one can be really tough. But Jillian Warejko, MD, a pediatric kidney specialist at Yale Medicine, says itâs important for kids to learn what to expect. âThereâs a lot of power in knowing your own health history,â Warejko says. âSo we try to teach kids to empower themselves and advocate for themselves.â You should tailor your conversation based on your childâs developmental age. And you may want to space your talks out over time. Here are some topics to get you started. How You Get It If your kids are teenagers or young adults, you can break down the basics of this autosomal dominant genetic disease. Warejko explains that a faulty gene on a non-sex chromosome causes ADPKD. That means that whether your child is male or female, thereâs a 50% chance theyâll get this mutated gene from you. And if they have the disease, thereâs a 50% chance theyâll pass it on to their kids. You may need to give younger kids less information. You can still bring up ADPKD. But use age-appropriate terms that arenât scary. âYou donât want kids to be fearful,â Warejko says. âFear can make people not want to go to the doctor.â In her practice, Warejko describes ADPKD like this: âIt sounds like a couple of family members have had this illness called kidney disease. And the reason youâre visiting with me today is because we want to make sure that, if you have kidney disease too, weâre doing everything in our power to make sure you stay as healthy as possible.â She also tells kids that itâs best to treat this disease early, when their kidneys are âgoodâ and still work like normal. And the best way to do that, she says, is to âmake sure that youâre checking in with us.â Symptoms to Watch For If your kids have ADPKD, they might not have any problems when theyâre children or young adults. âThe disease can be relatively quiet in those early years,â says Neera Dahl, MD, PhD, a kidney specialist with Yale Medicine. With that said, Dahl thinks parents and kids should know what to watch for. Tell your child to speak up if they notice: - Back or side pain - Blood or pain when they pee - Any other urine changes - Frequent headaches Encourage your kids to keep track of their health details. âIf the doctor tells them their blood pressure is a little high, take down that number,â Warejko says. âEveryone has a piece of âpaperâ wherever they go because our phones have ânotes.ââ You can also share what the disease feels like for you. But keep in mind that your child may not have the same experience. âThe tricky thing about ADPKD is that everyone is a little bit different, even among family members,â Warejko says. âBut I always encourage families to be open with one another.â When and How to Get Diagnosed Children may only need regular wellness visits once a year. But their doctor should check for high blood pressure or blood in the urine. âIf those are off, thatâs a reason to investigate further,â Dahl says. âOtherwise, itâs OK to monitor kids to see how theyâre doing.â Warejko stresses the importance of annual checkups throughout the late teens and early 20s. Sometimes young adults who might have ADPKD skip these screening tests, she says, because they feel healthy. Though they could have high blood pressure or cysts and not know it. âOne of the hardest parts about kidney disease is you donât feel it until you feel it,â she says.  To diagnose ADPKD, you may get: Imaging tests. The most common one is an ultrasound, Dahl says. Itâs a painless test that can take pictures of the urinary tract or kidneys. Other imaging tests include a computed tomography (CT) scan or magnetic resonance imaging (MRI). Genetic testing. This is a surefire way to know if you have ADPKD. But it might not be the right choice for everyone, especially young kids. âThereâs a lot of debate about what it means to genetically test someone whoâs under the age of 18, when theyâre not at an age that they can fully consent,â Warejko says. âNot every person wants to know what their genetic predisposition is.â Ask your doctor to refer you to a genetic counselor. They can help you figure out if this is something you or your family might want to do. Pre-implantation screening. This is for your adult kids who want to start a family. People who use in vitro fertilization (IVF) can get a special test to check for ADPKD in fertilized eggs. Itâs not 100% accurate. But it can be a choice for people who want to take steps to lower the odds that theyâll pass on the gene, Dahl says. Set a Good Example You can teach your kids some healthy habits to protect their kidneys. If they ask why, tell them you want to help them achieve their goals. Thatâs what Warejko does. She asks kids what they want to be when they grow up. Then she tells them, âI want you to be successful, and part of that is being healthy.â Her tips include: - Drink plenty of water. - Eat a low-salt diet. - Get enough physical activity. - Eat lots of fresh fruits and vegetables. - Avoid processed and fast foods. Warejko knows itâs not easy for everyone to make these healthy changes. Some families may not have access to fresh produce or live in a neighborhood where itâs safe to go for walks. Thatâs why she makes an effort to brainstorm with kids and parents. Sheâll help them find ways to get healthy food or exercise in their home. âI try to specifically ask, âWhat are the restrictions we need to work inside?ââ Life With ADPKD Treatment has come a long way in recent years. In 2018, the FDA approved tolvaptan (Jynarque), the first drug to treat adults with ADPKD. It can slow down cyst formation on the kidneys. âI think tolvaptan is going to change the trajectory and weâre not going to see as many people ending up with kidney failure,â Warejko says. âMy hope is that snowball will continue to roll downhill.â Show Sources Photo Credit: SDI Productions / Getty Image SOURCES: Jillian Warejko, MD, clinical pediatric nephrologist, Yale Medicine; assistant professor of pediatrics, Yale School of Medicine. Neera Dahl, MD, PhD, medical director of nephrology, Yale Medicine; associate professor of medicine, Yale School of Medicine. UpToDate: âPatient education: Polycystic kidney disease (Beyond the Basics).â National Institute of Diabetes and Digestive and Kidney Diseases: âAutosomal Dominant Polycystic Kidney Disease.â PKD Foundation: âTolvaptan treatment for ADPKD.â
Disease Research
A bipartisan group of senators announced a deal Sunday on framework legislation to address a recent surge in gun violence in the U.S.  The proposed legislation includes funding for school safety resources, strengthened background checks for buyers under the age of 21, incentives for states to implement their own red flag laws, penalties for straw purchases of firearms and increased protections for domestic violence victims.  The bipartisan group was made up of 20 senators, including 10 GOP lawmakers, many of whom are strong supporters of gun rights and political allies of the powerful National Rifle Association (NRA). With support from those 10 Republicans, the legislation likely has the votes to overcome the 60-vote threshold to avoid a filibuster in the Senate. Here are the Senate Republicans who are backing the bipartisan gun reform legislation.  Sen. John Cornyn (R-Texas)  Cornyn was among the initial group of nine lawmakers who began discussing gun legislation after the mass shooting at a Uvalde, Texas, elementary school last month that left 19 students and two teachers dead. Senate Minority Leader Mitch McConnell (R-Ky.) appointed Cornyn as the GOP’s lead negotiator in the talks. “The tragedies in Uvalde and elsewhere cried out for action,” Cornyn said in a tweet Sunday amid news of the bipartisan deal. “I worked closely with my colleagues to find an agreement to protect our communities from violence while also protecting law-abiding Texans’ right to bear arms.” Cornyn, who has an “A-plus” rating from the NRA, had previously offered assurances that he would not support any legislation that restricted gun rights. Sen. Thom Tillis (R-N.C.) Tillis also played an early role in the gun violence negotiations. He said he was not willing to support raising the age limit of purchasing AR-15–style rifles to 21 years of age, which is high on the Democratic wish list. Shortly after the Uvalde shooting, Tillis warned against blaming mass shootings on the proliferation of guns in America. “It’s horrible. And you know what we need to avoid is the reflexive reaction we have to say this could all be solved by not having guns in anyone’s hands,” he said, according to CNN. “We can always talk about reasonable measures, but we also have to talk about better situational awareness. I’m almost certain that in the coming days or weeks, we’re going to find out that there were signs that this person was at risk.” Sen. Roy Blunt (R-Mo.) Blunt, who is retiring from his Senate seat at the end of this year, worked with Sen. Debbie Stabenow (D-Mich.) on mental health provisions in the framework package, such as national funding for mental health clinics that will provide 24/7 mental health crisis responses among other services.  “We want to be sure that mental health care is not only available, but that we are encouraging people to seek care without the fear of stigmatization. This bipartisan proposal builds on the progress we have made and ensures community-based access points to care will be available over the long term,” Blunt said in a statement on Sunday.  “It will help keep people safe while protecting the constitutional rights of law-abiding Americans, and I urge our colleagues to give it their full consideration.” Rob Portman (R-Ohio) Portman recently told NBC affiliate WFMJ-TV that keeping firearms away from dangerous individuals and implementing safety measures at schools were his focuses in the talks. “We have the opportunity to do something [addressing mental and behavioral health] that we should be doing anyway,” he said. Portman also noted he doesn’t want to infringe on citizens who abide by gun laws. He also expressed interest in making juvenile records more accessible in systems used to prevent dangerous individuals from obtaining firearms. Richard Burr (R-N.C.) Burr, who is also retiring this year, has received nearly $7 million in donations from the NRA, according to data from Brady United, placing him second among GOP senators behind Sen. Mitt Romney (R-Utah). Asked about Democratic gun control proposals following the Uvalde shooting, Burr didn’t say specifically what he opposed or supported. “If somebody’s got a solution to this, by all means, let’s talk about it,” Burr said. “But nobody’s proposed that they’ve got one.”  Mitt Romney (R-Utah) Romney, who received more than $13.5 million in donations from the NRA, said in a tweet after the Uvalde shooting that “we must find answers” to the issue.  In a statement on Sunday, he said, “Families deserve to feel safe and secure in their communities.” “Proud to join my colleagues on this commonsense, bipartisan proposal that will save lives while also protecting the constitutional rights of law-abiding Americans. It deserves broad support.” Romney has regularly opposed Democratic-proposed gun control measures, though he said in 2018 that he was open to considering “more effective background checks.” Bill Cassidy (R-La.) Cassidy said he was open to discussion on gun reform legislation in the aftermath of the Uvalde school massacre. Among the initial group of nine lawmakers, Cassidy suggested that red flag laws and expanded background checks were not the right solution to the problem. “Senator Cassidy will always be an advocate for law-abiding citizens’ Second Amendment rights,” Cassidy’s spokesperson Ty Bofferding said in a statement to the Daily Advertiser last month. “Cassidy is open to conversations about solutions that will actually work to prevent these kinds of mass shootings. Unfortunately, expanded background checks or red flag laws, as Democrats are proposing as a solution, would not have prevented the tragedy in Texas.” Susan Collins (R-Maine) Collins previously said she would like to see red flag laws, which have already been enacted in her state of Maine, be part of the bipartisan proposal. “I believe that we should look at enacting a red flag law based on the one we have in Maine, which has due process rights and involves a medical professional in the decision,” she said last month. “I don’t know the details of the shooter, but it’s hard to believe he wasn’t mentally ill.”   Collins also expressed her support for creating a process for keeping firearms away from those who suffer from mental health issues. “I really think our focus should be on looking at what the states have done, what some states have done on red flag or yellow flag laws,” she added.  Lindsey Graham (R-S.C.) Graham has suggested that retired and former military members should provide armed security at schools, joining a chorus of GOP voices calling to “harden” schools against threats. “I will be working to create a certification process that allows former military members to go through school security training and become available to school districts throughout the country,” Graham said in a Twitter thread last month. “It is time to mobilize our retired and former service members who are willing to help secure our schools. Our schools are soft targets,” Graham added. “They contain our most valuable possession — our children, the future of our country — and must be protected.”  Pat Toomey (R-Pa.) Toomey recently told the Pittsburgh Post-Gazette that he wants to ensure background checks on all firearm sales.  “I certainly remain committed to the idea of the principle of the policy of expanding background checks to cover all commercial sales,” Toomey said last month. “I would also point out that even though we fell short, I think it’s the only measure that had bipartisan support — probably the only one, or one of the few, that would have it now.” Toomey first introduced an expanded background check legislation alongside Sen. Joe Manchin (D-W.Va.) in 2013 in response to the Sandy Hook Elementary School massacre, but the bill failed to reach the 60-vote filibuster threshold.
Mental Health Treatments
I was in my car when I reached breaking point. It had been another busy day at the GP surgery where I am a partner, and I had stopped to check my emails. What I read turned my blood cold: the suicidal teenager I had worked so hard to admit earlier that day had been discharged from A&E without even being assessed by the mental health team. I was genuinely afraid that this young person would die, but I knew there was nothing more I could do. I wept, and I could not stop. I phoned a colleague. She came and sat with me in a dark car park in the middle of nowhere and gently persuaded me that I needed to take some time off. I felt huge guilt but reluctantly agreed. The crash, once I let it happen, was profound. I found myself anxious about making tiny daily decisions and had dark thoughts about not being good enough: if I was just a better doctor, a better leader, maybe none of this would be happening. It took months of medication and therapy before I was able to return. I have now been back at work for almost a year – but I don’t feel able to stay. I have handed in my resignation and, by later this year, I will no longer be a GP partner in the NHS. I’m not the only GP to feel so broken. We signed up for what we hoped would be rewarding careers in our local communities, based on long-term relationships with patients and the kind of continuity of care that saves lives. But the impact of workforce shortages, austerity policies and then the Covid-19 pandemic has slowly eroded all the quality. Death by 1,000 cuts for the service, but also for GPs’ and support staff’s wellbeing. It wasn’t always this way. Eight years ago, I loved my job as a GP partner managing a small semi-rural surgery. Though the work was demanding and the hours long, we had a sense of control and self-determination, and knew that the work we were doing made a difference. So, what changed? By 2019, the pots of money we had to chase got ever smaller and more scattered. The time we used to have for meaningfully improving local care was taken instead by chasing central targets and top-down initiatives. This wasn’t to secure “extra” money. These were existing funds diverted into new projects, but with so many additional strings attached that hours of our time were wasted in claiming them. As job satisfaction fell, it became harder to recruit. We lost a partner to retirement and were never able to replace them. Now, if extra work was needed (a last-minute safeguarding conference for a vulnerable child, cover for a sick colleague, Covid vaccination clinics), this was split between a smaller group of partners. The hours and extra workload started to take its toll. We tried to work smart to meet these new difficulties. We teamed up with other local surgeries long before “primary care networks” became a buzz phrase. We ran collaborative patient support groups and shared clinical expertise to enable us to reduce hospital referrals. We looked to recruit from a broader pool of staff, taking on a paramedic, a pharmacist, a nurse practitioner. All valuable and valued colleagues. But these new colleagues could not work independently. They needed a GP alongside to provide support. And so the hours and the workload grew and, as they grew, our pay went down – a real terms 30% pay cut in the past 15 years. This made it even harder to recruit new partners. Workforce issues continued. Staff left, citing abusive patients and impossible workloads. We could not even find temporary staff to fill vacancies and had instead to rely heavily on agency locums, who come at a premium price and would not, understandably, cover all the workload. Any satisfaction we used to have at being good employers in our area was lost. Meanwhile, secondary care and social care delays meant we were helping patients with increasingly complex conditions in the community. Our appointment numbers increased – at one site by 25% over three years. As partners we took on yet more, spreading ourselves thinner again to cover the gaps. The number of partners in our practice halved. We all suffered burnout and ill health: two of the remaining partners needed extended time off work to recover. By the time I went off sick, I was very unwell. I was dealing with daily panic, tearfulness and poor sleep. I had lost confidence in my abilities as a doctor, and struggled with a blurring of boundaries as I found it harder and harder to say no to additional tasks piled at my door. As a practice, any aspiration of providing excellent care is gone. Yes, we still keep patients safe, but to the detriment of our own health. We have had to scale back, serving a smaller population from a reduced number of sites. GP practices are not just bricks and mortar. These buildings, in the heart of every community, are propped up by the partners who run them and the staff they employ. When they can no longer hold this unbearable weight, the whole practice, and the value it offers, crumbles and falls. We are making personal, financial, emotional and health sacrifices to keep services running for our patients and we cannot continue. We aren’t just exhausted. We are broken. And we are leaving. How can we work in a system that we feel is slowly killing us and our patients? The writer is a partner in a small rural GP practice In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, Mental Health America is available on 800-273-8255. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978
Mental Health Treatments
Researchers at the Francis Crick Institute and Aalborg University in Copenhagen have shown that changes can be detected in blood tests up to eight years before a diagnosis of Crohn’s disease and up to three years before a diagnosis of ulcerative colitis. This means the beginnings of inflammatory bowel diseases start a long time before symptoms occur, and in the future may provide an opportunity for doctors to take preventative action before symptoms begin, or prescribe medication when it will be most effective. Crohn’s disease and ulcerative colitis are collectively known as inflammatory bowel diseases (IBD). They are incurable conditions which involve excessive inflammation in the gut, leading to symptoms like abdominal pain and diarrhoea. Early diagnosis and treatment are key to improving outcomes, but nearly a quarter of the 25,000 people diagnosed each year in the UK wait over a year (Crohn's and Colitis UK). In their study published today in Cell Reports Medicine, the team used electronic health records from people in Denmark, comparing 20,000 people with an IBD diagnosis with controls from 4.6 million people without IBD. It was previously thought that most people have symptoms for about a year before diagnosis, but significant bowel damage is often seen, suggesting that changes have been taking place for a lot longer. The researchers confirmed this by looking at ten years of test results before diagnosis. They observed changes in a series of minerals, cells in the blood and markers of inflammation, such as faecal calprotectin, a molecule released into the gut during inflammation and currently used to determine which people with bowel symptoms need further investigations. These changes were observed up to eight years before diagnosis in Crohn’s disease and three years in ulcerative colitis. Importantly, most of the changes observed were subtle and would have appeared within a normal range for standard blood tests, so wouldn’t have been flagged as a cause for concern. It required a huge dataset to be able to detect these changes across many different markers. The researchers’ next steps are to investigate if treatment or prevention has an impact before people get symptoms, and whether the findings from this research could be developed further to predict who will develop IBD in the future. First author, Marie Vestergaard, PhD student at the Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, at Aalborg University, said: “So many young people are affected by IBD. Their lives, hopes and aspirations for the future are turned upside down by a diagnosis and trying to live with a chronic disease. As a young person myself, it gets me. I am happy that our research might help predicting who could potentially suffer from IBD and thus start treatment earlier which would greatly improve their quality of life.” James Lee, Group Leader of the Genetic Mechanisms of Disease Laboratory at the Crick, said, “Our research shows that the bowel damage we’re seeing at the point of diagnosis is just the tip of the iceberg. So many changes are subtly taking place in the body before the disease takes hold. “This has huge implications for prevention as it highlights that there’s a window of opportunity for treatment. We don’t yet know whether preventative measures like changing diet or stopping smoking would stop someone getting these diseases, but this opens the door to that possibility. It also underscores the importance of early diagnosis and treatment, as many of the changes in the gut are likely to have been happening long before people become ill.” Tine Jess, Director at the Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, at Aalborg University, said: “Our findings are novel and go hand-in-hand with emerging evidence that chronic inflammatory bowel diseases likely have their onset years prior to diagnosis. These incurable diseases affect young individuals and are twice as common as type 1 diabetes. Understanding the exact mechanisms behind their development is essential to ultimately prevent the diseases from occurring. Our unique Danish data resources combined with cross-disciplinary and international collaboration help answering yet unanswered questions critical for patients worldwide.” Sarah Sleet, CEO of Crohn’s & Colitis UK, said: “There are over 500,000 people in the UK with Crohn’s and Colitis. We know that earlier diagnosis leads to better outcomes for everyone, but waiting lists for diagnostic tests can be long. Not only that, many people put off going to the GP to get their symptoms checked out - either because they don’t realise how serious they could be, or through fear or embarrassment. Anything that could potentially speed up the process of getting an accurate diagnosis is a hugely positive step in the right direction.”
Disease Research
Fiona Phillips has said she has been diagnosed with Alzheimer's at the age of 62. The journalist and broadcaster discovered she had the disease a year ago after suffering months of brain fog and anxiety, she told the Mirror. Phillips, former host of ITV breakfast show GMTV, said dementia had "decimated" her family after her mother, father and uncle also had the disease. She added she was "getting on with it." The mother of two, who is a columnist for the Daily Mirror, told editor Alison Phillips that she was trying to "carry on" as normal, but wanted to share her story to help others. She said that despite fearing she would one day be diagnosed with Alzheimer's, it had still come as a shock when her doctor said her test results showed early stages of the disease. "It's something I might have thought I'd get at 80", she says. "But I was still only 61 years old." The presenter said that she felt "more angry than anything else" because the disease had already had such an impact on her family life. "My poor mum was crippled with it, then my dad, my grandparents, my uncle. It just keeps coming back for us," she said. Phillips said she was undergoing trials at University College Hospital in London for a drug called Miridesap, which could potentially slow the effects of the disease. She also described how her husband Martin Frizell, the editor of ITV's This Morning programme, has been helping her take the medication. She said: "Poor Martin, he has been injecting my stomach every day, he has been brilliant. "The drugs are brand new and they're expecting a lot from this and so am I." In the meantime, she said, "I am just getting on with it, I'm not taking notice of it. "I'm just doing what I normally do. I don't want to not work, be sitting around playing with my fingers, or watching telly. I just like doing things." Ms Phillips currently writes a column for the Daily Mirror and previously anchored GMTV for more than a decade from 1997. She also took part in BBC's Strictly Come Dancing in 2005. She has spoken publicly about her parents' battles with Alzheimer's in the past. Kate Lee, chief executive at the Alzheimer's Society, praised Phillips' decision to share her diagnosis, which raised "much-needed awareness of dementia". Hilary Evans, chief executive of Alzheimer's Research UK, said: "It takes such courage to go public with a diagnosis and Fiona knows better than most just how much good that can do. "Awareness is vital and Fiona's bravery will help untold people who are going through their own dementia journeys." She added that there were around 70,800 people under 65 with dementia in the UK.
Disease Research
A man has credited his digital watch for pointing medics towards an undiagnosed heart condition. Author Adam Croft, 36, from Flitwick in Bedfordshire, awoke to find his Apple device had been alerting him throughout the night that his heart was in atrial fibrillation. The NHS 111 service advised him to go to hospital "within the hour" where it was medically confirmed. "It's not a feature I'd ever expected to use," he said. Mr Croft said he had got up from the sofa one evening and "felt a bit dizzy" but when he got to the kitchen to get some water he "immediately felt the world closing in". "I managed to get down on the floor and ended up in a pool of cold sweat," he said. "Being a man I thought not much of it and took myself up to bed." The following morning, he woke up to find his watch had been notifying him every couple of hours that his heart was in a rhythm called atrial fibrillation - and to seek medical advice. "I called 111 who said get to hospital within the hour," he said. 'Little flutterings' Bedford Hospital arranged two electrocardiograms (ECGs) before his condition was medically confirmed. The writer said he had previously had "little flutterings" of the heart, which his watch had not picked up, but these had not happened for months. He had also "never had any pain or symptoms that I thought were serious". He added that he would not have called the NHS 111 service, where people can get advice about symptoms and treatment, if the watch had not alerted him. "I had no reason to," he said. "I just felt a bit light-headed... I had been feeling a bit rough so thought I might be coming down with something." What is atrial fibrillation? "Although atrial fibrillation is common, it isn't always obvious, and symptoms can be overlooked," says Chloe MacArthur, senior cardiac nurse at the British Heart Foundation. "They include palpitations (a racing, fluttering feeling in the chest), chest pain, shortness of breath, dizziness, feeling faint, unexplained tiredness and difficulty exercising. "Wearable devices can be helpful for improving exercise habits and eating behaviours and they can provide motivation to lead a healthier lifestyle - all of which contribute to lowering the risk of heart disease - but they are not a replacement for medical advice, and they cannot provide a diagnosis. "Often, atrial fibrillation is detected by a manual pulse check during a routine examination or check-up, or on an ECG. "Symptoms of atrial fibrillation can be noticeable. Anyone concerned about their heart health should speak to their doctor." Mr Croft said he had now been put on blood thinners before he undergoes a cardioversion procedure, a treatment that uses quick, low-energy shocks to restore a regular heart rhythm. In the meantime he has been given instructions to "take it easy". "It is something that will get worse and will happen more and more over time so it's a case of keeping my stress levels down and looking after myself," he said. "I find writing [and] to be able to live in a fictional world very relaxing anyway. "The watch will be staying on now."
Medical Innovations
Image source, PA MediaThe Conservative MP Andrew Bridgen has been suspended by his party after comparing the side effects of Covid vaccines to the Holocaust. In a tweet - which he has since deleted - he claimed that an unnamed cardiologist told him it was "the biggest crime since the holocaust". The North West Leicestershire MP began the pandemic raising concerns about lockdowns and later opposing the idea of mandatory vaccination, but he praised the UK's vaccine roll-out and tweeted encouraging others to get the jab after his first dose. However in recent months, he has made increasingly misleading statements about vaccine safety.Calling for vaccine to be suspended In December 2022, Mr Bridgen called in Parliament for a "complete suspension" of Covid vaccines based on what he described as, "robust data of significant harms and little ongoing benefit". This went against the overwhelming weight of evidence, from a number of different independent teams of researchers, that found that Covid vaccines' benefits far outweigh any known harms. The latest figures suggest the vaccines are more than 90% effective at preventing deaths, falling to 50% after six months. Older people still have around 60% protection against hospital admission, nine months after receiving a booster jab.Serious side effects do exist but they are rare. After more than 45 million people received at least two doses in England and Wales, 59 deaths involving the vaccines had been registered as of November 2022 - though more may be recorded as it takes time for such deaths to be investigated. There were 15 reports of suspected heart inflammation or scarring (myocarditis or pericarditis) for every one million second doses of the Pfizer vaccine given in the UK up until the end of last November according to the UK Health Security Agency, and roughly 11 cases of an unusual type of blood clot linked to the AstraZeneca vaccine per one million doses. A Danish study of four million people found no cases of heart failure among people who developed myocarditis or pericarditis after vaccination. These risks vary by age and this has been taken into account by health bodies who have made decisions about the vaccines. When it became clear the risk from blood clots was too close to the risk from Covid in younger age groups, the recommendations for younger people changed. Claims about vaccine side effectsAlso in December 2022, Mr Bridgen told MPs: "There have been more reported deaths and adverse reactions following mRNA vaccination [Pfizer and Moderna] in 18 months than there has been to every conventional vaccine administered worldwide for the last 50 years".At the time, we asked Mr Bridgen for the evidence for this. He referred us to information drawn from the UK Yellow Card scheme - set up by the medicines and vaccines regulator (MHRA) for people in the UK to report their concerns or symptoms after having the jab. But that data can't be used to back up his claim. The scheme works by allowing anyone to make a report relating to anything that happens to them after having a vaccine - the figures on their own cannot be used to tell if the vaccine was responsible for this. The scheme can't be used to accurately measure how vaccine side effects have changed over time. At different points, there might have been over-reporting - where symptoms people record aren't actually caused by the vaccine - and under-reporting, where people don't record genuine side effects. The MHRA said the fact that more people were reporting to the scheme was expected,"given the scale of the Covid-19 vaccination programme, and publicity in the context of the pandemic," rather than indicating a real rise in side effects. It is also UK data and Mr Bridgen did not provide evidence to compare this with all conventional vaccines worldwide for the last 50 years. Image source, Getty ImagesA better way of understanding the level of vaccine side effects is to look at clinical trials. These have helped us learn about genuine but rare side effects like blood clots and myocarditis. They have concluded that these are significantly outweighed by the deaths and illness that the Covid vaccines have prevented.Claims of a cover-upIn December, Mr Bridgen claimed in Parliament that the head of a cardiology research department with a "leadership role with the British Heart Foundation...sent out non-disclosure agreements to his research team to ensure that this important data [on vaccine harms] never sees the light of day".When asked by The Times newspaper to provide evidence, Mr Bridgen failed to do so.The British Heart Foundation said in a statement: "Scientific evidence shows that Covid-19 itself is much more likely to cause myocarditis than the vaccine is, and people who are vaccinated have a much lower risk of getting other serious complications caused by Covid-19."We employ a small leadership team of senior scientists and cardiologists to oversee and administer our research funding programmes, who also continue to undertake some of their own research. We can categorically say that nobody within this leadership team has acted in the way claimed by Mr Bridgen."Since then, Mr Bridgen has also referred to Covid vaccines as "experimental gene therapy" - a term used by those who spread anti-vaccine conspiracies online. The vaccines do not affect DNA and therefore the NHS does not define it as gene therapy. The BBC has approached Mr Bridgen for comment.
Vaccine Development
A recent scientific study published in the Journal of Social and Personal Relationships has shed light on the intriguing connection between the quality of our sleep and the quality of our romantic relationships. The research suggests that poor sleep can lead to increased feelings of anger, which, in turn, negatively impacts our perceptions of our romantic partnerships. Couples worldwide often face moments of sleeplessness, whether it’s due to stress, having young children, or other factors. Researchers wanted to know if there was a connection between poor sleep and how people perceive their romantic relationships. They also aimed to explore the role of emotions in this relationship dynamic. “What predicts whether romantic relationships last and are happy and satisfying is something I’ve been interested in my whole career,” said study author Erica B. Slotter, an associate professor in the Department of Psychological and Brain Sciences at Villanova University. “Our romantic bonds are important for both mental and physical well-being. In the field of relationships science, researchers have learned a lot over the past 50 years about the individual differences that matter for relationships (i.e., personality), as well as the communication and interaction styles within a relationship that work well versus not (i.e., conflict behaviors).” “Less attention has been paid over the years to the smaller things – things that fluctuate over time, sometimes even day to day – that might predict outcomes for relationships. Sleep is one of those ‘smaller things.’ Ongoing sleep deprivation is a serious issue that can impact well-being and is prevalent in American adults.” “Even among people who aren’t what we might consider chronically sleep deprived, sleep quality can vary day-to-day and certain periods of life (i.e., new parenthood) are characterized by less quality sleep than others,” explained Slotter. “We were interested in how relatively short term differences in sleep quality would be related to people’s emotional states, and thus their perceptions of their relationship.” To tackle this question, the researchers conducted a series of three studies involving a diverse group of participants, including college students and people in dating and marital relationships. In the initial study, the researchers sought to examine the association between sleep quality and perceived relationship quality. They gathered data from a sample of 209 romantically involved non-student adults who were recruited via the Prolific research platform. To assess sleep quality, participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI), a widely used self-report questionnaire that evaluates sleep quality over the past month. The PSQI covers various aspects of sleep, including sleep duration, sleep disturbances, and daytime dysfunction. To measure perceived relationship quality, participants responded to questions that gauged their overall satisfaction with their romantic relationships. These questions helped researchers understand how participants perceived the health and satisfaction of their partnerships. The results of Study 1 revealed a significant correlation between poor sleep quality, as indicated by the PSQI, and lower perceived relationship quality. Essentially, participants who reported experiencing poor sleep over the past month tended to have less positive views of their romantic relationships. This initial finding set the stage for further investigation into the emotional dynamics underlying this relationship. Expanding on the insights from the first study, the researchers conducted a second study to examine temporal changes in sleep quality, anger, and perceived relationship quality in a longitudinal study of dating and married couples. The sample included 134 couples recruited from the Chicago metro area. The researchers found that changes in sleep quality were associated with changes in general anger, with worse sleep quality predicting increased feelings of anger. Study 2 also provided evidence that changes in anger mediated the association between changes in sleep quality and changes in perceived relationship quality. This mediation suggested that fluctuations in anger played a significant role in how changes in sleep quality affected relationship quality. The third and final study sought to experimentally induce different affective states (emotional states) among 218 romantically involved college students. Participants were exposed to various emotional inductions, including anger, distress/sadness, positive affect, and a no affect manipulation as a control condition. In the anger induction condition, participants were asked to imagine a series of mishaps occurring on exam day designed to elicit anger and annoyance. In the distress/sadness condition, participants were asked to imagine sad occurrences in their immediate circumstance to elicit sadness and distress. In the positive affect condition, participants were asked to imagine positive events transpiring on exam day to elicit a positive state. In the control condition, participants completed no writing tasks but completed survey measures. Sleep quality had a significant main effect on all three affective states (anger, distress, and positive affect) across all conditions. Poor sleep was associated with more anger, more distress, and less positive affect. Poor sleep appeared to increase both baseline anger and reactivity to the anger induction, which could contribute to lower relationship quality among poorly rested individuals. In other words, poor sleep appeared to exacerbate feelings of anger, and this intensified anger was more likely to lead to negative perceptions of their romantic relationships. “In short, getting worse sleep predicted people perceiving that their relationships were worse – they perceived less intimacy, love, satisfaction, trust, passion, and commitment in their relationships,” Slotter told PsyPost. “Worse sleep also predicted people feeling angrier – in general, not necessarily as their partner. Increased feelings of anger mediate, or accounted for, the association between worse sleep and relationship quality. Taken together these findings suggest that sleeping less well predicts us feeling more irritable and angry, which then predicts us feeling less positively about our romantic relationships.” “We ran several studies looking at these ideas,” Slotter explained. “Most notably, our second study tracked couples over time, so we’re able to look at how changes in sleep (i.e., sleeping less well this month versus last month) mattered. The effects I mentioned previously were all associated with worse sleep on average, but also worsening sleep over time.” Like all scientific research, this study has some limitations to consider. For instance, sleep quality was primarily measured through self-reporting, which may not capture the full complexity of sleep patterns. Future research could benefit from incorporating more objective measures of sleep. “This work is all correlational,” Slotter noted. “We didn’t experimentally manipulate sleep. As such, we can’t claim that worse sleep ’causes’ our outcomes. We also did not examine whether our effects would look different among chronically versus occasionally sleep deprived people, and our sample was limited in terms of its demographic diversity.” The study, “Tired, angry, and unhappy with us: Poor sleep quality predicts increased anger and worsened perceptions of relationship quality“, was authored by Alexis Audigier, Sara Glass, Erica B. Slotter, and Elizabeth Pantesco.
Mental Health Treatments
The first trial in humans of the precise gene-editing technique known as base editing has shown promising results for keeping cholesterol levels in check. The approach injects into people a treatment called VERVE-101, which permanently deactivates a gene in the liver called PCSK9. That gene controls the level of low-density lipoprotein (LDL), or ‘bad’ cholesterol — a key contributor to heart disease. Verve Therapeutics, the biotechnology firm in Boston, Massachusetts, behind the treatment, reported that a one-time injection of VERVE-101 reduced the amount of LDL in the blood by up to 55% in its trial participants, who had a condition that causes lifelong high LDL. “It’s a tremendous scientific milestone because it’s the first time that they’ve been able to show that a single base pair of DNA editing, using CRISPR technology in humans, has had a clinical effect,” says Ritu Thamman, a cardiologist at the University of Pittsburgh in Pennsylvania. “From the clinical point of view, it has the potential to open a new way of treating coronary artery disease” that could involve people receiving a ‘one and done’ treatment rather than taking daily pills. But the findings have also drawn criticism. Two serious adverse events in the trial, including a death, have raised safety concerns, and Verve’s share price plummeted by nearly 40% following the results’ release despite their promise. Verve reported the findings, interim results from a phase 1b trial conducted in the United Kingdom and New Zealand, at a meeting of the American Heart Association in Philadelphia on 12 November. It will continue its trial next year in the United States, after receiving approval last month from the US Food and Drug Administration to enroll participants there. Precise edits Base editing uses CRISPR-Cas9 machinery to make very precise edits to a gene — chemically changing single nucleotide bases — without breaking the double strands of DNA as other gene-editing approaches do. The technique was developed by a team led by chemical biologist David Liu at Harvard University in Cambridge, Massachusetts, in 2018. By permanently switching off the PCSK9, VERVE-101 affects the enzymes encoded by the gene. These enzymes ordinarily prompt receptors for LDL-cholesterol, which are located on cell surfaces, to move inside the cell. With fewer available receptors to bind LDL, its levels in the blood increase. But when PCSK9 is deactivated, the enzyme loses function, reducing LDL levels. The treatment aims to protect against heart attacks and strokes. “If the blood LDL-cholesterol is very low lifelong, it’s very hard to get a heart attack,” says Sekar Kathiresan, Verve’s co-founder and chief executive officer. VERVE-101 consists of two RNA molecules packaged in a lipid nanoparticle — an mRNA molecule that edits adenine bases in DNA and a ‘guide RNA’ molecule to recognize PCSK9. After the treatment is injected, liver cells take up these nanoparticles, and once inside cells they make their way into the nucleii. Then, the base editor makes a single-letter change to the PCSK9 gene sequence, swapping an adenosine base with a guanine base. This turns off the gene and prevents liver cells from producing PCSK9 proteins. Dosing strategy Verve trialled the treatment in 10 people who had a life-threatening inherited disease called heterozygous familial hypercholesterolemia (HeFH), which causes high LDL levels from birth. The condition, which affects more than three million people in the United States and Europe, can cause premature heart attacks, sometimes in childhood. The participants also suffered from severe advanced coronary disease and took maximum doses of lipid-lowering tablets such as statins. Before receiving VERVE-101, the study participants had an average LDL level of 193 mg/dL. After 28 days, participants treated with either a high or low dose of VERVE-101 had their PCSK9 levels reduced by up to 84%. Their LDL-cholesterol levels dropped by up to 55% . That drop is large compared with conventional treatments. “We don’t see that with the statin — we never see that much of a difference,” says Thamman. The 55% reduction of LDL persisted for 6 months in participants who received the higher dose of VERVE-101. In a preclinical study with monkeys, LDL-cholesterol reduction lasted 2.5 years after a single dose of the treatment. “We learned that we get durable LDL lowering with the gene-editing strategy. This has never been done before,” said Karol Watson, a cardiologist at the University of California, Los Angeles, at a 12 November press briefing announcing the findings. Safety concerns The treatment came with some side effects: participants experienced brief flu-like symptoms, including fever, headaches and body aches, as well as a temporary increase in liver enzymes, which returned to normal within days. But two more serious events have raised some concerns. Two out of the ten participants experienced cardiovascular events, including one who died from a heart attack five weeks after receiving VERVE-101 another who had a heart attack after one day. An independent safety board concluded that the first event was expected in people who had such advanced heart disease and was not related to treatment. The board recommended the trial’s continuation of trial enrolment without changes to the drug protocol. Some analysts blamed the sharp drop in Verve’s share price on the safety concerns, and say that potentially risky gene therapies are a hard sell for diseases that have working conventional treatments. Gene therapies should be prioritized for conditions that have no available treatments, say some researchers. “The sentiment for editing when there are viable alternatives is going to be a challenge. Time will tell if non-rare is viable,” Michael Torres, cancer biologist and co-founder of genetic-medicines company ReCode Therapeutics, wrote in a post on X, formerly Twitter. “From a scientific standpoint, there is still a lot of going in terms of addressing some of the key aspects of this technology,” says Luigi Naldini, a gene therapist at the Vita-Salute San Raffaele University in Milan, Italy. “The delivery by nanoparticles is still in early stages in terms of tolerability.” Targeted changes There are other unknowns about the long-term effects of these genetic changes, says Naldini. Gene-editing approaches carry the risk of ‘off target’ edits elsewhere in the genome. In animal studies, the Verve team found no off-target editing in mice, and no evidence of the changes in the PSCK9 gene becoming heritable in monkeys. Verve aims to select the best therapeutic dose from the trial next year and to launch a phase 2 trial in 2025. The firm must also follow trial participants for 14 years, as mandated by the FDA for gene-editing therapies. “This is a gene editing study — you are changing the genome forever. Safety is going to be of the utmost importance, especially because there are currently safe and efficacious strategies available for lipid lowering,” said Watson at the press briefing.
Drug Discoveries
Political momentum for the monitoring and surveillance of Covid-19 is “fading”, the Australian virologist who developed a world-first method for rapidly isolating and characterising variants said. Prof Stuart Turville, with the University of New South Wales Kirby Institute, said while the impact of Covid-19 in Australia is waning, the Sars CoV-2 virus that causes disease is constantly changing and “there is still a lot we don’t know”. “How and why did the virus change between Delta and Omicron?” he said. “From that change and in the face of vaccination, what is the virus up to now in our bodies? For those who cannot sustain a robust vaccine response such as the elderly and immunocompromised, what does the virus now do? Will the virus turn up again and surprise us? “There are many jigsaw pieces we still don’t have. We won’t find them unless we look.” Turville and his team developed a method to speed up the process of isolating and characterising the risks posed by variants of concern. Called R-20, the methodology was used to rapidly analyse all major circulating viral variants in Australia, and helped researchers to ascertain that the vaccine-induced antibody response to Omicron was weaker than it was to the original Sars-CoV-2 strain. Turville acknowledged that funding thousands of people across multiple Australian institutions to track, trace and sequence the virus across all cases is no longer necessary or realistic. Monitoring needs to be consolidated and pragmatic, he said. “But the fear both myself and my colleagues have is that the political momentum to support us has simply moved on,” he said. “Both here and in the United States there is an element of ‘Thank you for your service, job well done’. There are still people working on this, we are still monitoring, still daily looking closely at understanding what the virus is up to and doing. “But the support for us to do it is starting to fade. The wind is out of the funding sails.” Guidelines for Covid-19 vaccination from the Australian Technical Advisory Group for Immunisation (Atagi) state that ongoing surveillance of infection rates, clinical outcomes, new variants and vaccine effectiveness is needed to inform future recommendations for additional booster doses. The inaugural chair in epidemiology at Deakin University, Prof Catherine Bennett, agreed “the surveillance hasn’t moved into a sustainable national system, and I would have expected that before we got to widespread community transmission,” she said. “We are still seeing waves of mutations,” Bennett said. “We need good data to know how that impacts our population, and every population will be slightly different. Different populations, even different states, saw different variants at varying times, which perhaps might lead to changes in immunity across variants.” She said genomic sequencing is now mainly examining samples from cases in hospital, whether they are in hospital for Covid or not. These cases may not represent what is spreading in the general population. “As an epidemiologist I want to know whether the mix of variants appearing in hospital are different to those in the general community, to see if a certain variant is more likely to put you in hospital than others,” Bennett said. “We need to actively go out and do community based testing on an intermittent basis. That way we can look at the whole iceberg, not just the tip of it.”
Epidemics & Outbreaks
June 9 (Reuters) - The Biden administration on Friday announced it would impose inflation penalties on 43 drugs for the third quarter of 2023, having fined 27 earlier this year, in a move it said would lower costs for older Americans by as much as $449 per dose. Drugmakers hiked the price of these 43 drugs by more than the rate of inflation and are required to pay the difference of those medicines to Medicare, the federal health program for Americans over age 65. "People taking 43 of these drugs could pay less (in coinsurance) to access these important treatments, starting July 1," Dr. Meena Seshamani, director for Medicare at the Centers for Medicare & Medicaid Services (CMS) told reporters. The Medicare agency plans to send the first invoices to drugmakers in 2025 for the rebates owed to Medicare this year and for 2024. President Joe Biden's signature Inflation Reduction Act (IRA) includes a provision that penalizes drugmakers for charging prices that rise faster than inflation for people on Medicare. Biden announced in March that his administration would subject 27 drugs to inflation fines for the second quarter of this year. The new list of 43 replaces that selection for the third quarter of 2023. The list of drugs facing the inflation penalty for the third quarter includes – for the second time – AbbVie's (ABBV.N) blockbuster arthritis drug Humira and Seagen's (SGEN.O) targeted cancer therapy Padcev, the White House said in a fact sheet. Our Standards: The Thomson Reuters Trust Principles.
Health Policy
A four-year-long study of middle-aged and older adults has found that that lonely individuals tend to develop sleep problems over time. These problems include difficulty falling asleep and maintaining sleep, early-morning awakenings, and feeling tired and unrefreshed after sleeping. The study was published in Psychiatry Research. Insomnia is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or experiencing nonrestorative sleep (feeling tired and unrefreshed after sleeping). It can lead to daytime fatigue, irritability, and impaired functioning in daily activities. Insomnia can be caused by various factors, including stress, anxiety, medical conditions, and lifestyle habits. Insomnia has also been linked to aging. Nearly half of adults aged 65 years or older experience insomnia symptoms. Insomnia symptoms, on the other hand, are associated with higher risks of cardiovascular diseases, dementia, increased hospitalization and nursing home admission, and risk of death. As the world population ages, insomnia is expected to become a more common problem, bringing with it all the associated adverse health consequences. Scientists have tried to explain the link between insomnia and aging in the hope of developing ways to prevent the development of insomnia. They have identified various factors that develop as people age that might be responsible for the onset of insomnia. The authors of the new study proposed that loneliness and social isolation might be two of the factors associated with insomnia in older adults. “I’ve always been intrigued by the intricate connections between our social lives and our health. The topic of social isolation and loneliness, particularly among middle-aged and older adults, is a pressing issue in our society. I was interested in exploring how these factors might influence sleep patterns, as sleep is a crucial aspect of overall health and well-being,” explained study co-author Bei Wu, Dean’s Professor in Global Health and Vice Dean for Research at the NYU Rory Meyers College of Nursing. The researchers used data from the Health and Retirement Study (HRS), a nationally-representative longitudinal survey of middle-aged and older adults in the United States, conducted since 1992. The Health and Retirement Study has been specifically designed to investigate the health, economic, and social factors that impact the well-being of individuals as they age. The researchers analyzed data of 9,430 participants who were over 50 years of age and who completed assessments of sleep, social isolation, and loneliness in the scope of this survey. These individuals had no insomnia symptoms at the start of the study. These researchers analyzed data from a 4-year period starting with waves 12 and 13 of the Health and Retirement Study. The mean age of participants was 68 years and 58.3% were women. The participants completed assessments of social isolation (the Steptoe’s Social Isolation Index), loneliness (revised UCLA Loneliness Scale), and insomnia symptoms (the Jenkins Sleep Questionnaire). The researchers also analyzed data on participants’ age, sex, race/ethnicity, education, income, smoking, alcohol consumption, physical exercise, obesity, depressive symptoms, daily living activities, cognitive function, and chronic conditions. The results showed that 1,522 participants (16.1%) developed at least one insomnia symptom during the study period. Roughly 15% of participants reported difficulties falling asleep, 11.7% reported difficulties staying asleep, 14.1% reported early-morning awakening, and 13.0% reported nonrestorative sleep i.e., feeling tired and unrefreshed after sleeping. Participants who reported being more socially isolated or lonely tended to belong to ethnic/racial minority groups more often, to be less educated, with lower income, less physically active, current or former smokers, having impairments related to daily living activities, having more depressive symptoms, lower levels of cognitive function, and more chronic medical conditions. Analysis of trends of change over time showed that lonely participants were almost twice more likely to develop at least one insomnia symptom over the study period compared to participants who were not lonely. When socio-demographic, economic and medical factors were controlled for, this risk was still more than 50% higher among lonely participants. “Our study underscores the significant impact that social factors can have on health,” Wu told PsyPost. “Specifically, we found that loneliness was associated with difficulties in initiating or maintaining sleep among middle-aged and older adults. This suggests that fostering social connections and addressing feelings of loneliness could potentially help improve sleep quality in this population.” The risk of developing at least one insomnia symptom was also higher in the group of participants who reported being socially isolated compared to those who were not socially isolated. However, this increased risk practically disappeared when socio-demographic, economic and medical factors were taken into account. “One surprising finding was that social isolation was not associated with the onset of insomnia symptoms after adjusting for health indicators. This indicates that the quality of social connections may be more important than the quantity when it comes to sleep health,” said study co-author Xiang Qi, a research scientist at Rory Meyers College of Nursing. The study makes an important contribution to understanding the link between age and insomnia. However, it also has limitations that need to be considered. Notably, insomnia and all other assessments were done solely using self-reports. This may have introduced bias. Additionally, researchers did not have data on the duration of insomnia symptoms nor were they able to control for the major depressive disorder, a condition known to be associated with insomnia. “As with any study, there are caveats,” Qi said. “Our study was observational, so we can’t establish causality. There may also be other unmeasured factors that could influence the results. Further research is needed to understand the mechanisms behind these associations and to explore potential interventions.” “I would like to add that our findings highlight the importance of public health interventions aimed at fostering close emotional relationships,” Wu explained. “Such interventions could potentially reduce the burden of poor sleep among middle-aged and older adults.” The paper “Associations of social isolation and loneliness with the onset of insomnia symptoms among middle-aged and older adults in the United States: A population-based cohort study” was authored by Xiang Qi, Susan K. Malone, Yaolin Pei, Zheng Zhu, and Bei Wu.
Mental Health Treatments
A reduction in the amount of time spent physically active when adults are over sixty years old is linked to lower quality of life, a Cambridge study of almost 1,500 adults has shown. The same was also true for increases in the amount of sedentary time, such as watching TV or reading. The researchers say this highlights the need to encourage older adults to remain active. Physical activity -- particularly when it is moderate-intensity and raises your heart rate -- is known to reduce the risk of a number of diseases, including heart disease, stroke, diabetes and cancer. The NHS recommends that adults do at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity a week. Older adults are also recommended to break up prolonged periods of being sedentary with light activity when physically possible, or at least with standing, as this has distinct health benefits for older people. A team led by researchers at the University of Cambridge examined activity levels among 1,433 participants aged 60 and above using accelerometers. The participants had been recruited to the EPIC (European Prospective Investigation into Cancer)-Norfolk study. Alongside this, the team also looked at health-related quality of life, a measure of health and wellbeing that includes pain, ability to care for yourself and anxiety/mood. Participants were given a score between 0 (worst quality of life) and 1 (best) based on their responses to a questionnaire. Lower quality of life scores are linked with an increased risk of hospitalisation, worse outcomes following hospitalisation, and early death. Participants were followed up an average of just under six years later to look at changes in their behaviour and quality of life. The results of the study are published in Health and Quality of Life Outcomes. On average, six years after their first assessment, both men and women were doing around 24 minutes less moderate-to-vigorous physical activity per day. At the same time, the total sedentary time increased by an average of around 33 minutes a day for men and around 38 minutes a day for women. Those individuals who did more moderate-to-vigorous physical activity and spent less time sedentary at their first assessment had a higher quality of life later on. An hour a day spent more active was associated with a 0.02 higher quality of life score. For every minute a day less of moderate-to-vigorous physical activity measured six years after the first assessment, quality of life scores dropped by 0.03. This means that an individual who spent 15 minutes a day less engaged in such activity would have seen their score drop by 0.45. Increases in sedentary behaviours were also associated with poorer quality of life -- a drop in the score of 0.012 for everyone minute a day increase in total sedentary time six years after the first measurement. This means that an individual who spent 15 minutes a day more sitting down would have seen their score drop by 0.18. To put the results into a clinical context, a 0.1 point improvement in quality of life scores has previously been associated with a 6.9% reduction in early death and a 4.2% reduction in risk of hospitalisation. Dr Dharani Yerrakalva from the Department of Public Health and Primary Care at the University of Cambridge said: "Keeping yourself active and limiting -- and where you can, breaking up -- the amount of time you spend sitting down is really important whatever stage of life you're at. This seems to be particularly important in later life, when it can lead to potentially significant improvements to your quality of life and your physical and mental wellbeing." Because the team measured physical activity and sedentary behaviour at different points of time, they say they can be reasonably confident that they have shown a causal link -- that is, that quality of life improves because people remain more physically active, for example. Dr Yerrakalva added: "There are several ways in which improvements in our physical behaviours might help maintain a better quality of life. For example, more physical activity reduces pain in common conditions such as osteoarthritis, and we know that being more physically active improves muscle strength which allows older adults to continue to care for themselves. Similarly, depression and anxiety are linked to quality of life, and can be improved by being more active and less sedentary." The EPIC-Norfolk study is funded by the Medical Research Council and Cancer Research UK. Five ways to keep yourself physically-active in older age Story Source: Journal Reference: Cite This Page:
Longevity
If you're sexually active, chances are you've probably worried about STIs at some point. Google is often our first port of call when we're in the midst of an STI panic, but in the age of online sex misinformation, that comes with a risk. Getting accurate, reliable information about sexual health on the internet can be a complete minefield. We talk a lot about the importance of understanding STIs, how they happen, and discussing them with sexual partners so that we can make informed choices regarding our sexual and reproductive health. The most common STI is chlamydia, with the Centre for Disease Control (CDC) declaring it the most reported sexually transmitted infection. It says there were four million chlamydial infections in 2018, and estimates that 1 in 20 sexually active young women aged 14-24 years has chlamydia. Usually, chlamydia infections develop in the vagina or anus following sex where protection has not been used, but did you know you can get chlamydia in your throat, too? Want more sex and dating stories in your inbox? Sign up for Mashable's new weekly After Dark newsletter. A lot of people make the mistake of thinking oral sex is completely STI-proof. Unfortunately, you’re not protected from pesky infections if you’ve had oral sex without using protective barriers like a dental dam. You could contract oral chlamydia. What is oral chlamydia? Rebecca Pickerill, clinical practice development manager at Brook, an NHS sexual health services provider, sayschlamydia is a bacterial infection, which can be transmitted through vaginal, anal, and oral sex generally. This means that chlamydia, while mostly considered a vaginal or anal infection, can also appear in and around the mouth. "Chlamydia is asymptomatic (meaning it has no symptoms, which can make it impossible to spot without an STI test) and it's treated with oral antibiotics," she tells Mashable. Dr. Rebecca Mawson, resident STI expert at contraceptive review platform The Lowdown says the most common place of infection is in the genitals and caused by penetrative sex. In rare cases it can also affect other parts of the body "like the rectum, throat, and conjunctiva in the eye. Oral chlamydia is probably not quite the right terminology [even though it is commonly used] as it is actually the back of the mouth and throat that is affected." "We don’t really know how commonly women have chlamydia in the throat as most clinics do not routinely screen for it. We tend to do vagina self-screening for chlamydia but not all sites like the rectum and throat," she explains. However, Pickerill explains that when a person is treated for vaginal chlamydia, after testing positive, the treatment would cover oral chlamydia as well. "The antibiotics given would treat all infection sites, including oral, anal and vaginal chlamydia. In practice, we don't test routinely for oral chlamydia due to test validity but testing is a clinical decision and would be based on an individual case assessment," she explains. How is oral chlamydia caused and what are the symptoms? Chlamydia infections in the throat are contracted from oral sex without using condoms or oral dams to prevent infection spreading from genitals to the throat. If a person who has chlamydia has unprotected oral sex without these barriers with another person, they could contract the infection. Mawson notes that chlamydia infections, no matter which body part if infected, are often symptom free. Mawson says "if someone was to have chlamydia in their throat that does have symptoms, they would probably be very similar to a normal sore throat like pain on swallowing and a low grade fever." However, this is rare. Most of the time, chlamydia is asymptomatic. A common myth about STIs is that you can only catch them once. This is untrue. You can contract chlamydia repeatedly, particularly if you often engage in unprotected sex without the use of barrier protection and are not regularly testing for STIs, which can cause complications. "If you have an infection it is really important to make sure all current sexual partners are treated so that you don’t get re-infections," Mawson explains. "If you have an infection it is really important to make sure all current sexual partners are treated so that you don’t get re-infections." What to do if you think you have oral chlamydia The best place to go if you are worried about oral chlamydia is your local sexual health clinic. They are used to managing infections of all different types and can talk about any concerns you have. Often you can do a an oral swab to see if you have an infection, which you can perform yourself. There are also online services but most only offer a genital screening, as oral screenings are not part of standard routine tests. As Pickerill explains, normal screening in the UK unfortunately assumes everyone that has oral sex will have had penetrative sex, so individual oral testing is not usual. So, if you only have oral sex it is important to get screened via your local clinic but you might have to discuss with a doctor or nurse first as you won’t fit the usual criteria. "This is different for men who have sex with men," Mawson adds. "If they give oral sex they are routinely offered a throat swab for chlamydia and gonorrhoea as they have higher rates." How to prevent oral chlamydia To prevent cases of oral chlamydia, it’s important to always get an STI test whenever you start a new relationship or have sex with a new sexual partner. In fact, it’s best if you can both get one done around the same time. You should also make sure you get an STI test if you have unprotected sex, especially unexpectedly (such as with incidents of condoms breaking/tearing or forgetting to take a contraceptive pill). Mawson says how long you should wait for a test after unprotected sex depends on what you’re screening for. "After unprotected sex wait 2 weeks for chlamydia and gonorrhoea, 4 weeks for syphilis and HIV (in some circumstances you also need a test at 3 months)," she says. "After unprotected sex wait 2 weeks for chlamydia and gonorrhoea, 4 weeks for syphilis and HIV (in some circumstances you also need a test at 3 months)." Mawson explains that these tests can be done discreetly by ordering online and having them posted out. "If your partner is negative for chlamydia and not having other sexual partners then you won’t get oral chlamydia. If you don’t have a regular partner and you want to protect yourself then use a condom with male partners and oral dams with female partners," she advises. It’s unfortunate that most sex clinics don’t test for oral infections as part of routine screening, which demonstrates how focused society (and medical professionals) are on penetration as the only ‘real’ type of sex. But oral chlamydia is very much a possibility, and although it’s not part of the typical STI test, don’t let this stop you from seeking medical advice after unprotected oral sex — especially if a sexual partner tells you they’ve tested positive. Visit a sexual health clinic if you have any worries and be open with clinicians. Any good specialist will allow you to take an oral swab if you have any cause for concern. Topics Sex & Relationships
Disease Research
Several teams of scientists believe they have uncovered the likely cause of a mysterious surge of severe hepatitis last year that hospitalized and killed children around the world. In three studies published this week, the groups detail evidence that a common but usually not pathogenic virus was strongly associated with the cases, likely aided by co-infection with other common viruses. The affected children might have been genetically unlucky as well. Early last year, health officials from the UK first reported on a cluster of severe hepatitis, with cases dating to fall 2021. Hepatitis is a catch-all term for liver inflammation, often accompanied by symptoms like fever, fatigue, and jaundice (yellowed skin and eyes); in severe cases, it can lead to outright liver failure or death. These children hadn’t tested positive for any known causes of hepatitis, including the group of unrelated viruses named after the condition. Before long, other places would report similar clusters. By July 2022, according to the World Health Organization, over 1,000 cases of this severe, unexplained childhood hepatitis were documented across 35 countries. Most children were hospitalized; about 5% became so sick that they needed a liver transplant; and 2% ultimately died as a result. There have been various theories as to the origin of these clusters. Many but not all children tested positive for adenoviruses, commonly encountered microbes that can cause illness; some also recently had SARS-CoV-2, the cause of covid-19. But the harm caused by these viruses usually doesn’t involve the kind of severe liver damage seen in these children, indicating that some other catalyst was in play here. One debunked theory blamed the covid-19 vaccines, but many of the affected children were too young to have received the shots. In three papers published this week in Nature, independent teams of scientists describe evidence pointing to a common suspect, albeit one that didn’t work alone: adeno-associated virus type 2 (AAV-2). Each group found that the vast majority of cases they studied had recently been infected by AAV-2, and at much higher rates than similarly matched control patients or patients who developed hepatitis from known causes. Some of the teams also found signs of AAV-2 infecting the children’s livers and indirect evidence that the organ was harmed as a result. AAV-2 is strange, even among microbes. It’s a satellite virus, meaning that it can only make more of itself inside a cell when another “helper” virus is infecting that same cell. As the name implies, adenoviruses are a common helper virus for AAV-2, but herpesviruses can be its partner as well. In many of these children, the scientists found these helper viruses too, and sometimes even more than one. The AAV-2 isolated from the affected children doesn’t appear to be genetically different in any important way from other known strains, but one study from UK researchers suggests another key factor behind the clusters: most of their cases carried the same variant of a gene that’s known to influence our immune response, and at a higher rate than the general population. It’s possible that carrying this variant made the children more vulnerable to the unlikely scenario that led to their hepatitis, the authors say. “It may turn out that in rare cases, you have kind of a perfect storm of events, where there’s a subset of children who were uniquely susceptible,” Charles Chiu, an infectious disease specialist at the University of California, San Francisco and one of the authors behind the study looking at U.S. children, told the New York Times. These studies alone aren’t proof that AAV-2 is to blame for the clusters. For one, they’re all based on a small sample of patients, and only from two of the many countries where cases were reported (the U.S. and UK). There are still unanswered questions about how exactly AAV-2 can do this to children, and we also don’t know why these clusters emerged when they did. It’s possible that the relative lack of other common infections during the first years of the pandemic led to an immunological gap, such that outbreaks of these diseases (and their rare complications) were temporarily larger than usual once people started regularly socializing again. Yet data from the U.S. has indicated that the documented rate of unexplained hepatitis cases in children didn’t increase last year from its pre-pandemic baseline. In other words, AAV-2 may have always been a rare but consistent cause of hepatitis, but we only now noticed it because we were finally looking for it. It’s also possible that some countries did experience a genuine surge last year, while others didn’t. Thankfully, the reported incidence of these unexplained hepatitis cases has dropped substantially since the peak last summer, so the immediate crisis seems to be over. But more research will have to be done to confirm what these scientists have found, as well as to better understand exactly what happened to these children and whether we can do something to prevent or reduce the risk of similar cases in the future.
Disease Research
Sam Whitehead/KFF Health News toggle caption Alexis Perkins, 25, tried to get a prescription for PrEP during a recent visit to her OB-GYN in Atlanta, but her doctor did not feel confident prescribing it. Sam Whitehead/KFF Health News Alexis Perkins, 25, tried to get a prescription for PrEP during a recent visit to her OB-GYN in Atlanta, but her doctor did not feel confident prescribing it. Sam Whitehead/KFF Health News Alexis Perkins thought her OB-GYN's office in Atlanta would be just the place to get a prescription for the type of drug that reduces a person's risk of contracting HIV. But during a recent visit, the medical assistant who greeted her had not heard of the medicines known as preexposure prophylaxis, or PrEP, and she seemed uncomfortable discussing it, Perkins says. Her provider had heard of it but didn't feel confident prescribing it. "She was at least honest enough to say that she was interested in it, but she didn't really know that much about it," says Perkins, a 25-year-old nurse, who decided to get on PrEP after participating in a sexual health education class and thinking more about her own risk. She's still trying to find a provider to write her a prescription. "If I wasn't really confident in myself, this could have been a very discouraging experience," Perkins says. PrEP is a crucial tool in the fight against the ongoing HIV epidemic and, when taken as prescribed, is highly effective at preventing infection from sexual contact or injection drug use. But more than a decade after the first PrEP drug was approved for the U.S. market, one of the groups that would benefit most from the medications isn't taking them: Black women, such as Perkins, whose gender identity align with their sex assigned at birth. Lack of awareness Doctors, public health researchers, and those who provide HIV treatment and prevention services say long-standing, systemic factors, such as stigma and racism, are major barriers to PrEP uptake among cisgender Black women. Transgender Black women face obstacles to PrEP uptake as well, especially discrimination related to their gender identity. But many researchers focus on cisgender Black women, who, they say, are often overlooked by the health care system and face obstacles like: noninclusive marketing leading to a lack of awareness about who would benefit, fewer treatment options for women than for men, and medical professionals wary to prescribe it. These challenges are even more apparent across the South, which has the highest rates of new HIV diagnoses in the country. Women had about a fifth of new HIV infections in 2021, according to recent data from the Centers for Disease Control and Prevention. And cisgender Black women made up an outsize share. "If we don't figure out how we can change the system, we're just going to continue to keep failing Black women," says Tiara Willie, an assistant professor of mental health at the Johns Hopkins Bloomberg School of Public Health. The FDA has approved three drugs for use as PrEP: the pills Descovy and Truvada, which also has a generic version, and the injectable Apretude. Descovy is newer and comes in a smaller tablet than Truvada, which can make it more desirable. It was approved for men and transgender women who have sex with men, but wasn't tested on people assigned female at birth. That decision frustrated HIV researchers and advocates, including Rochelle Walensky, who worked at the Harvard University Center for AIDS Research earlier in her career, before she led the CDC. In a 2019 editorial, Walensky and her colleague Robert H. Goldstein criticized this "two-tier system," in which men can get the medication knowing it's safe for them and with insurance approval, but women can't. Gilead Sciences, the company that makes Descovy, later announced it would conduct a trial focused on the drug's use among cisgender women. The company said that study is ongoing, with data expected in late 2024. The CDC, for its part, earlier this year announced an $8 million grant to fund studies on strategies to increase PrEP uptake among Black cisgender women. Black women face the same obstacles as other populations when it comes to PrEP, researchers said, but many do so with fewer resources. Recent data from the U.S. Census Bureau shows Black Americans disproportionately live in poverty and women are more likely than men to live in poverty. Frequent doctor visits Taking PrEP requires regular testing and doctor visits to check for HIV infection, which can present a "tremendous barrier" to access because of cost and logistics, says Michael Fordham, a program manager at the University of Alabama at Birmingham's 1917 Clinic, the largest HIV care facility in the state. "We're actually seeing PrEP patients more frequently than we see our patients living with HIV that are stable," he says. The CDC updated its PrEP guidelines in 2021 to reflect the latest science and drug approvals, but the agency has heard complaints from providers that they're still too onerous, says Robyn Neblett Fanfair, acting director of the agency's Division of HIV Prevention. She adds the CDC is "moving toward" guidelines that are more "timely and nimble." Fanfair says her division is also focused on reducing the costs associated with taking PrEP, which can be significant. Just starting on PrEP can cost more than $2,000. For now, the federal government mandates that private insurance plans cover PrEP, even as that rule faces a legal challenge. Still, in a recent study, CDC scientists found some 50,000 people had uncovered PrEP costs in 2018. "Policies that increase access to health insurance, such as Medicaid expansion, can improve access to PrEP," the study says. "This may be especially impactful for the southern US," where many states have yet to expand the state-federal insurance program for low-income people under the Affordable Care Act. But paying for PrEP isn't the only barrier to access, especially in the South. Dangers and stigma HIV and other sexually transmitted infections can still be uncomfortable for physicians and nurse practitioners to talk about in the "Bible Belt," despite their prevalence, says Anitra Walker, the vice president of operations at Mercy Care, an Atlanta-area health clinic that gets federal funding. Social stigma not only can prevent Black women from talking about PrEP with their friends, neighbors, and doctors, but it can seep into their domestic relationships, says Mauda Monger, an assistant professor at the School of Population Health at the University of Mississippi Medical Center. "If their partner is the person providing their housing, their food, and resources for their children, saying 'I'm on PrEP' openly may actually put her livelihood in jeopardy," says Monger, noting further that broaching the subject can put women at risk of physical harm. Increasing PrEP uptake requires expanding access to good jobs, affordable health care, and stable housing, Monger says, to allow Black women to feel more empowered to take control of their health. Researchers also said messaging about PrEP and how it's marketed needs to change. Willie, from Johns Hopkins, conducted focus groups in 2019 in Jackson, Mississippi, with Black cisgender women, who said they felt their experiences weren't reflected in advertising campaigns for PrEP. If "it wasn't just gay men or transgender people who are in the ads," one participant said, "then it would make everybody feel like ... it's not just for specific people." Researchers have to "work upstream" to undo those perceptions once they take hold, says Jessica Sales, an associate professor at Emory University's Rollins School of Public Health. Sam Whitehead/KFF Health News toggle caption Alexis Perkins is trying to find a provider to write her a prescription for PrEP. "If I wasn't really confident in myself, this could have been a very discouraging experience," she said. Sam Whitehead/KFF Health News Alexis Perkins is trying to find a provider to write her a prescription for PrEP. "If I wasn't really confident in myself, this could have been a very discouraging experience," she said. Sam Whitehead/KFF Health News Sales is partnering with Atlanta sexual health nonprofit SisterLove to train a small fleet of "influencers" to host informal conversations with community members and study their effectiveness in increasing PrEP knowledge, interest, and uptake among cisgender women. Perkins, the nurse who was unable to get a PrEP prescription from her OB-GYN, is part of the cohort. SisterLove's Healthy Love curriculum, backed by the CDC, gives Black women and their social groups the "freedom to hold conversations differently" than they would with medical providers, says the group's founder, Dázon Dixon Diallo. Failing to ensure cisgender Black women have access to — and are actually interested in taking — PrEP will undermine the fight to bring the HIV epidemic under control, Diallo warns. There's "damage that has to be undone," she says. "If we're not centering Black women in this epidemic, we are getting nowhere to the end." KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Epidemics & Outbreaks
Benefit claimants who fail to find work for more than 18 months will have to undertake work experience placements, under rules planned for late next year. If they refuse they will lose access to their benefits for a period, the government says. But the charity Mind said the use of sanctions would worsen peoples' mental health. It is part of new plans to get people back to work, which will also see an extra £2.5bn spent on career support. Under a plan that would need parliamentary approval, those solely eligible for the standard Universal Credit allowance who refuse to engage with job centre staff or accept work offered to them after six months will have their claims closed. That means they will have to go through the application process again if they want to keep receiving benefits and lose access to extras such as free prescriptions and legal aid during that time. Meanwhile, Labour pledged to invest an extra £1.1bn to cut NHS waiting lists to help get people back to work. According to the Treasury, the number of people not seeking work has risen sharply since the pandemic, hurting the economy. It said there were 300,000 people who had been registered as unemployed for over a year in the three months to July. But Vicki Nash from mental health charity Mind said: "The increase in the use of sanctions is deeply worrying. Evidence has repeatedly shown they don't work and make people's mental health worse". She added that changes to sick notes will also make it tougher to be signed off from work and could mean people don't get the time they need to recover. "Poverty and mental health problems form a vicious cycle that need to be tackled by every part of government working together. Today's announcements look like they have come from departments working on different planets," she said. Meanwhile, the number "inactive" due to long-term sickness or disability had risen by almost half a million since the pandemic to a record 2.6 million. Chancellor Jeremy Hunt said that many of these people wanted to work and that "with almost a million vacancies in the jobs market the opportunities are there". "These changes mean there's help and support for everyone [to find work] - but for those who refuse it, there are consequences too," he added. "Anyone choosing to coast on the hard work of taxpayers will lose their benefits." Under its Back to Work plan - which is part of next week's Autumn Statement - the government says it will expand and reform existing career help schemes for people with disabilities, health conditions or the long-term unemployed, as well as launch new ones. It will also put additional staff in job centres to help claimants struggling to find work. However, it said there would be stricter sanctions for "people who should be looking for work but are not". Under the current sanctions regime, such claimants only have a deduction applied to their benefits until they re-comply with their requirement to meet with a work coach and establish a personalised job-seeking plan. Ministers said the new rules would not apply to additional payments for child, housing or disability support. From late 2024 mandatory work placement trials will also be rolled out for people unemployed longer than 18 months, and benefits will be removed from those who refuse to take part. Digital tools will also be used to "track" attendance at job fairs and interviews under the tougher sanctions regime. The Secretary of State for Work and Pensions, Mel Stride, said: "Our message is clear: if you are fit, if you refuse to work, if you are taking taxpayers for a ride - we will take your benefits away." But Liberal Democrat's Treasurer Sarah Olney said the government seemed more interested in "penalising people than helping them get back into work." Separately, Labour has unveiled its own back to work plan with a focus on cutting NHS waiting lists. Since January waiting lists have risen by 500,000 to a record 7.8 million, it says. The party has pledged: - To provide an extra two million operations, scans and appointments a year by paying staff extra to run evening and weekend clinics. The plans will cost £1.1bn and be paid for by abolishing the non-dom tax status. - Recruit 8,500 more mental health professionals and introduce changes to incapacity benefits to encourage disabled people and people with health conditions to try work without fear of losing their income or having to be reassessed if the job does not work out. - Introduce a new statutory duty that would require job centres to work in partnership with organisations including the NHS to tackle the root causes of worklessness. Labour's shadow chancellor Rachel Reeves told the BBC: "Labour have committed to getting rid of the non-dom status. If you make your home in Britain you should pay your taxes here and under Labour you will. "We will put that money into creating every year an additional two million appointments, scans and operations in our National Health Service so that we can get those waiting lists down, get people the treatment they need, and get them in many cases back into work."
Mental Health Treatments
On Thursday, the Senate Committee on Health, Education, Labor, and Pensions voted to take a significant first step on a long road that could lead to far lower prices on new, better pharmaceutical drugs for Americans. The measure was part of an amendment to a bill reauthorizing the Pandemic and All-Hazards Preparedness Act, and was reported out of the committee 17-3. It allocates $3 million for the National Academies of Sciences, Engineering, and Medicine to study different models to pay for the development of new drugs. NASEM, which was created by Congress to provide high-quality advice on technical issues, would have to produce the report within two years. The bill’s language specifically instructs NASEM to examine two ways of funding new drugs: the government paying for it directly, and innovation prizes for inventors. Drugs created in this manner would presumably then be placed in the public domain and sold as generics. This issue is almost never discussed in U.S. politics and would likely sound arcane and meaningless to most people if they ever heard about it. But in reality, it’s both easy to understand and powerfully relevant to all of our lives. Different ways of paying for drug development could generate more drugs that we desperately need, while at the same time saving regular people huge amounts of money. The most important thing to understand about drugs is that they are expensive to discover and test for safety and efficacy — but once that’s done, they’re generally cheap to manufacture. According to the Food and Drug Administration, when a patent on a drug has expired and there are five generic companies producing it, the price will fall nearly 85 percent. In the 10 years from 2009 to 2019, the lower costs of generics saved the U.S. health care system $2.2 trillion. The current way of dealing with this dynamic is so entrenched that it may seem like a law of nature. First, pharmaceutical companies pay the high costs of developing new drugs. (At least theoretically — the federal government often pays for a significant chunk of the upfront outlays.) Then, so the drug companies can recoup their investment and make a profit, they are granted a patent on their discoveries that lasts 20 years. This gives them alone the right to make and sell the drug. In other words, for two decades the government steps in to prevent a free market from functioning. The most striking recent example of this is vaccines for Covid-19. Moderna raked in $36 billion for its vaccine in 2021 and 2022 — and if you try to make and sell a version of it yourself, you will go to jail. This case is especially galling, given that the government paid even more than usual for the drug’s development costs. The proposed study could lay the ground for a new world, in which the government would use different mechanisms in another pandemic to create incentives for the creation of treatments. Pharmaceutical companies would still make money, just not gargantuan amounts of it thanks to a public health emergency. You can measure the age of this current patent system by the fact that it’s mentioned in Article I, Section 8 of the Constitution: “The Congress shall have Power … To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries.” It’s important to read this carefully, however. Congress has the power to grant patents, but the Constitution does not require it to do so. Thomas Jefferson expounded on his perspective on this at great length in a letter he wrote in 1813. “Ideas,” he said, “should freely spread from one to another over the globe, for the moral and mutual instruction of man, and improvement of his condition. … Society may give an exclusive right to the profits arising from them as an encouragement to men to pursue ideas which may produce utility. but this may, or may not be done, according to the will and convenience of the society.” The time seems ripe now to consider whether our current system serves the the will and convenience of society. The U.S pharmaceutical industry is incredibly costly, with 2021 revenues of $550 billion and profits far higher than those of other industries. But the price may not be the worst part of it. Patents perversely disincentivize companies from developing actual cures — because when a patient is cured, they no longer will need the drug. As Chris Rock once said, “There ain’t no money in the cure. The money’s in the medicine. That’s how a drug dealer makes his money — on the comeback.” This has led to systematic underdevelopment of new antibiotics, with disastrous results: Over 1 million people worldwide are now killed every year by antibiotic-resistant bacteria, with the number potentially rising to 10 million by 2050. This is also a problem for new classes of drugs. Goldman Sachs analysts explained it straightforwardly in 2018, writing in a report: “The potential to deliver ‘one shot cures’ is one of the most attractive aspects of gene therapy [but] while this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.” Drug companies are also left unmotivated to research drugs to treat rare diseases, given the low number of potential buyers. This has long been recognized as a flaw in the patent system; the passage of the Orphan Drug Act in 1983 was an attempt to nudge pharmaceutical companies to make some effort in these areas. Notably, the Orphan Drug Act followed a 1979 FDA report examining the problem of drugs for unusual afflictions. Meanwhile, patents incentivize the development and promotion of truly dangerous drugs. The Sackler family made billions from helping to generate an opioid epidemic, inventing drugs that were extremely profitable because they were addictive and patients were desperate to keep using them, up until the point they expired. Thus, we might be much better off with the government simply absorbing all the cost of developing new drugs and then allowing any drug company to manufacture them. This makes particular sense because the government already pays for a large chunk of the expenses. Money from the National Institutes of Health contributed to the development of every single one of the 210 new drugs approved by the FDA from 2010-16, providing a cumulative subsidy to the drug industry of $100 billion. Dean Baker, a progressive economist at the Center for Economic and Policy Research, looks closely at this issue in his book “Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer.” He estimates that if patent protection for drugs and medical devices ended, with the government covering the tab for research, the net saving for regular Americans would be in the hundreds of billions of dollars each year. The proposed NASEM study would examine this issue and much more. But whether it will actually happen is still very much up in the air. The reauthorization of the Pandemic and All-Hazards Preparedness Act will have to pass the entire Senate, and the study would then have to survive reconciliation with the House version. (A House committee has approved its own PAHPA reauthorization, but without the study.) Most importantly, the pharmaceutical industry will be doing everything possible to knife this positive development in its crib. PhRMA, the industry’s trade group, has released a statement that it is “deeply concerned” because a new system of drug development could let “the government pick winners and losers.” That’s a power they intend to keep for themselves, along with all the profits that flow from it.
Drug Discoveries
A study of university students found that extraverted individuals tend to have lower cardiovascular reactivity to stress than introverts when they are exposed to a new stressor. However, this effect wasn’t seen when they faced the same stressor a second time. The study was published in the International Journal of Psychophysiology. Extraversion is a personality trait that reflects an individual’s tendency to be outgoing, social, and energetic. People high in extraversion enjoy interacting with others, seek external stimulation, and often display assertiveness and positive emotions. On the other hand, introverts, who are on the opposite spectrum of extraversion, are quieter, reflective, and often prefer solitude over social interactions. Previous research has shown many positive health benefits associated with being extraverted. This includes a lower likelihood of depression, anxiety, and even a longer lifespan. Physiologically, studies report that extraverts tend to have lower blood pressure at rest, reduced risk of hypertension as adolescents and reduced risk of acute heart infarction. However, there are also studies that reporting contradicting results. Study author Adam O’Riordan and his colleagues wanted to examine the influence of extraversion on the reactivity of the cardiovascular system to stress and its habituation to the source of stress. Previous studies have indicated that highly extraverted individuals tend to use more effective coping strategies and thus perceive less stress compared to introverts in equal situations. This might also include the body’s cardiovascular response to stress, but findings in this regard are not consistent. When under stress, the cardiovascular system undergoes significant changes to prepare the body for immediate action. Heart rate increases, pumping more blood to deliver oxygen and nutrients to muscles and vital organs. Blood vessels constrict, leading to elevated blood pressure, redirecting blood flow to essential areas. The body releases stress hormones like adrenaline and cortisol, which further boost heart rate and blood pressure, while also mobilizing energy stores for quick use. These changes collectively form the “fight or flight” response, optimizing the body to react swiftly in stressful situations. Study authors wanted to test whether the intensity of this response depends on one’s level of extraversion. The study involved 467 undergraduate students from Baylor University in Texas, with an average age of 19 and a majority (61%) being male. Participants were required to be healthy and were given specific instructions regarding food, drink, and exercise before the study. The stressor in this study was a challenging math task (the PASAT), made even more stressful with loud sounds and the idea of being watched and in competition. This task was done twice with a short break in between. In this task, an audio recording was played speaking single-digit numbers. Participants’ task was to remember the number they heard, add it to the next number they hear and report on the result. The procession of digits became faster and faster as the task progressed. To make the situation more stressful, the researchers used a loud buzzer that sounded at set intervals. They told participants that it indicates an incorrect answer. To increase stress even further, the researchers told participants that they were being video-recorded, that they should look at themselves in a mirror while answering, and that they were competing with other participants. Participants also completed assessments of extraversion (the Big Five Inventory) and affect state and self-reported stress (the Stress Reactivity Questionnaire, completed before the stress-inducement tasks, between the two tasks, and after them). The researchers took measurements of participants’ blood pressure (using a standard blood pressure cuff), and heart rate (using a semi-automatic sphygmomanometer) throughout the stress-inducement sessions. They used the heart rate and blood pressure data to calculate systolic and diastolic blood pressure along with arterial pressure. The results showed that participants, in general, had an increase in blood pressure and heart rate during the tasks. During the sessions, positive emotions decreased and negative emotions increased. More extraverted participants showed a lesser increase in these metrics during the first task and also felt less stressed. However, this difference wasn’t noticeable during the second task. “The findings indicate that higher levels of extraversion were associated with lower systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate reactivity in response to both the first and second exposure to the PASAT [the stress-inducing mental arithmetic task]. Additionally, extraversion was also significantly associated with lower levels of self-reported stress in response to the initial stress exposure, as well as a smaller reduction in positive affect in response to both exposures to the stressor. However, unexpectedly, no significant associations were observed between extraversion and cardiovascular habituation on repeated exposure to stress,” the study authors concluded. The study makes an important contribution to the scientific understanding of the relationships between personality and reaction to stress. However, it should be taken into account that all study participants were students i.e., young people. Results on other age and social groups might not be the same. Additionally, stress was induced with a mental arithmetic task, a task that is taxing, but lacks some of the key qualities of serious real-life stressors (such as important consequences). The study, “Extraversion is associated with lower cardiovascular reactivity to acute psychological stress”, was authored by Adam O’Riordan, Danielle A. Young, Alexandra T. Tyra, and Annie T. Ginty.
Stress and Wellness
Brazilian police have denied finding the bodies of missing British journalist Dom Phillips and his guide in the Amazon - just hours after his family said they were told the remains had been found 'tied to a tree'.The Phillips family were informed by the Brazilian ambassador to the UK of the discovery in a phone call early this morning, before President Jair Bolsonaro announced human 'innards' had been found floating in the river.But now, Brazilian police and indigenous search teams have dismissed the claims, saying the search for the missing pair continues. 'I've spoken with the team in the field and it's not true,' said Eliesio Marubo, a lawyer for UNIVAJA, which has organised search teams in the hunt for Phillips and indigenous expert Bruno Pereira. 'The search goes on.' Mr Phillips, 57, vanished in a remote part of the rainforest prowled by illegal loggers, miners and drug gangs on June 5 while travelling on a trip with indigenous expert Pereira. Mr Phillips' brother-in-law Paul Sherwood told The Guardian this morning: '[The ambassador] said he wanted us to know that… they had found two bodies.'He didn't describe the location and just said it was in the rainforest and he said they were tied to a tree and they hadn't been identified yet.''He said that when it was light, or when it was possible they would do an identification.'Mr Phillips' wife Alessandra Sampaio also confirmed the discovery of the two bodies and niece Dominique Davies told AFP via text message that 'two bodies have been found' in the search.Bolsonaro then said: 'The evidence leads us to believe something bad was done to them, because human innards were found floating in the river, which are now undergoing DNA testing.'  Brazilian police have bizarrely denied finding the bodies of missing British journalist Dom Phillips (pictured) and his guide in the Amazon   Fire crews helping search for the two men on Sunday uncovered a backpack, laptop and boots belonging to Mr Phillips tied to a half-sunken log (pictured, the moment the pack is found) Brazilian soldiers sit on a boat during the search operation in Atalaia do Norte yesterday The Javari region is an area notorious for illegal mining and drug trafficking, and the pair had reportedly faced threats before their disappearanceIt comes after boots and a backpack belonging to Mr Phillips were discovered by the search team. Yesterday, authorities uncovered the backpack containing his boots, clothes and a laptop tied to a half-sunken log in the area where the two men went missing. A health ID card and boots belonging to Mr Pereira were also uncovered.Maria Sampaio, Mr Phillips' mother-in-law, said after the discovery she believed the two men 'are no longer with us' and had 'given their lives in defence of the rainforest.'Alessandra Sampaio, Mr Phillips' wife who had earlier made a tearful appeal for her husband's return, reposted the sentiment and said she agreed.'They are no longer with us,' Maria wrote on Instagram. 'Mother nature has snatched them away with a grateful embrace. 'The material has been undone and incorporated into the earth they so loved and respected.'Their souls have joined those of so many others who gave their lives in defence of the rainforest and Indigenous peoples. 'Today they form part of an immense and pulsating vital energy that emanates from this immense greenery that is the heart of Brazil.'A suspect - 41-year-old Amarildo da Costa de Oliveira - was arrested after finding traces of blood on his fishing boat along with illegal ammunition. Alessandra Sampaio, Mr Phillips' wife, said bodies have been found in the AmazonSamples of the blood are on their way from the western Vale do Javri region of the Amazon, a vast area the size of Ireland and Wales combined, to government laboratories in the jungle capital of Manaus for analysis.In the meantime, a judge has granted police permission to continue holding Mr Oliveira - known as 'Pelado' - for further questioning.He has pleaded innocence, saying he is a fisherman and the ammunition he was carrying was used for his trade. Earlier, Elizeu Mayaruna, who works for indigenous agency Funai, told Reuters that, while searching the forest along the Itacoai river on Saturday, he found clothes, a tarp and a bottle of motor oil.Mayaruna and two other members of an indigenous search team acquainted with Pereira, a former Funai official, said they recognised a shirt and pants that belonged to him.Witnesses said they saw Pereira and Phillips, a freelance reporter who has written for the Guardian and the Washington Post, travelling down that river last Sunday.The two men were on a reporting trip in the remote jungle area near the border with Peru and Colombia that is home to the world's largest number of uncontacted indigenous people. The wild and lawless region has lured cocaine-smuggling gangs, along with illegal loggers, miners and hunters.News of the pair's disappearance resonated globally, with Brazilian icons from soccer great Pele to singer Caetano Veloso joining politicians, environmentalists and human rights activists in urging President Jair Bolsonaro to step up the search.Reuters witnesses saw the stretch of riverbank were Mayaruna discovered the clothing cordoned off by police on Sunday morning as investigators scoured the area, with a half dozen boats ferrying police, soldiers and firefighters back and forth. Federal police officers arrive at the pier with items found during a search for Indigenous expert Bruno Pereira and freelance British journalist Dom Phillips in Atalaia do Norte, Amazonas state, Brazil, Sunday, June 12 Bruno Araújo Pereira, an expert on the indigenous peoples of the Amazon, also went missing with his health ID card and clothes found alongside Mr Phillips' backpack Police officers and rescue team members sit on a boat during the search operation for British journalist Dom Phillips and indigenous expert Bruno Pereira Phillips talks to two indigenous men while visiting a community in Roraima, Brazil, on November 16, 2019Bolsonaro, who last year faced tough questioning from Phillips at news conferences about weakening environmental law enforcement in Brazil, said last week that the two men 'were on an adventure that is not recommended' and suggested that they could have been executed.State police detectives involved in the investigation have told Reuters they are focusing on poachers and illegal fisherman in the area, who clashed often with Pereira as he organised indigenous patrols of the local reservation.Some 150 soldiers had been deployed via riverboats to hunt for the missing men and interview locals, joining indigenous search teams who have been looking for the pair for a week.   Amariledo 'Pelado' da Costa was taken into custody by authorities in Amazonas, Brazil. His family claim he has been waterboarded by police in an effort to extract a confession A forensics worker analyzes the boat that was seized from a fisherman identified as Amariledo 'Pelado' da Costa, who was taken into custody Tuesday and was charged with illegal possession of drugs and restricted ammunition
Epidemics & Outbreaks
SEATTLE — A groundbreaking medical procedure for those with kidney stones will soon be offered at the University of Washington after more than two decades of research. It will also give astronauts the go ahead they need from NASA to travel to Mars. It's being called an absolute game changer. It's a groundbreaking procedure to get rid of painful stones while you're awake, no anesthesia needed. "This has the potential to be game changing," said Dr. Kennedy Hall with UW Medicine. Still being run through clinical trials at UW Medicine, this revolutionary procedure called burst wave lithotripsy uses an ultrasound wand and soundwaves to break apart the kidney stone. Ultrasonic propulsion is then used to move the stone fragments out, potentially giving patients relief in 10 minutes or less. "It would really kind of revolutionize the treatment of kidney stones in the sense that you could come to the clinic and have a stone treated before its a problem," said Dr. Jonathan Harper with UW Medicine. Seattle resident Mark Mackenzie will tell you first hand, this groundbreaking treatment works. He got a chance to take part in the clinical trial just days before he was to be operated on. "Nothing else in your life matters when you're experiencing kidney stone pain. I wrote an email to the folks that had done the treatment and just thanked them from the bottom of my heart for saving me from that ordeal. It's not a cure-all for everybody, but in some cases, as in mine, it can be, almost what amounts to a miracle cure," said Mackenzie. Dr. Kennedy Hall, an emergency medicine doctor at Harborview Medical Center, said this will also change how future patients are treated in the emergency room, who show up, having no idea they have a kidney stone. "There are a lot of patients with kidney stones, over a million visits a year to emergency departments. Many of them would have stones that we could intervene on at that point of care in the emergency department, so it's potentially groundbreaking," said Hall. This technology is also making it possible for astronauts to travel to Mars, since astronauts are a greater risk for developing kidney stones during space travel. It's so important to NASA, the space agency has been funding the research throughout the last 10 years. "They could potentially use this technology while there, to help break a stone or push it to where they could help stay on their mission and not have to come back to land," said Harper. Right now, this technology is only available through clinical trials, but according to UW Medicine, it may be available to be used on patients in a regular office setting within the next year or so.
Medical Innovations
Study reveals bacterial protein capable of keeping human cells healthy Researchers at the University of São Paulo (USP) in Brazil, partnering with colleagues in Australia, have identified a novel bacterial protein that can keep human cells healthy even when the cells have a heavy bacterial burden. The discovery could lead to new treatments for a wide array of diseases relating to mitochondrial dysfunction, such as cancer and auto-immune disorders. Mitochondria are organelles that supply most of the chemical energy needed to power cells' biochemical reactions. The study is published in the journal PNAS. The researchers analyzed more than 130 proteins released by Coxiella burnetii when this bacterium invades host cells, and found at least one to be capable of prolonging cell longevity by acting directly on mitochondria. After invading host cells, C. burnetii releases a hitherto unknown protein, which the authors call mitochondrial coxiella effector F (MceF). MceF interacts with glutathione peroxidase 4 (GPX4), an anti-oxidant enzyme located in the mitochondria, to improve mitochondrial function by promoting an anti-oxidizing effect that averts cell damage and death, which may occur when pathogens replicate inside mammalian cells. "C. burnetii uses various strategies to prevent the death of invaded cells and multiply inside them. One is modulation of GPX4 by MceF , the mechanism we discovered and reported in this article. Reallocation of these proteins in cellular mitochondria enables mammalian cells to live longer even when they're infected with a very large bacterial burden," said Dario Zamboni, one of the corresponding authors of the article and a professor at the Ribeirão Preto Medical School (FMRP-USP). The study was conducted at the Center for Research on Inflammatory Diseases (CRID), one of FAPESP's Research, Innovation and Dissemination Centers (RIDCs), in collaboration with Hayley Newton, a professor at Monash University in Australia. "Basically, we discovered a strategy used by C. burnetii to keep cells healthy for longer while replicating intensely. We found that its protein MceF redirects GPX4 to the mitochondria, where it acts as a potent antioxidant, detoxifying the infected cell and preventing cell components from aging, while allowing replication of the bacterium," said Robson Kriiger Loterio, first author of the article, which derived from his Ph.D. research. C. burnetii is the causative agent of a serious infection called Q fever, a relatively common but infrequently diagnosed zoonosis. According to the authors, agricultural outbreaks are "an increasingly significant economic and public health burden." The bacterium causes atypical pneumonia in humans and coxiellosis in some animals, such as cattle, sheep and goats. Zamboni explained that it is highly adapted to invade and control macrophages and monocytes—white blood cells that are part of the organism's front-line immune defense—inhibiting the host's responses to the infection. "The interest of studying this bacterium in depth lies precisely in its ability to subvert cell functions. Unlike other bacteria, which cause disease only when they multiply to reach large numbers, a single C. burnetii is enough to make a healthy person sick. So it acts efficiently to modulate the cells it invades. We refer to it jokingly as a brilliant cell biologist because of this ability to modulate everything in host cells," Zamboni said. Another interesting aspect of C. burnetii, he added, is that it replicates in cells for about a week. For comparison, Salmonella, which causes severe food poisoning, causes the death of host cells in less than 24 hours. "Observing C. burnetii is a good way to learn about how cells function. In the case of this study, it helped us understand how to treat mitochondrial dysfunction, and provided insights on programmed cell death in humans," he said. To analyze the bacterium's capacity to subvert macrophages and act directly on mitochondria, the researchers conducted in vitro assays and experiments involving larvae of the Greater wax moth (Galleria mellonella). In this first stage of the study, they investigated more than 80 novel proteins from C. burnettii with the potential to interact with host cells and subvert their functioning. "We ended up focusing on MceF because it acts directly on mitochondria, which play a key role in the process of cell death," Zamboni said. The group will now continue the research on two fronts, one aiming at a deeper understanding of other proteins of interest, and the other involving biochemical studies to find out more about how MceF influences GPX4. "The nice thing about this research is that by investigating a bacterium we're learning a lot about cell signaling, cell death and novel ways of reversing mitochondrial dysfunction. We don't need to invent a new technique. The process already occurs during the bacterium's interaction with host cells," he said. More information: Robson K. Loterio et al, Coxiella co-opts the Glutathione Peroxidase 4 to protect the host cell from oxidative stress–induced cell death, Proceedings of the National Academy of Sciences (2023). DOI: 10.1073/pnas.2308752120 Journal information: Proceedings of the National Academy of Sciences Provided by FAPESP
Disease Research
John Simon III was a hungry baby, a "chunky" toddler and a chubby little boy, his mother said. But by age 14, his weight had soared to 430 pounds and was a life-threatening medical condition. Nine months after weight-loss surgery that removed a portion of his stomach, John has lost about 150 pounds, boosting his health — and his hopes for the future. "It was like a whole new start," said John, who will start high school in California this fall. In Minnesota, Edward Kent was diagnosed with fatty liver disease. The 6-foot, 300-pound high school sophomore started using the obesity drug Wegovy in January — just a month after federal regulators approved it for children 12 and older — and has lost 40 pounds. "It's a huge deal and it will affect him for the rest of his life," said his mother, Dr. Barbara Van Eeckhout, an obstetrician-gynecologist. "This is about his health." John and Edward are among a small but growing group of young teens turning to treatments like body-altering surgery and new drugs that rewire metabolism to lose large amounts of weight. Critics urge caution at intervening so early, but the kids and their parents say the aggressive — and often costly — measures are necessary options after years of ineffective diet and exercise programs. "John has tried with all of his might," said his mother, Karen Tillman, 46, an accountant. "It's not because he couldn't try. It was getting harder and harder." Eighty percent of adolescents with excess weight carry it into adulthood, with potentially dire consequences for their health and longevity. Obesity was first classified as a complex, chronic disease a decade ago by the American Medical Association, but meaningful treatments have lagged far behind, said Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota. "It's a biologically driven disease. It's not a behavioral disease," Kelly said. "We need to get on it early. Don't wait until later in life because it's too late." In January, the American Academy of Pediatrics issuedfor kids as young as 12 and surgery for those as young as 13. The recommendations were immediately controversial. Mental Health America, an advocacy group, called them "dangerous" and "disheartening," saying they would increase eating disorders and perpetuate harmful stigma regarding weight. Some on social media accused doctors and parents of taking the easy way out, blaming things like junk food or video games — or accusing parents of "child abuse." Dr. David Ludwig, an endocrinologist and researcher at Boston Children's Hospital, warned that the "justified excitement" over new weight-loss medications shouldn't eclipse non-drug options. "Especially for children, diet and exercise must remain at the forefront of obesity prevention and treatment," he wrote in JAMA. But medical experts who treat kids with severe obesity say research is clear: Diet and exercise alone aren't enough. More than 240 diseases are associated with excess weight — including liver problems, diabetes and inflammation — and the signs show up early, said Dr. Janey Pratt, a Stanford University surgeon who performed surgery on John Simon. "It's already affecting major organs by the time they get to me," Pratt said. "You're dealing with a train that's headed over a cliff." Starting in elementary school, John struggled with joint pain, shortness of breath and sleep apnea so severe that, at age 12, he needed coffee to stay awake. He developed anxiety triggered by daily bullying at school and was hospitalized as a sixth grader for two months with post-traumatic stress disorder. "They call me names, hit me, push me, all of the above," John said. "It was a lot of hardship I had to go through." He tried diets and exercise, losing up to 40 pounds. But intense food cravings meant the weight always came back — plus more. By the time John met Dr. Callum Rowe, a pediatrics resident in a public health clinic at Children's Hospital, Los Angeles, John had a body mass index of 75. It was way off of the charts that measure body-mass index, or BMI, which is regarded as a flawed tool but widely used by doctors to screen for obesity. John, who has a shy smile and a soft voice, asked for help. He said he wanted to go on a "journey to wellness," Rowe recalled. "I found that very profound for a 13-year-old. He's an old soul to have that level of insight about what can I do to change my situation?" said Rowe, who referred John to the Stanford Medicine Children's Health weight-loss program. It meant traveling to Palo Alto, 350 miles north, but Karen Tillman said she was ready to do anything. "His weight was just going up by the minute," she said. Sign-ups for the Stanford surgery program have doubled since the release of the AAP guidelines, Pratt said. It's is among the busiest sites in the U.S., performing more than 50 of the 2,000 pediatric weight-loss surgeries logged each year. John was fortunate; fewer than 1% of children who qualify for metabolic surgery go through with the procedure. Doctors can be reluctant to refer, and families either don't know it's an option or it costs too much, experts said. Fees run upwards of $20,000 and can be as much as $100,000. John's surgery was covered by Medi-Cal, California's Medicaid program, which paid for 47 operations for kids ages 11 to 17 last year, according to state health records. Across the U.S., Medicaid coverage of weight-loss surgery for kids varies significantly by state. On average, children who receive weight-loss surgery lose about a quarter to a third of their body weight, studies show. But about 25% of kids regain the pounds and need further treatment, Pratt said. With Wegovy, adolescents lost about 16% of their body mass over nearly 16 months in a clinical trial. Those who take obesity drugs — requests for which have soared at Stanford and nationwide — regain weight once they stop, research shows. Some taking the drugs see like gallstones and inflammation of the pancreas. Edward Kent has responded well to the obesity medication, which has turned off his ravenous appetite "like a light switch," his mother said. At a recent exam, Edward's liver function had returned to normal. John Simon has lost about 35% of his body weight in less than a year. His liver function and insulin resistance have both improved, Pratt said. His arthritis is receding. He's sleeping better and moving more easily. John's struggle still extends past conquering cravings and improving his health. Attacks by bullies got so bad at his middle school, teachers were assigned to walk with him between classes. "He's going to come out with some type of hurt," said John's pastor, Charles Griffin III of DaySpring Christian Church. "The prayer is that when he does come out of this, he will be stronger." John graduated this month from his middle school, where officials wouldn't comment on steps they took to address the bullying. He'll go to a charter high school next year that will be smaller and, his mother hopes, more compassionate. John, now 15, is focused on the future. He has learned to cook healthy meals, like a recent dinner of sauteed shrimp and chard. He works out at a local gym, puts 18,000 steps on his pedometer every day and hopes to study hard to land his dream job as an automotive engineer. "I just want to live a happy, healthy life," he said. "Without the pain. And just without the weight." for more features.
Medical Innovations
By Kathleen Costello, MS, as told to Rachel Reiff Ellis Drugs don't work in people who donât take them. It sounds over-simplified, but it's true. And itâs not an MS-specific problem -- itâs a challenge in any ongoing condition. The World Health Organization has estimated that only 50% of people with a persistent illness continue long-term therapy. This is related to hundreds of billions of dollars a year in additional health care costs. With MS, when you donât stay with your treatment, thereâs the chance that the disease will continue unchecked. That means your immune system can go on causing inflammation and damage in your central nervous system. And âtime is brainâ: If thereâs damage, it can be permanent -- you may not get that function back. Research has shown over and over again that MS disease-modifying medications limit new clinical activity or relapses. They also slow progression and lessen the amount of new damage in the central nervous system. In short, not treating your condition can equal more disease activity. Studies show that the No. 1 reason people with MS donât keep up with their medication is that they simply forget to take it. There's a lot going on in life that can impact your ability to stick with your treatment. In addition to remembering to take your medication, itâs important to believe that it will help you. A number of recent studies have shown that this buy-in is key. When you believe it will be effective, it motivates you to stick to it. Other things that may affect your ability to stay on your medicine are side effects and cost. Whatâs the actual out-of-pocket amount? Is it too much to manage? Sometimes the expense of medication leads people to either ration theirs or not take it at all. You can also have difficulty when you donât keep up with other types of MS treatment, such as physical or occupational therapy. These can help you get stronger and have better endurance, mobility, and flexibility. And regular physical activity can help support mental health and lessen fatigue. But without doing these things consistently, you wonât get all the benefits. There have probably been more than 40,000 papers written on the topic of people following or not following their treatment plans. One thing weâve found is that proactive follow-up from providers is helpful in getting people to start and continue it. Results are better when providers simply check in and ask questions like, âAre you missing any doses of your medication?â or âAre you having any side effects? If so, what are they?â Â Itâs also important that you and your provider work together. Our job as providers is to explain and ensure that you understand the benefits of your medicine and any side effects and risks. At the same time, itâs important for us to understand whatâs important to you and what your concerns may be. Then that information can be used to make a shared decision. When we have shared goals and a shared decision-making process, we have the best chance for success. There are also practical things you can do to help you stay the course. Set reminders on your phone that tell you when itâs time for your medication. Engage loved ones to help you but not nag you. Have them check in to ask if youâve taken it. If not, what they can do to help you remember? The best way to stick to your plan is to address these things before they happen. Most importantly, take ownership of your health. Make sure you understand why your treatments are important. Donât be afraid to voice your concerns before you get started. Putting you in the driver's seat is probably the most important thing we can do as providers to help you maintain your therapy and manage your MS. Show Sources Photo Credits: Header Image: byryo / Getty Images Inset Image: Kathleen Costello SOURCES: Kathleen Costello, MS, ANP-BC, MSCN, associate vice-president, Healthcare Access for the National MS Society. World Health Organization: âAdherence To Long-term Therapies: Evidence for Action.â
Disease Research
Scientists discover new component in world's best-studied plant Wageningen researchers have discovered a previously unnoticed component within the thale cress: a thin film that encases the embryo in the seed. This discovery is particularly noteworthy because this species has been intensively studied for five decades. The newfound knowledge about the component could aid seed and breeding companies in maintaining the health of their seeds and plants. Researchers from Dolf Weijers' biochemistry group and Joris Sprakel's mechanobiology group detailed their findings in the journal Development. Although the exact role of this newly discovered component is not yet clear, scientists suspect that the embryonic envelope acts as a type of straitjacket, ensuring the embryo maintains the correct shape during its development. During the initial days after fertilization, the nutrient layer surrounding the embryo is not fully developed, allowing for more space. The membrane may play a crucial role in ensuring the embryo maintains its proper shape, preventing uncontrolled growth and bulging of cells, according to Weijers and Sprakel. Invisible force Despite its possible role to hold the baby plant in shape, the embryonic envelope is incredibly thin, which explains why plant researchers overlooked it for decades. Discoverers Yosapol Harnvanichvech and Cecilia Borassi stumbled upon the film accidentally while attempting to separate the sixteen cells of a young plant embryo. An invisible force was holding the cells together. It was only when the researchers looked under a microscope to understand why the cells were not detaching that they saw the film surrounding the embryo. "Then we knew what to look for," says Borassi enthusiastically. The plant scientists scanned detailed images of plant embryos that colleagues had taken years ago with an electron microscope. "It is typically one of those components that you only notice when you know it is there." When the Wageningen researchers looked at scientific publications, they discovered similar membranes in photos of embryos in tobacco plants. Weijers and Sprakel are convinced that the same component occurs in many more, if not all, plants. Factor in seed production The implications of this discovery are significant for seed and breeding companies, as the membrane is thought to play a crucial role in seed and embryo health. "If you do not know that such an embryonic membrane exists, you cannot take it into account," says Weijers. A damaged, deformed, or even missing membrane could have severe consequences for the growth and development of the baby plant. To understand the exact consequences, scientists must manipulate or remove the embryonic envelope in the lab, but this proves challenging as the envelope consists of fats and proteins that are attached to each other via cross-links. This makes it completely elastic, extremely strong and difficult to break down with chemicals. "We have tried endlessly, but we still haven't succeeded," says Harnvanichvech. Gatekeeper as an alternative hypothesis If fellow researchers succeed, we will gain clarity about the exact function of the membrane and the consequences of any mishaps. While the researchers suspect the previously mentioned straitjacket function is the most obvious role of the envelope, they do not rule out other possibilities. The envelope could act as a gatekeeper allowing only a select group of chemicals to pass through. "This way it may protect the young, vulnerable embryos against harmful substances," says Borassi. Finally, the embryonic envelope could serve as an attachment point for the protective fat layer that the plant later develops. The fat layer may adhere better to the membrane than to the embryo itself. Although more research is needed to reveal the role of the embryonic membrane, Harnvanichvech and Borassi are excited about their discovery. "It's really cool to discover something new with fundamental science," Borassi said. More information: Yosapol Harnvanichvech et al, An elastic proteinaceous envelope encapsulates the early Arabidopsis embryo, Development (2023). DOI: 10.1242/dev.201943 Journal information: Development Provided by Wageningen University
Disease Research
Cell Data, Surveillance Used to Enforce County Pandemic Rules Court documents are revealing the extent to which Santa Clara County, Calif., officials went to crack down on restricted religious gatherings at the Calvary Chapel megachurch during the height of the pandemic. (TNS) — Newly unearthed court documents reveal a bevy of extraordinary surveillance measures Santa Clara County used in trying to prove a San Jose megachurch and its congregants were violating COVID rules at the height of the pandemic. In its ongoing legal battle with Calvary Chapel, Santa Clara County used mobile phone data to map concentrations of congregants gathering on the church’s Hillsdale Avenue grounds and conducted multiple stealthy inspections in late 2020 and early 2021 that experts say raise major civil liberties questions. The use of third-party phone data — a technique known as “geofencing” — and the numerous visits by enforcement officers reveal the lengths to which a county known for its strict COVID response was willing to go in order to prove that the church was breaking the rules. The county is currently seeking nearly $3 million in public health fines from Calvary, a nondenominational Christian church with 3,000 congregants. Whether or not the church will fork over the money depends on the outcomes of state and federal cases that have been winding their way through the courts for nearly three years. “It is unconscionable how much time and money this county has spent surveilling and targeting this church when they should be focused on rebuilding the community,” said Mariah Gondeiro, an attorney for Calvary Chapel. In one striking example of the surveillance efforts, inspection officers with the county’s COVID-19 Business Compliance Unit parked a car at a neighboring church’s lot to observe the Calvary Chapel worshippers' behavior on four separate occasions in August and September of 2020. Officials at the Central Church of Christ, separated from Calvary by a chain link fence, asked the inspection officers to stop using its premises as a surveillance post that October, minister Alexander Tullis said. An official of the church initially permitted the county’s use of their property, but its leaders eventually pushed back on the idea, Tullis said. The county complied. Altogether, the county’s inspectors made 44 visits at or near Calvary Chapel between August 2020 and January 2021 at a cost of $219 an hour, repeatedly observing congregants gathering maskless and in large crowds as COVID numbers peaked — and before a vaccine was widely available, court records show. The church, led by pastor Mike McClure, has not denied that it broke the county’s COVID rules but has pushed back on the county fines, claiming that he and his congregation had the right to gather during the pandemic. County Counsel James Williams, whose office is pursuing the fines against Calvary, defended the use of the mobile phone data, which is anonymized, and the observation efforts by inspection officers. He said it’s likely the first time the surveillance technology has been used by the county in litigation but contended that Calvary Chapel was a unique public health hazard during the pandemic to which the county was compelled to respond. He confirmed the county has not tracked the cellphones of individuals at the church. As for the inspectors’ actions, Williams said it is not unusual for government enforcement officials to utilize such techniques to ensure businesses are in compliance — such as a tobacco shop suspected of selling cigarettes to minors. The court documents and their contents were first reported this week by independent journalist David Zweig. Mike Katz-Lacabe, director of research at the San Leandro-based Center for Human Rights and Privacy, said the use of geofencing in this particular case raises major civil liberties questions. Though the mobile phone data may be anonymized, Katz-Lacabe said that it is possible that the feature could be circumvented to allow tracking of individuals. “There are all kinds of concerns with geofencing when you talk about your First Amendment rights like freedom of expression or freedom of religion,” he said. “You could conceivably use it to see who goes to a mosque — or discriminate against certain religious groups or minorities.” In one example cited by Katz-Lacabe, anti-abortion groups in 2016 used such technology to send ads to women who were at abortion clinics, urging them to reconsider their choices. In the case of Calvary Chapel, Katz-Lacabe said the use of geofencing is juxtaposed with concerns around public health. “That is a balancing act that we as a society continue to struggle with,” he said. A federal court filing submitted in November shows the county utilized data from the Denver-based company SafeGraph to prove, from an analytics standpoint, that Calvary Chapel’s services from March 2020 to 2021 were uniquely large compared to other public and private spaces throughout the county. Geofencing uses aggregate mobile phone data points to show patterns of movement. The technology is used by law enforcement and more recently during the pandemic by public health agencies to understand the impact of social distancing on populations. The SafeGraph data relies on the company’s vast tranche of 47 million mobile phone devices across the country that opt-in to location tracking. In the case of Calvary Chapel, the county hired Stanford Law Professor Daniel Ho at a rate of $800 per hour to pore over data that specifically captured movement within the boundaries of the church’s property. “Given available knowledge about the spread of COVID-19 in indoor spaces with unmasked activity … there were strong reasons to believe that Calvary posed an unusually high risk,” he wrote. In a statement, Ho said he helped the county as an expert witness, “exclusively to analyze preexisting, aggregate mobility data to determine whether visit patterns for Calvary Chapel in 2020-2021 were outliers relative to other facilities.” ©2023 MediaNews Group, Inc., Distributed by Tribune Content Agency, LLC. In its ongoing legal battle with Calvary Chapel, Santa Clara County used mobile phone data to map concentrations of congregants gathering on the church’s Hillsdale Avenue grounds and conducted multiple stealthy inspections in late 2020 and early 2021 that experts say raise major civil liberties questions. The use of third-party phone data — a technique known as “geofencing” — and the numerous visits by enforcement officers reveal the lengths to which a county known for its strict COVID response was willing to go in order to prove that the church was breaking the rules. The county is currently seeking nearly $3 million in public health fines from Calvary, a nondenominational Christian church with 3,000 congregants. Whether or not the church will fork over the money depends on the outcomes of state and federal cases that have been winding their way through the courts for nearly three years. “It is unconscionable how much time and money this county has spent surveilling and targeting this church when they should be focused on rebuilding the community,” said Mariah Gondeiro, an attorney for Calvary Chapel. In one striking example of the surveillance efforts, inspection officers with the county’s COVID-19 Business Compliance Unit parked a car at a neighboring church’s lot to observe the Calvary Chapel worshippers' behavior on four separate occasions in August and September of 2020. Officials at the Central Church of Christ, separated from Calvary by a chain link fence, asked the inspection officers to stop using its premises as a surveillance post that October, minister Alexander Tullis said. An official of the church initially permitted the county’s use of their property, but its leaders eventually pushed back on the idea, Tullis said. The county complied. Altogether, the county’s inspectors made 44 visits at or near Calvary Chapel between August 2020 and January 2021 at a cost of $219 an hour, repeatedly observing congregants gathering maskless and in large crowds as COVID numbers peaked — and before a vaccine was widely available, court records show. The church, led by pastor Mike McClure, has not denied that it broke the county’s COVID rules but has pushed back on the county fines, claiming that he and his congregation had the right to gather during the pandemic. County Counsel James Williams, whose office is pursuing the fines against Calvary, defended the use of the mobile phone data, which is anonymized, and the observation efforts by inspection officers. He said it’s likely the first time the surveillance technology has been used by the county in litigation but contended that Calvary Chapel was a unique public health hazard during the pandemic to which the county was compelled to respond. He confirmed the county has not tracked the cellphones of individuals at the church. As for the inspectors’ actions, Williams said it is not unusual for government enforcement officials to utilize such techniques to ensure businesses are in compliance — such as a tobacco shop suspected of selling cigarettes to minors. The court documents and their contents were first reported this week by independent journalist David Zweig. Mike Katz-Lacabe, director of research at the San Leandro-based Center for Human Rights and Privacy, said the use of geofencing in this particular case raises major civil liberties questions. Though the mobile phone data may be anonymized, Katz-Lacabe said that it is possible that the feature could be circumvented to allow tracking of individuals. “There are all kinds of concerns with geofencing when you talk about your First Amendment rights like freedom of expression or freedom of religion,” he said. “You could conceivably use it to see who goes to a mosque — or discriminate against certain religious groups or minorities.” In one example cited by Katz-Lacabe, anti-abortion groups in 2016 used such technology to send ads to women who were at abortion clinics, urging them to reconsider their choices. In the case of Calvary Chapel, Katz-Lacabe said the use of geofencing is juxtaposed with concerns around public health. “That is a balancing act that we as a society continue to struggle with,” he said. A federal court filing submitted in November shows the county utilized data from the Denver-based company SafeGraph to prove, from an analytics standpoint, that Calvary Chapel’s services from March 2020 to 2021 were uniquely large compared to other public and private spaces throughout the county. Geofencing uses aggregate mobile phone data points to show patterns of movement. The technology is used by law enforcement and more recently during the pandemic by public health agencies to understand the impact of social distancing on populations. The SafeGraph data relies on the company’s vast tranche of 47 million mobile phone devices across the country that opt-in to location tracking. In the case of Calvary Chapel, the county hired Stanford Law Professor Daniel Ho at a rate of $800 per hour to pore over data that specifically captured movement within the boundaries of the church’s property. “Given available knowledge about the spread of COVID-19 in indoor spaces with unmasked activity … there were strong reasons to believe that Calvary posed an unusually high risk,” he wrote. In a statement, Ho said he helped the county as an expert witness, “exclusively to analyze preexisting, aggregate mobility data to determine whether visit patterns for Calvary Chapel in 2020-2021 were outliers relative to other facilities.” ©2023 MediaNews Group, Inc., Distributed by Tribune Content Agency, LLC.
Epidemics & Outbreaks
- The Biden administration unveiled a plan to eliminate the growing threat of fentanyl laced with xylazine, an illegal street drug cocktail that is fueling a wave of overdose deaths. - Fentanyl is an extremely potent synthetic opioid with its own soaring death toll. Xylazine is a cheap animal sedative not meant for human consumption. - Fentanyl laced with xylazine poses several health threats, including severe hypoventilation, the development of serious wounds and extreme withdrawal symptoms. The plan is the administration's first concrete action to address the dangerous combination since declaring it an "emerging threat" in April. It also builds on President Joe Biden's national drug control strategy — which aims to tackle the country's addiction and overdose epidemic — and his administration's other efforts to crack down on illegal fentanyl. "Even as we work to save lives from illicit fentanyl, this administration is hyper-vigilant in reacting to changes in the drug supply, like xylazine," Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, said during a call with reporters Monday. The plan directs several federal agencies, including the Centers for Disease Control and Prevention as well as the Food and Drug Administration, to expand access to testing, prevention and overdose recovery resources. It also aims to disrupt the illegal xylazine supply chain, among other efforts. Those agencies must develop and submit an implementation report to the White House in 60 days. The plan's long-term goal is a 15% reduction in xylazine-positive drug overdoses in at least three of four U.S. Census regions by 2025. Xylazine was detected in nearly 11% of fentanyl overdose deaths through June 2022, according to a report from the CDC released last week, up dramatically from about 3% of cases in January 2019. "The proportion of xylazine-involved deaths is continuously growing and is a great concern. Every one of these numbers is tragic," White House domestic policy advisor Neera Tanden said during a call with reporters. "They represent individuals, families and communities torn apart." The U.S. has been grappling with an opioid epidemic for years, and xylazine only adds to it. Drug dealers often mix the tranquilizer with fentanyl to extend the duration of the opioid's effects, which can include relaxation and euphoria. But dealers may also use xylazine as a cheap bulking agent to boost their supply of fentanyl. Xylazine can do major damage to the human body, including leaving drug users with severe skin ulcers, soft-tissue wounds and necrosis — sometimes described as rotting skin — that can lead to amputation. Fentanyl laced with xylazine poses several health threats, including severe hypoventilation, the development of serious wounds and extreme withdrawal symptoms. To address those health challenges, the administration's plan will develop and deploy a treatment framework for patients exposed to xylazine. That involves identifying the most effective practices for withdrawal management and clinical stabilization, or returning a patient to constant and steady function. The plan will also evaluate and deploy overdose reversal strategies that health-care providers, first responders, harm reduction staff, drug users and community bystanders can use. Those strategies will focus on the use of assisted breathing, hands-only CPR and naloxone, the first medicine approved in the U.S. to reverse opioid overdoses. Naloxone, marketed as Narcan, is effective against fentanyl but may have an insufficient response against xylazine since the tranquilizer is not an opioid. Even then, Gupta said, "I want to stress that these medications should still be used regardless." The plan also aims to ramp up testing for xylazine in other drugs. That involves developing and authorizing rapid test strips for clinical settings and deploying tests "at all levels of the supply chain, from wholesale seizure quantities to retail levels within communities," according to the plan. It also includes standardizing testing practices across medical examiners, coroners, public health laboratories and drug analysis laboratories. "Testing is currently ongoing in community and law enforcement settings, but not enough," Gupta said on the call. "We need more testing." Gupta said xylazine can be purchased from online vendors in China and Puerto Rico. "To a lesser extent," some drug traffickers are mixing xylazine with fentanyl in Mexico, according to Gupta. Another major component of the plan will identify the specific sources of xylazine and determine whether the tranquilizer was diverted from legitimate supplies or synthesized for illegal use. The plan will also enhance the Biden administration's ability to regulate the xylazine supply chain while maintaining the tranquilizer's availability for legitimate uses in animals in research. The administration will also explore potential regulatory options for disrupting the production, distribution and sale of illegal xylazine, according to the plan. That could potentially include scheduling xylazine under the Controlled Substances Act, which would designate a rating for the tranquilizer according to its abuse risk. The administration will also consider potential avenues for prosecuting those who manufacture, import, export, sell or distribute xylazine to support fentanyl trafficking. The last two components of the plan are scaling up research efforts on xylazine-laced fentanyl and developing an epidemiological data system to track the spread and effects of the drug combination. The "good news," is many actions outlined in the plan are "already underway," Gupta said. For example, the Drug Enforcement Administration in March warned the American public of a sharp increase in the trafficking of fentanyl mixed with xylazine. A month earlier, the FDA restricted the unlawful entry of xylazine in the U.S.
Drug Discoveries
Getting a BBL almost assassinated her. A woman on TikTok has claimed that her Brazilian butt lift procedure was “traumatizing” — and compared the feeling to getting beat up by 20 gorillas. Jordyn Genevie explained more about her BBL aftermath in a viral video that reached more than 1.2 million views on the social media app. She spoke about her experience in response to another TikToker’s video, in which they said that the pain was equivalent to being sore after not working out for a while and then doing so with an Olympic trainer. But Genevie reportedly had a totally different recovery. “I was about to die,” Genevie said of her BBL pain. “I remember waking up from surgery, screaming from the top of my lungs. The pain was unbearable.” She described it as “literally like getting dropped off in the jungle and getting your a– whooped by 20 gorillas … I mean, I don’t know, hitting your toe on the corner of a metal boxspring times a trillion. B–ch, it hurts. No, never again.” Warning: Video contains graphic language The Post has reached out to Genevie for further comment. In a standard BBL procedure, a doctor injects fat from other areas of the body into the butt to make it appear bigger. However, the cosmetic treatment can be risky: A 2020 study published in the National Library of Medicine revealed that the death rate for a BBL is 1 in 20,000. In the comments section of her post, many could relate to Genevie, confirming that the pain levels during recovery were out of this world. “I had this and I literally thought I was going to die,” one user commented. “The pain was soooooo horrific. I can’t tell you how painful and lasted 8-10 weeks.” “Thank you for being the first person to be honest,” someone else wrote. “I got mine in May & it was HORRIBLE too! Mentally & physically draining.” Another person added: “Anyone who asks how the pain is isn’t ready for one. Literally getting sliced open and rearranged. It’s going to be the most painful experience.” Other people were left reeling by her descriptions of the agony she felt. “BRO LMAOO NOT 20 gorillas,” one TikToker wrote, with another one adding, “Your examples had me dyingggggg omg😭😭😭😭😭😭.” However, Genevie is not the only person who has complained of severe discomfort after the procedure. Canadian TikToker Adea, who goes by the username @adee.ah, compared the aftermath of the surgery to feeling like you got “bruised” and “burned” all over your body. “You know when you hit yourself, and then the next day, you have, like, a bruise?” she asked. “And then someone touches it, or you touch it and it hurts? That’s how it feels all over your body.” Earlier this month, another TikToker claimed that she almost died after her BBL, as she reportedly developed necrosis, a death of the body tissue, in one of her butt cheeks, which caused one to become bigger than the other. She later had to get the necrosis removed.
Medical Innovations
Members of the Eastern Band of Cherokee Indians will vote Thursday on whether their Tribal Council should legalize the recreational use of marijuana on their reservation in western North Carolina. Although the state still criminalizes the possession of even small amounts of marijuana, the sovereign tribal nation has the authority to regulate cannabis on the Qualla Boundary, the tribe’s 57,000-acre reservation. The referendum asks whether tribal members support legalizing the possession and use of marijuana for anyone 21 and over and requiring the council to develop legislation to regulate the market. Tribal Council Chairman Richard French said the 12-member council voted in June to put the question on the ballot to gauge the level of support for legalization. If passed, Thursday’s vote will not automatically legalize the sale and use of marijuana, French added. But he said the council plans to abide by the referendum results when it decides whether to allow recreational use. “We made the move to give it to the people, and if the people vote it down, then that’s what we’ll go with,” he said. The council decriminalized possession of small amounts of cannabis in May 2021, making the reservation the only place in the state to legally carry marijuana. Later that year the council legalized medicinal marijuana and started laying the groundwork for a tribal-owned dispensary that is set to open later this fall. The tribe’s move into the cannabis industry is a potentially lucrative one — with strong support in recent polls for medicinal and recreational use but little support for legalization in the Republican-led state House. But some — including Principal Chief Richard Sneed — worry that the tribe could be expanding too fast. Sneed has pushed for medicinal use since becoming principal chief in 2017, but said he thinks the tribe should fully establish its medical program before it starts selling to everyone. “I feel like we’re putting the cart before the horse jumping straight to adult use having not even had the experience of running a dispensary under a medical program,” he said. French said he believes there is widespread support for medicinal marijuana among tribal citizens, but he’s not sure how they feel about allowing recreational use of the drug. There’s also been pushback from U.S. Rep. Chuck Edwards, a Republican whose district includes the Qualla Boundary. Edwards, who declined a request for an interview, on Friday introduced the Stop Pot Act, which would withhold some federal funds from tribal nations that legalize recreational marijuana, citing the upcoming vote by the Eastern Band of Cherokee Indians. In a column published last month in the tribe’s newspaper, the Cherokee One Feather, Edwards urged tribal citizens to reject recreational use, alluding to “criminal activity that would inevitably follow.” “It is my hope that cooler heads will prevail and this referendum will be defeated,” the congressman wrote. “The safety of our communities and our mountain way of life may depend on it.” A survey of registered voters in the state released in February by Meredith College, a private liberal arts college in Raleigh, found that 73% approve of legalizing medical marijuana. However, a bill to legalize medicinal use stalled in the House and is unlikely to get a hearing until next year. “What a brilliant business decision by the Eastern Band of Cherokee Indians to say, ‘OK, well we’re gonna move on with this,’” said Kevin Caldwell, southeast legislative manager for the Marijuana Policy Project, a nonprofit organization dedicated to legalizing cannabis. “To meet a need that is not being met in the greater state of North Carolina, more power to them.” Thirty-eight states have legalized medical use of marijuana, and 23 allow recreational use, according to the National Conference of State Legislatures. The delay, Caldwell said, means the state Legislature is passing on its opportunity to regulate the estimated $3 billion illicit market in North Carolina. “You already have this huge underground economy in North Carolina based around cannabis, and they continue to just stick their head in the sand and let that market go,” Caldwell said. In 2020, the Oglala Sioux Tribe in South Dakota became the first tribal nation in the U.S. to legalize recreational use of marijuana in a state that still considers it illegal, according to NORML, a national cannabis advocacy organization. And tribes including the Suquamish Tribe and the Las Vegas Paiutes have been operating their own dispensaries for years. Many tribal governments across the country, including the Eastern Band of Cherokee Indians, rely on casino revenues to bolster their economies, paying for infrastructure and services like health care and, in some cases, direct payments to tribal citizens. As some states are moving into sports betting, Sneed said tribal nations like his are looking for new ways to diversify their revenue streams. Even though he’d prefer to hold off on approval of recreational use, Sneed said that being the only legal seller of marijuana in North Carolina could be a good investment. “As I tell my colleagues here in the government and also my constituents, the window of opportunity for windfalls of revenue in the cannabis industry, that window is closing quickly,” Sneed said. It’s also an opportunity to provide hundreds of jobs to the tribe’s more than 16,000 members, said Forrest Parker, general manager of the tribe’s cannabis business, Qualla Enterprises. Parker said the company is doing everything it can in-house, including operating 75 indoor grow facilities and preparing to open a dispensary that will sell marijuana and products like edibles and vape cartridges. A research company hired by Qualla Enterprises found that in order to meet the needs of medicinal patients it will have to grow 40,000 pounds of marijuana a year — and 80,000 if recreational use is approved. Parker said currently Qualla Enterprises can produce about 25,000 a year, which means the business will eventually have to expand. Parker said he sees the tribe’s movement into the marijuana market as potentially life-changing for some tribal members. “That’s what motivates me every day, to know what this project is going to do to the people that I care about the most for generations to come,” he said.
Drug Discoveries
Starbucks Coffee at a cafe in Krakow, Poland, on May 30, 2022. (Jakub Porzycki/NurPhoto via Getty Images)Starbucks is holding gender-affirming care for transgender employees hostage as part of its fight against the unionization wave sweeping the country, according to a new National Labor Relations Board charge filed by workers at a store in Oklahoma.The unfair labor practice charge filed Monday says Starbucks has “interfered with, restrained, and coerced its employees in the exercise of their rights” under the National Labor Relations Act. It’s a complaint common among unionizing Starbucks workers; more than 200 unfair labor practice charges have been filed against Starbucks with the NLRB in the past year, many . But employees at the Oklahoma City store also accused Starbucks of “threatening employees with the loss of benefits (including the loss of gender-affirming healthcare for transgender employees) if they voted to be represented by a union,” according to a copy of the charge obtained by VICE News.  The new charge was first reported by Bloomberg. Neha Cremin, a worker at a Starbucks store in Oklahoma City, told Bloomberg that she recently had a one-on-one with her manager where she was told, “just know that if you unionize, when you are negotiating your benefits, you could gain, you could lose, or you could stay the same.” Cremin also told Bloomberg that the manager told her: “I know specifically, you have used the trans health-care benefits.”“I think the company realizes that we as trans partners feel particularly vulnerable at this time,” Cremin told Bloomberg. “I think that in some cases they are willing to take advantage of that.”Reached for comment about the allegations in the complaint, Starbucks spokesperson Reggie Borges told VICE News: “Claims are false. No truth to them.” Borges also told Bloomberg that the company is “not threatening our partners with the loss of benefits if they join a union,” and that Starbucks takes “a great deal of pride in offering industry-leading benefits and have done so for more than 50 years.”Mila Ward, a barista at a store in Indiana that last month became the first in the state to file for a union, told VICE News that she initially wanted to work for Starbucks because she’d heard that the company would “pay for all transition-related medical costs.” But the reality of the situation, she said, has been more complicated.In March, Wade underwent facial feminization surgery, which she says is rarely provided by employer-based insurance; Starbucks covered 100% of that procedure, Wade said. Getting that coverage, though, required purchasing Starbucks’ primary employer-based insurance, and she also resorted to starting a GoFundMe in order to pay for travel to get the procedure. Wade also said the range of coverage depends on the procedure. Hair removal, she said, is not covered outright but is reimbursed by the company; Wade said she’s paying $270, a “massive percentage of my take-home,” and the reimbursement checks can take up to three months to come in. (The hair removal procedure is required for bottom surgery, Wade said, which is covered by her primary insurance plan.) Starbucks workers have previously accused the company of threatening to take away benefits as part of a bad-faith effort to dissuade workers from unionizing, including pay raises and benefits, any help the company might provide to DACA recipients who work there, and unionized workers’ ability to transfer to other stores—an option frequently used by the many college students who work for the company. Starbucks has repeatedly denied the claims, saying that federal labor law prohibits the company from unilaterally setting benefits, which is true. But both the union and labor law experts say the company could simply offer such benefits to unionized workers, and unionizing workers have insisted that they wouldn’t sign a contract that doesn’t exceed the benefits Starbucks already offers.Pro-union workers have also repeatedly accused the company of retaliation, including firing leading organizers. In several cases, including in western New York, Memphis, and Phoenix, the NLRB has sided with the workers and their union. A federal judge last week ruled against a petition from the NLRB to immediately reinstate three fired workers in Phoenix. Wade said she has conflicting feelings about the healthcare Starbucks currently provides. “On the one hand, yes, I’ve been able to use it and it’s made a massive difference in my life, I would never have access to that surgery otherwise,” Wade said. “On the other hand, it definitely feels like they are using it to continue to market their allegedly progressive image and now having this captive workforce of highly-exploited, very poor trans people.”Want the best of VICE News straight to your inbox? Sign up here.Get the latest from VICE News in your inbox. Sign up right here.By signing up, you agree to the Terms of Use and Privacy Policy & to receive electronic communications from Vice Media Group, which may include marketing promotions, advertisements and sponsored content.
Health Policy
New lab-made substance mimics human tissue and could reduce/replace the use of animal-derived materials in research Scientists at UNSW Sydney have created a new material that could change the way human tissue can be grown in the lab and used in medical procedures. The new material belongs to a family of substances called hydrogels, the essence of life's "squishy" substances found in all living things, such as cartilage in animals and in plants like seaweed. The properties of hydrogels make them very useful in biomedical research because they can mimic human tissue, allowing cells to grow in a laboratory. There are also human-made hydrogels that are used in a broad range of commodity products ranging from food and cosmetics to contact lenses and absorbent materials, and more recently in medical research to seal wounds and replace damaged tissue. While they might function adequately as space fillers that encourage tissue growth, synthetic hydrogels fall short in recreating the complex properties of real human tissue. But in a research paper published in Nature Communications, scientists from UNSW describe how a new lab-made hydrogel behaves like natural tissue, with a number of surprising qualities that have implications for medical, food and manufacturing technology. Associate Professor Kris Kilian from UNSW's School of Materials Science & Engineering and School of Chemistry says the hydrogel material is made from very simple, short peptides, which are the building blocks of proteins. "The material is bioactive, which means that encapsulated cells behave as if they are living in natural tissue," A/Prof. Kilian says. "At the same time, the material is antimicrobial, meaning that it will prevent bacterial infections. This combination lands it in the sweet spot for materials that might be useful in medicine. The material is also self-healing, which means that it will reform after being squished, fractured, or after being expelled from a syringe. This makes it ideal for 3D bioprinting, or as an injectable material for medicine." Surprise discovery in lockdown Ashley Nguyen, a Ph.D. student in the UNSW School of Chemistry and first author on the paper, made this discovery during the COVID19 lockdown using computer simulations. Nguyen was looking for molecules that self-assemble—where they spontaneously arrange themselves without human intervention—and stumbled upon the concept of "tryptophan zippers." These are short chains of amino acids with multiple tryptophans that act as a zipper to promote self-assembly, which have been dubbed "Trpzip." "I was excited to identify a unique peptide sequence using computational simulations that might form a hydrogel," says Nguyen. "After we returned to the lab, I synthesized the top candidate and was thrilled to see it actually form a gel." Nguyen says the discovery of this hydrogel has the potential to be an ethical alternative to the widely used natural materials. "Natural hydrogels are used all over in society—from food processing to cosmetics—but require harvest from animals which poses ethical concerns," she says. "Also, animal-derived materials are problematic for use in humans because of the negative immune response that occurs. With Trpzip, we have a synthetic material that not only shows potential in many areas where natural materials are currently used, but also could outperform them in others, such as clinical research." Real world results To test the viability of Trpzip in biomedical research, A/Prof. Kilian's team partnered with researcher Dr. Shafagh Waters in the School of Biomedical Sciences at UNSW Sydney, who uses Matrigel—a hydrogel harvested from mouse tumors—for the culture of patient tissue in her research. "Matrigel has some disadvantages in research use because every batch is different. A chemically defined alternative could be cheaper and more uniform, which would prove highly beneficial to biomedical research," says Dr. Waters. A/Prof Kilian notes that the natural materials business is a billion-dollar industry and says the team is keen to explore pathways to commercialization. "We think that Trpzip hydrogels and materials like it will provide a more uniform and cost-effective alternative to animal-derived products. It would be a tremendous outcome if our material reduced the number of animals used in scientific research." The next phase of research will involve partnering with industry and clinical scientists to test the utility of Trpzip gels in tissue culture and explore applications that highlight the unique dynamic characteristics like 3D bioprinting and stem cell delivery. More information: Ashley K. Nguyen et al, Hierarchical assembly of tryptophan zipper peptides into stress-relaxing bioactive hydrogels, Nature Communications (2023). DOI: 10.1038/s41467-023-41907-1 Journal information: Nature Communications Provided by University of New South Wales
Medical Innovations
Consultants were paid a total of £1 million a day to work on the NHS Test and Trace system for more than a year of the pandemic, despite ministers being “very worried” about the spending. WhatsApp messages between Matt Hancock, then the health secretary, and his team of special advisers, show that he was shocked at learning the extent of Whitehall spending on external consultants to prop up the government’s ailing contact tracing system in January 2021. He asked for the “exit strategy” and Emma Dean, his special adviser, said she had been “nagging” the department about it since November 2020. Despite the concerns, figures show that the number of consultants actually increased to 2,586 the following month, and it was not until July 2021 that Dr Jenny Harries, the chief executive of the UK Health and Security Agency (UKHSA), told MPs that there was a “very detailed ramp-down plan” to cut the number of consultants. The agency said it planned to hire civil servants to replace the use of expensive external contractors. Another six months later, official data released to the public accounts committee showed that Test and Trace was still employing 1,476 consultants at an average daily rate of £1,244 – an average cost to the taxpayer of £1.8 million per day. Despite routine contact tracing ending in February 2022, UKHSA was still spending £573,000 per day on consultants in May that year. Overall, the cost of consultants to the taxpayer was £450 million. Mr Hancock appears to have been made aware of the problem after David Williams, a senior civil servant, appeared before a parliamentary select committee on Jan 19, 2021. Mr Williams told MPs the programme had been employing around 900 consultants at a rate of £1,000 per day. He said it would not have been possible to deliver the Test and Trace service without the use of “a range of consultants”, adding: “I don’t think we are being taken advantage of.” On hearing the news, Mr Hancock told his advisers: “I am very worried about this. What is our exit strategy from this use of consultants?” Others in his team replied that they were aware of the problem and tabled it for discussion at a “quad” meeting of senior Cabinet ministers the following day. Despite Ms Dean raising concerns in November 2020 it was a further 18 months before UKHSA said it planned to run the programme with “an absolute minimum” of external consultants in July 2022. The WhatsApp messages also raise fresh questions about the cost of the Test and Trace programme, which was accused by MPs of spending “unimaginable” sums and treating taxpayers “like an ATM machine” without making a “measurable difference” to case numbers in the UK. The contracts were awarded to a variety of top agencies, including Deloitte, IBM, Accenture and Boston Consulting Group. Lord Agnew, a Cabinet Office minister who ultimately resigned from Boris Johnson’s government over the handling of Covid fraud, wrote to senior civil servants arguing that Whitehall had become “infantilised” by an “unacceptable” reliance on management consultants. The Department of Health and Social Care and UKHSA have consistently defended the use of consultants during the pandemic, which they said was required to fulfil specialised roles “in competitive market places” including IT.
Epidemics & Outbreaks
- The FDA's independent advisors will make a recommendation on whether Eisai and Biogen's Alzheimer's treatment Leqembi should receive full approval. - The FDA will make a final decision on Leqembi on July 6. - Medicare has promised to broadly cover Leqembi, which costs $26,500 per year, if the FDA grants full approval of the treatment. [The stream is scheduled to begin at 10 a.m. ET. Please refresh the page if you don't see a player above at that time.] A panel of independent advisors to the Food and Drug Administration is meeting Friday to make a recommendation on whether the Alzheimer's drug Leqembi, made by Eisai and Biogen, should receive full approval from the agency. The FDA is not required to follow the advisors' recommendation, but a panel vote in favor of Leqembi would help pave the way for the treatment's approval this summer. The FDA is expected to make a final decision on Leqembi on July 6. It's the second Alzheimer's treatment from Eisai and Biogen to come under FDA review, after the controversial approval of the drug Aduhelm in the summer of 2021. The drug regulator granted expedited approval to Aduhelm, developed by the two companies, despite 10 out of 11 advisory committee members concluding that the treatment did not demonstrate a clinical benefit. A congressional investigation subsequently found that the approval of Aduhelm was "rife with irregularities." Leqembi is technically already available on the U.S. market after receiving fast-track approval in January, but very few seniors can access the expensive treatment because Medicare is restricting coverage to only people who are participating in clinical trials. There are no clinical trials underway. As consequence, most seniors can only access Leqembi if they can afford to pay for the drug out of pocket. Leqembi has a list price of $26,500 per year. Medicare has promised to broadly cover Leqembi on the same day the FDA fully approves the drug. The Veterans Health Administration is already covering the treatment for veterans. Members of Congress and organizations that lobby on behalf of Alzheimer's patients are closely watching Friday's advisory committee meeting. FDA staff said the clinical trial data submitted by Eisai appeared to confirm the clinical benefit of Leqembi for Alzheimer's patients, suggesting that the agency is poised to approve the treatment this summer. Leqembi slowed cognitive decline in early Alzheimer's patients by 27% in the trial, but the treatment also carries serious risks of brain swelling and bleeding. The antibody is administered twice monthly through intravenous infusion. The advisory committee is unusually small, with just six voting members. Acting chair Dr. Robert Alexander was granted a waiver to lead the panel Friday despite holding stocks valued up to $150,000 in companies that compete with Eisai and Biogen. The FDA disclosure did not name the companies. Alexander is the chief scientific officer of the Alzheimer's Prevention Initiative at the Banner Alzheimer's Institute. Banner is conducting an Alzheimer's clinical trial for a competing firm, and Alexander receives $50,000 to $100,000 in salary per year from funding supporting the trial. Bryan Marshall, who heads the office that manages the FDA's advisory committees, asked the agency to grant Alexander a waiver because he has unique expertise that is "invaluable" to Friday's meeting. Another committee member, Dr. David Weissman, is not participating in Friday's meeting, because he is the principal investigator for Biogen and Eisai clinical trials on Leqembi and another Alzheimer's treatment called Aduhelm at Abington Neurological Associates.
Drug Discoveries
As I walk through the doors of ward 23, I am struck by a sense of deja vu. Bay after bay, bed after bed, is full of sick, sometimes very sick, patients. They are mostly elderly and look frail. Most have flu, some have COVID, and others have respiratory infections.The really unlucky ones have a combination of two or more of these viruses. The scene brings back memories of my visits to hospitals full of COVID patients at the height of the pandemic.One of the ward 23's patients is John Greenwood. He's 92 years old. He lives alone. His wife is in a nursing home. John woke in the early hours of Sunday morning, barely able to move. He had been struck down by flu.John's son rushed him to The Royal Preston Hospital. They could not risk waiting two hours for an ambulance. More on Nhs There's a dilemma at the heart of the NHS - but politicians don't want to talk about it | Adam Boulton NHS nurse suffers miscarriage following five-hour wait in A&E 'Climbing over people... blood on the floor': Patient waited 36 hours for treatment in A&E ordeal "When I was young, the way people talked, I just thought people would get healthier and healthier and hospitals won't be required as much," John tells me from his hospital bed."And it's just gone the opposite." If you are an NHS worker and would like to share your experiences with us anonymously, please email [email protected]'I've never seen anything like this' Image: The Royal Preston Hospital is under relentless pressure John has made good progress in his recovery, but is clearly still not fully over his infection."When I came in I couldn't take a drink, I couldn't do anything, and I'm getting slightly stronger every day," he says."I couldn't even use my mobile phone. I still feel very weak."I've had to have a bed bath this morning, they said 'can you do it yourself?'"The ward is operating at 100% capacity, and it has been for some time.As soon as a bed is vacant, it is filled again with a waiting patient. The pressure is relentless.Professor Mohammed Munavvar says he has never seen a winter like it."I have been here as a respiratory consultant on this ward on this hospital for 24 years, and I've never, ever seen anything like this before," he says.Read more:Ambulance response times worst on recordHow many spare beds does your local hospital have? Image: Professor Mohammed Munavvar says he's never known a winter quite like this One of the worst winters ever for the NHSProfessor Munavvar is one of northwest England's most senior respiratory consultants.His expertise helped this hospital to navigate the hospital through the peak of the pandemic. His skill is being tested again as the NHS buckles under one of the worst winters ever.But this winter, he says, is the worst he's ever seen."You've got a COVID bay, you've got influenza patients, you've got COVID again after that," he says, and worries that this pressure will impact hospital waiting lists."If we focus our time and efforts on our acute hospital then we have less time to do our other jobs, which are seeing patients in the clinics, doing procedures and endoscopy units in theatres," he says."So already with the two-three year backlog that has developed thanks to COVID, we were trying to play catch-up, we were trying to clear some of that backlog, now this will set us back again." Strikes bringing even more woeAnd this is why the small positive from this month's NHS performance figures, of the elective waiting list for England falling from 7.21 million to 7.19 million, is unlikely to be repeated next month.The data represents November last year, ahead of the flu season and before the industrial action by health workers.More dates are set to be announced by ambulance workers, and the British Medical Association, the doctors' union, is balloting its members on strike action.Ambulance response times and waking times for treating continue to climb. This is because of rising demand and the inability of ambulances to discharge their patients because there is little or no capacity inside the hospital.This is largely due to the delayed discharge of patients who have no social care package in place. The government's plan to buy up care home beds has been criticised by some health leaders as too little too late.In the short term at least, it is hoped it will create some capacity to ease the pressure.There are also indications that COVID and flu infections are beginning to fall.This has happened for two consecutive weeks now, so earlier fears that the figures might not give the true picture because of the Christmas holidays might be unfounded. Still, it is too early to say for sure.Ward 23 is full and likely to remain so for a number of weeks to come.
Epidemics & Outbreaks
‘It was stunning': Bipartisan anger aimed at Medicare Advantage care denials A bipartisan group of lawmakers is increasingly concerned that insurance companies are preying on seniors. Enrollment in Medicare’s private-sector alternative is surging — and so are the complaints to Congress. More than 30 million older Americans are enrolled in Medicare Advantage plans, wooed by lower premiums and more benefits than traditional Medicare offers. But a bipartisan group of lawmakers is increasingly concerned that insurance companies are preying on seniors, and, in some cases, denying care that would otherwise be approved by traditional Medicare. “It was stunning how many times senators on both sides of the aisle kept linking constituent problems with denying authorizations for care,” Sen. Ron Wyden (D-Ore.) said in an interview, referring to a bevy of complaints from colleagues during a recent Senate Finance Committee hearing. Congress has already gone after insurers for their celebrity-filled ads and misleading directories. But its scrutiny of these care denials, which is expected to continue into next year, could have a far greater impact and reshape the rules for one of the most profitable parts of the insurance industry. “CMS is very attuned to what is going on on the Hill,” Sean Creighton, managing director of policy for consulting firm Avalere Health, said of the Centers for Medicare and Medicaid Services. He added that next year will likely bring “more scrutiny by the Hill and CMS on this, and there will be more reporting requirements for the plans and actions the plans are required to take to lessen the burden on providers and patients.” Legislation requiring insurers to more quickly approve requests for routine care passed unanimously in the House in 2022, but stalled in the Senate over cost concerns. The Improving Seniors’ Timely Access to Care Act, which mandates insurers quickly approve requests for routine care and respond within 24 hours to any urgent request, was reintroduced this year in the House and passed out of the House Ways and Means Committee this summer as part of a larger health care package. Still, lawmakers are peppering the Biden administration with demands for reforming the commonly used tool called prior authorization, the process in which health insurers require patients to get insurer approval ahead of time for certain treatments or medications. It “has turned into a process of basically just stopping people from getting care,” said Rep. Pramila Jayapal (D-Wash.), leader of the House Progressive Caucus. Jayapal was one of more than three dozen House Democrats who told CMS this month of “a concerning rise in prior authorizations,” accused health insurers of prioritizing “profits over people” and asked for “a robust method of enforcement to rein in this behavior.” Unlike traditional Medicare, Medicare Advantage plans can employ prior authorization and restrict beneficiaries to certain doctors within their network. Those are among the incentives private insurers have to participate in the program and enrollment has doubled during the last decade. But Sen. James Lankford (R-Okla.) said some hospitals in his state won’t take Medicare Advantage plans any more. “We can’t do it because we can’t afford the constant chasing from all the denials,” he said. AHIP, the trade group representing insurers, told POLITICO that prior authorization was among the tools that can curb wasteful spending. “These tools are important when coordinating care, reducing unnecessary and low-value care, and promoting affordability for patients and consumers,” said spokesperson David Allen in a statement. CMS has a track record of responding to liberal concerns, which could translate into big changes for Medicare Advantage in the coming years. Earlier this month, it proposed a rule to improve the standards for behavioral health networks following complaints from Congress about woefully inaccurate mental health provider directories, which some lawmakers said amounted to fraud. It also for the first time this year is evaluating Medicare Advantage television ads before they air, following prodding from lawmakers and numerous complaints from elderly consumers who felt duped by the ubiquitous ads. CMS also proposed a rule earlier this month that plans be required to factor the impact of prior authorization denials on marginalized and underserved communities, part of a larger effort by the agency to close gaps in health equity. The rule, if finalized, would take effect in 2025. Sen. Elizabeth Warren (D-Mass.), who wants the agency to go further, has proposed an amendment that would require CMS to collect and publish data from Medicare Advantage plans on their prior authorization practices to make public the number of prior authorization requests, denials and appeals by type of medical care. She has support from Sen. Mike Crapo (R-Idaho), who said during a recent hearing that his support for Medicare Advantage plans “does not mean that I like the prior authorization process and that I do not see some problems here that need to be solved.” Insurer advocacy group Better Medicare Alliance told POLITICO it supports legislation and regulations to create an electronic prior authorization process that could expedite prior authorization decisions that typically take up to a week or more. “Our goal has always been to protect prior authorization’s essential function — coordinating safe, effective, high-value care — while also strengthening and streamlining this clinical tool to better serve beneficiaries,” Mary Beth Donahue, president and CEO of the group, said in a statement. Creighton suspects insurers would be fine with implementing guardrails for prior authorization, as long as they can continue to use it. “It is super important that in this case one doesn’t throw out the prior authorization with the bath water,” he said. “It is just finding that balance.” But many physicians complain that balance has tipped too far in favor of Medicare Advantage plans. A survey released earlier this month by the physicians’ trade group Medical Group Management Association found 97 percent of medical group practices said an insurer delayed or denied medically necessary care. Another 92 percent said they had hired staff specifically to process prior authorization requests. A December 2022 survey from the American Medical Association also found that 94 percent of physicians reported care delays due to prior authorization denials or processing. “Even when you are doing the most cost-effective treatment, you are going through the [prior authorization] process,” said Vivek Kavadi, chief radiation oncology officer for U.S. Oncology, a network of more than 1,200 physicians. Studies show that oncology faces the most prior approval requests. Five oncologists told POLITICO that prior authorization requests are increasing as more patients migrate from traditional Medicare to Medicare Advantage. This surge of insurer prior approval demands has put a strain on their practices’ resources, they said. A 2020 survey of oncologists by the American Society for Radiation Oncology (ASTRO) found 64 percent reported treatment delays due to prior authorization requests increased during the pandemic. Insurers may at times contract with radiation benefit managers, companies that manage claims processing and keep a cut of savings they generate. This can encourage more services requiring prior authorization and create a “greater incentive to identify opportunities where denials can be pushed on to the provider,” said Constantine Mantz, chief policy officer for the oncology network GenesisCare. EviCore, a radiation benefit manager, said its work is meant to ensure patients receive care grounded in the latest clinical evidence as quickly as possible. “For requests that don’t meet evidence-based guidelines, the [physician] has the opportunity to discuss the case … which can help resolve any concerns prior to initiating a formal appeal,” the company said in a statement. BMA did not wish to comment and AHIP declined to respond to a list of questions on radiation benefit managers. Medicare Advantage plans have been slow to update their coverage policies and at times lag Medicare in which treatments are covered, Mantz said. This can lead to situations where a Medicare Advantage plan denies care after a prior authorization request that would be covered under traditional Medicare. HHS’ Office of the Inspector General in a 2022 report found 13 percent out of a sample of claims from Medicare Advantage plans in which care was denied under prior authorization for services that should have been approved. Some of the examples OIG found included prior authorization denials of advanced imaging services and stays at inpatient rehabilitation facilities. If a request is denied, a doctor can file an appeal and eventually speak with another physician to plead their case. Recent studies have shown that most appeals to a denial get overturned. In 2021, Medicare Advantage plans fully or partially denied more than 2 million claims through prior authorization, but 82 percent of those were overturned after an appeal, according to an analysis from the think tank KFF. A 2019 survey from ASTRO found 62 percent of oncologists, who appealed on behalf of their patients, got their prior authorization denial overturned. But doctors say getting through the appeals process can take weeks. “It feels more like the business model is a way for insurance companies to potentially reduce costs by feeling that physicians won’t want to participate in this peer-to-peer process because it is a burden on time,” said Amar Rewari, chief of radiation oncology for the Maryland-based health system Luminis Health.
Health Policy
Idiopathic hypersomnia (IH) is a rare neurological disorder. Treatment can help, but thereâs no cure. You may snooze upwards of 9 hours a night without feeling refreshed. You may fight to wake up in the morning. Your sleepiness may persist or get worse, even when you take lengthy naps during the day. If you live with IH, youâd probably like to know whatâs causing your symptoms. Unfortunately, thatâs not  something experts have figured out yet. âLiterally, the name idiopathic hypersomnia means youâre sleepy and we donât know why,â says Sabra Abbott, MD, assistant professor of neurology and sleep medicine at Northwestern University Feinberg School of Medicine in Chicago. Lots of sleep specialists are trying to solve the IH puzzle, including Lynn Marie Trotti, MD, associate professor of neurology at Emory University School of Medicine in Atlanta. Sleep disorders tend to run in families, so your genes likely have something to do with it. But Trotti says she and her colleagues still donât know the main source of all this extra sleepiness. âThe big mystery really is what causes idiopathic hypersomnia,â Trotti says. Theories Behind Idiopathic Hypersomnia We don't yet know why people with IH are so sleepy, or why the disorder causes cognitive symptoms like brain fog, memory troubles, or poor attention. But thanks to ongoing research, Trotti and Abbott say there are some emerging clues, including: Something triggers your GABA-A receptors. These are neurotransmitters that inhibit your central nervous system. Drugs like benzodiazepines can activate them. Doctors use these kinds of meds to treat anxiety and insomnia. Trotti says people with IH sometimes have higher levels of natural benzodiazepines in their spinal fluid. âAnd the fact that thereâs a difference suggests that (GABA-A receptors) might be related to the sleepiness in idiopathic hypersomnia,â she says. Thereâs ongoing research into this theory. But Abbott says the idea is that something in your body acts like an all-day sleeping pill. âThatâs helpful for when youâre trying to go to sleep, but not when youâre trying to be awake during the day.â Your circadian rhythm is out of sync. Everyone has a natural sleep-wake cycle. If you have IH, you might stay up late and have a lot of trouble waking up early. This âkind of suggests that there might at least be a component of a circadian timing issue,â Trotti says.  Abbott says she sees a lot of overlap between IH and something called delayed sleep-wake phase disorder. These are your natural night owls who fall asleep and get up later, she says. While the average circadian rhythm for most of us is just a little bit longer than 24 hours, she says this group operates differently. âItâs sort of like theyâre living a 25-hour day,â Abbott says. âTheir sleep window is longer because their internal day is longer. Theyâre always playing catch-up.â Chronic Fatigue vs. Idiopathic Hypersomnia Since IH is a bit of a mystery, it can go undiagnosed for a long time. It can seem like other conditions. That might have something to do with how we think and talk about sleep. You might hear people use terms like "fatigue" and "sleepiness" interchangeably, but they arenât the same thing. Hereâs how Trotti explains the difference: Hypersomnia means you either sleep too long or you fall asleep when you shouldnât, such as taking naps during the day. Fatigue, on the other hand, is a weariness or lack of energy that doesnât tend to raise your sleep time. With that said, Trotti says about 20% of people with hypersomnia also have chronic fatigue syndrome. But a careful history of your symptoms can help your doctor figure out whatâs going on. They might ask: - What do your night and day schedules look like? - How much time do you spend asleep? - How much time do you spend resting but awake? - How much time do you spend trying to function while tired? Sleep tests are also helpful. When it comes to hypersomnia, your doctor will see if: - You fall asleep fast during a daytime nap - You sleep more than 11 hours in a 24-hour period Trotti says you wouldnât expect the above symptoms if you have chronic fatigue syndrome without a hypersomnia disorder. Where Is Research Headed? Abbott says thereâs a lot of interest in the GABA hypothesis. Most ongoing research is in that area because some anti-GABA drugs can reverse symptoms in some people with IH. In the future, there may be more drugs like this made specifically for IH. âItâs a disorder we still donât know a lot about and donât have great treatments for,â Abbott says. âBut as I tell my patients, there are people actively researching it. Hopefully, 5 or 10 years from now, weâre going to have better answers in terms of what causes it and what treats it.â Show Sources Photo Credit: iLexx / Getty Images SOURCES: Lynn Marie Trotti, MD, associate professor, department of neurology, Emory University School of Medicine. Sabra M. Abbott, MD, PhD, assistant professor of neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine. Sleep Medicine Clinics: âIdiopathic Hypersomnia.â Genetic and Rare Diseases Information Center: âIdiopathic hypersomnia.â
Disease Research
Epidemiologists this summer are closely watching the sharp rise in flu activity in the Southern Hemisphere, where it is currently winter, to see if it’s a sign of what’s to come in the U.S. The Australian Department of Health and Aged Care reported an increase in influenza-like illness activity in almost all jurisdictions in the final two weeks of May. The illness activity was highest in young children ages 5 to 9, followed by children 4 years and younger, and then those ages 10 to 14. "There are several countries experiencing higher or earlier activity compared with years prior to the COVID-19 pandemic, while others are experiencing typical activity for this time of year or activity that is lower than historical trends," Dr. Carrie Reed, chief of CDC’s Influenza Division Epidemiology and Prevention branch, told Fox News Digital. A review of both the World Health Organization’s surveillance data and the latest Australian Surveillance Report shows the increasing flu activity in Australia is currently within historic ranges, she added. "However," she said, the CDC "continues to monitor influenza trends across the globe." The flu season in the Southern Hemisphere usually occurs between April and September — while the flu season occurs between October through May in the Northern Hemisphere, Reed said. "What goes on in the Southern Hemisphere is frequently an important predictor of things to come regarding the flu season," Dr. Aaron Glatt, chief of infectious diseases at Mount Sinai South Nassau Hospital in Long Island, New York, told Fox News Digital. The activity in the Southern Hemisphere often portends what will happen in the United States in the following winter. The activity often portends what will happen in the United States in the following winter, he said — while also noting, "There are no hard and fast rules." He added, "We just have to wait and see whether it is accurate or not every year." Reed also emphasized that Southern Hemisphere flu activity does not necessarily predict what will happen in the U.S. "This is because different influenza viruses may predominate in different parts of the world and population immunity may be different between populations in the Northern and Southern Hemispheres," Reed said. Current flu activity in US Most areas across the country report "minimal" or "low" influenza-like activity, which is typical for this time of year, according to the CDC’s Weekly U.S. Influenza Surveillance Report. Between 2010 and 2020, flu resulted in 9 million to 41 million illnesses every year, 140,000 to 710,000 annual hospitalizations, and 12,000 to 52,000 annual deaths — yet the exact number is unknown, according to the CDC. Many people recover from the flu without seeking care, while some may seek care later in their illness when the flu can no longer be detected on a respiratory sample. "Sensitive flu tests are only likely to detect flu if performed within a week after onset of illness," the agency noted on its website. "In addition, some commonly used tests to diagnose flu in clinical settings are not highly sensitive and can provide false negative results (i.e. they miss true flu infections)." States are only required to report deaths from the flu for children less than 18 years of age, so many cases of adults are not reported. Because surveillance data may "drastically under-represent the true burden of flu in the U.S.," the agency uses statistical models to estimate the annual number of seasonal flu-related cases, hospitalizations and deaths, per its website. Why is it hard to forecast the flu? Generally, people start getting sick from the flu around October, with clinics starting to get busy between December and February, according to recent report. Unknown variables, such as the weather and how many people in the population will be immune to the flu during the winter, make it difficult to predict the upcoming flu season. Experts point to predictable human activities that spread flu every year — children going back to school and people traveling to see loved ones over the holidays. But it’s the unknown variables, such as the weather and how many people in the population will be immune to the flu during the winter, that make it difficult to predict the upcoming flu season. Human behavior and social interactions also play a role, so masking by a large number people could help make a difference in blunting the spread of flu. "There is no way to know what flu activity in the United States will look like this season," Reed said. "Each flu season is different, and the best way to protect yourself is by getting an annual flu vaccine." September and October are generally good times to be vaccinated against flu, she said. People accustomed to normally getting their annual flu vaccine will have the option to also get vaccinated for an updated COVID-19 vaccine as well as potentially the new respiratory syncytial virus (RSV) vaccine, two of which are now FDA-approved for adults over the age of 60, according to recent reports. The CDC’s Advisory Committee on Immunization Practices will meet on June 21-23 to provide recommendations for specific patient populations to get vaccinated for RSV.
Epidemics & Outbreaks
Sleep is crucial for preserving both our physical and mental well-being. As recent research unfolds, we discover more intriguing aspects of this indispensable bodily process. Let’s explore some of these groundbreaking insights. - Sleep and Emotional Regulation. Research in “Nature Human Behaviour” indicates that good sleep can support emotional stability, reducing unexpected and intense emotional reactions. To elaborate: Lack of sleep intensifies the activity in the brain’s limbic system, the center for emotions. Meanwhile, the prefrontal cortex, which moderates our reactions, is less engaged. - Sleep and Creativity. From the University of California, findings reveal that the phases of REM sleep, where dreams materialize, bolster creativity. This boost is believed to be due to the brain’s information synthesis during REM, allowing the fusion of varied concepts. To be more specific: Those who had restful periods and underwent REM sleep excelled in tasks demanding imaginative solutions. - Sleep and Cardiovascular Diseases. The “European Heart Journal” highlights a connection between persistent sleep shortages and a heightened risk for cardiovascular ailments. To clarify: Individuals consistently getting only 5-6 hours of sleep daily face a risk of heart disease that’s double compared to those who enjoy 7-8 hours of rest. Source: Cappuccio, F.P., Cooper, D., D’Elia, L., Strazzullo, P., & Miller, M.A. (2011). Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. European Heart Journal, 32(12), 1484-1492. - Sleep and Learning. “Science Advances” underscores the significance of deep sleep in bolstering one’s ability to learn, with a particular emphasis on solidifying memories. To elaborate: Through deep sleep, the brain strengthens and arranges fresh information, optimizing the way we learn. Source: Gais, S., Molle, M., Helms, K., & Born, J. (2002). Learning-dependent increases in sleep spindle density. Journal of Neuroscience, 22(15), 6830-6834. Prioritizing Sleep: Key to Health, Mood, and Well-being In our modern, bustling lives, rest often takes a backseat to work, social activities, and leisure. Yet, quality sleep remains pivotal for optimal physical and mental well-being. Table of Contents The Significance of Sleep Sleep is our body’s rejuvenation method. Even during slumber, our brains remain engaged, undergoing unique activities distinct from our waking hours. It’s in the depth of sleep that our body mends its cells, and tissues, and produces crucial hormones. A recurring sleep deficit has been scientifically associated with a higher likelihood of numerous health concerns, encompassing obesity, diabetes, and cardiovascular issues. Beyond physical health, sleep plays a pivotal role in emotional balance and stress alleviation. A refreshed state empowers us to navigate daily challenges more adeptly, minimizing feelings of anxiety or overwhelm. Moreover, quality rest is tied to enhanced cognitive abilities and memory, facilitating both learning and overall efficiency. How Many Hours Should We Sleep? Sleep requirements can differ based on one’s age, way of life, and other individualistic elements. Still, the National Sleep Foundation offers a basic framework for sleep duration by age: - Newborns (0-3 months): 14-17 hours - Babies (4-11 months): 12-15 hours - Young toddlers (1-2 years): 11-14 hours - Pre-school kids (3-5 years): 10-13 hours - Children in school (6-13 years): 9-11 hours - Adolescents (14-17 years): 8-10 hours - The general adult population (18-64 years): 7-9 hours - Seniors (65 years and above): 7-8 hours Bear in mind, these figures serve as broad benchmarks; the ideal amount can vary based on the individual’s unique needs. Enhancing Your Sleep Quality: Some Useful Tips Want better sleep? Consider these strategies to optimize your night’s rest: - Stick to a Sleep Schedule: Aim to sleep and rise at consistent times, even during weekends. - Prioritize Comfort: Ensure your sleeping space is calm, dim, and cool. Investing in a good mattress and plush pillows can make a big difference. - Reduce Screen Time: Electronics emit blue light that can disrupt sleep. Try keeping devices like phones, tablets, or computers at bay for at least an hour before sleeping. - Watch Your Diet: Minimize evening consumption of caffeine and alcohol as they can disturb your sleep cycle. - Incorporate Physical Activity: A regular exercise routine can positively impact your sleep. But remember, it’s best not to work out too close to bedtime to prevent feeling too awake to drift off. References: - National Sleep Foundation. How Much Sleep Do We Need? - National Institute of Neurological Disorders and Stroke. Brain Basics: Understanding Sleep - Mayo Clinic. 6 Tips to Better Sleep In Summary: Amid our hectic routines, we sometimes forget the significance of sleep for our holistic health. Adopting the suggested practices can elevate your sleep quality, leading to mornings filled with vitality and focus. Consider sleep as an integral part of your daily regimen, benefiting both your health and mood. Embrace it, and the rewards will be plentiful. Wishing you restful nights ahead! Read Also:
Mental Health Treatments
Experts: Up to one-third of Covid-19 cases become 'long Covid' 05:13 - Source: CNN CNN  —  Jessica Rosario loved watching her 15-year-old, Eliana, play flute with the rest of the marching band during Open Door Christian School football games. But after the homecoming game in 2021, she got an alarming call from the Ohio school’s band director. Rosario’s daughter was on the floor of the band room, clutching her chest. “We ran up to the school, went into the band room, and I found her laying on the floor with her legs elevated on a chair, and I’m looking at her, and she’s not really moving,” Rosario said. The freshman couldn’t speak or stand. When paramedics transported her to the ambulance, she was dead weight, her mom says. Eliana’s condition turned out to be an extreme form of long Covid. She’s one of potentially millions of US children who have symptoms long after their initial infection. Children – even healthy teens and the very young – can have long Covid, several studies have found, and it can follow an infection that’s severe or mild. When Eliana collapsed, EMTs rushed her to University Hospitals Elyria Medical Center. “We had a room full of doctors. They were there ready to go, which I totally believe that God was in control of everything at this point,” Rosario said. Eliana’s blood tests, toxicology screens, chest X-ray and CT scan all looked OK, but she still had this strange paralysis. The hospital transferred her to UH Rainbow Babies & Children’s and hoped that the experts there could solve the mystery. “I was praying all this time for God to do a miracle and guide these doctors and nurses to shine some light on whatever it was that was causing this,” Rosario said. Eliana and the rest of the family had caught the coronavirus over Christmas 2020. Eliana’s case was mild, her mother says, but weeks after she recovered, she developed chest pain, heart palpitations and lightheadedness. Tests didn’t show any problems, and a pediatric cardiologist gave her the all-clear. The temporary paralysis came later. It went away and returned. The medical team eventually determined that Eliana’s chest pain and her elevated heart rate may have been related to inflammation due to Covid-19 – 10 months before the trip to the hospital. Doctors officially diagnosed her with Covid-related postural orthostatic tachycardia syndrome or POTS, a blood circulation disorder that causes an elevated heart rate when standing. Eliana had long Covid, also called post-Covid or long-haul Covid. “I had never heard of long haul until we were in the hospital,” Rosario said. More than a quarter of kids who get Covid-19 may develop long-term symptoms, according to a study from June. A 2021 study suggested that it may be even more; more than half of children between ages 6 and 16 in that study had at least one Covid-19 symptom that lasted more than four months. There’s no specific test or treatment for long Covid for kids or adults. Symptoms can include fatigue, rash, stomachache, headache, muscle ache, loss of smell and taste, circulation problems, trouble concentrating and pain, according to the American Academy of Pediatrics. The vast majority of children recover – sometimes even faster than adults do, according to UNICEF. But in some cases, kids can have symptoms for months or more. It’s still not clear why some kids develop long Covid and others don’t, but experts do know that children and adolescents don’t have to have been severely ill with Covid-19 to get long-term symptoms. Several institutions, including the National Institutes of Health, have studies underway to learn more. Dr. Amy Edwards, associate medical director of pediatric infection control at UH Rainbow Babies & Children’s, manages the hospital’s long Covid clinic and says she has been booked solid since she started seeing children with the condition in early 2021. “We just started seeing patients, and it slowly spread like wildfire,” Edwards said. “Looking at our first 60 patients that came to our clinic, we found that about 13% of our patients had these functional neurologic deficits.” These are conditions in which it appears the nervous system isn’t working the way it should, but doctors can’t figure out why. “In the case of our kids, it most always presents with loss of limb function, an inability to walk or move an arm, something like that,” Edwards said. “When you’re talking about 60 kids, 13% is a big number, especially when you’re talking about loss of limb function that has to be regained with physical therapy. It’s not a rare 1% complication.” It doesn’t help that not everyone believes these children are sick. The Rosarios and their pediatricians understood, but Edwards says that more than one adult has asked her how she knows that the children aren’t just making up their symptoms for attention or to get out of school. “One of the biggest things that I do with these kids is provide a diagnosis and reassure the families that they’re not crazy, because so many of these kids have been to see doctor after doctor after doctor who tell them they’re faking it or chalk it up to anxiety or whatever,” Edwards said. “I want to help them know they are not alone. I can’t cure them, but we can help.” Lynda Varno is grateful for that help and recognition. Her 12-year-old son, Ayden, had Covid-19 in November 2020. He recovered and seemed fine. Four months later, he used a push mower to mow the lawn of their rural Ohio home and, at bedtime, mentioned to his parents that his back hurt. When he woke up the next day, he couldn’t move. “He was in so much pain, from his head down to his toes,” Varno said. The local ER and, later, his pediatrician chalked it up to growing pains. But the boy who jumped on a trampoline every day, who loved to run and play football, could barely walk or move. “That pain level was still there. Nothing was helping,” Varno said. She spent months taking him to several hospitals, but none could find a way to ease his pain. It got so bad that it triggered nonepileptic seizures – up to 100 a day at one point, his mom said. It wasn’t until the next year, when Varno saw Edwards talk on the news about starting a pediatric long Covid unit, that she thought things could get better. “I just remember sitting there just sobbing because Ayden met every single thing she talked about,” Varno said. “It gave me goosebumps. I just sat there crying and saying, ‘God, thank you so much. This is what we needed.’ “ Varno got an appointment and said “it’s been a blessing ever since.” In addition to complex pediatric long Covid, Ayden had been diagnosed with orthostatic intolerance, an inability to remain upright without symptoms like lightheadedness, and dysautonomia, a dysfunction of the nerves that regulate involuntary body functions like heart rate and blood pressure. Edwards’ clinic uses an integrated approach to long Covid treatment. Ayden’s regimen included physical therapy, acupuncture, deep breathing and cognitive behavioral therapy, as well as diet changes. Children at the clinic are often urged to lower sugar in their diet and add more healthy whole foods. The eating plan limits animal products and emphasizes minimally processed foods, vegetables, fruits, whole grains, beans, seeds and nuts. Although more research is needed in children and adults, some early studies suggest that a plant-based diet may generally benefit adults with long Covid. In January 2022, Ayden started with Sara Pesut, a physical therapist at University Hospitals. She normally works with adults with functional neurological disorders, but Ayden and some of the others at the pediatric long Covid clinic were around the same age as her own children. “It was kind of like, ‘how do I not lean into this problem and try to help if I know something that could possibly help these families?’ ” Pesut said. He came to her first appointment in a wheelchair, she said, but after about three weeks working on balance, body position exercises and other activities, he no longer needed it. “It just kind of evolved from there,” Pesut said. “He’s really done a wonderful job.” Ayden went for PT for 9 months and also had some virtual visits for check-ins, as well as doing home exercises and following his therapy guidelines at home, Pesut said. Ayden went from a point where he couldn’t feed, bathe himself or walk to running and playing sports. “It has been like night and day from where Ayden was this time last year to now. It is a complete 180,” his mother said. Edwards’ clinic isn’t the only one to see kids with these extreme symptoms. At Johns Hopkins Children’s Center, pediatric rehabilitation physician Dr. Amanda Morrow said the main symptom is severe fatigue, but she has also seen patients like Edwards’ who have more complicated conditions. With treatment, she believes, long Covid won’t mean a lifetime of problems for any child. “We’re hopeful that the more we can support these kids earlier on and provide recommendations and things, we’re hopeful that that helps out their recovery or maybe doesn’t trigger them to go down this road where things are really difficult long-term,” said Morrow, who is also an assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. Murrow and Edwards remind parents that the best way to protect kids from long Covid is to keep them from catching the virus in the first place. Vaccinations are important, as well as precautions like wearing a mask when cases are high and washing hands thoroughly. Eliana spent eight days in the hospital and then was treated as an outpatient at Edwards’ pediatric long Covid clinic. “We work with them as if they’ve had a stroke, and they recover very, very well, actually,” Edwards said. When Eliana came into the clinic, physical therapist Art Lukovich said, he had to go back to basics and figure out what would help her best. “You don’t see stuff like this,” he said. He had her go back to the foundations of movement and motor control, and he figured out how much he could push. “Which has definitely given me some sleepless nights and gray hairs, but definitely worth it in the end.” “I had a sense of humility since this is a young lady that basically had her life put on pause because of this,” he added. In eight months of physical therapy, Eliana went from a wheelchair to a walker to a cane, her mom says. “When I saw her run for the first time in the clinic, I definitely had that moment where I was like ‘Oh, my God.’ I think her mother and I both looked at each other and thought, ‘wow!’ We didn’t completely think we could get there,” Lukovich said. Today, Eliana is back to school and back to feeling good. She finished her freshman year with straight As. Her mother is proud of the way she handled long Covid. “Not once did she cry. Not once did she panic. She gave me strength every day,” Rosario said. “She’s come a long way, and with the right people in place, she’s now running and jumping and riding roller coasters.”
Epidemics & Outbreaks
GNN has reported on dozens of studies that purport to find the culprit compounds or hidden keys to various diseases, but rarely do they ever sound like something out of a Marvel comic book. Now, a study published in the journal Nature Aging is seeking a treatment for neurodegenerative diseases like Huntington’s in the trunks of trees. In it, the researchers demonstrate that transporting a protein called SPP found in the plant cells responsible for photosynthesis into cultured human and animal cells brought about a reduction in protein clumping and symptoms of Huntington’s—the primary objective of the study. Huntington’s is a proteinopathy and one of 9 neurodegenerative disorders that are brought about by toxic aggregations of proteins called polyglutamine that don’t stick together in healthy humans. In humans and animals, it causes the death or dysfunction of brain cells, but in plants, where such proteinopathies like Huntington’s are also present, it causes no damage at all. In order to explore how plants deal with toxic protein aggregation, Dr. Ernesto Llamas, the first author of the study from the University of Cologne’s CECAD Cluster of Excellence for Aging Research, introduced the toxic mutant protein ‘huntingtin’ into plants, which causes cell death in human neurons. In contrast to animal and human models, Dr. Llamas found that thale cress plants actively removed huntingtin protein clumps and avoided harmful effects. Hoping to see if such an effect could be replicated with animals, the study team investigated what was happening and found that the plants avoided the toxic aggregation of mutant huntingtin due to their chloroplasts—plant-specific organelles that perform photosynthesis. “Unlike humans,” Dr. Llamas said, “plants have chloroplasts: an extracellular type of organelle that could provide an expanded molecular machinery to get rid of toxic protein aggregates.” The multidisciplinary team identified the chloroplast plant protein SPP as the reason why plants are unaffected by the problematic human protein. They found that producing the plant SPP in models of Huntington’s disease such as human cultured cells and worms like the nematode C. elegans reduced protein clumps and symptoms of the disease. “We were pleased to observe that expression of the plant SPP protein improved motility of C. elegans worms affected by huntingtin even at later aging stages where the symptoms are even worse,” said Dr. Hyun Ju Lee, a postdoc also involved in the study. The results of Dr. Llamas’ team’s study could open the door for testing SPP as a potential therapy for Huntington’s disease, and hopes plants could grow to play a bigger role in contributing to the treatment of human diseases. MORE RESEARCH LIKE THIS: Cures and Prevention For Some of the Worst Diseases Come From a Surprising Ally – Our Sewers “Many people don’t notice that plants can persist amongst variable and extreme environmental conditions that cause protein aggregation,” Dr. Llamas said. “We usually forget that some plants can live thousands of years and should be studied as models of aging research.” They aren’t just hoping though. Llamas and his team members believe there is real value in their discovery, and study co-author Dr. Seda Koyuncu says they’re going to found a start-up to produce plant-derived therapeutic proteins and test them as potential therapeutics to treat neurodegenerative diseases in humans. SHARE This Unorthodox Way Of Finding A Cure With Your Friends…
Disease Research
A patient who heckled First Minister Humza Yousaf during an independence convention says she is "disgusted" by the response to her appeals. Theresa Mallett, 61, has been left disabled and in constant pain after an operation by rogue surgeon Sam Eljamel. The first minister spoke to Ms Mallett after she called for a public inquiry - but she has now written to him and NHS Tayside to say she feels "let down". The Scottish government said it recognised former patients' distress. Ms Mallett brought the SNP's independence convention to a standstill when she heckled the first minister last month. Afterwards, she agreed to meet Mr Yousaf at her home in Glenrothes. Ms Mallett told the BBC he appeared to be listening to her requests for a public inquiry but then wrote her a letter which she says ignored their discussion. She said she thought that he and the health board had treated her "despicably" and described their response as "so disappointing". Ms Mallett told the BBC Scotland: "When we met he said a public inquiry was not off the table. "I said I didn't want an independent review and didn't want to deal with NHS Tayside. "But after we met I got a phone call from the health board saying the first minister had been in touch with them." Sam Eljamel was the former head of neurosurgery at NHS Tayside and a Scottish government adviser. Investigations by the BBC found that he had harmed patients for years but been allowed to carry on operating. At the end of 2013 Mr Eljamel was suspended by the health board and then he was allowed to voluntarily remove himself from the GMC register and avoid any disciplinary action. He now works as a surgeon in Libya. Last year a damning report highlighted failures in how NHS Tayside oversaw their head of neurosurgery. And in April, Health Secretary Michael Matheson said he would launch an independent review of NHS Tayside in relation to the scandal. However, that review has not yet begun. More than 120 former patients who have been harmed by Eljamel have said publicly that they do not want an independent review and will only accept a full public inquiry that looks at systemic and governance issues. 'No life at all' Ms Mallett wrote jointly to the health board and the first minister to express her dismay at the way she feels she has been treated. The grandmother says Mr Yousaf wrote to her suggesting she be part of an independent review of patients - something she and the other patients have already rejected. She wrote: "I feel let down by you Humza. Disgusted and disappointed. "This is not a real offer of help. Do you really want me to be reviewed by those who harmed me?" She says she "has been left with no life at all" and wants a public inquiry to look into systemic problems at the health board, In the letter, she says she felt the health board "badgered and harassed" her and tried to put words into her mouth when they phoned her - which they told her they did at the first minister's behest. Obviously everyone in government and beyond has enormous sympathy for Theresa Mallett and the other women harmed by Sam Eljamel. But they don't want sympathy, they want justice. So the debate here is over the best way to deliver that. A full-blown public inquiry would have the power - under the 2005 Inquiries Act - to compel witnesses to appear, to have them testify under oath, and to hand over documents and other evidence. But that power can come at the cost of flexibility. These judge-led proceedings take place within a strict framework, requiring everything from detailed terms of reference to legal representation for core participants at inquiry hearings. They frequently take years, and cost millions of pounds. An independent review meanwhile could be much more nimble. It may well be able to hand similar conclusions to ministers much more quickly, and at a fraction of the cost - but it would not have the same power to dig into the facts of the case, and its findings might not be seen to carry the same weight. With the disgraced surgeon unlikely to return from Libya to face the music, Humza Yousaf's argument is that it might be quicker to learn lessons in his absence with an independent review. But Ms Mallett and others like her also want to see tough questions posed of NHS Tayside - and they believe that can only happen at a full public inquiry. 'End the neglect' Scottish Labour's Jackie Baillie said it was "a powerful intervention" in the Eljamel saga. "After months of refusing to hold an independent inquiry, it now seems that the voices and experiences of patients are being shut out," she said. "This is nothing short of a betrayal of the women involved. "Humza Yousaf and Michael Matheson must end the neglect of the women failed in this scandal and do what is needed so that their voices are heard." The Scottish government said the first minister would be replying to Ms Mallett's letter shortly. A spokesperson said: "He is aware of the seriousness of this issue and has taken a personal interest in finding a solution, including visiting Ms Mallett at her home to hear from her directly. "We recognise the significant ongoing concern and distress being experienced by former patients of Professor Eljamel. "When the first minister met Ms Mallett, he outlined that the Scottish government has committed to establishing an independent commission that could engage directly with former patients and deliver answers quicker than a public inquiry would. "We will provide more detail on the scope of the commission shortly." NHS Tayside said that it was unable to comment on individual patients due to patient confidentiality. But it added: "NHS Tayside apologises to former patients of Professor Eljamel and remains committed to do whatever is required to support any independent process which is being set up by Scottish government to respond to the ongoing concerns of these former patients. "The board continues to work closely with the government regarding these next steps."
Health Policy
Nov. 7, 2023 -- When Allan Greenberg was diagnosed with prostate cancer in 2012, he elected to take a then-uncommon approach to treating the disease. He did practically nothing. Now, at the age of 83, with little to no change in Greenbergâs prostate cancer, the retired college professor is considering forgoing both active surveillance and treatment altogether in the winter of his life, but he hasnât made his decision yet. âAt my age, treatment is the last thing I would consider,â Greenberg said from his home in Vermont. âEven if it has seemed that things were getting worse, I'm not sure I would undergo any treatment at this point.â So if treatment is off the table, why even bother with surveillance? Active Surveillance Thatâs the question thousands of aging men must consider as the likelihood appears low they will die from a low-grade prostate cancer diagnosis made a decade or more earlier. Active surveillance for prostate cancer replaces radiation treatment or a prostatectomy with regular monitoring. Surveillance can include prostate-specific antigen (PSA) blood tests, MRIs, and biopsies. Active surveillance is intended for only grade 1, or low-risk, prostate cancers and some low-risk grade 2s. Prostate cancer ranges from grade group 1 (lowest grade) to grade group 5. A Gleason score is the traditional system for classifying how severe the cancer is. Cells are graded on a scale of 1 to 5 based on various factors. A pathologist will assign one Gleason grade to the most predominant pattern in a biopsy and a second Gleason grade to the second most predominant pattern. A Gleason score of 3+3, for example, is considered low grade. âThere's a wealth of literature showing that grade group 1 prostate cancer, in particular, is very, very different from other types of cancer,â said Kevin Ginsburg, MD, an assistant professor of urology at Wayne State University School of Medicine in Detroit. âAs a consequence of that, the harms of treatment often very frequently outweigh the benefits." Ginsburg, who is also the prostate program co-director at the Michigan Urological Surgery Improvement Collaborative, says the drawbacks of active surveillance -- the cancer spreading and killing the patient -- are low. A study from Johns Hopkins looking at a group of more than 1,800 men found that âthe risk of cancer death or metastasis was less than 1% over long-term follow-up.â âI firmly believe that with good high-quality active surveillance, the chances of missing the ability to treat and cure someone if and when that point arises is very, very, very low,â Ginsberg said. The benefits of active surveillance include avoiding debilitating treatments that can leave a patient incontinent or impotent. For many men who choose active surveillance, it's a quality-of-life issue. Prostate cancer is slow-moving, which lends itself to monitoring. Cancer in Lowercase Laurence Klotz, MD, a urologist at the University of Toronto, named and helped establish active surveillance more than 30 years ago. Back then, 95% of men with low-grade prostate cancer were being treated. Now, active surveillance is the preferred option for low-risk cancer. The number of men with prostate cancer who opted for active surveillance doubled nationally between 2014 and 2021, with about 60% of men eligible for active surveillance choosing it. Thatâs up from 27% in 2014 and 10% in 2010. A recent study out of Italy found that 83% of men chose active surveillance over immediate treatment. Last year, the American Urological Association and the American Society for Radiation Oncology strengthened their recommendation for active surveillance. Klotz sees advanced technology as the âmalady of modern medicine.â More sophisticated diagnostic tools can lead to overdiagnosis -- and thus overtreatment -- in any specialty, including prostate cancer. âWe'd be better off in the diagnostic strategy where this wasn't identified at all,â Klotz said. âThe majority of prostate cancers do not pose a threat to the patient.â Michael Leapman, MD, an associate professor of urology at the Yale School of Medicine in New Haven, CT, notes that PSA blood tests are effective at identifying early-stage prostate cancer but not so great in distinguishing between aggressive and less worrisome tumors. âThe movement for active surveillance is really born out of the recognition that there are a large number of prostate cancers that are classified as prostate cancer, but they're indolent and are unlikely to cause a problem in a man's life,â Leapman said. Some experts are even pushing to stop calling early, low-grade prostate tumors âcancers.â Daniel Lewis, MD, an internal medicine doctor with the Facey Medical Group in Los Angeles, said a patient's decision to go on active surveillance is influenced by their tolerance for risk. When one of his patients receives a diagnosis of prostate cancer and elects to have active surveillance, he asks if they want a second opinion. Lewis, also chairperson of the Black Physicians Council at Facey, often sees looks of relief on the faces of patients who donât need treatment. Dying With -- Not From -- Prostate Cancer Participating in and stopping active surveillance are personalized decisions for patients. Factors to consider include quality of life, age, overall health, and life expectancy. Some men reduce their active surveillance later in life, opting for only the occasional PSA test. Others stop surveillance altogether, having lived a long life and choosing not to invest time in surveillance of something that, by that point, is unlikely to be the cause of their death. While some men may continue surveillance for peace of mind, others discontinue because, well, why not? Ira Kaget was diagnosed with low-level prostate cancer in March 2009 at the age of 66. After the initial shock, Kaget, now 80, researched the topic and spoke with experts. With his Gleason score a mere 3+3 and the horror stories he heard of men who regretted treatment, he opted for active surveillance. He gets an MRI-informed targeted biopsy every 2 years and frequent PSA tests. Now, almost 15 years after his initial diagnosis and little change to his condition, Kaget has no plans to change course. âI plan to continue with this, continue monitoring, and I'm very intent on managing my case,â Kaget said. âThe goal is to die with it instead of because of it.â
Disease Research
- Eli Lilly sued 10 medical spas, wellness clinics and compounding pharmacies across the U.S. for allegedly selling cheaper, unauthorized versions of the company's diabetes drug Mounjaro. - The lawsuits come as Eli Lilly grapples with a shortage of Mounjaro, which can also help patients lose unwanted pounds. - Eli Lilly initiated several lawsuits in federal courts in Florida, Texas, Arizona, Georgia, Minnesota, South Carolina and Utah. Those suits asked the courts for orders blocking the sales of counterfeit versions of Mounjaro and an unspecified amount of monetary damages. The actions come as Eli Lilly grapples with a shortage of Mounjaro in the U.S. due to skyrocketing demand. Much of the drug's popularity comes from its off-label ability to help patients lose unwanted pounds. Eli Lilly initiated several lawsuits in federal courts in Florida, Texas, Arizona, Georgia, Minnesota, South Carolina and Utah. The litigation asked the courts for orders blocking the sales of counterfeit versions of Mounjaro and an unspecified amount of monetary damages. Eli Lilly specifically accuses the spas, clinics and compounding pharmacies of marketing and selling "compounded" drug products that claim to contain tirzepatide, the active ingredient in Mounjaro. Compounded drugs are custom-made versions of a treatment that are not approved by the Food and Drug Administration. Eli Lilly is the sole patent holder of tirzepatide and does not sell that ingredient to outside entities. It's unclear what the spas and clinics are actually selling to consumers. "Rather than invest the time and resources necessary to research, develop, and test their products in order to ensure that they are safe and effective and to obtain regulatory approval to market them, Defendant is simply creating, marketing, selling, and distributing unapproved new drugs for unapproved uses throughout Florida and fourteen other states," Eli Lilly wrote in one suit against Rx Compound Store, a compound pharmacy based in Florida. Eli Lilly, in the suit, added that selling counterfeit versions of Mounjaro "puts patients at risk by exposing them to drugs that have not been shown to be safe or effective." Rx Compound Store did not immediately respond to a request for comment on the suit. The moves come months after Novo Nordisk filed several lawsuits accusing spas and medical clinics of selling compounded versions of its highly popular weight loss drugs Ozempic and Wegovy. The FDA in May warned about the safety risks of unauthorized versions of Ozempic and Wegovy after reports emerged of adverse health reactions to compounded versions of the drugs. The FDA has not issued a warning about compounded versions of tirzepatide. However, Mounjaro, Ozempic and Wegovy have all been in short supply in the U.S. since last year, according to the FDA's database. Analysts and industry executives have said annual sales of those drugs and similar treatments for weight loss could hit $100 billion within a decade.
Drug Discoveries
MINNEAPOLIS -- Minneapolis is backing away from enforcing laws that criminalize buying psychedelic plants or using them in private. Mayor Jacob Frey on Friday ordered police to stop using taxpayer dollars to enforce most laws against hallucinogenic plants. Minneapolis still prioritizes enforcing laws against selling psychedelic plants, bringing them to schools or using them while driving. Minneapolis Police Chief Brian O’Hara in a statement said he stands by the mayor's decision. Announcing the order, Frey cited the potential for hallucinogenic plants to treat mental illnesses including depression and post-traumatic stress disorder. “Experts are telling us that these plants help people, and that’s the business we should be in – helping people,” Frey said in a statement. “With a rise in deaths of despair in our city, and in our society, the data is showing that these plants can help be a remedy.” Some researchers believe psilocybin, the compound in psychedelic mushrooms, changes the way the brain organizes itself and can help users overcome things like depression, alcoholism and post-traumatic stress disorder. A drug that’s related to the anesthetic ketamine was cleared by the FDA to help people with hard-to-treat depression. But medical experts caution that more research is needed on the drugs’ efficacy and the extent of the risks of psychedelics, which can cause hallucinations. The American Psychiatric Association has not endorsed the use of psychedelics in treatment, noting the Food and Drug Administration has yet to offer a final determination. The FDA designated psilocybin as a “breakthrough therapy” in 2018, a label that’s designed to speed the development and review of drugs to treat a serious condition. MDMA, also known as ecstasy, also has that designation for PTSD treatment. The FDA in June released draft guidance for researchers designing clinical trials testing psychedelic drugs as potential treatments for a variety of medical conditions. The Biden administration has also provided to the National Institutes of Health and other agencies funding for dozens of projects studying psychedelic drugs with potential benefit for mental and behavioral health. Earlier this year, Oregon became the first state in the nation to legalize the adult use of psilocybin. Colorado’s voters last year voted to decriminalize psilocybin. Denver was the first city to decriminalize personal possession and consumption of psilocybin in 2019. A Minneapolis-based organization that advocates for immigrant rights and criminal-justice reform touted the mayor's order. “This is an important first step to undo all the harms inflicted from the war on people who use drugs, which was created to target brown and Black peoples,” DecriMN Coalition founding member Jessica Nielson said in a statement. “These natural medicines and their use by Indigenous peoples predate any of these laws."
Mental Health Treatments
Throughout the pandemic, Black Americans have made up a disproportionate share of cases, hospitalizations and deaths compared to any other racial or ethnic group. Now, doctors and advocates are warning the Black community is facing another barrier: access to long COVID care. Long COVID occurs when patients who were infected with the COVID-19 virus have lingering symptoms for more than four weeks after recovering. In some cases, these symptoms can persist for months or even years. According to data from the U.S. Census Bureau Household Pulse Survey, with the latest update conducted between Jan. 4 and Jan. 16, 28.7% of Black respondents said they currently have or have had long COVID. By comparison, 27.6% of white adults reporting having or having had long COVID. Hispanic adults were the only racial/ethnic group with a higher percentage reporting long COVID at 31.7%. However, when it came to adults currently with long COVID who are suffering from significant limitations, Black patients had the highest share of people reporting, the survey shows. Data shows 34.6% of Black Americans with long COVID report severe limitations on their ability to perform day-to-day activities. Hispanics had the second highest rates of severe physical limitations at 32% and those who reported being multiple races or another race were 30.5%. 'Nobody wanted to listen to me' One of those people is Chimére Smith, a 40-year-old former middle school English teacher from Baltimore, Maryland. Smith said she contracted COVID in late March 2020. Her symptoms started off with a scratchy throat and soon progressed to a myriad of symptoms including extreme fatigue, a persistent cough, fogginess, headaches, nausea, diarrhea and spinal pain. "I remember trying to do some type of social media dance with my partner and after like two minutes, I had to sit down because the world was spinning," she told ABC News. "And so, within those first few days, as I said to my partner, 'I think I have COVID.'" Smith said she went to two hospitals in the Baltimore area, both of which were familiar with her medical history, but doctors refused to test her for COVID-19. "They told me that my symptoms were not profound enough to test," she said. "They told me that they didn't have enough tests. They told me that I was fine and that I was just being anxious because we were out of school for the unforeseeable future. I got a lot of doctors telling me I was anxious, and that I was okay." However, Smith's symptoms continued for several weeks and even months, to the point where she lost vision in her left eye and was left unable to work or drive. Smith said she paid more than a dozen visits to doctors and hospitals asking for help, but she said she was discharged after every visit with no treatment plan in place. Smith said she had never been dismissed by a doctor before and felt discouraged. "I felt extremely frustrated," she said. "I was incredibly sad and depressed about that. I felt very despondent. I had several white male doctors sit at my bedside and ask me, 'Are you sure there's nothing personal going on in your life? Are you sure? Is it a relationship issue? Was it a job issue?'" She continued, "But nobody wanted to listen to me. And so, it was infuriating. I felt powerless. The way that some of those doctors talk to me, I can tell they were talking to me that way because I was a Black female patient, who they assumed did not know anything about what was happening to her body." In April 2021, Smith testified before the U.S. House Energy and Commerce Subcommittee on Health on the lingering effects of COVID-19. Implicit bias in the medical field There is a history of distrust when it comes to the Black community and the health care system due to beliefs among patients that doctors won't treat them as well as their white counterparts. A 2012 meta-analysis found Black patients were 22% less likely than white patients to receive any pain medication. There is also a fear of being used as guinea pigs in clinical research or other studies as what occurred during the Tuskegee experiments from 1932 to 1971. Black men were injected with syphilis to track progression of the sexually transmitted in infection, but the study was conducted without informed consent and patients never received treatment for the disease. What's more, eugenics movements in the 20th century saw many women across communities or of color forcibly sterilized. Dr. Panagis Galiatsatos, an assistant professor and physician in pulmonary and critical care medicine at the Johns Hopkins University School of Medicine, told ABC News there is unconscious and implicit bias in the medical field that may lead to doctors dismissing Black patients compared to white patients. "I can tell you, for a lot of affluent patients coming to our clinic or white patients, what got them to this clinic is that their doctor took their symptoms seriously and got him to our clinic," Galiatsatos, a member of the Johns Hopkins Post-Acute COVID-19 Team, said. "Counter that with disadvantaged patients from a socioeconomic standpoint or Black/African-American patients, it took them several doctors to listen to what they're experiencing before someone took them seriously." During the period when she thought no one was listening to her, Smith said she felt like she was going to die before anyone figured out what was wrong. It wasn't until a year and two months after Smith's symptoms first began that she visited a doctor who told her she believed that Smith was suffering from long COVID. "I had a doctor's appointment on May 20, which was my 39th birthday, and on that day was when a physician, a Black woman said to me, for the very first time, 'I believe you,'" she said. "And when she said that I cried like a baby. Because I could not believe somebody was actually telling me, 'I believe you. Everything that you're saying to me, convinces me that you had COVID.'" Trouble accessing care It's not just a matter of getting doctors to believe Black patients. There's also trouble accessing care among the Black community. "So, with my own eyes, my colleagues and I have seen it in our own clinic, where those that are so economically disadvantaged, those of minority race, their persistence of symptoms by the time they get to our clinic have been going on for a little over a year," Galiatsatos said. "When we counter that versus populations of higher socioeconomic status or the white race, for instance, those individuals usually catch us well within three to six months." There are several factors at play. Black Americans traditionally have less access to insurance – let alone quality insurance -- allowing them allowing them to see a doctor at a post COVID clinic. "So many of our patients that we've taken on have had to go through several insurance authorizations just to get a referral to come to us, and that's what they will say is part of their delay," Galiatsatos said. Additionally, despite several clinics opening up across the country, Black patients are more likely to rely on public transportation, meaning less access to clinics. Galiatsatos said fewer than 10% of the patients he sees at the post-COVID clinic are Black. Black households are also less likely to have internet. According to the Joint Center for Political and Economic Studies, 34% of Black adults in the U.S. do not have home broadband, meaning they may not have information about long COVID or know where to go to receive care. What's more, a 2022 study found Black Americans make up about 15% of the U.S. workforce, but are much more likely than white Americans to hold frontline or essential jobs, accounting for 30% of bus drivers and 20% of food service workers, for example. "A day missed of work is a day missed of income," Galiatsatos said. "If those patients have long COVID, they're going to decide between a paycheck and their health every day and that's not fair to them." To close the racial gap in long COVID care, Galiatsatos recommends more regular implicit bias training among doctors and more telemedicine so patients can access specialized clinics. Smith, the long COVID patient, said school buildings, historically black colleges and universities, churches and other community organizations can be used to educate Black communities on the effects of COVID and long COVID. While Smith is able to cook and drive again, she still is unable to work and experiences several symptoms including brain fog, short-term memory loss, joint pain, gastrointestinal inflammation and headaches. She hopes her story will help educate others and convince them to be their own advocate if they get pushback from physicians. "This has been my reality for three years," she said. "I would rather be in a classroom with 40 kids, talking about how to write a great essay, than sitting here talking to you. Three years later, and I still get no comfort. I love telling my story to inspire other Black people and Black families, but I don't get any joy."
Epidemics & Outbreaks
En una tendencia similar a la adopción de microdosis de LSD en Silicon Valley, el consumo de ketamina bajo supervisión ha comenzado a ganar popularidad entre círculos de profesionales que buscan mejorar su rendimiento laboral y afrontar de forma diferente los momentos cotidianos de estrés. La droga, de efecto casi inmediato y una duración de aproximadamente 45 minutos por cada 100 miligramos, es descrita por la Administración de Control de Drogas de EEUU (DEA) como un “alucinógeno anestésico disociativo” que distorsiona los sentidos y causa una sensación de separación entre consciencia y cuerpo. “Es genial cuando las personas tienen intenciones de prosperar, ser más claras, más creativas y productivas en su vida y en su trabajo”, opinó Reid Robison, director clínico de la empresa Numinus Wellness, en declaraciones a Bloomberg. Robison dirige sesiones grupales de ketamina, aunque su compañía también ofrece una larga lista de terapias alternativas, algunas con MDMA y psilocibina, otras con cannabis (más enfocada en trastornos neurológicos) y otras que estimulan el nervio vago para tratar los ataques de epilepsia o usan bótox para prevenir migrañas. Incluida en el “paquete” de beneficios laborales “Esperamos ayudarlos no solo en la curación, sino también en el crecimiento y mejoría de sus vidas”, asegura Robison, quien por razones legales primero debe asegurarse de que los participantes en sus sesiones tengan un diagnóstico de salud mental apropiado. Como herramienta de superación personal, la ketamina tiene algunas ventajas sobre otros psicodélicos como la ayahuasca, que es ilegal en la mayoría de los países y puede provocar el tipo de expulsiones corporales que la gente trata de evitar en ambientes de trabajo. El fármaco se ha recetado de manera no autorizada durante años para controlar la depresión, pero no está aprobado por la Administración de Alimentos y Medicamentos (FDA). Como ocurre con otros medicamentos, existen riesgos de adicción y sobredosis. Según Bloomberg, algunos directores y ejecutivos están pagando para que sus empleados accedan a un tratamiento con ketamina, a veces en entornos grupales destinados a resolver fricciones en la oficina. También te puede interesar: “Ketatations” Kaia Roman, una emprendedora y “biohacker” radicada en Santa Cruz, California, y su socio comercial Mike “Zappy” Zapolin están a la vanguardia de la tendencia. En 2020, el dúo registró como marca el acrónimo “ketatation”, derivado de “meditación con ketamina” en inglés. Una sola sesión puede costar US$ 300. Desde el comienzo de la pandemia, ambos han supervisado grupos de “ketatation” en Miami, Los Ángeles, Nueva York, y Utah. Zapolin, que se hace llamar “el consejero psicodélico de las estrellas”, ha tratado con ketamina al ex jugador de la NBA Lamar Odom, al lobo de Wall Street Jordan Belfort y a equipos ejecutivos de Silicon Valley. “Los colocamos en colchonetas de yoga en la habitación, tenemos una receta de un médico y una experiencia de 45 minutos juntos”, seguida de una discusión guiada, explicó. “Hay una ESP [percepción extrasensorial] increíble que sucede dentro del grupo”. Chase Hudson, cofundador de HempLucid, una compañía de CBD en Provo, Utah, reunió a su equipo de liderazgo de cinco personas para sesiones de ketamina supervisadas por Robison de Numinus Wellness. En una sesión típica, el grupo toma una dosis amigable para animar la conversación y discutir de trabajo. Hablar desde el corazón, no desde la mente En una sesión reciente, se dio cuenta de que él, su director de marketing y su director de ventas no podían comunicarse claramente porque sus egos se interponían en el camino. “Tuve una disolución del ego… y de pronto estás hablando desde el corazón y no desde la mente”, contó. Hudson dice que su objetivo es “cerrar la brecha entre el mundo psicodélico y el espacio corporativo”; de ahí que incluye entre los beneficios que brinda a sus 15 empleados el acceso a tratamientos con ketamina. La compañía de productos para el cuidado personal Dr. Bronner's Magic Soaps también comenzó a ofrecer terapia asistida con ketamina a sus trabajadores el año pasado. Utilizó un administrador del plan de beneficios de seguro de terapia psicodélica llamado Enthea, que recaudó US$ 2 millones de capitalistas de riesgo, anticipando que la terapia psicodélica basada en el empleador es un mercado en crecimiento. Desde 2015, Dr. Bronner's Magic Soaps ha donado más de US$ 23 millones a organizaciones de investigación y defensa de las drogas, según documentos corporativos. Eso incluye a científicos que investigan las propiedades curativas del éxtasis, grupos de activistas que ayudaron a despenalizar los “hongos mágicos” en varios estados y una pequeña organización sin fines de lucro que trabaja para preservar el hábitat del peyote. En EEUU el boom de la ketamina para tratar la salud mental es innegable. Un reporte de The Guardian publicado en abril contabilizó una docena de clínicas solo Manhattan. Lauren Taus, una psicoterapeuta privada que brinda servicios asistidos con ketamina, dijo a ese medio que existe “una carrera loca por comercializar la práctica, que está liderada por ricos empresarios”, así como por la industria de la telesalud. Entrega a domicilio Existen empresas, como Better U y Wondermed, que ofrecen entregas directas a domicilio de ketamina en paquetes de terapia mucho más baratas: 30 dosis diarias por US$ 129 al mes. Están acompañados de llamadas de Zoom con terapeutas, listas de reproducción, meditaciones guiadas e información educativa. “Mucha gente ve las clínicas de ketamina como un gran negocio para obtener grandes márgenes, porque la ketamina en sí misma es muy barata”, dijo Ben Spielberg, director ejecutivo fundador de Bespoke Treatment, que ofrece infusiones de ketamina. “Pero realmente no podría estar más lejos de la verdad: las personas que más se benefician de las terapias con ketamina rara vez pueden permitírselo. Muchos de ellos están discapacitados debido a sus condiciones de salud mental y US$ 400 o US$ 600 por infusión es un obstáculo insuperable”, apuntó Spielberg a The Guardian.
Mental Health Treatments
Concord, N.H. — Andy Hoang eagerly began her first nursing job this year in New Hampshire, with a desire to specialize in cardiac care. She was excited about attending a November practice session on how to respond to someone in cardiac arrest. But as things were getting under way at Dartmouth-Hitchcock Medical Center, Hoang, 23, started to feel dizzy and nauseous. She felt she needed to sit down. "That's the last thing I remember," she told The Associated Press in an interview. "I woke up to a room full of doctors and nurses." It turned out that she, herself, had gone into cardiac arrest and needed help immediately. Her colleagues sprang into action - instead of practicing chest compressions on a mannequin in a simulated environment, they went to work on her. "One checked her carotid, one her femoral (arteries), and she did not have a pulse," instructor Lisa Davenport said. The nurses started CPR and a "code blue," or medical emergency, team was called. A first "What was really stressful about the situation was that we never had a real code blue in the center," Davenport said. "We train for them all the time." Davenport shouted for help. Luckily, the Lebanon hospital's critical care team was nearby, attending a separate session. More nurses came in, hooked Hoang up to defibrillator for monitoring, inserted an IV line and placed her on oxygen. A doctor and nurse from another department rushed in with crash carts. Hoang was waking up by the time an emergency team arrived. Davenport estimated 15 minutes passed from the time Hoang slumped over to when they got her on a stretcher and sent her to the emergency department. But it felt longer. "It worked out, but it was pretty frightening for all of us," she said. "You just don't expect that to happen with someone as young as Andy." Charmaine Martin, one of the nurses at the scene, agreed it was a scary moment, but also one "where I saw and felt supported and we all worked as a team," she said in a statement. Hoang, who recently returned to work, couldn't believe what had happened either. "I would say I'm your pretty average healthy 23-year-old," she said. She goes to the gym four times a week, runs, and eats well. "I'm on my feet 12, 13 hours a day at work, so I want to make sure that I'm in shape for that." Cardiac arrest vs. heart attacks Cardiac arrest - the sudden loss of heart function - causes more than 436,000 deaths in the United States each year, according to the American Heart Association. It is different from a heart attack, which happens when blood flow to the heart is blocked. A person can suffer cardiac arrest after having a heart attack, but the association says other conditions can also disrupt the heart's rhythm and lead to cardiac arrest, including having a thickened heart muscle or cardiomyopathy, heart failure, arrhythmias and more. According to information compiled by the National Heart, Lung and Blood Institute, a person's risk of cardiac arrest increases with age. It is rare in someone younger than 30. Genetic arrhythmias, problems with the structure of the heart or coronary arteries, heart inflammation and substance abuse are the main risk factors in younger people. Most cardiac arrests also occur in men and women's risk increases after menopause. Unlikely victim Hoang said before the day she suffered cardiac arrest, she had passed out twice before. The first time, she hadn't eaten and her blood sugar was low. The second time was preceded by a sharp pain in her abdomen. "So, nothing like this, nothing to this extent," she said. Hoang, who grew up in Vietnam and came to the United States in 2016 as a student, said her family has no history of heart problems. She had been living with a family in Montana before she got her nursing degree in Michigan, then headed to New Hampshire. While recovering, Hoang wore a patch that recorded the electrical activity of her heart. Doctors hope to learn more from the data. The experience has strengthened her relationship with the other nurses - Hoang now regards them as best friends. "We basically went through this whole life-or-death experience," she said. "I am so grateful for Andy and her courage. She is an excellent nurse and someone I call friend," Martin said. Hoang said she feels like she's part of a family at work, not just an employee. Her family told the AP they are extremely grateful that she was surrounded by medical personnel when she went into cardiac arrest. It was care given by nurses to her grandfather, who died a couple of years ago, that made Hoang want to switch her career focus from graphic design to nursing. But she never expected she would become a patient. "It really changed my perspective on how I view life, like 'Hug your family a little longer,'" she said. "Tell them that you love them, because it might be the last time you get to say it to them. And just cherish life for what you've been given. It's precious, and I didn't realize how precious it was until I nearly lost it." for more features.
Medical Innovations
Drug companies charge more for insulin in the United States than in nearly three dozen other countries RAND researchers examined—and it's not even close. The average list price for a vial of insulin in Canada was $12. Step across the border into America, and it's $98.70. Those differences help explain why insulin has become a symbol of the high cost of American health care. Its prices have shot up in recent years, for reasons that are opaque at best, with those who can least afford it often paying the most. Reining in those prices has become the rare political cause embraced by Democrats and Republicans alike. “This isn't just some academic question: 'How do our prices compare with those in other countries?'” said Andrew Mulcahy, a senior policy researcher at RAND who specializes in health care economics and led the study. “It's becoming a very practical question, because there are ideas out there to do something about it, and they can benefit from this kind of analysis.” Diabetes is one of the most pervasive, deadly, and expensive diseases in the United States. More than 30 million people have it, and nearly a quarter of them use insulin to manage their symptoms and prevent life-threatening complications. Per-person spending on insulin, for those with employer-paid health insurance, doubled between 2012 and 2016. The U.S. Department of Health and Human Services asked RAND to investigate how American insulin prices compare with those in other parts of the world. Researchers obtained list prices for all types of insulin from 33 countries in Europe, Asia, Australia, and the Americas. Plotted on a graph, the U.S. prices stand alone. The average price in America, across all types of insulin, was more than ten times higher than the average for all of the other countries combined. In fact, the closest any country came to paying the $98.70 American average was the $21.48 average that Chile pays. The differences were especially stark when the researchers looked at rapid-acting insulin, which makes up about a third of the U.S. market. Its average price in other countries was just over $8. In America, it was $119. “It comes at a high cost, and not just financially, but in terms of your life,” said Mila Clarke Buckley, 30, whose autoimmune diabetes is slowly shutting down her pancreas. She runs a top-rated blog for fellow diabetics, “Hangry Woman,” from her home in Houston. She has more than 30,000 readers. “It's not like one day you can just stop taking insulin,” she said. “You really have to manage your life thinking, OK, this is my No. 1 priority, to be able to get this little pen of liquid so that I can live.” Insulin prices in the United States are higher than prices in nearly three dozen other countries RAND researchers examined—and it's not even close.Share on Twitter The prices RAND used in its study—the list prices, set by drug manufacturers—were the most available for comparison across different countries. They're a good starting point for understanding the true cost of insulin. In the cryptic world of drug-price setting, the list price is like an opening bid. The companies that manage the drug formularies that you might see on your insurance plan then enter the picture. They negotiate discounts and rebates in a closed-door process that yields a second, lower price that insurers ultimately pay. Drug manufacturers compete for their business by offering generous discounts, which gives them every reason to set their initial prices high. Even if those discounts cut 50 percent from the price, RAND's study noted, Americans would still be paying several times more for insulin than what people in other countries pay. It's hard to track the final prices that patients like Buckley actually pay at the pharmacy counter. Those who have insurance still have to cover deductibles and copays, which can be significant. Those who don't have insurance can find themselves paying the full list price. Drug companies have started to introduce lower-priced insulins and discount cards to help those struggling to pay. But nearly a third of the people who responded to an American Diabetes Association survey said they had postponed doctors' appointments or put off paying bills to afford their insulin. A quarter had skipped a rent or mortgage payment. Photo courtesy of Mila Clarke Buckley Buckley has been there. When her husband lost his job a few years ago—and with it, their health insurance—she, too, found herself caught between paying their bills and paying for insulin. She paid the bills. “It was an impossible choice, but we had nothing left to give,” she said. For several weeks, she watched her blood-sugar levels creep up as she rationed what little insulin she had, until her husband could find another job. “It was terrifying,” she said. “That's why we need to really force this conversation to stay open. It's important to live in a country where insulin is accessible and affordable and people don't have to make choices to go without just so they can get their insulin.” Several states have capped how much their residents can be asked to pay out of pocket for insulin. A few have filed lawsuits against the major drugmakers. At the federal level, policymakers have talked about—but not yet acted on—ideas to allow the importation of cheaper insulin, or to peg prices here to those in other countries. One proposal would cut back the middlemen so that list prices can more closely reflect the final pharmacy prices. You really have to manage your life thinking, OK, this is my No. 1 priority, to be able to get this little pen of liquid so that I can live. Mila Clarke Buckley Rep. Earl “Buddy” Carter of Georgia offered a backhanded thank-you to industry executives during a 2019 hearing on the soaring price of insulin. “You have done something here today that we have been trying to do in Congress [for years],” he told them. “And that is to create bipartisanship.” Researchers at RAND are now starting to look at how American prices for other prescription drugs compare with those in other countries. “We really need to have a better sense of just how much more we're paying,” RAND's Mulcahy said. “It's not just insulin; it's across the board. My hope is that this insulin report is the start of a long string of analyses doing this kind of international drug-price comparison.” Mila Clarke Buckley knows her insulin costs will go up. The type of diabetes she has—latent autoimmune diabetes in adults, or LADA—is a progressive disease, breaking down her body's ability to function without increasing doses of insulin. Sooner or later, she will become completely insulin dependent. She has a separate tab on her household budget for when that day comes: “Mila's Diabetes Care.” “It happened to me; it can happen to you any day,” she said. “That's why we need to have this conversation, because the prices are astronomical, and it affects real lives. One day, I didn't have diabetes, and the next day, I found out I did, and it changed my entire life.”
Drug Discoveries
Scientists develop synthetic molecules that can 'ferry' mucus-clearing ions blocked by cystic fibrosis A University at Buffalo-led research team has developed molecules that could help unclog thick, sticky mucus from the lungs of people suffering from cystic fibrosis. The chronic disease is caused by a defective protein channel that prevents chloride ions from leaving cells and creating the watery conditions necessary to clear mucus. Researchers' synthetic molecules offer something of a detour by binding to ions and carrying them through the cell membrane. "We found that these molecules can serve as an effective ferry to transport chloride across the cell and therefore restore the level of airway surface liquid, or ASL, to essentially that of a normal cell," says the study's lead author, Bing Gong, Ph.D., UB Distinguished Professor in the Department of Chemistry, within the College of Arts and Sciences. "One day, they could be leveraged into a drug that treats cystic fibrosis, a very painful and unpleasant disease." The inability to clear mucus makes breathing difficult and risk of infection high for the nearly 40,000 Americans living with cystic fibrous. It is one of the most common fatal genetic diseases in the United States. "It is exciting when scientific discoveries can be applied in ways that will potentially improve the health and well-being of people with complex conditions like cystic fibrosis that have limited treatment options," says co-author Daniel Miller, a UB Ph.D. graduate who is now assistant professor of chemistry at Hofstra University. Helping chloride ions escape cells In healthy lungs, chloride ions exit the cell via a tube-shaped protein channel called a cystic fibrosis transmembrane conductance regulator (CFTR). Once outside the cell, chloride ions attract water that helps tiny, hair-like cilia sweep out mucus from the airways. In cystic fibrosis, the CFTR channel is either defective or nonexistent. Without chloride ions to attract water, mucus hardens and the cilia can't clear it. Gong's lab previously developed synthetic binders for positively charged ions called cations, but chloride is a negatively charged ion, or anion. "Synthetic anion binding is much more challenging because anions can be all kinds of shapes—spherical, octahedral, even tetrahedral," Gong says. "It's hard to tailor-make clothes for them, so to speak." The solution turned out to be macrocycles, a form of molecule with a ring containing 12 or more atoms. Gong's team's nontoxic macrocycles are characterized by a star-shaped, rigid backbone that can selectively lock anions into place with its binding cavities. Computational chemistry, conducted by Zurek and Miller, was used to illustrate the macrocycles and their anion binding on a molecular scale. Models confirmed the macrocycles' structure and positive charge of its binding activity. "Our computations were able to provide a deeper understanding of the orientation and positioning of the macrocycle relative to chloride," Miller says. Researchers found the macrocycles were not only effective binders—they were essentially bodyguards. "The interior of a cell membrane is hydrophobic—it doesn't like positively or negatively charged ions—but our macrocycles actually gave anions a hydrophobic shield so they can travel to the other side of the cell membrane," Gong says. When the macrocycles were applied to tissue taken from the airways of cystic fibrosis patients, ASL visibly thickened. In fact, cells treated with the macrocycles had an ASL 50% higher than that of the control cystic fibrosis cells. The macrocycles do have some limitations. The fixed size of their binding cavity prevents them from binding with small or very large anions. Plus, only small quantities can currently be produced due to the required high-dilution conditions. Gong's lab will now try to adjust the cavity size, as well as scale up production. Life expectancy on the rise Just a few decades ago, most cystic fibrosis patients died in their early adulthood. However, life expectancy is now approximately 56 and many with the disease live full life spans, thanks in part to advances in treatment. These include a drug called Trikafta, which helps the CFTR channel funnel out ions like it's supposed to. However, the drug is expensive and, in certain countries, not even on the market. "Developing new treatments for cystic fibrosis treatment remains a crucial effort," Gong says. "Our research in anion and cation binding can apply to not only cystic fibrosis, but a host of other channel diseases caused by defective ion channels." More information: Ruikai Cao et al, Aromatic pentaamide macrocycles bind anions with high affinity for transport across biomembranes, Nature Chemistry (2023). DOI: 10.1038/s41557-023-01315-w Journal information: Nature Chemistry Provided by University at Buffalo
Drug Discoveries
Canadian medical researchers have trained a machine-learning AI to accurately predict Type 2 diabetes from just six to 10 seconds of the patient's spoken voice. This was achieved after the model identified 14 acoustic features for differences between non-diabetic and Type 2 diabetic individuals. The AI focused on a set of vocal features, including slight changes in pitch and vocal intensity that the human ears can't hear of doctors, and paired that data with basic health information, including the patient's age, sex, height, and weight. Sex proved to be decisive, the researchers found: The AI can diagnose the disease with 89 percent for women, but slightly less accurately, 86 percent for men. The AI model promises to dramatically reduce the cost for ordinary people suffering from the chronic health condition, which traditionally must be tested in person. Type 2 diabetes is a condition which causes a person's blood sugar to get too high. More than 4million people in the UK are thought to have some form of diabetes. Type 2 diabetes is associated with being overweight and you may be more likely to get it if it's in the family. The condition means the body does not react properly to insulin – the hormone which controls absorption of sugar into the blood – and cannot properly regulate sugar glucose levels in the blood. Excess fat in the liver increases the risk of developing type 2 diabetes as the buildup makes it harder to control glucose levels, and also makes the body more resistant to insulin. Weight loss is the key to reducing liver fat and getting symptoms under control. It can lead to more serious problems with nerves, vision and the heart. Treatment usually involves changing your diet and lifestyle, but more serious cases may require medication. The remote, automated diagnosis could help millions to judge from data collected by the International Diabetes Federation, which reports that nearly half of adults living with diabetes, or 240 million adults, don't know they have the condition. 'Our research highlights significant vocal variations between individuals with and without Type 2 diabetes,' said Jaycee Kaufman, first author of the paper and a research scientist at Klick Labs, which plans to market the software. Kaufman hopes the company's AI could 'transform how the medical community screens for diabetes.' In the past, costly in-person diagnostic tests, including blood work, have been required to screen for prediabetes and Type 2 diabetes. Among the most common tests employed are the glycated hemoglobin (A1C) test, the fasting blood glucose (FBG) test and the Oral glucose tolerance tests (OGTT), which all require patients to make a physical trip to their healthcare provider. 'Current methods of detection can require a lot of time, travel, and cost,' Kaufman noted in a statement accompanying the new study, published Tuesday in Mayo Clinic Proceedings: Digital Health. 'Voice technology has the potential to remove these barriers entirely,' she said. Working with faculty at Ontario Tech University in Canada, Klick Labs scientists trained the AI using recordings made by 267 test subjects recruited from India. Approximately 72 percent, a control group of 79 women and 113 men, had been previously diagnosed as nondiabetic, while 18 women and 57 men had been previously diagnosed with Type 2 diabetes. The recruitment occurred with adherence to American Diabetes Association guidelines, according to the researchers for Klick Labs. The 267 participants were asked to record a phrase on their cell phones six times daily for two weeks. From the resulting 18,000 individual recordings, Klick's scientists zeroed in on 14 acoustic features in search of repeatable, consistent differences between the groups with and without Type 2 diabetes. Four of those acoustic features proved to be the most useful in accurately predicting who did and did not have diabetes. 'Pitch' and 'standard deviation from pitch' were useful for both male and female patients, while a feature called 'relative average perturbation jitter' was more useful predicting the disease in women. For men, auditory features called 'intensity' and and '11-point amplitude perturbation quotient shimmer' served as red flags for men. Kaufman at Klick labs described the sex-based differences found via the AI's signals processing as 'surprising.' The firm's AI got more accurate when the the age and body-mass index (BMI) of the person behind the voice recordings were incorporated into their prediction model, the team reported in their peer-reviewed paper 'Our research underscores the tremendous potential of voice technology in identifying Type 2 diabetes and other health conditions,' according to Yan Fossat, vice president of Klick Labs and the new study's principal investigator. Fossat also teaches at Ontario Tech University, where he is an adjunct professor in the school's Faculty of Science, focusing on mathematical modeling and computational science for digital health. The professor said that he hopes Klick's non-intrusive and accessible AI approach, which could lead to diagnoses done via a simple phone app, helps to identify and aid the many millions of undiagnosed people quietly suffering from Type 2 diabetes. 'Voice technology could revolutionize healthcare practices as an accessible and affordable digital screening tool,' Fossat added. The next steps, he said, will start with attempts to replicate the new study. Fossat expressed the hope that Klick Labs could soon expand their voice-diagnosing research to other medical areas, like prediabetes, women's health and hypertension.
Medical Innovations
Smoothies can be a tasty and convenient way to get the important fruits and vegetables you need for a healthy diet. But is a banana and blueberry smoothie the best combo? Researchers at the University of California, Davis, suggest that blending certain ingredients in smoothies can influence whether your body is getting a nutritional boost. The study, published today in the Royal Society of Chemistry’s journal Food and Function, used smoothies to test how various levels of polyphenol oxidase, an enzyme in many fruits and vegetables, affects the levels of flavanols in food to be absorbed by the body. Flavanols are a group of bioactive compounds that are good for your heart and cognitive health and are naturally found in apples, pears, blueberries, blackberries, grapes and cocoa — common smoothie ingredients. “We sought to understand, on a very practical level, how a common food and food preparation like a banana-based smoothie could affect the availability of flavanols to be absorbed after intake,” said lead author Javier Ottaviani, director of the Core Laboratory of Mars Edge, which is part of Mars, Inc., and an adjunct researcher with the UC Davis Department of Nutrition. Slice an apple or peel a banana and the fruit will quickly turn brown. That happens because of polyphenol oxidase, or PPO, an enzyme naturally present in those foods. The browning occurs when the food containing that enzyme is exposed to air, cut or bruised. The researchers wanted to know whether consuming freshly prepared smoothies made with different PPO-containing fruits impacted the amount of flavanols available to the body. Bananas versus berries The researchers had participants drink a smoothie made with banana, which has naturally high PPO activity, and a smoothie made with mixed berries, which have naturally low PPO activity. Participants also took a flavanol capsule as a control. Blood and urine samples were analyzed to measure how much flavanols were present in the body after ingesting the smoothie samples and capsule. The researchers found that those who drank the banana smoothie had 84% lower levels of flavanols in their body compared to the control. “We were really surprised to see how quickly adding a single banana decreased the level of flavanols in the smoothie and the levels of flavanol absorbed in the body,” Ottaviani said. “This highlights how food preparation and combinations can affect the absorption of dietary compounds in foods.” Last year, the Academy of Nutrition and Dietetics issued a dietary recommendation, advising people to consume 400 to 600 milligrams of flavanols daily for cardiometabolic health. Ottaviani said for people who are trying to consume those flavanols, they should consider preparing smoothies by combining flavanol-rich fruits like berries with other ingredients that also have a low PPO activity like pineapple, oranges, mango or yogurt. He also said bananas remain a great fruit to be eaten or consumed in smoothies. For those who want to consume smoothies with bananas, or other high PPO activity fruits and vegetables such as beet greens, the suggestion is to not combine them with flavanol-rich fruits such as berries, grapes and cocoa. The findings of this study could spur future research into how other foods are prepared and the effects on flavanols, for example, Ottaviani said tea is a major dietary source of flavanols and depending on how it is prepared, a different amount of flavanols would be available for absorption. “This is certainly an area that deserves more attention in the field of polyphenols and bioactive compounds in general,” said Ottaviani. Jodi Ensunsa, Reedmond Fong, Jennifer Kimball and Alan Crozier, all affiliated with the UC Davis Department of Nutrition and researchers affiliated with the UC Davis Department of Internal Medicine, University of Reading, King Saud University and Mars, Inc. contributed to the research. The study was funded by a research grant from Mars, Inc., which collaborates with researchers to study potential benefits of cocoa flavanols for human health.
Nutrition Research
MANCHESTER, England - ‘Smiling’ nurse Lucy Letby offered to take photos of a baby girl after murdering her at the fourth attempt, a court heard.Letby, 33, allegedly injected air into the premature infant’s feeding tube and bloodstream. Prosecutors say she tried three times to kill the tiny baby before succeeding the fourth time.Letby is on trial in the United Kingdom and denies murdering seven babies and attempting to murder 10 others at the neonatal unit of the Countess of Chester Hospital between June 2015 and June 2016.A jury at Manchester Crown Court heard how one baby, who can only be referred to as Child I for legal reasons, weighed only 2 pounds and 2 ounces when she was born 10 weeks premature at Liverpool Women’s Hospital August 2015.BABY ATTACKED BY ALLEGED ‘KILLER NURSE’ LUCY LETBY RECOVERED AFTER BEING MOVED TO NEW HOSPITAL Neonatal nurse Lucy Letby, 32, is alleged to have murdered seven babies and attempted to kill 10 more. (Credit: SWNS)She was transferred to the Countess of Chester Hospital later that month, and it is alleged Letby first tried to kill the infant during a day shift on Sept. 30, 2015, and twice during night shifts the following month.Letby allegedly then caused Child I’s fatal collapse on Oct. 23, 2015, and jurors heard a statement from her mother in which she recalled how she was called at home in the early hours that day and asked to attend the hospital urgently with her partner.On arrival, she saw medics, including Dr. John Gibbs, trying to resuscitate her daughter."I heard them all counting times," she said."I asked Dr. Gibbs how long had they been doing this, to which he said 20 minutes."I remember thinking they can't keep doing it."I said to Dr. Gibbs 'You can't do any more’."DOCTORS 'CAN'T THINK OF A NATURAL CAUSE' FOR PROJECTILE VOMITING OF BABY ALLEGEDLY OVERFED BY NURSE LUCY LETBY General view of Countess of Chester Hospital as seen on Monday, Nov. 4, 2022. (Charlie Purvey/Splash News for Fox News Digital)After Child I was pronounced dead, her parents were moved to a private room, where Letby and another nurse asked if they wanted her to bathe Baby I’s body.The mother said she agreed, because she "didn’t want to look back and regret it."She said, "Lucy brought the bath in. She said she could come in and take some photos which we could keep." "While we were bathing her, Lucy came back in. She was smiling and kept going on about how she was present at the first bath and how [Child I] had loved it."I wished she would just stop talking. Eventually she realized and stopped. It was not something we wanted to hear."Earlier, the mother said that although Child I had initially been unwell due to her prematurity, she felt her daughter was well enough to go home after six weeks.She said, "I was able to sit her on my knee. I remember looking at her and thinking ‘We are going home’. She looked like a full-term baby. She didn’t look frail or small."LUCY LETBY TRIAL: FATHER TESTIFIES BABY GIRL WAS LEFT SEVERELY DISABLED AFTER NURSE TRIED TO KILL HER Cheshire Police in the U.K. search the home of Lucy Letby in 2018, when they found handwritten notes that were shown to jurors this week. (Peter Byrne/PA Images via Getty Images)The mother added, "I didn't have too much to do with Lucy. She always appeared reserved compared to other nurses. She didn't really interact with parents."The court heard evidence from medical staff about Child I’s fluctuating condition in hospital.Baby I experienced oxygen "desaturation" at times, they said, and needed ventilation, but this was "normal" in premature babies.At an earlier hearing, lawyers for Letby said they did not accept she harmed Child I and a series of medical problems may have been "inevitable" due to the infant’s "extreme prematurity."The court heard how Letby had sent a sympathy card to the infant's parents and also kept an image of it on her phone.CLICK HERE TO GET THE FOX NEWS APPThe trial - expected to last at least six months - continues. Ian Leonard is a freelance journalist who reports on UK news for Fox News Digital. Ian has contributed articles to The Times, The Daily Telegraph, The Guardian, Daily Mail, The Sun, Daily Mirror, and many others. He's also worked as a producer for BBC Radio 5 Live. He can be followed on Twitter @iancleonard
Epidemics & Outbreaks
Andy Pendergrass grew up in rural Louisiana as an extremely active and athletic kid. But always looming in the back of his mind was the fact that both his mother and maternal grandmother had rheumatoid arthritis (RA). Pendergrass knew that his family history meant his chances of having the autoimmune disease were higher than average, but he brushed off the possibility. âI played football in high school, so something always hurt,â Pendergrass, 33, says. Even if he had had an inkling that it might be RA, âI would have just said âIâm a guy. Guys donât get itâ¦â and just sort of generalized it like that.â At age 23, Pendergrass finally learned that he, too, had RA. But the road to his diagnosis was hardly simple or straightforward. Coming to terms with his condition wasn't easy, either. A Delayed Diagnosis Pendergrass now suspects his RA symptoms cropped up much earlier, in high school. Thatâs when he noticed pain that seemed âodd.â Still, he chalked up the symptoms to plantar fasciitis, a form of heel pain common among those who play intense sports. It wasnât until Pendergrass went to see his doctor with a severe sinus infection that he sought medical attention for his foot pain. The doctor, Pendergrass says, agreed it might be plantar fasciitis, â'til I mentioned that it was really bad in my toes.â Aware that RA ran in Pendergrassâs family, the doctor ordered blood tests. A couple of days later, the doctor called to confirm a diagnosis for RA and referred Pendergrass to a rheumatologist. The rheumatologist, however, told Pendergrass that his symptoms didnât stem from RA but from flat feet. The new verdict left Pendergrass deeply confused. âI have really big arches in my feet, so it was bizarre,â he says. At the time, Pendergrass was getting ready to move to Alaska with his new wife, Polly. He didnât have time to sort through the conflicting diagnoses. âI decided not to bother with the pain and put it off.â The news took a mental and emotional toll on Pendergrass, a young man who prized being physically active. âAt the time, the biggest question on my mind was what the rest of my life was going to look like,â he says. Acceptance of his lifelong condition came after time, research, and support, especially from Pendergrassâs mother. âItâs hard for people who donât have the disease to understand. Because you canât look at me and say when Iâm having flare-ups,â he says. âThatâs one of the things she understands.â Looking Ahead, Reaching Out In the decade since his diagnosis, Pendergrass has managed to keep his athletic dreams alive, even if he canât exactly take up any sport without hesitation, as he once envisioned. In the last couple of years, he has also gotten into CrossFit -- a form of high-intensity interval training exercises that involve squats, pulling, and pushing with adjustable weights -- and enjoys playing golf. He credits CrossFit workouts with strengthening his muscles and easing stress on his joints. That type of workout may not be the best choice for some people with RA who have unstable joints. Check with your doctor if you have RA before starting a new exercise plan to be sure it is OK for you. âI want to maximize the time that I get to be an athlete. Itâs my passion; itâs where I get my frustration out, and I feel free,â he says. âAnd I donât want RA to mess with that. If that means I need to eat clean, stay away from inflammatory foods, and stretch more, then so be it.â Pendergrass moved back to his home state of Louisiana a couple of years ago. Living with a chronic disease can be isolating, particularly for those who live outside major cities. But social media has given Pendergrass an avenue to find support and to link with others. Recently, he set up an Instagram account @rheumadad to share his journey. âHonestly, if there are any young guys out there, I would like to really connect with them. Because I think we lack a community of young guys with arthritis to be able to commiserate with, to share ideas with, and to just feel like I belong,â he says. Pendergrass has two young sons now. The thought that his children might become the fourth generation with RA has crossed his mind. But Pendergrass refuses to dwell on it. âI donât allow those thoughts to really take root in my mind. I know itâs possible. Iâm not going to put my head in the sand. And so, if it happens, we will deal with it. It will break my heart. âThe rest of your life is not going to be consumed with having RA. You can let it ⦠but you shouldn't. Life is about way more than having RA.â
Disease Research
The Polish woman who believes she is Madeleine McCann has been dealt a devastating blow. Julia Faustyna, who also goes by Julia Wendell, 21, has submitted DNA to be tested in the hope that she will be confirmed to be the British girl, who vanished aged three from a Portuguese vacation apartment in 2007. But Ms. Wendell may be battling cancer, her spokeswoman has revealed, and she is awaiting test results back over fears she has leukemia. “We are still waiting on the result of DNA testing that will show us exactly what Julia’s ethnic background is and what country she and her true family are from. These kinds of tests are very accurate,” Ms. Wendell’s representative and private detective Dr. Fia Johansson told The Sun. “Of course depending on the result of that we will continue our investigation to see if Julia is could be Madeleine or another missing person. “But now the focus is on Julia as a person – not Madeleine. “She has had a neglected childhood and suffered much abuse. “Her health is very poor she has bad asthma and she suffers lots of pain in her bones. “She is booked in for a CT and MRI scan because of the pain in her bones. “Her blood work is also abnormal so my doctor here in the US is investigating whether she could have leukemia so we are awaiting the results of that. And if she needs any treatment we will make sure she gets that.” Ms. Wendell has submitted samples for three different forensic examinations that will outline her DNA sequence, along with a 23andMe-style genetic test to establish her ancestry. If Ms. Wendell’s ancestry comes from the same region as Madeleine’s parents, Gerry and Kate McCann, Dr. Johansson said she will immediately send the DNA sequence to Portuguese investigators for comparison. Ms. Wendell – who has said she does not “remember most of my childhood” – previously said that Madeleine’s parents have agreed to a DNA test. She claims that details of her childhood don’t add up, leading her to believe that she was abducted as a toddler, and that she has a spot in her right eye and a beauty mark on her cheek similar to Madeleine. Earlier this month, however, Pawel Noga from the Provincial Police Headquarters in Wroclaw told Polish news outlet Gazeta that authorities have “ruled out” Ms. Wendell’s version of events to be “true”, according to an English translation of the outlet’s report. In a 15-minute video posted to her Instagram, Ms. Wendell and Dr. Johansson refuted the officers’ statement. Dr. Johansson said that “no police officers in Poland said that she (Julia) or she is not Madeleine McCann” and it was “all lies”. She said the pair also intended to “force” Ms. Wendell’s mother to submit to a DNA test. Internet users have also speculated that Ms. Wendell could be Swiss girl Livia Schepp, who disappeared in 2011 with her twin Alessia, aged six. “Julia is very open to the idea she may indeed be another missing child and they are hoping to carry out a DNA test with her family,” Dr. Johansson recently told The Sun. “I’ve spoken to her about this and she is open to the fact she could be any missing child out there – not just Madeleine. Julia just wants to know the truth about who she is. “One of the reasons she made the connection to Madeleine is because one of the suspects in Madeleine’s case looks very much like a man who she says abused her as a child. “But the same man could be connected to Madeleine and other missing children – this is how predators and traffickers work. “Julia has taken a DNA test and we are investigating if it’s possible to check her DNA with that of missing Livia. “We are investigating all possibilities at this stage.” Ms Wendell’s family in Poland, meanwhile, have spoken of their “devastation” at her claims. “For us as a family it is obvious that Julia is our daughter, granddaughter, sister, niece, cousin and step-niece. We have memories, we have pictures,” the family said in a Facebook statement, via Polish missing persons organization Missing Years Ago. “Julia also has these photos, because she took them from the family home with the birth certificate, as well as numerous hospital discharges. “We always tried to understand all situations that happened with Julia. Numerous therapies, medicines, psychologists and psychiatrists – Julia had it all guaranteed. She wasn’t left alone. “Threats to our address from Julia, her lies and manipulations, activity on the internet. We’ve seen it all and we’ve tried to prevent it, to explain, we’ve asked her to stop.” The family hinted at Ms. Wendell’s motivations, writing that she “always wanted to be popular”. But, Dr. Johansson urged the family to consider a DNA test, and to “get in touch with us directly so we can discuss the case with them rather than releasing statements online”. “Some of the information Julia has told us and the evidence we’ve seen doesn’t match what the family are saying so we would like to talk about it directly with them,” she told The Sun. “It seems suspicious to me that Julia’s family will not take a test, which could clear these claims up very quickly.”
Disease Research
One in three life-or-death 999 ambulance calls in some parts of England are not attended by a paramedic, NHS figures obtained by the Guardian reveal. The disclosure has prompted fears that seriously unwell or badly injured patients may receive inadequate care from a less-qualified member of ambulance staff lacking a paramedic’s skills. Healthwatch, the health and social care services watchdog, voiced concern that patients were facing a “postcode lottery” in their chances of being treated by a paramedic. The situation is being blamed on staff shortages across NHS ambulance services. Daisy Cooper, the Liberal Democrat health spokesperson, said: “When you call 999 in a life-or-death situation you expect a rapid response from a fully qualified paramedic, so many people will be shocked to learn that this isn’t always the case. “It’s deeply worrying that the NHS staffing crisis has reached such a point that people cannot even be certain that a fully trained paramedic will be able to attend life-threatening emergencies. In times of need, patients shouldn’t be left wondering if the person treating them has the skills to do so.” NHS ambulance trusts in England said they often did or did not send a paramedic to attend a category 1 call, the most serious type of call that involve life-threatening emergencies such as someone having collapsed, stopped breathing or gone into cardiac arrest. The East Midlands ambulance service said paramedics attended 105,325 of the 155,239 category 1 calls it had during 2022-23 – just 68% of the total. In the other 49,914 calls – which represents 32% of the total – someone other than a paramedic arrived to help. That 32% was the highest proportion of life-or-death calls not attended by a paramedic. Two other ambulance services do not send a paramedic to a significant minority of category 1 calls, freedom of information requests showed. In 2022-23 the Yorkshire ambulance service did that with 20% of its most critical calls – double the 10.5% seen just two years earlier. And the South Western ambulance service used another type of resource than a paramedic to attend 11,396 category 1 calls last year – 9.4% of the total and almost double the number in 2020-21. Emergency medical technicians (EMTs) and emergency care assistants, both of which have clinical skills but are not qualified paramedics, are thought to attend most of the calls that paramedics do not. The union Unison, which represents thousands of ambulance staff, warned that patients could be harmed if the NHS-wide lack of paramedics led to EMTs and others having to deal with emergencies. “Paramedic shortages mustn’t be used to justify staff continually working beyond their clinical competency. Ultimately patients will suffer,” said Sara Gorton, Unison’s head of health. “The huge pressures facing ambulance services are well recognised, but these figures are alarming.” The College of Paramedics, which represents the profession, said paramedics should always attend a medical emergency to ensure that patients get the best care and lives are saved. First responders, usually volunteers who have received training in first aid and potentially life-saving skills, can play a role in helping patients before an ambulance arrives, it said. A spokesperson added: “However, the college would expect arrangements to be in place for paramedics to be able to attend to all those emergency calls and therefore patients where the paramedics’ knowledge, skills and competence will provide the patient with the best outcome. “Category 1 and category 2 calls represent the most critically and severely ill patients where a timely and high-quality clinical intervention is required. “Paramedics can provide this high-quality care to patients to save lives and prevent deterioration.” Large and rising numbers of category 2 incidents – which include suspected heart attacks and strokes – are also not attended by a paramedic, the ambulance trusts’ figures also showed. For example, last year 36% % of category 2 calls answered by the East Midlands ambulance service did not involve a paramedic – again the highest proportion in England. It did send a paramedic to 318,200 of the 475,488 such calls it attended but not the other 157,288. Similarly, 28% of the category 2 calls answered by the Yorkshire ambulance service did not involve a paramedic. It was the same for one in six or one in seven such calls which the South East Coast ambulance service (17.8%), South Coast ambulance service (17.3%), South Western ambulance service (17.1%), East of England ambulance service (15.6%) and London ambulance services (15.4%) attended. Louise Ansari, Healthwatch’s chief executive, said: “These figures are likely to be of concern for patients, especially as they show a ‘postcode lottery’ when it comes to the level of fully trained paramedics attending category 1 and 2 calls.” She urged NHS England and the Department of Health to monitor the impact of someone other than a paramedic attending such calls may have “on patient experience, safety or health outcomes... [and] ensure there is transparency on the level of care being provided for the most serious ambulance callouts”. Nine of England’s 11 regional ambulance services provided the data, which they routinely collect, to the Guardian. However, the North East and Isle of Wight services, and those covering Scotland, Wales and Northern Ireland did not. Martin Flaherty, the managing director of the Association of Ambulance Chief Executives, denied that patient safety was being compromised by paramedics not attending 999 calls. “AACE has no particular patient safety concerns around this data and our committed, mixed crews attend thousands of incidents every day, saving many lives, with the support of paramedics and specialists always available,” he said. “This data reflects how ambulance services across the UK have different response models, each utilising different staff mixes made up of highly skilled ambulance crews formed of paramedics, emergency medical technicians, emergency care assistants, ambulance support crews and volunteers. “The most important aspect of responding to any life-threatening emergency is to get a clinician, and the life-saving equipment on board our vehicles, to the patient as quickly as possible so they can deliver life-saving interventions such as defibrillation. This does not always require a paramedic,” Flaherty added. An NHS spokesperson said: “This misleading story fails to account for the fact that while most ambulance call outs will be attended by a fully qualified paramedic, there will be occasions where other dedicated healthcare professionals such as a doctor will arrive instead, so a patient can be promptly treated at the scene – this happens in health systems around the world. “Thanks to hardworking staff, waiting times for ambulances has reduced for three consecutive months and are now 10 minutes quicker than a year ago, even as the NHS faced record levels of demand over summer.”
Health Policy
The overwhelming majority of academic studies have one chance to make a splash. Once that moment has passed – which tends to be when the paper is published – the spotlight moves on in the relentless search for new material. But not all studies adhere to that trend. Some return time after time. And it must come as no surprise that this happens most with reports that tackle questions of global importance, or that reach controversial conclusions, or manage to achieve both at once. As the Covid inquiry opens, the value of lockdowns is about as important as questions can get. Last February, a trio of researchers posted a working paper online that reviewed published work on the impact of Covid lockdowns on mortality rates. In short, it looked for evidence that lockdowns saved lives. The findings were arresting: the authors concluded that lockdowns prevented only 0.2% of US and European deaths in the first wave of the pandemic. For all the headlines that followed, the report and its authors drew flak. The researchers were economists not epidemiologists or public health experts, namely Prof Steve Hanke from Johns Hopkins University and the libertarian thinktank, the Cato Institute; Jonas Herby, a consultant at the Centre for Political Studies in Copenhagen, and Lars Jonung, emeritus professor at Lund University in Sweden, a country famed for its looser restrictions on the pandemic. The review raised eyebrows among many experts. It focused on 34 studies, about a third coming from other economists, but excluded important epidemiological studies. It didn’t seem to take account of the timing of lockdowns. And it defined “lockdown” as any government policy consisting of at least one nonpharmaceutical intervention (NPI), where NPIs meant measures such as closing schools or businesses, but also more minor things such as mandating face masks. The implication was that a requirement to wear face coverings alone, or to stay home while infected, would qualify as a lockdown. On reading the paper, Adam Kucharski, professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine, spoke of “half-baked methods”. At the time, Dr Joshua Sharfstein, vice dean of the Johns Hopkins School of Public Health, distanced the school from the work, saying it was not a peer-reviewed scientific study and that “serious questions” had been raised about its methodology. He also corrected a potential misunderstanding: the study did not compare lockdowns with doing nothing. Instead, it compared legally enforced interventions with interventions not required by law. As the study said: “We do not look at the effect of voluntary behavioural change.” That would include people choosing to keep themselves safe because there was a pandemic under way. The response to the paper fuelled a rewrite. Version two appeared, again online, in May last year. The authors dropped some studies they decided were no longer eligible and changed some of their calculations. This time, instead of claiming lockdowns prevented only 0.2% of US and European deaths in the first wave, the figure became 3.2%, a 16-fold increase. In normal circumstances, scientists would wait for the research to be peer-reviewed and published in a scientific journal to read the final word from the authors. But the latest headline-grabbing version, “Did lockdowns work?” has come out as a book – a “revised and extended” version of the May working paper. Its publisher is the neoliberal thinktank, the Institute of Economic Affairs, credited with coming up with many of Liz Truss and Kwasi Kwarteng’s free market policies. The book maintains that lockdowns – as defined by the authors – prevented 3.2% of US and EU deaths in the first wave of the pandemic. But it notes that based on nine specific NPIs, lockdowns in Europe and the US reduced mortality by 10.7% in the spring of 2020 – about 23,000 in Europe and 16,000 in the US. Kucharski said much of the report is identical to the May 2022 pre-print, “so all the sensible criticisms made back then, from a lack of accounting for epidemic dynamics to performing a ‘meta-analysis’ on datasets that aren’t independent, still hold.” But he said it was “a shame the report added so little insight “because we do need rigorous analysis of how effective different measures were during dynamic epidemic waves – lockdowns were a blunt, last-ditch tool and countries need to find a better alternative for future pandemics.” Prof Rowland Kao, an epidemiologist at Edinburgh University, said specific details about the UK’s lockdown matter too. In the first lockdown, care homes suffered brutal, disproportionate death rates because, despite the restrictions, residents were not adequately protected from infected patients arriving from hospitals. “As it stood, lockdown without protection of people in care homes wasn’t in a position to achieve one of its most important potential outcomes.” Prof Devi Sridhar, a public health expert at Edinburgh University said: “The real questions are whether these severe restrictions, and the harm they cause to employment, mental health, society, are worth the lives being saved and also whether these places would have anyway been closed or starved of business because people voluntarily choose not to put themselves and their loved ones at risk.” She cited the example of Florida, where governor, Ron DeSantis, adopted a “freedom” approach, yet businesses introduced their own guidelines for running safely, alongside mask mandates that were often more stringent than in Britain, for example, requiring children as young as two to wear masks. Many businesses still had to close because of sick employees, or workers and customers staying away out of fear. On the release of the latest version of the report, Sharfstein told the Guardian: “In every country, Sweden included, the interventions themselves saved many, many lives. But in every country, Sweden included, there were major economic impacts.” “Whether the interventions should have been required by law or purely voluntary depends a lot on local circumstances, among other factors,” he added. “But it’s important to make sure people don’t get confused and think that we would all have been fine just living our lives as usual in the spring of 2020. That would have been catastrophic.”
Epidemics & Outbreaks
Dozens of babies have died or been harmed in England due to problems with the 'wild west' NHS translation service, it was revealed today. Patients who don't speak English are supposed to be provided with an interpreter when using public services. However, problems accessing one within the NHS has contributed to the death or serious brain injury of 80 babies within the last five years, according to the patient safety watchdog. In one case, a woman died during childbirth after neither she or her husband, who fled war in Sudan, were made aware that she was going to be induced or told how critical her condition was after giving birth due to poor communication. Non-English speaking patients have also claimed NHS staff have resorted to using Google Translate to inform them about their care, including to tell one woman she needed an emergency operation. Experts today warned that the interpreter service is 'extremely patchy'. The data, from the Healthcare Safety Investigation Branch (HSIB), was obtained by the BBC through a Freedom of Information request. It asked for figures relating to incidents from 2018-2022 where a baby died or was diagnosed with a severe brain injury in their first week of life. Of the 2,607 cases identified, 80 referenced interpretation or communication problems due to language difficulties as a contributing factor. The BBC said it was prompted to ask for the data after a woman died during childbirth and was uninformed of how critical her condition was due to a lack of interpreter. Rana Abdelkarim, 38, and her husband Modar Mohammednour, originally from Sudan, believed she was going to hospital for a routine appointment. As a result, her husband stayed at home to look after their three-year-old daughter. However, the appointment at Gloucestershire Royal Hospital on March 8, 2021 was actually to induce labour because she had gestational diabetes — which means it is safer to give birth sooner. The couple, who spoke limited English, had not been provided with an interpreter so were unaware of the plan. It meant Rana gave birth without her husband present. She then began to bleed heavily and was taken for emergency surgery. However, she became unresponsive and died. The hospital did not call Modar until after Rana's death, meaning he had no idea that his child had been born or that his wife had been in a critical condition. He told the BBC: 'They called me and said to me, "you have to come hospital very quick' and then he said 'we tried to keep her alive but she's passed away".' Modar said better access to an interpreter would have helped the couple understand what was happening. 'It would have helped me and her to take the right decision for how she's going to deliver the baby and she can know what is going to happen to her,' he added. The HSIB found that Rana was uninformed due to a lack of interpreter, there was a 30 minute delay in staff activating an emergency call bell after she began to bleed heavily and a further delay in transferring her blood. Patients have the right to a professional interpreter throughout their care and the NHS is legally responsible for providing one. Professor Mark Pietroni, medical director and deputy chief executive of the trust, said: 'The death of Rana following the birth of her baby is devastating for her family and we would like to extend our heart-felt sympathies to her family members. We want to take this opportunity to apologise once again for the immeasurable distress that this loss has caused. 'The Trust has acted on the recommendations from the coroner to ensure that all lessons identified have been learnt and embedded into our day-to-day practice. 'The circumstances leading to Rana’s death were immediately and thoroughly investigated. An independent safety investigation was conducted by the HSIB. Alongside this, the Trust undertook further investigation to ensure clarity for Rana’s family regarding the cause of her death. The findings of these investigations were shared with Rana’s family and HM Coroner and we have implemented all 10 recommendations made in the HSIB report. 'We are absolutely committed to delivering the safest possible service. To do this we will invite external reviews where appropriate, and build on our commitment to listen to women, their partners and staff to create a culture that enables excellent care.' In a separate case at a hospital in Glasgow, an unidentified woman told the BBC that NHS staff used Google Translate to communicate with her. The woman, from Syria, had suffered a life-threatening bleed shortly after labour and medics were initially unable to reach an interpreter over the phone. This saw staff spend 15 minutes on the translation website to tell her she was being rushed into emergency surgery, during which her uterus had been removed — despite her pleading for it not to be removed, as she wanted to have more children. Professor Hassan Shehata, vice president for global health at the Royal College of Obstetricians and Gynaecologists, told the BBC that language barriers in the NHS 'exacerbate risk' as it means women struggle to 'engage with maternity services and communicate their concerns to healthcare professionals'. The National Register of Public Service Interpreters, a voluntary regulator of professional interpreters, has likened the NHS to the 'wild West'. It said the provision of interpreters was 'extremely patchy'. Mike Orlov, its executive director, told the broadcaster that there are frequent cases of staff using family members or friends for language services. An NHS spokesperson said: 'Community language translation and interpretation services are vital for patient safety and local areas who commission these services are responsible for applying the highest quality standards possible. 'NHS England is currently completing a review to identify if and how we can support improvements in the commissioning and delivery of translation services.' It comes after data last week revealed that two in three maternity units in England are not safe enough, according to figures from the Care Quality Commission. It ranked 67 per cent of services as either 'inadequate' or 'requires improvement', up from 55 per cent a year ago. The proportion of units deemed 'inadequate' — the lowest rating — has doubled, its figures show. Such a ruling means there is a high risk of avoidable harm for mothers and babies, under the CQC's criteria. The regulator said the situation was 'unacceptable' and warned maternity safety 'is still so far from where it needs to be'. Health leaders have blamed a shortage of midwives. Inspectors have also warned of culture and leadership problems.
Global Health
Cancer patients face worsening NHS delays and compromised care due to a lack of staff, radiology leaders have warned. A poll of all 60 directors of the UK's cancer centres by the Royal College of Radiologists (RCR) found 95% felt staff shortages were leading to longer waiting times for appointments and delays in cancer treatment. In 97% of centres, patient treatment had been delayed because of staff shortages over the past year, while in around half shortages were causing delays almost every month. Some 88% of cancer specialists were concerned shortages are compromising patient care. The RCR said the situation was a "ticking time bomb" as delays can be potentially harmful for patients, with every month of delay increasing the risk of death by 10%. Doctors are making difficult decisions about how to prioritise patients. This "serious situation" has resulted in some hospitals considering limiting access to new chemotherapy treatments, and moving patients around hospitals. Read more: Smartphone camera lens technology to be used to diagnose thousands of skin cancer patients Multi-cancer blood test could 'help save thousands of lives' by speeding up diagnosis, study suggests Dr Tom Roques, vice chair of clinical oncology at the RCR, said recruitment and retention are key to solving the crisis. "Our major concern at the moment is that patients are not being diagnosed with cancer and other serious conditions quickly enough and they're not getting their treatment quickly enough," he told Sky News. "This is a problem of years of underfunding of the cancer workforce. "So, because we've not been increasing medical school places and training places quickly enough, we've ended up with this problem of not enough doctors." Dr Roques added: "We know that too many young doctors are leaving the UK to work overseas. "We know too many experienced doctors are retiring early, and we've got to think of ways of changing that, and that's really about conditions of work as well as pay." For Bryony - an earlier diagnosis could have been a game-changer. She was diagnosed with pancreatic cancer in 2019 and had symptoms "so gradual" they began to "feel normal". However, Bryony said catching the cancer quicker may have prevented it from spreading to her lymph nodes. "I think I saw eight different GPS. I didn't see one person consistently," she told Sky News. "I was tested for celiac, anaemia, thyroid, I do wonder whether if I had seen one doctor consistently over those five years, maybe the dots would have been joined." Bryony's journey to remission has been tough. It has meant nine months of back-to-back treatment - both physically and mentally gruelling. She said: "7% make it to five years. I had a 1% chance of seeing my daughter reach her 18th birthday. And I was very likely to die within 12 weeks." Bryony said, given the circumstances, she was "grateful" to be alive. Tens of thousands of patients will receive faster treatment, NHS says A government spokesperson said: "There are more doctors, nurses and staff working in the NHS than ever before. "The NHS is also seeing, treating and saving record numbers of people with cancer but we know there is more to do." The NHS said from July onwards, tens of thousands of patients will receive a diagnosis and treatment for skin cancer faster, through a new process which involves taking high-spec images of spots, moles or lesions on people's skin. The hope is this "simple" technology will give specialist dermatologists the opportunity to double the number of patients they can meet in a day.
Disease Research
The Biden administration has picked the first 10 high-priced prescription drugs subject to federal price negotiations, taking a swipe at the powerful pharmaceutical industry. It marks a major turning point in a long-fought battle to control ever-rising drug prices for seniors and, eventually, other Americans. Under the 2022 Inflation Reduction Act, Congress gave the federal government the power to negotiate prices for certain high-cost drugs under Medicare. The list of drugs selected by the Centers for Medicare & Medicaid Services will grow over time. The first eligible drugs treat diabetes, blood clots, blood cancers, arthritis, and heart disease — and accounted for about $50 billion in spending from June 2022 to May 2023. The United States is clearly an outlier on drug costs, with drugmakers charging Americans many times more than residents of other countries “simply because they could,” Biden said Tuesday at the White House. “I think it’s outrageous. That’s why these negotiations matter.” He added, “We’re going to keep standing up to Big Pharma and we’re not going to back down.” Democratic lawmakers cheered the announcement, and the pharmaceutical industry, which has filed a raft of lawsuits against the law, condemned it. The companies have until Oct. 2 to present data on their drugs to CMS, which will make initial price offers in February, setting off negotiations set to end next August. The prices would go into effect in January 2026. Here are five things to know about the impact: 1. How important is this step? Medicare has long been in control of the prices for its services, setting physician payments and hospital payments for about 65 million Medicare beneficiaries. But it was previously prohibited from involvement in pricing prescription drugs, which it started covering in 2006. Until now the drug industry has successfully fought off price negotiations with Washington, although in most of the rest of the world governments set prices for medicines. While the first 10 drugs selected for negotiations are used by a minority of patients — 9 million — CMS plans by 2029 to have negotiated prices for 50 drugs on the market. “There’s a symbolic impact, but also Medicare spent $50 billion on these 10 drugs in a 12-month period. That’s a lot of money,” said Juliette Cubanski, deputy director of KFF’s analysis of Medicare policy. The long-term consequences of the new policy are unknown, said Alice Chen, vice dean for research at University of Southern California’s Sol Price School of Public Policy. The drug industry says the negotiations are essentially price controls that will stifle drug development, but the Congressional Budget Office estimated only a few drugs would not be developed each year as a result of the policy. Biden administration officials say reining in drug prices is key to slowing the skyrocketing costs of U.S. health care. 2. How will the negotiations affect Medicare patients? In some cases, patients may save a lot of money, but the main thrust of Medicare price negotiation policy is to provide savings to the Medicare program — and taxpayers — by lowering its overall costs. The drugs selected by CMS range from specialized, hyper-expensive drugs like the cancer pill Imbruvica (used by about 26,000 patients in 2021 at an annual price of $121,000 per patient) to extremely common medications such as Eliquis (a blood thinner for which Medicare paid about $4,000 each for 3.1 million patients). While the negotiations could help patients whose Medicare drug plans require them to make large copayments for drugs, the relief for patients will come from another segment of the Inflation Reduction Act that caps drug spending by Medicare recipients at $2,000 per year starting in 2025. 3. What do the Medicare price negotiations mean for those not on Medicare? One theory is that reducing the prices drug companies can charge in Medicare will lead them to increase prices for the privately insured. But that would be true only if companies aren’t already pricing their drugs as high as the private market will bear, said Tricia Neuman, executive director of KFF’s program on Medicare policy. Another theory is that Medicare price negotiations will equip private health plans to drive a harder bargain. David Mitchell, president of the advocacy group Patients for Affordable Drugs, predicted that disclosure of negotiated Medicare prices “will embolden and arm private sector negotiators to seek that lower price for those they cover.” Stacie B. Dusetzina, a professor of health policy at Vanderbilt University, said the effect on pricing outside Medicare isn’t clear. “I’d hedge my bet that it doesn’t change,” she said. Nonetheless, Dusetzina described one way it could: Because the government will be selecting drugs for Medicare negotiations based partly on the listed gross prices for the drugs — distinct from the net cost after rebates are taken into account — the process could give drug companies an incentive to lower the list prices and narrow the gap between gross and net. That could benefit people outside Medicare whose out-of-pocket payments are pegged to the list prices, she said. 4. What are drug companies doing to stop this? Even though negotiated prices won’t take effect until 2026, drug companies haven’t wasted time turning to the courts to try to stop the new program in its tracks. At least six drug companies have filed lawsuits to halt the Medicare drug negotiation program, as have the U.S. Chamber of Commerce and the Pharmaceutical Research and Manufacturers of America, known as PhRMA. The lawsuits include a variety of legal arguments. Merck & Co., Johnson & Johnson, and Bristol Myers Squibb are among the companies arguing their First Amendment rights are being violated because the program would force them to make statements on negotiated prices they believe are untrue. Lawsuits also say the program unconstitutionally coerces drugmakers into selling their products at inadequate prices. “It is akin to the Government taking your car on terms that you would never voluntarily accept and threatening to also take your house if you do not ‘agree’ that the taking was ‘fair,’” Janssen, part of Johnson & Johnson, wrote in its lawsuit. Nicholas Bagley, a law professor at the University of Michigan, predicted the lawsuits would fail because Medicare is a voluntary program for drug companies, and those wishing to participate must abide by its rules. 5. What if a drug suddenly gets cheaper by 2026? In theory, it could happen. Under guidelines CMS issued this year, the agency will cancel or adjourn negotiations on any drug on its list if a cheaper copycat version enters the market and finds substantial buyers. According to company statements this year, two biosimilar versions of Stelara, a Johnson & Johnson drug on the list, are prepared to launch in early 2025. If they succeed, it would presumably scotch CMS’ plan to demand a lower price for Stelara. Other drugs on the list have managed to maintain exclusive rights for decades. For example, Enbrel, which the FDA first approved in 1998 and cost Medicare $1.5 billion in 2021, will not face competition until 2029 at the earliest.
Health Policy
A Parkinson’s patient can now walk 6km (3.7 miles) thanks to an implant targeting the spinal cord. The Guardian reports that the man — 62-year-old “Marc” from Bordeaux, France — developed severe mobility impairments from the degenerative disease. “I practically could not walk anymore without falling frequently, several times a day,” he said in a press release announcing the breakthrough. “In some situations, such as entering a lift, I’d trample on the spot, as though I was frozen there, you might say.” Wearing the spinal implant allows him to walk “almost normally” as the research team eyes a full clinical trial. Marc underwent a “precision neurosurgical procedure” two years ago at Lausanne University Hospital (CHUV), which helped facilitate the research. The surgery fitted him with an electrode field placed against his spinal cord and an electrical impulse generator under the skin of his abdomen. Although conventional Parkinson’s treatments often target brain regions affected by the loss of dopamine-producing neurons, this approach instead focuses on the spinal area associated with activating leg muscles for walking. The procedure used a personalized map of Marc’s spinal cord, identifying the specific locations signaling leg movements. He wears a movement sensor on each leg that tells the implant he’s trying to walk; it then switches on and sends electrical impulses to the targeted spinal neurons, adapting to his movement in real-time. “In response to precise stimulation of the lumbar spinal cord, I’ve observed for the first time remarkable improvements of gait deficits due to Parkinson’s disease,” project supervisor Jocelyne Bloch, professor and neurosurgeon at CHUV Lausanne University hospital, said in a webinar discussing the patient’s success. “I really believe that these results open realistic perspectives to develop a treatment.” The patient says he could walk practically normally with the stimulation after several weeks of rehab. He now wears it for around eight hours daily, only turning it off when sleeping or lying down for a while. “I turn on the stimulation in the morning and I turn off in the evening,” he said. “This allows me to walk better and to stabilise. Right now, I’m not even afraid of the stairs anymore. Every Sunday I go to the lake, and I walk around 6 kilometres. It’s incredible.” The researchers caution that there’s still a vast chasm between tailoring the approach to one person vs. optimizing it for wide-scale use. Co-leads Grégoire Courtine and Bloch are working on a commercial version of the neuroprosthetic in conjunction with Onward Medical. “Our ambition is to provide general access to this innovative technology to improve the quality of life of Parkinson’s patients significantly, all over the world,” they said. In the meantime, research on six new patients will continue in 2024. The team says a “generous donation” of $1 million from the Michael J. Fox Foundation for Parkinson’s Research is funding the upcoming work. In 2021, the actor’s organization announced it had contributed over $1.5 billion to Parkinson’s research.
Medical Innovations
A strategy for cellular reprogramming involves using targeted genetic interventions to engineer a cell into a new state. The technique holds great promise in immunotherapy, for instance, where researchers could reprogram a patient's T-cells so they are more potent cancer killers. Someday, the approach could also help identify life-saving cancer treatments or regenerative therapies that repair disease-ravaged organs. But the human body has about 20,000 genes, and a genetic perturbation could be on a combination of genes or on any of the over 1,000 transcription factors that regulate the genes. Because the search space is vast and genetic experiments are costly, scientists often struggle to find the ideal perturbation for their particular application. Researchers from MIT and Harvard University developed a new, computational approach that can efficiently identify optimal genetic perturbations based on a much smaller number of experiments than traditional methods. Their algorithmic technique leverages the cause-and-effect relationship between factors in a complex system, such as genome regulation, to prioritize the best intervention in each round of sequential experiments. The researchers conducted a rigorous theoretical analysis to determine that their technique did, indeed, identify optimal interventions. With that theoretical framework in place, they applied the algorithms to real biological data designed to mimic a cellular reprogramming experiment. Their algorithms were the most efficient and effective. "Too often, large-scale experiments are designed empirically. A careful causal framework for sequential experimentation may allow identifying optimal interventions with fewer trials, thereby reducing experimental costs," says co-senior author Caroline Uhler, a professor in the Department of Electrical Engineering and Computer Science (EECS) who is also co-director of the Eric and Wendy Schmidt Center at the Broad Institute of MIT and Harvard, and a researcher at MIT's Laboratory for Information and Decision Systems (LIDS) and Institute for Data, Systems and Society (IDSS). Joining Uhler on the paper, which appears today in Nature Machine Intelligence, are lead author Jiaqi Zhang, a graduate student and Eric and Wendy Schmidt Center Fellow; co-senior author Themistoklis P. Sapsis, professor of mechanical and ocean engineering at MIT and a member of IDSS; and others at Harvard and MIT. Active learning When scientists try to design an effective intervention for a complex system, like in cellular reprogramming, they often perform experiments sequentially. Such settings are ideally suited for the use of a machine-learning approach called active learning. Data samples are collected and used to learn a model of the system that incorporates the knowledge gathered so far. From this model, an acquisition function is designed -- an equation that evaluates all potential interventions and picks the best one to test in the next trial. This process is repeated until an optimal intervention is identified (or resources to fund subsequent experiments run out). "While there are several generic acquisition functions to sequentially design experiments, these are not effective for problems of such complexity, leading to very slow convergence," Sapsis explains. Acquisition functions typically consider correlation between factors, such as which genes are co-expressed. But focusing only on correlation ignores the regulatory relationships or causal structure of the system. For instance, a genetic intervention can only affect the expression of downstream genes, but a correlation-based approach would not be able to distinguish between genes that are upstream or downstream. "You can learn some of this causal knowledge from the data and use that to design an intervention more efficiently," Zhang explains. The MIT and Harvard researchers leveraged this underlying causal structure for their technique. First, they carefully constructed an algorithm so it can only learn models of the system that account for causal relationships. Then the researchers designed the acquisition function so it automatically evaluates interventions using information on these causal relationships. They crafted this function so it prioritizes the most informative interventions, meaning those most likely to lead to the optimal intervention in subsequent experiments. "By considering causal models instead of correlation-based models, we can already rule out certain interventions. Then, whenever you get new data, you can learn a more accurate causal model and thereby further shrink the space of interventions," Uhler explains. This smaller search space, coupled with the acquisition function's special focus on the most informative interventions, is what makes their approach so efficient. The researchers further improved their acquisition function using a technique known as output weighting, inspired by the study of extreme events in complex systems. This method carefully emphasizes interventions that are likely to be closer to the optimal intervention. "Essentially, we view an optimal intervention as an 'extreme event' within the space of all possible, suboptimal interventions and use some of the ideas we have developed for these problems," Sapsis says. Enhanced efficiency They tested their algorithms using real biological data in a simulated cellular reprogramming experiment. For this test, they sought a genetic perturbation that would result in a desired shift in average gene expression. Their acquisition functions consistently identified better interventions than baseline methods through every step in the multi-stage experiment. "If you cut the experiment off at any stage, ours would still be more efficient than the baselines. This means you could run fewer experiments and get the same or better results," Zhang says. The researchers are currently working with experimentalists to apply their technique toward cellular reprogramming in the lab. Their approach could also be applied to problems outside genomics, such as identifying optimal prices for consumer products or enabling optimal feedback control in fluid mechanics applications. In the future, they plan to enhance their technique for optimizations beyond those that seek to match a desired mean. In addition, their method assumes that scientists already understand the causal relationships in their system, but future work could explore how to use AI to learn that information, as well. This work was funded, in part, by the Office of Naval Research, the MIT-IBM Watson AI Lab, the MIT J-Clinic for Machine Learning and Health, the Eric and Wendy Schmidt Center at the Broad Institute, a Simons Investigator Award, the Air Force Office of Scientific Research, and a National Science Foundation Graduate Fellowship. Story Source: Journal Reference: Cite This Page:
Medical Innovations
- For Immediate Release: - Today, the U.S. Food and Drug Administration published a new draft guidance to highlight fundamental considerations to researchers investigating the use of psychedelic drugs for potential treatment of medical conditions, including psychiatric or substance use disorders. This is the first FDA draft guidance that presents considerations to industry for designing clinical trials for psychedelic drugs. There has been growing interest in the therapeutic potential of psychedelic drugs in recent years. They are being evaluated for use in the potential treatment of conditions such as depression, post-traumatic stress disorder, substance use disorders and other conditions. However, designing clinical studies to evaluate the safety and effectiveness of these compounds presents a number of unique challenges that require careful consideration. “Psychedelic drugs show initial promise as potential treatments for mood, anxiety and substance use disorders. However, these are still investigational products. Sponsors evaluating the therapeutic potential of these drugs should consider their unique characteristics when designing clinical studies,” said Tiffany Farchione, M.D., director of the Division of Psychiatry in the FDA’s Center for Drug Evaluation and Research. “By publishing this draft guidance, the FDA hopes to outline the challenges inherent in designing psychedelic drug development programs and provide information on how to address these challenges. The goal is to help researchers design studies that will yield interpretable results that will be capable of supporting future drug applications.” The purpose of the draft guidance is to advise researchers on study design and other considerations as they develop medications that contain psychedelics. Within the draft guidance, the term psychedelics refers to “classic psychedelics,” typically understood to be drugs such as psilocybin and lysergic acid diethylamide (LSD) that act on the brain’s serotonin system, as well as “entactogens” or “empathogens” such as methylenedioxymethamphetamine (MDMA). The document describes basic considerations throughout the drug development process including trial conduct, data collection, subject safety and new drug application requirements. For example, psychedelic drugs may produce psychoactive effects such as mood and cognitive changes, as well as hallucinations. As a result, there is the potential for abuse of these drugs, which is a drug safety issue that requires careful consideration and putting sufficient safety measures in place for preventing misuse throughout clinical development. For psychedelics that are currently Schedule I controlled substances, the draft guidance notes that activities associated with investigations under an Investigational New Drug Application must comply with applicable Drug Enforcement Administration regulatory requirements. The evidentiary standard for establishing effectiveness of psychedelic drugs is the same as for all other drugs. However, there are unique factors investigators may need to consider when designing their clinical trials if those trials are to be considered adequate and well-controlled. The draft guidance also addresses the role of psychotherapy in psychedelic drug development, considerations for safety monitoring and the importance of characterizing dose-response and the durability of any treatment effect. The FDA is encouraging the public to provide comments on the draft guidance. Comments should be submitted within 60 days to ensure the agency considers them. Related Information ### The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products. Inquiries - Media: - April Grant - 202-657-8179 - Consumer: - 888-INFO-FDA
Drug Discoveries
US medical insurance giant Centene is looking to sell its nearly 60 NHS GP practices, as part of a move to exit the UK health market. The company also announced on Monday that it has sold its network of 53 UK private hospitals – Circle Health – to a company in the Middle East for $1.2bn (£948m). Centene took over privately-owned AT Medics, set up in 2004 by six NHS GPs and overseeing 37 London GP practices, in 2021. Operose now serves over 640,000 UK patients in surgeries and digitally, making it the largest primary care organisation in the country. The sale of Operose is expected to be made by Christmas this year, according to the FT. The newspaper also reported Centene divesting both its GP and private hospital network in the UK indicates it has given up on plans to create an easy pathway to private healthcare by encouraging NHS GPs to refer patients to its Circle Health hospitals. In its press statement Centene said its sale of Circle Health to PureHealth reflects the company’s ‘continued execution of its value creation efforts as the company refocuses its portfolio on core lines of business’. Centene’s entry into UK general practice just under two years ago faced legal challenges by campaigners trying to tackle NHS privatisation, who argued that patients were not adequately consulted on the takeover. However, a High Court judge dismissed the case last year, saying she did not accept that the North Central London CCG had given ‘insufficient notice to the public’. Tower Hamlets LMC chair Dr Jackie Applebee, one of the GPs who led the campaign, said this news ‘completely endorses’ their efforts. ‘We said, way back then, they wouldn’t be able to make a profit, and we said we were concerned that they’d sell when they realised this – and what would happen to all those patients then?’ she said. Dr Applebee told Pulse she hopes ‘no ICB will ever consider selling off any general practice again to the private sector’ and the Government will ‘wake up, smell the coffee and just keep the NHS public’. On the impact of this future sale on patients, she said: ‘I think patients will be feeling insecure. They’ll be wondering “will my general practice exist? If I’m feeling ill, will there be a GP for me to go to?” ‘They’ll be worried about their GP closing down. They’ll be worried about access to general practice. If you can’t get access to general practice, you can’t get access to healthcare at all, really. ‘So insecurity, uncertainty, lack of continuity. Continuity has been shown time and again to be good for outcomes. These patients are going to lose out on continuity. It’s really got to stop. It’s not fair on patients.’ Andrew Pow, board member of the Association of Independent Specialist Medical Accountants, told Pulse that if larger GP providers are struggling ‘it highlights the significant issues in resource and funding that providers currently have’. ‘All GP practices, whether corporate ones or GP-owned ones, need to have a secure workforce and make a profit. In GP-owned ones the profit is what pays partners to run practices,’ he said. Mr Pow added: ‘The last two years have seen significant cost increases and these are not being matched with increases in funding with practices of all sizes under pressure. ‘Commissioners need to take notice of what is happening in the market place and address the need for funding increases to cover the additional costs practices now have. ‘Simply scaling delivery models will not result in efficiencies to cover these costs.’ The reports of Centene divesting its UK business follows on from news earlier this month that private healthcare company Babylon is seeking to sell off its UK operations amid financial troubles. This could include its GP at Hand offering which currently serves around 100,000 NHS patients in London.
Health Policy
In June, GNN reported on the first evidence of a drug that was able to regrow adult teeth in mice, after it was discovered by a dental scientist named Takahashi in Japan years ago. Now, a pharmaceutical firm called Toregem Biopharma, funded by Kyoto University where Takahashi is based, is moving forward with clinical trials in healthy human adults. Slated to begin in July of next year, the trials will investigate whether or not Takahashi’s antibody-based drug that targets a protein which suppresses the growth of new teeth from our “teeth buds,” is successful in adults. If so, the next trial will include children with anodontia, a condition where they are born without some of their teeth. In 2018, Takahashi showed that ferrets, who like humans have tooth buds, baby teeth, and permanent teeth, were able to regrow their teeth when given the drug. “The idea of growing new teeth is every dentist’s dream. I’ve been working on this since I was a graduate student. I was confident I’d be able to make it happen,” Mr. Takahashi said. Anodontia is a congenital condition present in about 1% of the population that impedes the development of teeth. About 10% of those patients have oligodontia, in which they lack 6 or more natural teeth. Around 2005, and upon Takahashi’s return to Japan, literature began being published that pinpointed certain genes in mice that when deleted caused them to grow fewer or more teeth. Investigating the latter, Takahashi found that this gene synthesized its own protein called USAG-1, and that when he targeted it with a neutralizing antibody, the mouse’s teeth proceeded to grow like normal. SHARE This Huge Dental Breakthrough With Anyone Missing Teeth…
Drug Discoveries
- The governor of California, Gavin Newsom, has vetoed a bill that would have removed criminal penalties for the possession and use of psychedelic mushrooms. - Newsom cited that in order for him to enact the measure into law, more work needs to be done to set up regulated treatment guidelines on hallucinogens. - The legislation would have made California the third state to decriminalize certain hallucinogens. California Gov. Gavin Newsom has vetoed a bill aimed at decriminalizing the possession and personal use of several hallucinogens, including psychedelic mushrooms. The legislation vetoed Saturday would have allowed those 21 and older to possess psilocybin, the hallucinogenic component in what's known as psychedelic mushrooms. It also would have covered dimethyltryptamine (DMT) and mescaline. The bill would not have legalized the sale of the substances and would have barred any possession of the substances on school grounds. Instead, it would have ensured people are neither arrested nor prosecuted for possessing limited amounts of plant-based hallucinogens. Newsom, a Democrat who championed legalizing cannabis in 2016, said in a statement Saturday that more needs to be done before California decriminalizes the hallucinogens. "California should immediately begin work to set up regulated treatment guidelines - replete with dosing information, therapeutic guidelines, rules to prevent against exploitation during guided treatments, and medical clearance of no underlying psychoses," Newsom's statement said. "Unfortunately, this bill would decriminalize possession prior to these guidelines going into place, and I cannot sign it." The legislation, which would have taken effect in 2025, would have required the California Health and Human Services Agency to study and to make recommendations to lawmakers on the therapeutic use of psychedelic substances. Even if California made the bill a law, the drugs would still be illegal under federal law. In recent years, psychedelics have emerged as an alternative approach to treating a variety of mental illnesses, including post-traumatic stress disorder. The Federal Drug Administration designated psilocybin as a "breakthrough therapy" for treatment-resistant depression in 2019 and recently published a draft guideline on using psychedelics in clinical trials. Public opinion on psychedelics, which have been mostly associated with 1960s drug culture, has also shifted to support therapeutic use. Supporters of the legislation include veterans, who have talked about the benefits of using psychedelics to treat trauma and other illnesses. "Psilocybin gave me my life back," Joe McKay, a retired New York City firefighter who responded to the 9/11 attacks, said at an Assembly hearing in July. "No one should go to jail for using this medicine to try to heal." But opponents said the drugs’ benefits are still largely unknown, and the bill could lead to more crimes — though studies in recent years have shown decriminalization does not increase crime rates. Organizations representing parents also worried the legislation would have made it easier for children and young people to access the drugs. The California Coalition for Psychedelic Safety and Education, which opposed the measure, said more safeguards are necessary before decriminalization occurs. "We’re grateful that Governor Newsom listened to some of the top medical experts, psychedelic researchers and psychiatrists in the country who all warned that legalization without guardrails was at best premature for both personal and therapeutic use," the coalition said in a statement Saturday. "Any move toward decriminalization will require appropriate public education campaigns, safety protocols and emergency response procedures to help keep Californians safe." State Sen. Scott Wiener, who authored the bill, called the veto a missed opportunity for California to follow the science and lead the nation. "This is a setback for the huge number of Californians — including combat veterans and first responders — who are safely using and benefiting from these non-addictive substances and who will now continue to be classified as criminals under California law," Wiener said in a statement Saturday. "The evidence is beyond dispute that criminalizing access to these substances only serves to make people less safe and reduce access to help." He said he would introduce new legislation in the future. Wiener unsuccessfully attempted to pass a broader piece of legislation last year that would have also decriminalized the use and possession of LSD and MDMA, commonly known as ecstasy. Lawmakers can override a governor’s veto with a two-thirds vote, but they have not tried in decades. In 2020, Oregon voters approved decriminalizing small amounts of psychedelics, and separately were the first to approve the supervised use of psilocybin in a therapeutic setting. Two years later, Colorado voters also passed a ballot measure to decriminalize psychedelic mushrooms and to create state-regulated centers where participants can experience the drug under supervision. In California, cities including Oakland, San Francisco, Santa Cruz and Berkeley have decriminalized natural psychedelics that come from plants and fungi. Despite Newsom’s veto, California voters might have a chance to weigh in on the issue next year. Advocates are attempting to place two initiatives to expand psychedelic use on the November 2024 ballot. One would legalize the use and sale of mushrooms for people 21 and older, and the other would ask voters to approve borrowing $5 billion to establish a state agency tasked with researching psychedelic therapies.
Drug Discoveries
If you’ve been following Covid  news, then you’re likely well aware there’s a new variant in town that’s concerning the scientific community. Known as XBB, the variant is believed to be the most immune-evasive to date and currently accounts for over 40% of infections in the United States, according to data from the US Centers for Disease Control and Prevention.It’s been called the “kraken variant” by some, and according to the World Health Organisation, it has now been identified in at least 28 other countries.As the BBC reported, some cases of XBB.1.5 variant, which evolved from XBB, have already been recorded in the UK – the mutation helped it beat the body’s immune defences, but has also reduced its ability to infect human cells, the report said.Because XBB is relatively new, scientists are still working to figure out if and how the variant behaves differently from other recent variants. Though XBB’s symptoms are expected to be on par with past omicron infections, doctors say they are seeing some issues becoming more prevalent than others.“Viruses typically mutate to become more contagious and less severe; it appears that this is happening with this strain of the coronavirus,” Dr. Henry Redel, the chief of infectious disease at Saint Peter’s University Hospital in New Brunswick, New Jersey, tells HuffPost US.We asked infectious disease experts what they’re seeing in US hospitals right now. Here’s what they said.The most common XBB Covid symptoms appear to be congestion and body aches.There’s limited data on XBB, but experts suspect the symptoms associated with XBB infections will be similar to the symptoms people experienced with Covid throughout 2022. That said, evidence has shown that the symptom profile has shifted a bit with each variant. Omicron caused more cold-like symptoms (like fatigue, runny nose, sneezing and muscle aches), for example, whereas delta and alpha more commonly triggered anosmia (loss of smell) and ageusia (loss of taste).So, what is on the docket for XBB? “In general, I think people are more achy and still have congestion and headache,” Dr Julie Parsonnet, an infectious diseases specialist with Stanford Health Care, tells HuffPost. You may also expect to see the other usual symptoms: fever, chills, cough and sore throat.Less common symptoms include loss of taste and smell and shortness of breath.Anosmia and ageusia appear, anecdotally, to be less common with XBB. Experts don’t expect ageusia and anosmia to make a comeback just yet. “Since XBB is part of the Omicron group, I expect that loss of taste and smell will not be common, but I have not seen data yet,” says Dr. Thomas Campbell, a professor in the department of infectious disease at the University of Colorado Anschutz Medical Campus. One thing doctors on the front lines are seeing less of: severe shortness of breath, Redel says. Rarely have recent patients needed supplemental oxygen, he added. Redel notes he’s seeing many more Covid patients come in with classic upper respiratory symptoms – like runny nose, congestion and sore throats – along with fever and muscle aches. Open Image ModalMalcolm P Chapman via Getty ImagesCommon symptoms have changed since the original iteration of the coronavirus.What causes symptoms to change between subvariants?Because so many people have been infected – in some cases, multiple times — it’s tough to pin down exactly how the symptomatology is influenced by the host versus specific traits of the virus. Parsonnet suspects that immunity plays a pretty big role. “There is likely a strong element of underlying immunity, but there may also be differences in the virus’s ability to cause symptoms,” Parsonnet tells HuffPost.According to Dr. Martin Krsak, an infectious disease expert at the University of Colorado Anschutz Medical Campus, people’s genetics and underlying health – i.e. whether they have a chronic disease or prior injury – also influence the type of symptoms they develop. Like Parsonnet, Krsak says that each variant and the way it infects our cells likely impacts symptoms as well. “Variants have a different capacity to evade prior immunity and also a different capacity to bind to the main target on human cells,” he says. Does the current Covid booster prevent you from getting infected with XBB?A pre-print study from Japan determined that XBB came to be during the summer of 2022 when two sub-variants of the BA.2 omicron lineage combined. Scientists believe that, in this process, XBB picked up mutations that help it better evade immunity conferred by both vaccination and previous infections. XBB’s mutations also let it attach to our cells more easily, enabling it to spread more efficiently than other versions of omicron. “It binds tighter, appears more transmissible, and is also immune-evasive,” says Dr. Eric M. Poeschla, the head of the Division of Infectious Diseases at the University of Colorado Anschutz Medical Campus. It’s unknown whether those mutations alter the virus’ clinical profile and the symptoms it causes, Parsonnet says. The updated Covid booster, which was tweaked in 2022 to target newer variants of Omicron, doesn’t work super well at preventing infections of XBB, considering there are so many new infections in the community, Parsonnet says. But the fact that there hasn’t been a rapid increase in deaths shows that the shots, combined with the immense amount of immunity gained from past infections, continue to protect many people from severe outcomes. Together, that immunity will help blunt the XBB wave, according to Poeschla. Of course, there’s always the very real risk of long Covid, which is a debilitating condition that can follow even a mild case of the coronavirus. Long Covid can cause lasting fatigue, brain fog, respiratory issues and more. There’s still a lot for us to learn about XBB and the symptoms or potential complications it may cause.But there’s one thing we know for sure: There’s a benefit to being vaccinated rather than not. “The bivalent booster offers some protection against all omicron-based variants and is highly recommended, especially for those over 65 or with serious other risks,” Poeschla says.Experts are still learning about Covid-19. The information in this story is what was known or available at the time of publication, but guidance could change as scientists discover more about the virus. To keep up to date with health advice and cases in your area, visit gov.uk/coronavirus and nhs.uk.
Epidemics & Outbreaks
LauriPatterson/Getty Images toggle caption A fiber found in barley, called beta-glucan, may improve insulin sensitivity, lower blood pressure and increase satiation between meals, research shows. LauriPatterson/Getty Images A fiber found in barley, called beta-glucan, may improve insulin sensitivity, lower blood pressure and increase satiation between meals, research shows. LauriPatterson/Getty Images For several months now, I've been studying how the new medications, Ozempic and Wegovy, cause dramatic weight loss. Both medications contain a compound, semaglutide, that squelches hunger like a fly swatter smashes a mosquito. People who take the medication say they no longer have constant cravings for food, so they eat less frequently. The drug seems to quiet what some people call "food noise," the constant internal chatter telling them to eat. While reading study after study about Wevgovy and Ozempic, I learned that the drug mimics a hormone that our bodies naturally make when we're eating food. It's called GLP-1. This made me wonder: Could we increase levels of this hormone by changing our diet? Turns out, the answer is yes – you can increase your body's production of GLP-1 with your diet, says Frank Duca, who studies metabolic diseases at the University of Arizona. One of the key foods that triggers its release is a food most Americans struggle to eat enough of, even though it comes with a cornucopia of health benefits. Yup, I'm talking about fiber. "Whenever my family finds out that I'm studying obesity or diabetes, they say, 'Oh, what's the wonder drug? What do I need to take? What do I need to do?'" Duca explains. "And I say, 'Eat more fiber.' " But here's the hitch. Not all fiber works the same way. Duca and other researchers are beginning to show that particular types of fibers are more potent at triggering GLP-1 release and at regulating hunger than others. "We're seeing now that companies are adding fiber to foods, but a lot of the time, they don't add the kind of fiber that's super beneficial for you," Duca says. How GLP-1 helps flip hunger into satisfaction To understand why fiber is so important for producing GLP-1, let's look at what happens when you don't eat much fiber. Let's say you wake up in the morning feeling hungry and you eat two slices of white bread and a fried egg. As the digested food moves into the small intestine, many of the nutrients, such as the carbohydrates, fats and amino acids, trigger an avalanche of activity in your blood and brain. "The food activates cells in your intestine, which then release a ton of hormones," says Sinju Sundaresan, who's a gut physiologist at Midwestern University. About 20 of these hormones, including GLP-1, are known as satiation hormones. "They tell your body to start absorption, and to suppress your hunger signals," Sundaresan says. So you slow down eating and eventually stop because you feel satisfied. At this point, GLP-1 kicks into action. It stimulates the release of insulin and slows down how quickly the bread and egg moves from your stomach into the intestine. So you don't use up the fuel all at once, says Gary Schwartz, who studies the neuroscience of eating and appetite at Albert Einstein College of Medicine. GLP-1 also likely activates neural circuitry inside the brain by turning on nerves inside the lining of your gut. "These neurons collect information from the gut, and then signal all the way to the brain stem, where you find another signaling pathway for GLP-1," Schwartz explains. But GLP-1's actions are extremely fast. "Once the hormone hits the blood, it begins to be degraded," says integrated physiologist Darleen Sandoval, at the University of Colorado, who has studied GLP-1 for more than a decade. "By the time GLP-1 gets to the heart and the rest of the circulation, there's very little of it left," she says. And so an hour or two after eating this no-fiber breakfast, GLP-1 levels in your blood plummet. And when lunch rolls around, you're hungry again. This is where GLP-1 differs substantially from semaglutide, the active ingredient in weight-loss drugs. GLP-1 sticks around in the blood for only a few minutes, but semaglutide persists for days. And this stability allows the drug to go into the brain, where it squelches appetite and cravings directly, says Sandoval. That's why people on these drugs lose so much weight. "In mice or rats, we can give naturally occurring GLP-1 directly into the animals' brains, and it stops them from eating," Sandoval says. But, back to our breakfast scenarios: What if, instead of eating white bread, you had two slices of rye bread, with about 8 to 10 grams of fiber in them? Turns out, adding that hefty portion of fiber adds another opportunity for your intestine to release GLP-1, many hours after the meal. Satiation hormones last longer after eating fiber Our bodies don't have the capacity to break down fiber. So it moves through our small intestines largely unchanged, and eventually – approximately 4 to 10 hours after a meal – reaches our colons. Here, inside the large intestine, the fiber meets a whole crew of microbes that can digest the fiber. Bacteria in your large intestine can break down certain dietary fibers into smaller molecules. And these smaller molecules can trigger the release of not only GLP-1, but also another key hormone that decreases your appetite, called PYY (peptide YY). These smaller molecules also can suppress appetite on their own, and have been linked to lower body weight and better glucose regulation. Since this extra boost of GLP-1 and PYY occurs hours after you eat, it can tamp down cravings between meals and even the overall desire to eat the next meal. "PPY regulates satiety – that is how long you wait between meals," says the University of Arizona's Frank Duca. "The release of PYY, in addition to the GLP-1, can increase the length of time between meals," he says. These hormones may even influence how much you eat at the next meal. "This is what's called a second meal effect," says Edward Deehan, a nutritional microbiologist at the University of Nebraska-Lincoln. "If you eat a lot of fiber at one meal, by the time it's in your colon, it's around the time of your next meal. So you may have improved insulin responses and improved satiety or a feeling of fullness," Deehan says. But, not all fiber is equal: To get this extra boost of satiation hormones, you need to eat fiber that bacteria can digest. These fibers are called fermentable because bacteria literally ferment them, in a similar way that yeast ferments barley into beer. Scientists, such as Duca, have just started trying to figure out which fermentable fibers may be best at suppressing appetite and inducing weight-loss. "So the agricultural community in the U.S. could prioritize the growing of grains with these fibers," he explains. In one preliminary study with mice, Duca and his colleagues found that a fiber in barley, called beta-glucan, induced the most weight loss in obese animals. "At face value and, at least in our settings, it was only beta-glucan that was effective," he says. How To Add Barley To Your Diet Cooking barley is super easy. Some recipes call for soaking the grain before boiling. But it's not necessary. Simply add one cup of barley and three cups of water to a pot. For pearled barley, continue boiling for about 30 minutes. For hulled barley, boil for about 40 minutes. Strain the water and you're ready! You can throw barley into soups or on salads and boiled barley is a great fiber-rich substitute for white rice. You can also buy barley flour and use it for baking breads, muffins and pancakes. Beta-glucan is also found in oats and rye. And indeed, studies with people have found that beta-glucan fiber may improve insulin sensitivity, lower blood pressure and increase satiation between meals. Other fermentable fibers include dextrin in wheat, oligosaccharides in beans, peas and lentils, and pectin in apples, pears and green bananas. If your diet currently doesn't include much fiber, Duca says, don't worry too much about which fiber you start adding. "Just being aware of how much fiber you're eating and increasing it, that's a huge step to improving your health," he says. "Then once you get into the habit of eating more fiber, you can be more specific about adding more beta glucan and barley." But beware of processed foods that claim to have fiber added to them, Duca says. "Companies are hearing that they need to increase the fiber in their foods, but then a lot of times, they're adding fiber that isn't super beneficial for you," he says. "It's the type of fiber that just passes right through you, without triggering the release of any hormones." This story was edited by Jane Greenhalgh
Nutrition Research
An estimated one in nine adult women struggle with an abnormal and painful fat buildup in the lower body — and no amount of diet or exercise can help. Lipedema, a relatively common but often overlooked disease, causes fat to accumulate in the lower part of the body, primarily the butt, thighs and calves. For many women, like Molly Friar, an event planner in Sacramento, California, it can cause debilitating pain and impaired mobility. In an effort to raise awareness of this condition, Friar, 53, spoke with Fox News Digital about her long journey to diagnosis — and what she calls her newfound "freedom." Friar was just 11 years old when she started to notice that her body was different than everyone else’s, she said during a phone interview. "The lipedema itself is governed by hormone changes, so that's when things really took off for me," she said. "My legs were different from every other girl in my class, and I started to get a bit of a stomach in my lower abdomen." It was puzzling for Friar, who was very fit and athletic. She played soccer, basketball and softball, and was also a cheerleader — yet no matter how active she was or how carefully she ate, her lower body carried an abnormal amount of fat. "Somehow my legs and stomach were always disproportionately bigger than everybody else's," she said. Adding complexity to the situation, Friar is adopted — so she had no context that might have predicted this genetic condition. "I don't have pictures of my family to look at, to see a grandmother or an aunt or other women in my life that were affected by it," she said. Friar felt "completely out of place," she said, as everyone else in her family was "super skinny" and she was not. A spiral of shame Friar was just 12 years old when her parents put her on a Weight Watchers program. "They felt like that was the best thing they could do to help me," she said. "I always felt like there was a person inside of me who was thin and just wanted to get out." Throughout her adolescence and young adulthood, Friar worked out every day, biking to the gym and taking aerobics with all the adults. "That’s absolutely where I started a battle of shame around my body — something I couldn't control," she said. "I would eat less or not eat, and exercise more, and do all the things I could think of to outpace something that I didn't know existed." She added, "I always felt like there was a person inside of me who was thin and just wanted to get out." In addition to the body image struggles, Friar’s condition also came with extreme pain. Lipedema causes inflammation and extreme bruising — "I would just brush up against something and get a bruise," said Friar. The activities that were pleasant for other people, like getting a massage during a pedicure, created "excruciating pain" for Friar. For someone with lipedema, she explained, running a hand over the skin is like touching a rocky beach — "you can feel the nodules like pebbles under the skin." Other common symptoms include swelling, a feeling of heaviness in the legs and excess fatigue. For some patients, the condition can cause difficulty walking, heightened anxiety and depression, joint issues, venous (vein) disease and other complications, according to Cleveland Clinic. Desperate for a diagnosis In 2016, when Friar was 45 years old, she lost 50 pounds — but didn’t lose a centimeter in her calves. She started digging in to figure out what was going on. "I knew something wasn’t right," she said. In her online research, it wasn’t long before Friar was looking at photos of women with lipedema, with abnormal fat deposits in their lower bodies. "In that moment, I cried — it was like looking in a mirror," she told Fox News Digital. "I felt validated and relieved and ecstatic — I finally had an answer." But the relief was short-lived, as Friar quickly realized there was no cure for her condition. "It’s something that you have to try to battle for the rest of your life." "I felt validated and relieved and ecstatic — I finally had an answer." There are, however, options to alleviate some symptoms that come with lipedema, as Friar found out when she began seeing her doctor, Jaime S. Schwartz, M.D., in Beverly Hills, California. A board-certified plastic surgeon and world-renowned lipedema specialist, Schwartz has dedicated much of his career to raising awareness for fat disorders like lipedema. He launched Total Lipedema Care to help women like Friar. "Most people will tell you that the lower half of their body just started growing a lot larger than the upper half, usually during puberty," Schwartz told Fox News Digital. "It doesn't start as pain, but they start seeing physical changes that don’t really make sense." Lipedema is usually misdiagnosed as morbid obesity, Schwartz noted. Surgery is the best option to relieve lipedema symptoms. "In the U.S., many doctors tell women, ‘You're fat, you did this to yourself,’" he said. But the good news, he said, is that awareness is slowly starting to grow. "Over the past five years, it's gone from no one knowing about it to a lot of people knowing about it, so it's definitely getting better." Path to freedom As Schwartz told Friar, he recommends surgery as the best option to relieve lipedema symptoms. At his practice, Schwartz performs a patented procedure called manual lipedema extraction, which involves a combination of liposuction and the removal of underlying nodules of fat through small incisions. "When I take the ‘bad tissue’ out, people feel better as soon as the next day," Schwartz said. "That's the only thing that I've seen that works — and I've seen everything that's out there." Friar ended up having a total of three surgeries — one on the back of her legs, one in the stomach area and one on the front of her legs. "For me, the surgery was life-changing," Friar said. "I feel it changed the game for me — it extended my life and I gained back probably 75% to 80% of my mobility." "I'm willing to shout from the rooftops if I can help even one person recognize the symptoms and be able to help themselves." Each surgery required around six weeks of recovery time. "It isn’t easy, but I would do it 1,000 times over," she said. One caveat is that some insurance companies have been slow to cover the cost of lipedema surgeries. Friar had to pay out of pocket for the procedures, which can range from $4,000 to $16,000, according to Schwartz's website. "I was very, very lucky — there are so many women who want the surgery that can't afford it," she said. In addition to the surgeries, dietary changes have had a big impact on Friar’s quality of life. "The optimal diet for me is gluten-free and dairy-free, with no added sugars, no processed foods, low salt and very little alcohol," she said. She also wears medical-grade compression gear at night and lighter-compression leggings during the day. "It helps alleviate a lot of the inflammation and excess fluid in the body," she said. Other non-surgical options for relief include exercise and medications or supplements to reduce inflammation. As Schwartz told Fox News Digital, Friar’s case was pretty typical of most women’s experiences with lipedema, although he noted her positive mindset. "A lot of women have had this for so long, and it defeats them emotionally, psychologically and mentally," he said. "But Molly has always had such an amazing outlook and personality." He added, "Obviously, it's been emotional for her at times, but she never let it defeat her." ‘Like night and day’ Friar said her life now is "like night and day" compared to before. "Getting a massage for me is now enjoyable," she said through tears. "I can climb to the top of a mountain, and I can walk six miles and not stop." "It’s like your mobility gets taken away from you, and when you instantly get it back, it's newfound freedom." Friar’s goal is to increase awareness around this condition, among patients and doctors alike, so other women don’t have to live in shame for years like she did. "It’s something we need to be talking about," she said. "It’s such a visual thing, involving our bodies and how we present ourselves to the world, and it’s something we can’t control." "I'm willing to shout from the rooftops if I can help even one person recognize the symptoms and be able to help themselves." For many of Schwartz’s patients, he said, the disease has "destroyed their lives." "They don't go out, they don't socialize, they're afraid to work or wear certain clothes in public," he said. Some women can't have their grandchildren sit on their lap or can't hold their spouse's hand because it’s too painful, he said. "So when they have surgery and they're not in pain, not only do they look different and they're so happy to rediscover their body, but they can even have their dog sit in their lap for the first time," he said. "It’s a very overwhelming reality for them in a beautiful way," he also said. It is estimated that around 11% of women are living with lipedema today.
Disease Research
NEW YORK -- The federal government will, for the first time, dictate staffing levels at nursing homes, the Biden administration said Friday, responding to systemic problems bared by mass COVID-19 deaths. While such regulation has been sought for decades by allies of older adults and those with disabilities, the proposed threshold is far lower than many advocates had hoped. It seemed destined to draw ire from the nursing home industry as well, which opposes staffing minimums as unfunded mandates. With criticism expected, a promise made with fanfare in President Joe Biden’s 2022 State of the Union speech had its details revealed as many Americans turned away from the news for a holiday weekend. “Establishing minimum staffing standards for nursing homes will improve resident safety,” Health Secretary Xavier Becerra said in a statement. “When facilities are understaffed, residents suffer.” The proposed rules, which now enter a public comment period and would take years more to fully take effect, call for staffing equivalent to 3 hours per resident per day, just over half an hour of it coming from registered nurses. The rules also call for facilities to have an RN on staff 24 hours a day, every day. The average U.S. nursing home already has overall caregiver staffing of about 3.6 hours per resident per day, according to government reports, including RN staffing just above the half-hour mark. Still, the government insists a majority of the country’s roughly 15,000 nursing homes, which house some 1.2 million people, would have to add staff under the proposed rules. Chiquita Brooks-LaSure, who heads the Centers for Medicare and Medicaid Services, or CMS, called the move “an important first step.” CMS oversees nursing homes. A senior White House official, speaking on the condition of anonymity ahead of the announcement, said the Biden administration was open to revisiting the staffing threshold once implemented. “I would caution anyone who thinks that the status quo – in which there is no federal floor for nursing home staffing – is preferable to the standards we’re proposing,” said Stacy Sanders, an aide to Beccera. “This standard would raise staffing levels for more than 75% of nursing homes, bringing more nurse aides to the bedside and ensuring every nursing home has a registered nurse on site 24/7.” The new thresholds are drastically lower than those that had long been eyed by advocates after a landmark 2001 CMS-funded study recommended an average of 4.1 hours of nursing care per resident daily. Most U.S. facilities don’t meet that threshold. Many advocates said even it was insufficient, not taking into account quality of life, simply determining the point at which residents could suffer potential harm. After the Democratic president elevated the issue in his State of the Union speech, advocates were initially elated, expecting the most significant change for residents since the Nursing Home Reform Act of 1987. That changed after a copy of a new CMS-funded study on the subject was inadvertently posted this week, claiming there is “no obvious plateau at which quality and safety are maximized.” Advocates were bereft, saying they felt betrayed by administration officials they thought to be allies. “This was not the time for an incremental step,” said Richard Mollott, who leads the Long Term Care Community Coalition. “You really had a once-in-a-generation opportunity.” Current law requires only that homes have “sufficient” staffing, but it leaves nearly all interpretation to states. Thirty-eight states and the District of Columbia have their own staffing regulations. Some are so low that advocates say they’re meaningless, and, across the board, enforcement is often toothless. The problem has long been apparent to front-line nurse aides – the low-paid, overwhelmingly female and disproportionately minority backbone of facility staffs – and to residents themselves, whose call bells go unanswered, whose showers become less frequent and who lie hungry, awaiting help with meals. The coronavirus pandemic, which claimed more than 167,000 U.S. nursing home residents, brought the greatest attention to poor staffing in history. But, in its wake, many homes saw their staffing grow even thinner. Across all job types, Bureau of Labor Statistics data shows nursing homes have 218,200 fewer employees than in February 2020, when the first U.S. outbreak of the coronavirus arrived at a nursing home outside Seattle. The American Health Care Association, the biggest lobbyist on behalf of nursing homes, has waged a relentless campaign claiming facilities were teetering, with Medicaid subsidies insufficient, widespread hiring and retention issues and rampant home closures, and it warned a staffing mandate would only exacerbate those issues. But there has been no sign of widespread closures, the profitability of homes has repeatedly been exposed and critics have argued, if they just paid better, the workers would come. ___ Sedensky can be reached at [email protected] and https://twitter.com/sedensky.
Health Policy
A mother who describes herself as a 'secret eater' with a bread obsession has revealed how she was motivated to lose nine stone after getting stuck in a plane seat.  Jill Rutherford, 53, from Bedlington, Newcastle, started piling on the pounds during her first job as a seamstress aged 16, tucking into sweet treats in between stitches.And she would also eat large amounts of bread, putting away four slices at breakfast, five slices for lunch, four in the evening, and could demolish an entire breadbasket at the local chippy - all before dinner.The self-confessed 'secret eater' used to scoff three chocolate bars on the drive home and then hide the evidence from husband John, 56. Jill Rutherford (pictured) from Newcastle tipped the scales at almost 21stone at her highest weight (pictured here before losing weight)At her biggest, Jill tipped the scales 20st 10lb and once split the seams on her size 26 trousers.The most 'mortifying' experience was when Jill found herself 'wedged' in a plane seat during a trip to Dubai and ended up arriving 'black and blue' from bruising.The turning point came in 2016 when she received a devastating breast cancer diagnosis and was determined to live a healthier lifestyle.After beating the disease, she joined Slimming World and overhauled her diet - shedding a whopping nine stone. After: After losing around nine stone, Jill now weighs in at 11st 10lb, and has gone from a size 26 to a size 12The mum-of-two is now down 11st 10lb and can fit into a svelte size 12.Jill said: 'I was so unfit I couldn't walk up a flight of stairs or bend over and tie my own shoelaces.'I was such a secret eater and obsessed with any type of white bread, as long as there was a thick layer of butter on top.'The flight was so humiliating - I didn't get up and use the loo for the entire 11-hour flight. According to Jill (pictured before losing weight) she was a 'secret eater' before embarking on Slimming World, eating some 15 slices of bread every day'I knew I had to make a change and I can't believe how far I've come.'Jill noticed her weight spiralling out of control from the aged 19, when she first moved in with her husband John, a farm labourer, who loved to cook.She used to sneak off the local chippy for a large cod and chip, basket of bread, and full-fat coke, before going tucking into a massive homemade dinner.She said: 'It was the norm to tuck into several slices of bread in the evening after John went to work.'In my head if nobody saw me do it, then it didn't count.' Two events kick started Jill's weight loss journey - getting stuck in a plane seat and then being diagnosed with breast cancer  Jill has described getting stuck on a plane seat when she was at a larger size (pictured) as being 'mortifying'Jill's continued to gain weight after the arrival of her children - Joe, 33, and Jack, 30.She was left 'mortified' during trip to visit her eldest when he moved to Australia in 2016, after she found herself getting stuck in the plane seat.'I bought myself two seats for the flight, so I didn't sit next to anyone.'But when we landed in Dubai during the first leg of the trip I was completely wedged - it was so embarrassing.'When we eventually arrived, I was completely black and blue with bruises.'According to Jill (pictured after losing weight) medics put her cancer diagnosis down to her weight - and said she would likely get ill again unless she changed her lifestyleWhen Jill returned home, she noticed a lump under arm pit and was devastated to learn she had developed breast cancer.After a lumpectomy, 26 rounds of radiotherapy and six-months of chemotherapy, Jill was announced cancer-free.But she was dealt another blow when she claimed doctors put her diagnosis down to her weight.Jill continues: 'The doctor said my unhealthy lifestyle and obesity was a massive factor.Before and after: as well as overhauling her diet, Jill took up exercise, and says she went from being barely able to walk to going to the gym three times a week'If I continued the same path, it was very likely to return. Hearing that was a huge wake-up call for me and I knew had to make a change.'Towards the end of 2016, Jill signed up to Slimming World and was determined to make a change.She swapped her sugary snacks for healthier alternatives and calorie-controlled meals.She also started exercising - going out for walks with her Jack Russel Betty and eventually joining a running club.  It took Jill a couple of years to shed the weight and reach her goal size, but she says it was worth it as she is now 'happier than ever' The 53-year-old is now a Slimming World consultant herself, and says she wants to help others reach their goal weightJill shed a whopping eight stone and dropped to a healthy 12st 7lb.She is now a healthier size 14 and has more energy than ever before.'I was barely able to walk and now I'm going to the gym three times a week.'I've now become a consultant at Slimming World to help others, like they helped me.'It took me a couple of years to hit my target weight but I'm happier than ever.' Jill's daily diet - before and after BEFORE Breakfast: Four slices of toast with thick butter and jamLunch: Four or five slices of white bread or rolls with tomato soupDinner: Big portion of fish and chips or spaghetti BologneseSnacks: Four slices of toast, chocolate, biscuits, crumpets  AFTERBreakfast: Weetabix and natural yogurtLunch: Boiled eggs, ham and saladDinner: Slimming world recipe pasta, Bolognese, Shepard's pie Read more Exercise WON'T help you lose weight, says top diet expert... who says you should follow this advice to beat the bulge Fast way to lose weight: Delicious healthy recipes to get you in the best shape for 2023 Seven ways to lose weight with MINIMAL effort: Trick your mind with smaller plates, kill those hunger pangs with cups of tea and ALWAYS park far away from the store entrance
Nutrition Research
Starting July 1, Australia will allow the legal use of MDMA, commonly known as ecstasy, and psilocybin, the hallucinogenic ingredient in "magic mushrooms," to treat post-traumatic stress disorder (PTSD) and treatment-resistant depression, respectively. Authorized by the Therapeutic Goods Administration (TGA), Australia's drug regulator, this landmark decision will make the country one of the world's first to recognize psychedelic drugs as legitimate medical treatments, according to news reports. In making the decision, the regulatory body cited "sufficient evidence" that the drugs can be helpful to certain patients with PTSD and depression, although currently, no drugs containing the psychedelics have been fully evaluated for safety and effectiveness and added to the TGA's database of approved drugs. The step will reclassify both MDMA and psilocybin from prohibited substances to controlled drugs, meaning they can now be legally prescribed and taken for select purposes. It will also establish a way for psychiatrists to become authorized to prescribe and administer the drugs in clinical settings. In clinical trials, patients given psychedelics are closely monitored by healthcare professionals in controlled settings, which will be the same case for patients attempting to receive psychedelic-assisted therapy in Australia, per the decision. A growing number of studies and clinical trials suggest that psilocybin may help patients with treatment-resistant depression, potentially by boosting connectivity between different areas of the brain. The hallucinogen MDMA, also known as molly, increases the activity of certain neurotransmitters in the brain, such as serotonin, as well as hormones like oxytocin and prolactin — a property that could help treat PTSD by allowing patients to work through trauma under reduced levels of arousal and stress, according to recent studies. However, some scientists say there is not yet enough research surrounding psychedelics in therapeutic settings and that Australia's decision to authorize these drugs as medicines happened too soon. "It's not for everybody," Susan Rossell, a neuropsychologist at Swinburne University of Technology in Melbourne, told Nature. She emphasized that some patients may experience negative feelings or "bad trips" if the drugs are not administered properly. "We need to work out who these people are that are going to have bad experiences, and not recommend it," she said. Rossell is currently working on Australia's only active clinical trial looking into psilocybin-assisted therapy's effectiveness in treating depression, according to Nature. Currently, the U.S. authorizes psilocybin and MDMA treatment in certain cases under compassionate use, a law that allows some individual patients to access drugs that are currently being tested in clinical trials but are not yet approved by the Food and Drug Administration. In March 2022, the nonprofit Mind Medicine Australia filed applications to the TGA to make these two psychedelics legally available in therapeutic settings in the country. These applications were eventually approved in February 2023. Per the decision, starting in July, psychiatrists can submit applications to human research ethics committees (HRECs) in Australia to become authorized prescribers of MDMA and psilocybin, with final approval falling under the TGA, according to The Washington Post. However, Rossell told Nature that she fears there will not be enough oversight surrounding psychedelic-assisted therapies. "Once something's been approved, how does an HREC monitor whether they're actually sticking to what they said they would do?" she told Nature. "They just don't have the resources to do it. So there's no regulatory oversight." Other countries that have not yet approved therapeutic psychedelic use may now be looking to Australia as this decision plays out in the coming months, experts say. "Australia is creating an interesting model that could pave the way forward for the rest of the world," Dr. Michael Alpert, a psychiatrist at Harvard Medical School, told ABC News in March after the decision was first announced in February. "It will be interesting to see what Australia is going to do to ensure that patients receive a consistent standard of care when receiving these services." Live Science newsletter Stay up to date on the latest science news by signing up for our Essentials newsletter. Kiley Price is a Live Science staff writer based in New York City. Her work has appeared in National Geographic, Slate, Mongabay and more. She holds a bachelor's degree from Wake Forest University, where she studied biology and journalism, and is pursuing a master's degree at New York University's Science, Health and Environmental Reporting Program.
Drug Discoveries
A woman has been given the all-clear from cancer after being treated with a drug described as a "miracle". Carrie Downey's bowel cancer disappeared within six months of taking dostarlimab. She is one of a small number of people globally to be given the drug for bowel cancer. While it is still being clinically trialled, data so far has shown the drug has a 100% success rate against a specific variant of the disease. Early trials have shown it to be effective on between 3% to 5% of bowel cancers with a particular gene mutation. Wales and Italy are the only countries so far to have approved dostarlimab as a standard offer for the disease. While investigating pains from a previous hernia mesh implant, doctors discovered Carrie, from Port Talbot, had bowel cancer. An operation to remove the tumour would have left 42-year-old Carrie needing a permanent stoma. What does dostarlimab do? After a referral to Dr Craig Barrington, a consultant oncologist at Singleton Hospital in Swansea, she was offered dostarlimab instead - which works by helping the immune system to destroy the cancer. Carrie said: "[Dr Barrington] said something along the lines of: 'What would you do if I said we could get the same result, no evidence of cancer, without having a permanent stoma and major surgery?' "He had checked my biopsies and knew I had this rare mutation... He asked if I would like to go ahead with it." Carrie was given dostarlimab infusions for six months. Subsequent tests showed there was no longer any evidence of her having the disease. "I'm just so thankful to Dr Barrington and his team that I got the chance and that he had looked into the mutation and looking at these new therapies," she said. "He has given me my life back. I will be forever grateful to him." All 36 patients in the United States who took part in an early phase trial which used dostarlimab to treat their bowel cancer were cured. So far in Wales, fewer than 10 bowel cancer patients have received the treatment - which is administered every three weeks for six months. Those who have finished their course of treatment have seen the cancer disappear and those whose treatment is ongoing have experienced positive results. All have reported the side effects of the drug to be minimal or non-existent. 'Unheard of in oncological care' Dr Barrington said: "I've been blown away by the results. I accept the numbers are small so far and it's early phase data but to get 100% complete response in a drug which is well tolerated and works incredibly quickly is unheard of in oncological care. "Patients report even after their first treatment their symptoms have disappeared. It's just remarkable." Dostarlimab can be offered to patients who have stage two or stage three cancer. It is already routinely used to treat endometrial cancer, which has the same gene mutation found in colorectal cancer. Dr Barrington added: "To have it as an option for patients as a standard of care is really exciting. I think it completely revolutionises the way we approach colorectal cancer. "These patients would have typically had surgery in the past. A small number of patients are now not needing surgery so that's space for someone else to move up the list." What are the symptoms of bowel cancer? - changes in your poo, such as having softer poo, diarrhoea or constipation that is not usual for you - needing to poo more or less often than usual for you - blood in your poo, which may look red or black - bleeding from your bottom - often feeling like you need to poo, even if you've just been to the toilet - tummy pain - bloating - losing weight without trying - feeling very tired for no reason Source: NHS - Bowel cancer symptoms Wales is the first UK nation to have dostarlimab approved as a standard treatment offer. It was ratified by Welsh Government following a robust process of checks and evaluation of its benefits. Janet Baker, from Newport in Pembrokeshire, has also been treated with dostarlimab. She is waiting for her final meeting with Dr Barrington where she is also hoping to get the all clear. The 73-year-old grandmother said her bowel cancer symptoms disappeared after her first treatment session at Withybush Hospital. "I still pinch myself that I feel so well and have felt so well all through the treatment really. I don't have any symptoms so I'm hoping everything is gone. I do still feel it's a miracle," Janet said. "It takes half an hour to put the drug in, we often go for lunch on the way home and that's it for three weeks. I'm fine." She added: "I'm almost ashamed to tell others about it because I have a friend going through a really rough time having chemo and it knocks her out every time and she can hardly get out of bed." Around 42,000 people are diagnosed with bowel cancer in the UK every year. It is the fourth most common type of cancer in Wales and the second biggest killer.
Drug Discoveries
Among the latest artificial intelligence innovations in health care, a routine chest X-ray could help identify non-smokers who are at a high risk for lung cancer. The study findings will be presented this week at the annual meeting of the Radiological Society of North America (RSNA) in Chicago. Researchers from the Cardiovascular Imaging Research Center (CIRC) at Massachusetts General Hospital (MGH) and Harvard Medical School in Boston developed a deep learning AI model using 147,497 chest X-rays of asymptomatic smokers and never-smokers. The model "learned" to recognize patterns associated with lung disease in the X-ray images. Next, the researchers applied the AI model to a total of 17,407 patients, with an average age of 63 years old. Of the 28% of patients flagged as high risk by the AI model, 2.9% of them were later diagnosed with lung cancer within the next six years. That was more than twice the share of the patients in the low-risk group who ultimately were diagnosed. "The AI tool could identify non-smokers at a high risk of developing lung cancer over the next six years," said senior author Michael T. Lu, M.D., director of artificial intelligence and co-director of CIRC at MGH, in an email to Fox News Digital. "The AI accomplished this by ‘looking’ at existing chest X-ray images obtained for cough, fever or other routine indications." Chest X-rays are one of the most common medical tests, Lu noted. "The underlying idea is that there is information on the chest X-ray about the individual’s health and risk of cancer that we currently don’t use, but can be extracted from the image using AI," he said. "This is a way to get more value out of existing chest X-rays, and for patients to make more personalized decisions about their health." The study findings could help open up new detection opportunities for non-smokers, who tend to fall between the cracks when it comes to screening for this disease. "Lung cancer is increasingly common in non-smokers, but currently we have very limited tools to tell who is at risk of lung cancer and who could benefit from further tests like lung cancer screening chest CT scans," Lu said. "Since cigarette smoking rates are declining, approaches to detect[ing] lung cancer early in those who do not smoke are going to be increasingly important," he added. Current guidelines from the United States Preventive Services Task Force (USPSTF) and Medicare recommend lung cancer screenings for adults between the ages of 50 and 80 who have at least a 20-pack-year smoking history and who currently smoke or have quit within the past 15 years. There is no recommended screening for people who have never smoked or have only smoked very little. "However, lung cancer is increasingly common in never-smokers and often presents at an advanced stage," said the study's lead author, Anika S. Walia, a medical student at Boston University School of Medicine and researcher at CIRC, in a statement. The main limitation of the study is that it was retrospective, meaning the researchers looked at people who had chest X-rays in the past. "This was necessary to be able to know who was later diagnosed with lung cancer in the six years after the chest X-ray," Lu noted. Looking ahead, the study authors said that a clinical trial is necessary to determine whether high-risk people identified by the AI tool would benefit from further tests. "Lung cancer screening CT is much more accurate than chest X-ray for detecting lung cancer, but it is not feasible or desirable for all non-smokers to get" a CT scan, Lu said. "This AI tool could help identify the non-smokers at the highest risk who are most likely to benefit from CT." Dr. Harvey Castro, a Dallas, Texas-based board-certified emergency medicine physician and national speaker on artificial intelligence in health care, was not involved in the study but offered his input on the findings. "The use of AI to predict lung cancer risk in never-smokers is a significant advancement," he told Fox News Digital in an email. "It addresses a gap in current screening guidelines, which primarily focus on individuals with a history of smoking." He noted that the model's use of routine chest X-rays makes it a "potentially accessible and cost-effective tool for early detection." "Around 10% to 20% of lung cancers occur in people who have never smoked cigarettes or have smoked fewer than 100 total cigarettes." The fact that the AI model was developed and validated using a large dataset adds credibility to its predictive power, Castro added. The expert pointed out some caveats, however. "There is a potential risk of overdiagnosis and overtreatment," he said. The potential for ethical and privacy concerns could also be a concern, Castro noted. "The use of AI in health care raises questions about data privacy and the ethical implications of algorithm-based decision-making," he said. Castro also called for the study to be replicated in diverse populations to ensure that it applies across different demographic groups. "Longer-term studies beyond six years would also be beneficial to understand the full implications of using this AI tool." Overall, Castro said the study presents a "promising tool" for lung cancer screening in never-smokers, but that it requires careful consideration of its potential risks and limitations. "As an ER physician interested in AI and health care, such insights are crucial for evaluating the practical and ethical implications of integrating AI into clinical practice," he said. Lung cancer is the leading cause of cancer death, with around 238,340 new cases and 127,070 deaths expected in the U.S. this year, according to the American Cancer Society. Around 10% to 20% of lung cancers occur in people who have never smoked cigarettes or have smoked fewer than 100 total cigarettes in their lives.
Medical Innovations
Buttock enlargement surgery - also known as a Brazilian butt-lift (BBL) - is the fastest-growing cosmetic surgery procedure but also one of the most dangerous. This week, a coroner said she would write to the government to try to prevent any more deaths after Melissa Kerr, 31, died in Turkey during an operation - so what is the appeal of the surgery? What happened to Melissa Kerr? Ms Kerr, from Gorleston, in Norfolk, died at a private hospital in Istanbul, in November 2019 while undergoing the procedure. A fatal clot travelled to her lungs after fat taken during a liposuction procedure was injected into her buttocks. She handed over £3,200 in cash for the surgery, but at the Norwich inquest coroner Jacqueline Lake found Ms Kerr was not given enough information to make a safe decision about the procedure. Ms Lake says she will now be writing a "prevention of future deaths" report in the hope fatalities of cosmetic surgery tourists "can be prevented by way of better information". BBLs carry the highest risk of all cosmetic surgeries - with more than one death occurring per 4,000 procedures, the inquest was told. What is a Brazilian butt-lift (BBL)? BBLs are used to make buttocks bigger, more rounded or lifted. Surgeons insert silicone-filled implants and/or inject fat transferred from other parts of the body. Despite the dangers, the British Association of Aesthetic Plastic Surgeons (BAAPS) says the procedure is the fastest-growing type of cosmetic surgery, with its popularity increasing by 20% year-on-year. It now recommends surgeons only carry out a procedure called superficial gluteal lipofilling (SGL). While it uses fat collected from the body, this is only injected below the skin whereas BBLs insert fat deep into the muscles. It also recommends surgeons should only carry out SGLs while simultaneously using ultrasound scans so they can see where the cannulas are going. Why do people want them? Ms Kerr, a psychological well-being practitioner at mental health charity Mind, was "self-conscious" about her appearance. Her twin sister, Natasha Kerr, told the BBC that Melissa - who had two Masters degrees - "became unhappy about her body due to weight gain and after exhausting all other avenues, she felt there was no other option than to have surgery". Consultant clinical psychologist Dr Anu Sayal-Bennett, a chartered member of the British Psychological Society, says she feels the allure of celebrity culture and choreographed social media images are behind the trend for BBLs. She says celebrities like Kim Kardashian, with their strikingly curvaceous bodies, are fuelling a fashion. "Despite there being so much about body positivity, there are pressures for women - and men too - to look a certain way," added Dr Sayal-Bennett. Plastic surgeons often refer their patients to her as they recognise the importance of psychological screenings. Those surgeons' ethics are such, she says, that if patients don't meet the criteria then they will not operate - but she warns this is not the case across the world. Why are people so keen to travel abroad to have a Brazilian butt-lift? Adverts for cosmetic surgery clinics in Turkey show glamorous images of women in swimsuits promoting the surgery, alongside special offers for patients combining procedures. Dr Sayal-Bennett says the advertising is "terribly seductive". "The glossy adverts: you can get your BBL, sip your cocktails and have your beach holiday and it's cheap at the price. "But it's an illusion - it's major surgery." It is mainly the cost that is the deciding factor, says Dr Nora Nugent, vice-president of BAAPS. "In the UK, the surgery can cost between £6,000 and £12,000, but can be more. "Adverts I've seen for the procedure in Turkey range from £3,500 to £5,000," Dr Nugent adds. "Some people went overseas when surgeons who follow BAAPS guidelines weren't carrying out the procedure between 2018 and 2022." Both experts agree the glossy images from overseas belie the reality. "The buttocks are swollen, sore and bruised and where the fat has been taken out - which can be at several sites - there is swelling and bruising there as well, explains Dr Nugent. "You need padded dressings and compression bandages so you're not going to be sitting on a beach." Both doctors stress the importance of aftercare following the surgery. Why is the procedure so risky? UK inquests have been held into the deaths of three women - Melissa Kerr, Abimbola Ajoke Bamgbose, from Dartford, Kent, and Leah Cambridge, from Leeds - who travelled to Turkey for BBLs or linked procedures. People have died during BBLs due to fat being injected into large veins which then travels to the major organs. The high fatality risk prompted BAAPS in 2018 to ask its members not to carry out the surgery. It found complications ranged from severe bacterial infections including MRSA, necrosis - where tissue dies - scarring, wound ruptures and abscesses. In 2018, BAAPS heard how one London hospital had experienced a six-fold increase since 2013 in cases needing urgent follow-up care from surgeries carried out abroad. While Ms Kerr's inquest heard mortality rates were one in 4,000, Dr Nugent says more recent research has shown it is likely in the range of one in 13,000 to 15,000. What should people do before travelling to Turkey? In an "unprecedented" move BAAPS issued a joint statement on patient safety with the Turkish Society of Plastic Reconstructive and Aesthetic Surgeons (TSPRAS) this summer. The organisations now urge anyone travelling to Turkey for plastic surgery to follow these new guidelines. They were put out after BAAPS found complications in patients seeking treatment abroad rose by 35% in 2022. "We cannot stop people from going overseas - our insurance and hospital costs in the UK are so much higher," says Dr Nugent. "But the least we can do is point them towards what they should be asking of their surgeons, how the procedure will be carried out and details about the routine aftercare." The new advice for any potential patients going to Turkey includes: - Check that any Turkish surgeons are TSPRAS members and have Turkish board certification - Plastic surgeons should have practiced in their speciality area for at least five years - Surgeons should offer an aftercare plan and patients should know their name and how to contact them - It is compulsory in Turkey to have a comprehensive consent form completed ahead of travel What does the Department of Health say? "All cosmetic procedures have risks that can affect people's physical and emotional health and safety standards in other countries may not be as high as in the UK," a spokesperson said. "We urge anyone considering a cosmetic procedure abroad to do their research into the standards and qualifications that apply in the country they are travelling to. "They should ensure adequate insurance arrangements are in place and that they have access to appropriate aftercare in the UK in the event of any complications. "Our sympathies go out to Melissa Kerr's family and we will look into concerns raised in the coroner's report."
Medical Innovations
A new implant targeting Nature Medicine on Monday.has restored one man's ability to walk after 25 years of suffering from the disease, according to a study published in the journal Marc Gauthier, 63, was diagnosed with Parkinson's at age 36 and experienced decreased locomotive functioning as the illness progressed. With help from the experimental, surgically implanted device, he is now able to walk over three miles without stopping, according to the study. "Getting into an elevator ... sounds simple. For me, before, it was impossible," Gauthier said in an interview with NeuroRestore, a Swiss research and treatment center that works to restore neurological functions. "I was skating, I was freezing. Now ... I have no problem," he added. Parkinson's is a brain disorder that results in. Roughly 90% of patients with advanced Parkinson's disease experience what the study calls "locomotor deficits," which impact the ability to walk freely. Though there is currently no known cure for Parkinson's, it is becoming increasingly treatable. The epidural implant, developed by the Swiss Federal Institute of Technology, University Hospital Lausanne and NeuroRestore, sits on the lower region of the spinal cord and sends signals to the legs through the brain. As the implant stimulates those nerves, it works to "alleviate asymmetry and promote longer steps, improve balance and reduce freezing of gait," allowing the leg muscles to move more comfortably, according to the study. In Gauthier's case, a small generator embedded in his abdominal skin supplied direct power to the implant. Following the implantation, rehabilitation sessions were conducted two to three times a week for three months. Researchers remain cautious about the therapy's future prospects. "This is only one participant," said Grégoire Courtine, director of NeuroRestore and a neuroscientist himself. "We don't know whether all the individuals with Parkinson's disease will respond to the therapy," Courtine said, adding that the team is "committed" to building out the technology and testing it on six additional patients in the near future. for more features.
Medical Innovations
Respiratory infections like the common cold often start with a stuffy nose, and this minor ailment is sometimes followed by pain and tenderness around the cheeks, eyes and forehead — a telltale symptom of blocked sinuses. But what do clogged sinuses actually look like? To paint this mucus-filled picture, let's first discuss what the sinuses are and how they function in the body. "It is easiest to think of the nasal passageway as a main highway, with the sinuses as rest stops," Dr. John Fornadley, an ear, nose and throat specialist and a clinical associate professor of surgery at Penn State, told Live Science by email. The sinuses are four pairs of small, air-filled cavities lined with a layer of mucus. Two pairs of sinuses are located inside facial bones — one pair in the cheekbones, or "maxillary" bones, and another pair in the frontal bone just above the eyes. The other two pairs of sinuses are located within skull bones that sit just behind the nose, according to the medical resource StatPearls. All the sinus cavities are connected to the main nasal passageway through a network of narrow tunnels, and they also connect to one another, Fornadley said. This unique structure helps sinuses fulfill a number of important roles in the body. For instance, the hollow cavities reduce the weight of the head and help cushion the brain from potential damage that could be caused by traumatic injuries to the face, according to StatPearls. They also vibrate as we speak, which boosts the resonance, or deep quality, of our voices; this is why people with clogged sinuses may speak with a flat, nasal voice. Of course, one of the most important functions of sinuses relates to breathing. When you inhale air through your nose or mouth, it passes through the sinuses and begins to warm to body temperature. The tissues of the sinuses have an ample blood supply that helps warm up the air, and these tissues also produce mucus that helps to moisturize the air and clear it of pollutants, such as dust particles and bacteria, according to StatPearls. This prevents cold, dry air from harming the lungs and also helps oxygen pass from the lungs into the blood. The sinuses drain any excess mucus through the passages that connect to the nasal cavity. Blocked sinus symptoms can start when these cavities don't drain properly. Nasal congestion, which causes the tissues in the nose to swell and leads to rapid mucus buildup, is one of the main culprits that can block these openings and stop the normal drainage of mucus from the sinus cavities. "Nasal obstruction can cause sinus congestion the same way a clogged sewer pipe can make the bathtub slow to drain," Fornadley said. So when your sinuses feel clogged, you can imagine mucus pooling around these openings and trickling out very slowly. When mucus gets trapped in the sinuses, it often leads to sinusitis, a condition in which the sinus lining gets swollen and inflamed, according to the American College of Allergy, Asthma & Immunology. Sinusitis causes pain and tenderness around the cheeks, eyes and forehead, as well as additional symptoms such as jaw pain, fever, coughing and fatigue. Sinusitis brought on by respiratory viruses cannot be treated with antibiotics, but some symptoms can be managed with decongestants. This type of medication works by reducing swelling in the blood vessels and tissues of the nose, which helps reopen up the sinus passages, according to the Cleveland Clinic. (Be wary, though, as some popular decongestants have recently been found not to work.) This article is for informational purposes only and is not meant to offer medical advice. Live Science newsletter Stay up to date on the latest science news by signing up for our Essentials newsletter. Anna Gora is a health writer at Live Science, having previously worked across Coach, Fit&Well, T3, TechRadar and Tom's Guide. She is a certified personal trainer, nutritionist and health coach with nearly 10 years of professional experience. Anna holds a Bachelor's degree in Nutrition from the Warsaw University of Life Sciences, a Master’s degree in Nutrition, Physical Activity & Public Health from the University of Bristol, as well as various health coaching certificates. She is passionate about empowering people to live a healthy lifestyle and promoting the benefits of a plant-based diet.
Disease Research
People would be allowed to grow six marijuana plants for personal use and give their friends pot as a gift under a proposed law being introduced to the New South Wales parliament on Wednesday, as the government comes under more pressure to enact drug reform. The legislation would also allow people to carry up to 50g of cannabis, in a change that Legalise Cannabis MP Jeremy Buckingham hopes would reduce the number of Aboriginal people caught under laws he believes are racist. Government data obtained by Guardian Australia reveals Aboriginal people were 10 times more likely to have a marijuana-related interaction with police than non-Indigenous people. “It is clear that cannabis prohibition is a racist law,” Buckingham said. “It is clear it being used to target young Aboriginal Australians.” The data revealed through questions on notice to the parliament shows that, between 2020 and 2022, there were 54,174 people caught by police with cannabis. Of those, 19,232 were Aboriginal people. While First Nations people accounted for more than 35% of all interactions over the three years, just 3.5% of the NSW population is Aboriginal. Buckingham said the statistics showed the “laws are being used against First Nations people”. “In a lot of instances, this is a ‘crime’ that is the first interaction First Nations people have with police,” he said. Under the proposed changes, adults would be allowed to grow up to six plants at home, either indoors or outdoors, and could give other adults their harvest as long as it was not sold. Buckingham will introduce the bill during the final sitting week of the year, with the intention for it to be referred to a committee for further consideration before the government’s promised drug summit. The government went to the election promising to hold a drug summit at which reforms would be discussed but the premier, Chris Minns, has repeatedly refused to outline a timeframe other than saying it will happen in 2024. Earlier in the year the government announced people who were caught with small quantities of illicit drugs for personal use could be issued with fines that they could work off by seeking help as part of a drug law overhaul. Advocates have welcomed the introduction of the diversion scheme but said the changes do not go far enough, with a group of people who took part in NSW’s last drug summit in 1999 to gather at parliament on Wednesday to call for urgent reform. The long-serving former Labor premier Bob Carr and the Sydney lord mayor, Clover Moore, were among those scheduled to attend, 25 years after they took part in the event which resulted in the creation of the state’s safe injecting room. “At the beginning of the drug summit the catchcry was courage,” Carr said. “I still believe that courage is vital in this difficult area of drug policy.” The Uniting church, which runs the safe injecting room in Kings Cross, is calling on Minns’ government to announce a date for its own drug summit after the event at parliament on Wednesday. Uniting’s head of advocacy, Emma Maiden, said the decriminalisation of drugs in NSW would have a “profound impact” on reducing First Nations incarceration rates and remove the stigma for drug users around seeking help. The ACT recently passed laws reducing the penalties for people possessing small amounts of drugs including cocaine, heroin and methamphetamine for personal use. Maiden called on the government to emulate the 1999 summit by shutting down parliament for five days and inviting all MPs to attend. “We’re just hope that nothing’s ruled out,” she said. “We don’t want possible solutions taken off the table.”
Drug Discoveries
By Steven R. Feldman, MD, PhD, as told to Jodi Helmer When you have psoriasis, your immune system overreacts and causes inflammation. It can cause plaques -- red, thick, itchy, inflamed patches of skin -- along with silver-colored scales, cracked skin, and swollen and stiff joints. These can be embarrassing and uncomfortable, and may leave you wondering whether the symptoms will ever disappear. There's no cure for this disease. But there are treatments that work to reduce symptoms and can help you achieve the goal of clear skin or remission. Older medicines used to treat psoriasis were quite toxic. So we'd try to get the disease under control, then reduce your dose to the lowest amount of medication possible. We usually didnât clear the skin completely because the doses of the drugs needed to do that caused too many serious side effects. Newer medications are much safer. So complete clearing is more common than it used to be. Once your psoriasis is clear, doctors often recommend that you stay on the medicine to keep it that way. Your symptoms might not come back, but that may not mean the disease is in remission. What Is Remission in Psoriasis? There's no standard definition for remission in psoriasis. You and your dermatologist may use the word âremissionâ when almost all lesions have disappeared from your skin. But the more accurate term for that state is "nearly clear." Youâre considered "completely clear" when you don't have any psoriasis lesions. The Psoriasis Area and Severity Index (PASI) score doctors use to evaluate the color, thickness, and scaling of psoriasis shows a 100% reduction in lesions when you're clear. Having far fewer (or no) lesions is the goal of treatment. But even having zero lesions doesnât mean your psoriasis is in remission. True remission means that your skin is completely clear and youâre no longer taking medication to control the disease. The two terms â âcompletely clearâ and âremissionâ -- are often used to mean the same thing. A 2022 study found that almost 80% of people with psoriasis who believe their psoriasis is in remission are still getting treatment for the condition. Among this group, the average remission (or symptom-free period) lasted 31 months. The new medications for psoriasis are so effective that we wonder if some patients who are clear while on treatment might be in remission, meaning they could stay clear when they're off treatment. With some treatments, you just need a dose of medication every few months to keep your psoriasis under control. Current medications are very safe, too, so thereâs no need to stop taking them once your symptoms clear. Making Psoriasis Remission Last Your immune system is complicated, and it can be hard to predict who'll have long-term remission. People with psoriasis are genetically prone to make too much of the signaling molecules that cause inflammation and other symptoms. They may not have a drug-free remission because stopping the medication doesn't change their genes. We do know that people with guttate psoriasis -- a form of the disease that causes sudden breakouts of small plaques on your arms, legs, and torso -- tend to have long remissions once medication clears their symptoms. In most cases, you may have alternating periods of clear skin and psoriasis flares. But there isnât much data about how long psoriasis remission lasts. The American Academy of Dermatology Association notes that most periods of remission last between 1 and 12 months. Separate research shows that more than 41% of those who achieved psoriasis remission started taking medication again after a year. And 86% went back on their medication after 5 years in remission. You can take steps to make your remission periods last longer: Avoid injuries. Psoriasis plaques tend to pop up in areas where you have injuries to your skin. Avoiding bumps, cuts, and bruises may help prevent flares. Keep your skin moisturized. Psoriasis flares are more common in dry skin. Dry skin is also more likely to crack and bleed, making psoriasis symptoms worse. Using moisturizer and a humidifier can keep your skin from drying out and prevent flares. Also avoid harsh soaps and detergents, which dry your skin. Spend time outside. The sun helps calm your skinâs immune system, which could reduce psoriasis symptoms. But wear a hat and sunscreen on unaffected skin, even on cloudy days. Sunburn injures your skin, increasing the risk that psoriasis will come back. Eat healthy foods. Obesity is linked to increased inflammation. And eating anti-inflammatory foods like salmon, lean meats, low-fat dairy products, and lots of fruits and vegetables might help ease psoriasis symptoms. For some people, a gluten-free diet may also help. Limit alcohol, which may make your psoriasis symptoms worse. Take your medication. Staying on your psoriasis medicine even after your skin clears can help keep your psoriasis under control and let you stay symptom-free for longer periods. Work with your dermatologist to come up with a treatment plan that will help clear your skin, ease your symptoms, and maybe even get you to remission.  Show Sources Photo Credit: LightFieldStudios / Getty Images SOURCES: Steven R. Feldman, MD, PhD, professor of dermatology, Wake Forest University School of Medicine, Wake Forest, NC. Dermatology Therapy: âDemographic and Clinical Factors Associated with Patient-Reported Remission in Psoriasis.â American Academy of Dermatology Association: âHow Long Will I Have to Treat My Psoriasis?â Dermatology Therapy: âRemission Duration and Long-Term Outcomes in Patients with Moderate-to-Severe Psoriasis Treated by Biologics or Tofacitinib in Controlled Clinical Trials: A 15-Year Single-Center Experience.â National Psoriasis Foundation: âDietary Modifications.â
Disease Research
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 spokesperson 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. We have opened 108 new community diagnostic centres and these have delivered over four million tests, checks and scans since July 2021 - supporting patients to be diagnosed and access treatment more quickly. "There are record numbers of staff working in the NHS with over 53,600 more people compared to a year ago - including over 5,400 more doctors and over 12,900 more nurses. We will publish a workforce plan shortly to ensure we have the right numbers of staff, with the right skills to continue cutting waiting lists and delivering high quality services."
Global Health
Two children who experienced intense, insatiable hunger that drove them to overeat have rare, never-before-seen genetic mutations that interfere with leptin, a key hormone that helps tell the body when it is full, a new case report says. After white fat cells make leptin, it plugs into the brainstem and hypothalamus, brain regions that help control appetite. While the "hunger hormone" ghrelin constantly fluctuates, rising with fasts and falling after food intake, leptin levels remain relatively steady and are related to the body's total amount of white fat. Thus, leptin tells the body how much energy it has stored in fat and shifts the body into "starvation mode" when those stores fall too low. Rarely, people can carry genetic mutations that interfere with the production or secretion of leptin, or effectively block its effects in the brain. Prior to the new case report, published Wednesday (June 14) in The New England Journal of Medicine, scientists had found 21 genetic variants that messed with leptin production, release or sensitivity, resulting in insatiable hunger, known as hyperphagia. In the new case report, the authors describe two unrelated children, a 14-year-old boy and a 2-year-old girl, who carried slightly different leptin-disrupting genetic mutations. Both children had high levels of leptin in their blood, which coincided with their high body fat percentages. After ruling out the Prader–Willi and Bardet–Biedl syndromes — two other rare genetic conditions that can lead to high appetite and weight gain in childhood — doctors checked each child's leptin gene, called LEP. They found that each child carried a distinct version, or variant, of the LEP gene; they named the boy's P64S and the girl's G59S. These genes coded for slightly modified versions of leptin. Through studies with human cells in lab dishes, the team tested how well the children's leptin bound to the receptor it would normally plug into in the brain. Both versions of leptin bound to the receptor, but they triggered "marginal, if any, signaling." In the presence of normal leptin, the variant versions blocked the receptor and didn't allow normal leptin to plug in. So while the children made high quantities of modified leptin, the hormone couldn't signal to the brain that their bodies contained ample amounts of stored energy. Without this signal, the kids' appetites couldn't be sated — their brains were attempting to compensate for an energy deficit that didn't exist. To treat the children, the doctors provided metreleptin, a synthetic form of leptin. At first, both kids required "higher-than-usual doses" of the treatment to overcome the effects of their leptin variants in the brain. Both children also participated in fasting and exercise programs, to help reduce their white fat and therefore their leptin production. This "eventually evoked a therapeutic response, with a normalization of food intake and satiety and weight loss," the authors wrote in the case report. Both children developed antibodies against the metreleptin, which their doctors expected, but this didn't appear to affect the drug's effectiveness. There were no serious side effects and "both patients eventually attained near-normal weight." Live Science newsletter Stay up to date on the latest science news by signing up for our Essentials newsletter. 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.
Disease Research
Photo illustration by LA Johnson/Getty Images/NPR Photo illustration by LA Johnson/Getty Images/NPR Before the overdose, Griffin Hoffmann was a sophomore, about to lead his Portland, Ore., high school's tennis team. Sienna Vaughn was a junior in Plano, Texas, who participated in Girl Scouts and cheerleading. Laird Ramirez was 17 years old living near Charlotte and competing on his high school's wrestling team. He was rarely seen without his skateboard. The teens thought they were taking prescription pills for pain and relaxation, drugs like Valium or Percocet, that they bought from friends or from social media. But the pills they took were counterfeits – they hadn't come from a pharmacy and it turned out they contained fentanyl, a potent, often deadly, synthetic opioid. Just 2 milligrams can kill you. Griffin, Sienna and Laird's deaths are part of a grim crisis happening all across the country. Their stories, taken from local news reports, are among the dozens NPR reviewed, and they illustrate a new challenge for schools this fall. "[Fentanyl's] infiltration into schools is certainly something that cannot be ignored," says Alberto Carvalho, the superintendent of the Los Angeles Unified School District. LAUSD is one of the largest districts to stock naloxone, a medicine that reverses opioid overdoses, throughout its schools. "We cannot close our eyes. We cannot look the other way," he says. Fentanyl was involved in the vast majority of all teen overdose deaths – 84% – in 2021, and the problem has been growing. According to the Centers for Disease Control and Prevention, fentanyl-related adolescent overdose deaths nearly tripled from 2019 to 2021. And nearly a quarter of those deaths involved counterfeit pills that weren't prescribed by a doctor. Lauren Tanz, an epidemiologist who studies overdose prevention at the CDC, says a number of factors contributed to these alarming numbers. "The combination of more easily available drugs – particularly highly potent drugs like fentanyl that are available via social media and through counterfeit pills – and a mental health crisis among adolescents that was exacerbated during the COVID-19 pandemic is resulting in an increase in overdose deaths among kids." This academic year, education leaders are grappling with how to approach a drug use crisis unlike any they've seen before. "If our students are having contact with these substances, considering the devastating implications and consequences," says Carvalho, "then we need to be active participants in the solution, and not necessarily shy away from it or punt it to somebody else because it falls outside of the realm of traditional education." Schools can't do it alone It's happening all across the country – from Tennessee to Texas; from Maryland to Oregon. In some cases, a single high school or school district has seen multiple fentanyl overdose deaths. School buildings have posters in the hallways memorializing students who have died. Social media posts and back-to-school messages from school staff include warnings and pleas to turn in pills students have bought online, "no questions asked." In addition to stocking naloxone – often known by the brand name Narcan – schools have revamped their drug awareness and prevention programs. Some are promoting the use of test strips to help identify if a pill contains fentanyl, although the small paper tests can still be considered drug paraphernalia and are illegal in several states. But Becky Pringle, president of the National Education Association, the nation's largest teachers union, warns schools are just one piece of the puzzle. "We can't possibly do this alone. This is not a school crisis. This is a community crisis," says the former middle school teacher. "So it's not just educators in schools. It's parents and families. It's the communities themselves. It's every level of government. We have to come together. Too often, the ills of society find the way to our schoolhouse doors, but the resources of society don't follow them." There are multiple bipartisan pieces of federal legislation aimed at supporting schools in dealing with fentanyl, including one proposed bill that would give money to schools to stock naloxone and train teachers and nurses in updated drug education. Mourning families are often leading the charge Some families of students who have died have been frustrated with how schools are responding or say schools could do more. Of the 20 largest districts in the country, only five confirmed to NPR that they stocked naloxone in all of their schools last school year. And in schools across the country, drug education is ad-hoc, not standardized and oftentimes outdated. The 2021, the National Survey of Drug Use and Health found only about 60% of surveyed 12-17-year-olds self-reported that they saw or heard drug or alcohol prevention messaging in school. Avery Kalafatas, an 18-year-old from the Bay Area, says she knew nearly nothing about fentanyl until it killed her cousin, Aidan Mullin. He was like an older brother to Kalafatas; the two shared a love of the outdoors and camping. Mullin had an interest in agriculture, and a fondness for growing peppers and playing the guitar. In November of 2020, Mullin, then 18, took what he thought was a Percocet. It contained a lethal dose of fentanyl. His death was a devastating blow. "And it took me a while in my grieving process to obviously get past the shock and the sadness of it. But in that process, I was honestly pretty angry that this wasn't talked about more," she says. Kalafatas began to educate herself about the synthetic opioid. "As I became more aware of it through my cousin's death, I really saw a big need for more education, both among parents, and especially teens." Kalafatas founded the nonprofit Project 1 Life with a mission to educate adolescents and foster youth-led conversations about fentanyl, the deadly and frighteningly ubiquitous opioid found in so many counterfeit pills. "This isn't like the drug crisis we were dealing with 20 years ago, it's a completely different ballgame," Kalafatas says. A different ballgame because many students aren't intentionally seeking out the deadly drug they're overdosing on. Ed Ternan, a father from Pasadena, Calif., runs the nonprofit Song for Charlie with his wife, Mary. They use social media to inform teens about fentanyl-laced counterfeit prescription pills. He says the growing fentanyl crisis requires a new approach to how families and educators talk to students about drugs. "We need to revive drug education in America. In a way, we need to Narcan drug education – we need to breathe life into it, bring it back," Ternan says. He says they've learned from consulting with experts in youth mental health and drug education that the "just say no" message of the past isn't an effective way to communicate with teenagers. Instead, they craft fact-based messages they hope teenagers will actually pay attention to. Rather than focus on "Don't do drugs, they might harm you," Song for Charlie's messaging is: "You're getting ripped off. These dealers advertising on social media do not care. They don't know you, they're not your friend, and they are lying to you about what they're selling you," Ternan explains. That's what happened to Ternan's youngest son, Charlie. "He was very much the calming influence...in our family," he says. "A very steady, level-headed guy with more of a subtle, dry sense of humor." In May 2020, Charlie was on his college campus in northern California. He was weeks away from graduation, and was prepping for a job interview. He was also in pain. Ternan says his son had recently undergone back surgery. Charlie purchased what he thought was a Percocet off of Snapchat. It contained fentanyl. "He actually took it a couple hours before he was supposed to have a job interview on the phone," Ternan says. "And so he died very quickly in his room at his frat house waiting for the phone to ring at about four o'clock on a Thursday afternoon." After his son's death, Ternan says most of the information about fentanyl he could find was buried on government websites and in a smattering of news articles. "You can put that information in those places for the next 10 years, and Charlie and his friends would never have seen it because that's not where they are." Where they are is on social media. Ternan and his wife funneled their grief into action; they founded their nonprofit and partnered with social media platforms to disseminate information about fentanyl. Ternan says their messages also appeal to teenagers' strong social bonds. He's learned that telling teens to warn their friends about fentanyl is more powerful than stoking fear of their own harm. This kind of awareness could save lives. The latest research from the CDC found there were bystanders present at two thirds of teen overdose deaths. Tanz, the CDC researcher, sees this as a potential opportunity for intervention and education. "These are people that were nearby who could have intervened or responded to the overdose," she says. "It means we can educate family and friends to recognize warning signs ... and that might improve bystander response and prevent deaths." Peer-to-peer conversations have also been central to Kalafatas' efforts at Project 1 Life. "Hearing it from someone that's not an adult, parent, or teacher... makes it much more real," she says. "I think the Fentanyl crisis is an inflection point in our national conversation about drugs," Ternan explains. "It's forced us to look in the mirror and acknowledge our shortcomings and say we got to do better." Both Kalafatas and Ternan want schools to use some of the lessons they've learned to educate students. With schools also struggling to address mental health, learning loss and so many other challenges, they say it's been an uphill battle. But they also say it's a necessary one. Schools have the potential to reach millions of kids if they decide to talk to and teach students about the dangers of fentanyl. "Having these conversations, and having them right, can be the difference between life and death," Kalafatas says. Reported and written by: Elissa Nadworny and Lee V. Gaines Reporting contributed by: Sequoia Carrillo Edited by: Nicole Cohen Visual design and development by: LA Johnson
Epidemics & Outbreaks
We know that major disruptions in sleep, such as shift work, can have a profound impact on your health. This is the first study to show that even small differences in sleep timings across the week seems to be linked to differences in gut bacterial species. Some of these associations were linked to dietary differences but our data also indicates that other, as yet unknown, factors may be involved. We need intervention trials to find out whether improving sleep time consistency can lead to beneficial changes in the gut microbiome and related health outcomes.Senior author Dr Wendy Hall from the School of Life Course & Population Sciences 02 August 2023 Irregular sleep patterns associated with harmful gut bacteria New research has found irregular sleep patterns are associated with harmful bacteria in your gut. The study, published today in The European Journal of Nutrition, by researchers from King’s and ZOE, the personalised nutrition company, is the first to find multiple associations between social jet lag – the shift in your internal body clock when your sleeping patterns change between workdays and free days - and diet quality, diet habits, inflammation and gut microbiome composition in a single cohort. Previous research has shown that working shifts disrupts the body clock and can increase risk of weight gain, heart problems and diabetes. However, there is less awareness that our biological rhythms can be affected by smaller inconsistencies in sleeping patterns due to waking early with an alarm clock on workdays, for example, compared to waking naturally on non-workdays for people working regular hours. The composition of the microbes in your gut (microbiome) may negatively or positively affect your health by producing toxins or beneficial metabolites. Specific species of microbes can correspond to an individual’s risk of long-term health conditions such as diabetes, heart disease and obesity. The microbiome is influenced by the food you consume which makes the diversity of your gut adjustable. In a cohort of 934 people from the ZOE PREDICT study, the largest ongoing nutritional study of its kind, researchers assessed blood, stool and gut microbiome samples as well as glucose measurements in those whose sleep was irregular compared to those who had a routine sleep schedule. While previous studies into the association between social jet lag and metabolic risk factors have been done in populations with obesity or diabetes, this cohort consisted of mainly lean and healthy individuals with most getting more than seven hours sleep per night throughout the week. Researchers found that just a 90-minute difference in the timing of the midpoint of sleep – the halfway point between sleep time and wake-up time - is associated with differences in gut microbiome composition. Having social jet lag was associated with lower overall diet quality, higher intakes of sugar-sweetened beverages, and lower intakes of fruits and nuts, which may directly influence the abundance of specific microbiota in your gut. Three out of the six microbiota species more abundant in the social jet lag group have ‘unfavourable’ associations with health. These microbes are associated with poor diet quality, indicators of obesity and cardiometabolic health, and markers in your blood related to higher levels of inflammation and cardiovascular risk. Sleep is a key pillar of health, and this research is particularly timely given the growing interest in circadian rhythms and the gut microbiome. Even a 90-minute difference in the mid-point of sleep can encourage microbiota species which have unfavourable associations with your health.First author Kate Bermingham, PhD, from the School of Life Course & Population Sciences and senior nutrition scientist at ZOE Previous research has found social jetlag is associated with weight gain, chronic illness and mental fatigue. Dr Sarah Berry from King’s College London and chief scientist at ZOE added: “Maintaining regular sleep patterns, so when we go to bed and when we wake each day, is an easily adjustable lifestyle behaviour we can all do, that may impact your health via your gut microbiome for the better.”
Nutrition Research
Until recently, our understanding of Parkinson's disease has been quite limited, which has been apparent in the limited treatment options and management of this debilitating condition. Our recent understanding has primarily revolved around the genetic factors responsible for familial cases, while the causative factors in the vast majority of patients remained unknown. However, in a new study, researchers from the University of Copenhagen have unveiled new insights into the workings of the brain in Parkinson's patients. Leading the groundbreaking discovery is Professor Shohreh Issazadeh-Navikas. “For the first time, we can show that mitochondria, the vital energy producers within brain cells, particularly neurons, undergo damage, leading to disruptions in mitochondrial DNA[LP1] . This initiates and spreads the disease like a wildfire through the brain,” says Shohreh Issazadeh-Navikas and adds: “Our findings establish that the spread of the damaged genetic material, the mitochondrial DNA, causes the symptoms reminiscent of Parkinson’s disease and its progression to dementia.” Parkinson's disease is a chronic condition that affects the central nervous system, leading to symptoms such as difficulty walking, tremors, cognitive challenges, and, eventually, dementia.[LP2] The disease afflicts over 10 million people worldwide. While there is currently no cure, certain medical treatments can offer relief from its symptoms. Small fragments of mitochondrial DNA spreads the disease By examining both human and mouse brains, researchers discovered that the damage to mitochondria in brain cells occurs and spreads when these cells have defects in anti-viral response genes. They sought to understand why this damage occurred and how it contributed to the disease. Their search led to a remarkable revelation. “Small fragments of – actually DNA – from the mitochondria are released into the cell. When these fragments of damaged DNA are misplaced, they become toxic to the cell, prompting nerve cells to expel this toxic mitochondrial DNA,” Shohreh Issazadeh-Navikas explains. “Given the interconnected nature of brain cells, these toxic DNA fragments spread to neighboring and distant cells, similar to an uncontrolled forest fire sparked by a casual bonfire” she adds. The dream is a blood sample Shohreh Issazadeh-Navikas envisions that this study marks the initial stride towards a better understanding of the disease, and the development of future treatments, diagnostics, and measurement of treatment efficacy for Parkinson’s disease. She also expressed hope that “detecting the damaged mitochondrial DNA could serve as an early biomarker for disease development”. Biomarkers are objective indicators of specific medical conditions observed in patients. While some biomarkers are common, such as blood pressure, body temperature and body mass index, others provide insights into particular diseases, like gene mutations in cancer or level of blood sugar for diabetes. Identifying a biomarker for Parkinson’s disease holds significant promise for enhancing future treatments. “It could be possible that the damage of the mitochondrial DNA in the brain cells leaks from the brain into the blood. That would make it possible to take a small sample of a patient’s blood as a way of diagnosing early on or to establish the favorable response to future treatments.” Professor Issazadeh-Navikas also envisions the possibility of detection of damaged mitochondrial DNA in the bloodstream, making it feasible to diagnose the disease or gauge treatment responses through a simple blood test. The researchers' next endeavor involves investigating how mitochondrial DNA damage can serve as predictive markers for different disease stages and progression. “Furthermore, we are dedicated to exploring potential therapeutic strategies aimed at restoring normal mitochondrial function to rectify the mitochondrial dysfunctions implicated in the disease.” You can read “Mitochondrial DNA damage triggers spread of Parkinson's disease-like pathology “ in Molecular Psychiatry. Journal Molecular Psychiatry Article Title Mitochondrial DNA damage triggers spread of Parkinson’s disease-like pathology Article Publication Date 2-Oct-2023 COI Statement The authors declare no competing interests.
Disease Research
Plans are under way to restart COVID surveillance ahead of winter. The announcement comes after the rollout of vaccines was brought forward due to a new variant emerging, one which officials have indicated is the most concerning since the arrival of Omicron. BA.2.86, which was detected in the UK, last month, has a "high number of mutations" and may already be causing "significant community transmission" among Britons. Read more: Should we be worried about new COVID variant? The UK Health Security Agency (UKHSA) said surveillance would resume to deal with a time of year when the NHS always faces increased demand due to seasonal illnesses. Schools returning from holidays also drive respiratory diseases, though this could be neutered somewhat by the concrete crisis which has seen some forced to stay shut. Professor Steven Riley, UKHSA's director general of data, analytics, and surveillance, said: "Plans for the restart of COVID-19 surveillance for the winter season, when health pressures usually rise, is in progress and UKHSA will make a further announcement regarding 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.'' But there will be no ramping up of routine testing, which has long been absent across the UK, while there is no suggestion people will be asked to take precautions like wearing masks. Instead, UKHSA and NHS officials are urging people to take up the offer of a booster jab when it comes. The rollout will start among care home residents and those who are immunocompromised on 11 September, and then pregnant women, carers, social care staff, and people aged 65 and over. It was originally not due to start until October. Latest figures show the number of people in hospital with COVID-19 in England has reached a three-month high, with 3.4 admissions per 100,000 people in the week to 27 August. The highest admission rates concern people aged 85 and older, at 34.2 per 100,000. It is too early to determine if the rise is linked to the new variant, with other factors - like increased socialising - also possible contributors. The overall numbers also remain well below those seen in the spring (10.5 per 100,000) and last Christmas (11.8).
Epidemics & Outbreaks
That existential concern is what drives much of the drama in the blockbuster film. And though it never quite reaches the level of full-blown pathology for Robbie’s Barbie or America Ferrara's Gloria, who also struggles with "irrepressible thoughts of death," it certainly raises a question: When does the fear of death — actually called thanatophobia, but also known as a preoccupation with death, having intrusive thoughts of death and “death anxiety” — constitute a mental-health crisis? “There are many terms which people use to talk about this fear, and often they are used interchangeably,” explains Rachel Menzies, psychologist, prominent death-anxiety researcher and director of the Sydney, Australia-based Menzies Anxiety Centre, for the “psychological treatment of death-anxiety and related conditions.” “There is currently no formal diagnosis for death anxiety, although some people consider it a type of specific phobia,” she tells Yahoo Life. “However, you can think of death anxiety as a normal and universal part of being human, in that all of us have to grapple with our awareness of death and the discomfort that can come with this. When the anxiety becomes more severe, this is when it is particularly important to seek help.” Menzies stresses that “all of us can likely benefit from facing our mortality and normalizing death,” which is partly why she so appreciated Barbie, which she recently watched. “I thought it did an excellent job at depicting and normalizing death anxiety … I've already had a few conversations with patients about it and it seems to have really struck a chord with people.” Death anxiety, in general, she explains, “refers to any negative feeling people may have about death or dying. This can include feelings of fear, dread or sadness. It is completely normal to think about death, and death anxiety exists on a spectrum, such that some people will experience only mild discomfort about death and dying, whereas others may experience intense distress.” It can also, when harnessed correctly, be a positive force in our lives, according to psychologist David Rosmarin, founder of Center for Anxiety in New York and Boston and Harvard Medical School associate professor. "On one hand, it’s a good thing, because death is inevitable, and being aware of our mortality can have positive effects: It can make us more humble, it can make us think twice before we do certain things, it can make us more cautious, it can make us think about issues of greater meaning and purpose and why we’re here," he tells Yahoo Life. "So, it’s a double-edged sword." Here's what to know about death anxiety. Take note if anxiety over death disrupts your daily existence “When it becomes invasive and disrupts your normal functioning, or interferes with your quality of life, then it’s problematic,” Elaine Eshbaugh, professor of gerontology at the University of Northern Iowa who has researched death anxiety, tells Yahoo Life. Other red flags are if it impacts your relationships or work life, adds Menzies, who says, “If people are finding that they are routinely troubled by thoughts of their own death or that of others, or that it is impacting their mood, or leading to unhelpful coping behaviors, this is usually a sign that they could benefit from getting professional support.” Rosmarin says that having severe enough death anxiety to warrant treatment is a rarity, noting, "We see more than 1,000 patients a year, but if we see one or two with death anxiety, that would be a lot." Similarly, he says, thanatophobia is a "rare phobia — it’s not like, snakes, heights, planes, death." Anxiety around death is typically not the only symptom at play “For people with severe death anxiety, it would be unlikely that they’d only be anxious about that,” notes Eshbaugh, who explains that it’s “related to generalized anxiety disorder [GAD], so it’s rare to have an overwhelming fear of death and no other anxieties.” Rosmarin adds that, with GAD, "people have multiple worries, and often they pertain to death, but typically it’s not about them but their kids or their loved ones — did their flight land? Do they have a disease?" While death anxiety is not a mental health diagnosis in and of itself, it would typically present itself as part of a “constellation of symptoms,” says Eshbaugh — not only of GAD but also possibly part depression, post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD), which would bring with it a “more irrational death anxiety, such as, ‘if I don’t [tap the table] 47 times I’m going to die,’” she says. Menzies, in fact, found in one study that, “Across 12 different disorders, death anxiety significantly predicted symptom severity." There are factors that can make some more susceptible than others Barbie may or may not find comfort in one of Eshbaugh’s findings, which is there's “a higher rate of death anxiety among females." Also seen in women, and a contributing factor, is “a higher rate of ruminative thought, meaning you can’t let go of something, and that you tend to ruminate or perseverate on an issue, no matter what that is," she says. Another factor, says Eshbaugh, is the level of interactions and familiarity with older adults — and that the lower the level, the higher the possibility of having death anxiety seems to be. Similarly, “in general, the more exposure you have had to death, the less death anxiety you have.” For individuals who actually are closer to death, either through age or illness, she adds, “it either goes up or it goes down — some of death anxiety is fear of the unknown, and when you’re in hospice, for example, you have a little less fear of the unknown. So sometimes you find the death anxiety is actually going to decrease.” Approaches to treatment A therapist’s approach will largely depend on the related diagnosis, says Eshbaugh, so if a patient is dealing with PTSD, for example, then trauma-therapy approaches such as EMDR can be effective. If the anxiety over death is a manifestation of clinical depression, then one would treat the depression, using therapy and maybe medication, “because when we’re talking about obsessive and ruminating thoughts, sometimes medication is really helpful.” But generally speaking, says Menzies, who coauthored Free Yourself from Death Anxiety: A CBT Self-Help Guide for Fear of Death and Dying, it's CBT (Cognitive Behavior Therapy), which is "the most evidence-based treatment for death anxiety. This involves addressing unhelpful beliefs which may underlie the anxiety, as well as managing behaviors which we know drive anxiety, such as avoidance behaviors, reassurance seeking, and so forth.” The clinicians at Rosmarin's center all work with CBT, which he says is "focused on change," as well as DBT (Dialectical Behavior Therapy), which is "a broader approach, but balances change with acceptance, because sometimes you can’t make those changes and you have to learn to sit with the fact that we’re imperfect." It's something Barbie (spoiler alert!) decided she's ready to sit with, choosing life — with all of its imperfections and promise of death — over her bright pink fantasy world. "Death anxiety can make life harder, but it can also make life better, and if we use it to have a better sense of meaning, of purpose, and to avoid impulsive, dangerous things, all of that is actually very positive," Rosmarin says. "Barbie decides it’s better to be a human and have the uncertainty."
Mental Health Treatments
July 19, 2023 -- Itâs well known that exercise is beneficial to oneâs health and particularly that it protects against heart disease. But how much exercise should people get? And how should they apportion their exercise time? Current guidelines (such as those from the World Health Organization and the American Heart Association) recommend at least 150 minutes (2.5 hours) of moderate-to-vigorous exercise weekly to lower the risk of cardiovascular disease and death, but these guidelines donât specify how those hours should be divided up. The U.K. National Health Service recommends spreading the exercise evenly over 4 to 5 days, or doing some every day. The question is whether exercise is just as helpful if itâs concentrated over 1 or 2 days -- sometimes called a âweekend warriorâ pattern because many people who canât exercise during the busy workweek can make the time to do so on the weekend. A new study has encouraging news for weekend warriors: Itâs the amount of exercise, not the pattern of exercise, that counts, even if the workouts arenât evenly distributed over the week. Improving Cardiovascular Risk Lead study author Shaan Khurshid, MD, MPH, instructor of medicine at Massachusetts General Hospital in Boston, shared the researchersâ motivation for conducting the study. âThe weekend warrior pattern has been studied previously, but typically relying on self-reported data, which may be biased, or too small to look at specific cardiovascular outcomes,â Khurshid said. The researchers wanted a more objective measure of how much exercise individuals were actually getting and also wanted to investigate the question in a much larger sample. To do so, they studied 89,573 participants in the U.K. Biobank, a huge biomedical database and research resource that has in-depth genetic and health information from half a million U.K. residents. The average age of the participants was 62, and a little over half were female. For 1 week, participants wore a device on their wrist that recorded their total physical activity, as well as the amount of time spent at different levels of exercise intensity. The researchers compared three exercise patterns: - Active-weekend warrior (at least 150 minutes of mild-to-moderate physical activity, with the total amount of exercise over 1 to 2 days) - Active-regular (the same amount of exercise, but spread over more time) - Inactive (less than 150 minutes). âWe saw the opportunity to leverage the largest sample of measured activity to date in order to more definitively address the question of whether activity pattern affects specific major cardiovascular diseases differently,â Khurshid said. Participants were followed for a median of 6.3 years to see if they had developed one of four types of heart problems: atrial fibrillation, heart attack, heart failure, and stroke. A little over a third of participants (33.7%) were classified as inactive, while close to a fifth (24%) were active-regular. The largest percentage (42.2%) was active-weekend warriors. After adjusting for other factors that can affect the risk of developing heart problems (such as age, sex, racial/ethnic background, tobacco use, and self-reported health and diet quality), the researchers found that both exercise patterns were associated with a lower risk of developing these conditions: - Heart attack: 25% lower for active-weekend warriors, 35% lower for active-regular - Heart failure: 38% lower for active-weekend warriors, 36% lower for active-regular - Atrial fibrillation: 22% lower for active-weekend warriors, 19% lower for active-regular - Stroke: 21% lower for active-weekend warriors, 17% lower for active regular âThe take-home is that efforts to optimize activity, even if concentrated within just a day or 2 each week, should be expected to result in improved cardiovascular risk profiles,â Khurshid said. Maintaining Good Habits Pinchas King, a 53-year-old publisher from Passaic, NJ, exercises on a regular basis. âI try to exercise every day by going on a treadmill, and I start with high-intensity exercise,â he said. King exercises for many reasons. âIt gives me ongoing energy and also has multiple health benefits, such as preventing cancer, heart disease, and neurodegenerative diseases such as Parkinsonâs,â he said. He considers himself fortunate to be able to include exercise in a regular routine but is aware that many people arenât able to do so. âThe results of this study sound good and for those people who donât have time during the week [to exercise], the study is useful,â he said. But he expressed concern that people who already have an exercise regimen spread over the course of the week âmight give up that good habit and postpone exercise until the weekend, and then maybe not end up doing it at all or doing less than the recommended amount.â King considers the â2-day optionâ as a ânice substitute when necessaryâ -- for example, if youâve been sick or have been particularly busy and were unable to exercise on a given week. âBut I think itâs better that people find time to incorporate exercise into their daily lives because waiting until the weekend might make it harder to implement.â âEvery Minute Countsâ According to the CDC, only 28% of U.S. adults get the amount of exercise recommended by the guidelines. One reason many people donât exercise enough is that their busy schedule may not allow them time. Peter Katzmarzyk, PhD, associate executive director for population and public health sciences at the Pennington Biomedical Research Center in Baton Rouge, LA, said the study findings are encouraging for people in this situation. âThese results are important as they point out that physical activity can be accumulated throughout the week in different ways, which opens up more options for busy people to get their physical activity in,â said Katzmarzyk, co-author of an accompanying editorial in which he writes, âevery minute countsâ â especially among the three-quarters of U.S. adults who donât achieve the recommended exercise goal. Khurshid agrees. âPatients should be encouraged to achieve recommended activity levels and should not be discouraged if, for whatever reasons, they are only able to focus exercise within only 1 or a few days of the week,â he said. âInstead, our findings suggest that it is the volume of activity, rather than the pattern, that matters most.âÂ
Stress and Wellness
I never thought the $99.95 Withings Body Smart would become the most contentious device in my home. In retrospect, perhaps I should have. Everybody in my life has an opinion about this scale and whether it even belongs in my bathroom. The irony is, most days, it doesn’t tell me how much I weigh. That’s by design. What drew me to the Body Smart is its Eyes-Closed Mode, which hides any number or graph from your sight. In its place, you get smiley faces, happy animations, and if you so choose, the weather and local air quality index. All your metrics — including body composition — are still recorded in the Withings app, but you can choose if and when you look at them. It seems counterintuitive. Scales, smart or otherwise, have one job: to tell you how much something weighs. But like many people, I have a fraught relationship with my bathroom scale. Before this review, I was ready to toss my $45 Eufy smart scale because I never used it. But then my doctor suggested I lose five pounds of body fat, and I was curious to see whether Eyes-Closed Mode would make the process more tolerable. So that’s what I’ve been up to these past three months — and whatever I expected to happen or however I thought I’d feel, it wasn’t this. Weighing in Like half of the global population, I, too, have struggled with my weight. I put on 50 pounds in 2015 despite no changes to my diet or activity levels. For two years, no diet or exercise regimen made a difference. Finally, I got diagnosed with polycystic ovary syndrome (PCOS), which can cause weight gain while also making it harder to lose weight. Armed with a diagnosis and treatment plan, I’ve been busting my butt ever since to “get back to normal.” (Funny story, this is how I got started testing fitness trackers and smartwatches.) By 2021, I’d managed to lose 42 pounds — before putting back on 15 pounds last year after my mom died. A crotchety doctor and review opportunity is as good a reason as any to get back on track. But before embarking, my doctor was very specific about losing five pounds of fat, not necessarily weight. If I could turn it into muscle, even better. Body recomposition — or turning fat into muscle — is no cakewalk, especially if you have a hormonal disorder. Considering the cards are stacked against me, a smart scale and its fancy bioelectrical impedance analysis (BIA) theoretically ought to help someone like me keep better track of whether a particular plan is having the intended effect. Functionally, there’s little difference between the majority of smart scales on the market. They all tell you how much you weigh, estimate your body composition, and digitally record your data within an app. So I couldn’t help but chuckle when I unboxed the Body Smart. It looked nearly identical to my Eufy scale. So much so, my spouse was unaware I’d swapped it out until they first stepped on the scale about a week after setup. That said, there are differences in the algorithms they use, build quality, companion app, and the metrics tracked. The extra $55 for the Body Smart got me four weight sensors instead of two, heart rate measurements, daily weather and air quality index readings, Wi-Fi compatibility, and a snazzier color LCD screen. The only spec where the Eufy beats out the Body Smart is that it can detect up to 16 different people compared to the Body Smart’s eight. Battery-wise, the Body Smart runs on four AAA batteries, and I still have 80 percent left after three months of regular use. Oh, and the Body Smart has an optional Withings Plus subscription for $9.95 a month or $99.95 annually. That gets you coaching, video workouts, and recipes, but it’s not at all necessary to view your metrics. For this experiment, I figured I should try using the Body Smart without Eyes-Closed Mode to see how it felt to use the device normally. That means each time I stepped on the scale, I saw my numerical weight and graphs indicating trends or whether I was in the healthy range for body fat, muscle, water, and bone density percentages. I also tested the Body Smart against other consumer BIA devices: my Eufy scale, the Samsung Galaxy Watch 5 Pro’s BIA feature, and Tempo’s new body scan feature. (The latter works similarly to Amazon’s method for its defunct Halo trackers by rendering a 3D scan of your body.) As far as accuracy, both scales were within one- or two-tenths of a pound. My bone mass, visceral fat (the “bad” kind of fat), and water percentages were also within a few percentage points of each other. Where I really saw a huge difference was in my muscle and body fat mass — the exact thing I was trying to measure! On average, Eufy said my body fat percentage was about 40–42 percent while my muscle mass was 55–56 percent. Conversely, Withings said my body fat percentage ranged between 32 and 34 percent, while my muscle mass was between 65 and 67 percent. The Galaxy Watch 5 Pro (and later, the Watch 6) said I was between 38–43 percent body fat, while the Tempo said I was 30–31 percent body fat. That’s a pretty wide range! Especially since Withings reports my average weight has remained stable within a three-pound window. All my testing was done under the same circumstances to minimize inaccuracies, but as I mention in the sidebar, BIA isn’t an especially accurate or reliable form of body composition analysis. What’s more important was that Withings delivered consistent results time after time. But even with all this context, viewing these numbers and graphs did a whammy on my confidence and mental health. So after using the Body Smart normally for two weeks, I was very ready to dive into Eyes-Closed Mode. Eyes-Closed Mode A smart scale that records but doesn’t show you your weight isn’t new. It was a feature on the QardioBase 2, which I tested a few years ago. But I’m not the same person I was then. Now feels about the right time to note that before my PCOS journey, I struggled with lifelong disordered eating and body dysmorphia. When I reviewed the QardioBase 2, I was in the thick of disordered eating habits, so its version of Eyes-Closed Mode didn’t help a lick. I’ve made a lot of progress since then, but I’m still wary of scales as a whole — even though I know it could be a helpful tool for my ultimate goals. So ostensibly, Withings’ Eyes-Closed Mode is a feature that ought to suit someone like me. I wanted to take this as an opportunity to not only gauge my physical progress but also my mental progress. It did not go how I expected, but I learned a lot. With Eyes-Closed Mode on, you never see a single graph or numerical value related to your body. It’s a smiley face, a happy animation (stars, balloons, etc.), the weather forecast, and the AQI of your neighborhood. At first, I had the urge to whip out the Withings app to see my score. Over time, I was able to forget about it for days — knowing that the data was recorded for a time when I could evaluate it with the right mindset. Immediately, I noticed how much quieter my brain was without endless pep talks about why a plateau or my weight fluctuating wasn’t an automatic sign of failure. I was able to focus on the weather forecast. It sounds stupid, but I came to enjoy it. It distracted me enough that I could plan my run or what outfit I’d wear that day. Fun things. Once New York City became engulfed in wildfire smoke, I gained an appreciation for the AQI readout. I now know that, most days, New York City hovers between low and moderate air quality. It’s also a much faster experience. When I had all the graphs enabled, waiting for each one to pop up felt like a chore. It encouraged me to dwell on the metrics longer. With this, you’re only absorbing three data points — and most of them don’t have to do with you. But you have to face the music eventually, and that’s where Eyes-Closed Mode became frustrating. On the one hand, the Withings app tries to paint a more holistic picture of your health and fitness. It focuses on your trends rather than individual data points. If you measure yourself multiple times, it presents the average for that day. There’s a ton of educational material to read to give context. It can be annoying if you’re looking for a full history of measurements, but honestly, that might be a good thing because you focus on the big picture. It also uses gentler colors when depicting unhealthy and healthy ranges for your metrics. Again, this might sound silly, but many health apps depict unhealthy zones in bright red, and it feels awful. The Withings app tries to paint a more holistic picture of your health and fitness However, if you enable integrations, you may unintentionally end up seeing your weight in other health and fitness apps. For example, I tested Lumen and a few other health gadgets at the same time. Most will ask you to input your demographic data (age, height, weight, sex, etc.) at setup. Several asked me to regularly confirm my weight or would just automatically pull in the data. You can disable the latter in permissions, but I’m human. I forgot and was treated to some unpleasant surprises. But my point is you can’t really escape your weight since so many algorithms use it to give you health insights. Essentially, this feature helped when I was on the scale, but it didn’t stop intrusive thoughts from creeping in later. That was humbling. Though I’ve made a lot of progress in healing my relationship with body image and weight, I still felt the occasional urge to obsess over the numbers. I didn’t let it get to a dangerous point, but it’s sobering to realize an earlier version of myself probably would’ve spiraled. I’m still processing the impact that this experience has had on my mental health and probably will be for a while. But right now, I wouldn’t say it was wholly negative. Technically, I succeeded in losing 0.5 percent body fat and gaining 0.5 percent muscle. It just wasn’t the panacea I’d been hoping for. A step in the right direction I relayed this whole experience to a friend of mine. She’s an avid practitioner of Olympic weightlifting who has also struggled with disordered eating. I asked what she thought about this feature and whether she’d ever consider using it to track her gains. We had a long and frank discussion about the role body fat and weight play in fitness culture, society’s obsession with thinness, and the struggle of wanting to measure progress but not at the expense of mental health. In other words, her answer was an emphatic no. I surveyed roughly 10 other friends and family about the Body Smart, its Eyes-Closed feature, and smart scales in general. While this is not representative of the general population, I figured I’d get at least one positive response. Some were curious like me, others were dismissive, but none were enthusiastic. All were at least a little wary. It broke my heart when my perfectly healthy 9-year-old cousin overheard one conversation and asked if a smart scale would help her lose weight. I wanted to review this product from this particular perspective because nothing about how I felt is unique. Sixty-two percent of female athletes and 33 percent of male athletes struggle with disordered eating. A 2023 meta-analysis found that, globally, 22 percent of children have disordered eating. A University of North Carolina survey found that 75 percent of US women have disordered eating or symptoms consistent with eating disorders. The statistics indicate that everyone knows of at least one person who is or has struggled with disordered eating. And yet, tech companies often treat this as an afterthought when designing fitness tracking features. I frequently ask companies whether they consider people with disordered eating or eating disorders when designing their products. They generally tell me yes, but in my lived experience, the onus is on consumers to “make the best choice for themselves.” To that, I say the Body Smart is an example of providing an alternative way to engage with data. The Aura Strap 2 was another gadget that added valuable context to body composition. Neither was perfect, but both prove that it’s possible for companies to do better. I can only speak to my experience, but I don’t blame the Body Smart for the complicated feelings it stirred up. This is a well-made, accessible product. I fully believe that, if used correctly, it could be a useful health-tracking tool. I’m impressed that Withings’ app design acknowledges people like me exist. That it puts in the effort to contextualize your data. If you’re looking for a smart scale, this one hits a good balance of cost, features, and thoughtfulness. Out of curiosity, I reverted to the scale’s normal mode this past week. It was a bad time, and I’ve switched back to Eyes-Closed Mode. I can’t avoid my numbers forever, and I don’t intend to — but I am grateful that I can take a break. Photography by Victoria Song / The Verge
Mental Health Treatments
A trip to a local county fair ended with a young woman developing a stroke and being rushed to the hospital after going on a new ride. Halfway through the ride, which swings fairgoers rapidly in circles, the 37-year-old woman started to develop a headache and lost coordination of the muscles on the right side of her body. She also started to walk clumsily, due to the loss of muscle control. Her husband immediately rushed her to the emergency department, where she was diagnosed with vertigo — a condition in which problems with the inner ear or part of the brain cause dizziness — and sent home with a prescription for anti-nausea drugs. However, two days later her symptoms persisted and she was taken back to hospital. Doctors involved in the case, published Aug. 26 in the journal Cureus, found that her heart rate and breathing rate had soared, and her blood pressure, which was already historically high, was also extremely elevated. They took a computed tomography (CT) scan of her brain that revealed that she had an area of dead tissue near an artery that supplies the right side of the cerebellum, part of the brain that regulates muscle movements and controls balance. This suggested that she'd had a stroke. Strokes are the fifth leading cause of death in the U.S. and occur when blood flow to the brain is interrupted, depriving tissues of oxygen and causing them to die. Risk factors include having high blood pressure, obesity, smoking and having an inactive lifestyle. In this case, the woman had a 10-year history of smoking a pack of cigarettes a day, and she had untreated high blood pressure. Doctors couldn't find the exact source of the woman's stroke, although they suspected it was caused by an embolism, in which an artery is blocked by a blood clot that traveled from another part of the body. They prescribed her medications to control her post-stroke headaches and reduce her risk of developing heart disease, and her status was tracked through physical therapy follow-up appointments. Over the next month, the woman didn't report any new symptoms of stroke and said she'd quit smoking. However, her coordination had worsened. A magnetic resonance imaging (MRI) scan of her brain showed no evidence of another stroke, but six months later, a scan of her head and neck revealed a bulge in the wall of an artery that supplies the right side of her cerebellum. The artery hadn't yet ruptured, but needed to be closely monitored, doctors concluded. Based on previous cases of people having strokes on rollercoasters and other amusement park rides, the report authors suggest that hyperextension of the neck and tearing of blood vessels may lead to ride-induced strokes. Rides commonly display health warnings, for example, for people with high blood pressure, certain heart conditions and those who are pregnant. However, it is rare to see signs highlighting potential neurological risks, they wrote. "Healthcare providers need to be vigilant in identifying and managing these cases, and further research on specific risk factors in young individuals is crucial to improving prevention and safety measures in amusement park settings," they concluded. Live Science newsletter Stay up to date on the latest science news by signing up for our Essentials newsletter. Emily is a health news writer based in London, United Kingdom. She holds a bachelor's degree in biology from Durham University and a master's degree in clinical and therapeutic neuroscience from Oxford University. She has worked in science communication, medical writing and as a local news reporter while undertaking journalism training. In 2018, she was named one of MHP Communications' 30 journalists to watch under 30. ([email protected])
Disease Research
Focused ultrasound turns chemo from shotgun blast to sniper shot When fighting cancer, chemotherapy is still a bit of a blunt instrument. By combining it with soundwaves, however, researchers have found a way to turn it into more of a scalpel than a club, sparing damage to nearby tissue and the body as a whole. Even though the number of ways doctors can fight cancer is rapidly increasing, traditional chemotherapy is still widely used to combat tumors. In fact, according to a study in The Lancet Oncology, it is predicted that the number of people needing the treatment is set to increase by 53% between 2018 and 2040. But many of the well-known issues with chemotherapy still exist: it can cause hair loss, nausea, weight loss, anemia, peripheral neuropathy, and more. Plus, because chemo drugs treat the whole body, they can cause damage to cells outside of the intended tumor targets. Attempting to make chemotherapy a more targeted solution, researchers in 2020 combined cancer-fighting chemicals with bursts of laser light to activate them at tumor sites. While that treatment shows promise, its efficacy is limited to a few millimeters below the skin, which is the maximum depth a laser beam can penetrate in order to activate the chemicals. Seeking to harness the power of the targeted activation of chemotherapeutic drugs but increase the depths at which they can function, scientists at the City University of Hong Kong (CityU) turned to the idea of using soundwaves. Working with cancer cell cultures in their lab, the researchers created a small-molecule platinum-based prodrug called cyaninplatin, which gathered at the tumor sites. Prodrugs are compounds that are inert until they are activated inside the body. They then beamed the cyaninplatin with highly-targeted ultrasound waves, which converted it to carboplatin, a common chemotherapy drug. This induced tumor death by damaging the mitochondria inside the cancer cells. The method was able to reduce cancer cell viability by 51% when tissue coverage was 1 cm thick (about 0.4 in) and 33% with tissue coverage at a thickness of 2 cm. Further testing in mice showed that the method was able to completely eliminate two tumors after six days of treatment and dramatically inhibit the growth of additional tumors. “Our well-designed functional ultrasound enables the sono-sensitized chemotherapy to be a precise tumor-specific treatment with good penetration performance,” said study co-author Zhu Guangyu from CityU's Department of Chemistry. “More importantly, our system allows the ultrasound to focus on a specific area within 8 mm, and hence highly focuses the ultrasound energy on a tiny area to activate sono-responsive prodrugs, providing an efficient approach with minimal side effects.” In addition, because cyaninplatin fluoresces, the researchers found that their method can also be used as an imaging system that can allow for 3D mapping of tumors, precise guidance of the drug particles, and real-time monitoring of the drug's accumulation in tumors. The research has been published in the journal Science Advances. Source: City University of Hong Kong
Medical Innovations
By Michelle RobertsDigital health editorThe World Health Organization says it is working with experts to come up with a new name for monkeypox. It comes after more than 30 scientists wrote last week about the "urgent need for a non-discriminatory and non-stigmatising" name for the virus and the disease it causes. Continued reference to the virus as African is both inaccurate and discriminatory, they said.Some 1,600 cases of the disease have been reported globally in recent weeks.While 72 deaths have been reported in countries where monkeypox was already endemic, none have been seen in the newly affected 32 countries, such as the UK. The World Health Organization says it will hold an emergency meeting next week to determine whether to classify the outbreak as a public health emergency of international concern - the highest alarm the UN agency can sound.The only other diseases this has happened for in the past are Swine flu, polio, Ebola, Zika and Covid. World Health Organization chief Tedros Adhanom Ghebreyesus said: "The outbreak of monkeypox is unusual and concerning. "For that reason I have decided to convene the Emergency Committee under the international health regulations next week, to assess whether this outbreak represents a public health emergency of international concern."Monkeypox is caused by the monkeypox virus, a member of the same family of viruses as smallpox, although it is much less severe.Infections are usually mild and the risk to the general population is low, but the UK government has bought stocks of smallpox vaccine to guard against it. It causes a rash that looks a bit like chickenpox. The virus can be spread when someone is in close contact with an infected person. It has not previously been described as a sexually transmitted infection, but it can be passed on by close contact.Anyone with the virus should abstain from sex while they have symptoms.
Epidemics & Outbreaks
Urgent heart and cancer care is being compromised by the ongoing doctors' strike, NHS England bosses are warning. In a letter to the British Medical Association (BMA), NHS bosses also said there were problems ensuring emergency C-section births were available. It said the 'Christmas Day' cover provided by member of the doctors' union in the walkout was not enough. But the BMA said problems were down to bad planning with hospitals not cancelling enough non-emergency care. The letter was signed by senior leaders at NHS England including the medical director Prof Sir Stephen Powis and Dame Ruth May. It was sent on Tuesday after the latest strike in England got under way, on Monday 2 October. This walkout involves both junior doctors and consultants who between them make up more than four-fifths of doctors in hospitals. The strike ends on Thursday at 07:00 BST. Emergency cover is being provided along with some basic staffing on wards. But the NHS England letter said that was not enough, pointing out the level of staffing on Christmas Day is appropriate because demand falls significantly and hospitals are much less full than they are at the moment. It went on to say NHS England was becoming "increasingly concerned about time-sensitive urgent treatment". This could include chemotherapy and urgent support for cancer patients who are unwell after treatment or patients with heart failure, a condition which means the heart does not work as well as it should, who need support. By the end of this walkout doctors will have taken part in 30 days of strike action. NHS England said the repeated walkouts had had a cumulative effect, leaving services less able to cope, partly because demand had built up. It also called for better arrangements to call doctors off the picket line if needed. BMA leader Prof Phil Banfield said: "I do not agree that the Christmas and Boxing Day model is unsafe or that is the reason for the issue detailed." He said on top of the cover provided, the BMA had agreed the NHS also had access to non-striking junior doctors and consultants - a third are not members of the union - as well as staff doctors who did not work at either grade and so were not eligible to strike. "There is clear evidence of the failure by some trusts to adequately prepare for industrial action," Prof Banfield said. "In particular the BMA is aware that some trusts have continued with significant amounts of elective activity during industrial action." More than one million appointments and treatments have been postponed since strike action in the NHS began in December. Nurses, physios and ambulance workers have also been involved in walkouts. All large-scale stoppages have now ended apart from those involving doctors, as well as action by radiographers.
Health Policy
Oregon's first-in-the-nation law that decriminalized the possession of small amounts of heroin, cocaine and other illicit drugs in favor of an emphasis on addiction treatment is facing strong headwinds in the progressive state after an explosion of public drug use fueled by the proliferation of fentanyl and a surge in deaths from opioids, including those of children. "The inability for people to live their day-to-day life without encountering open-air drug use is so pressing on urban folks' minds," said John Horvick, vice president of polling firm DHM Research. "That has very much changed people's perspective about what they think Measure 110 is." When the law was approved by 58% of Oregon voters three years ago, supporters championed Measure 110 as a revolutionary approach that would transform addiction by minimizing penalties for drug use and investing instead in recovery. But even top Democratic lawmakers who backed the law, which will likely dominate the upcoming legislative session, say they're now open to revisiting it after the biggest increase in synthetic opioid deaths among states that have reported their numbers. The cycle of addiction and homelessness spurred by fentanyl is most visible in Portland, where it's not unusual to see people using it in broad daylight on busy city streets. "Everything's on the table," said Democratic state Sen. Kate Lieber, co-chair of a new joint legislative committee created to tackle addiction. "We have got to do something to make sure that we have safer streets and that we're saving lives." Measure 110 directed the state's cannabis tax revenue toward drug addiction treatment services while decriminalizing the possession of so-called "personal use" amounts of illicit drugs. Possession of under a gram of heroin, for example, is only subject to a ticket and a maximum fine of $100. Those caught with small amounts of drugs can have the citation dismissed by calling a 24-hour hotline to complete an addiction screening within 45 days, but those who don't do a screening are not penalized for failing to pay the fine. In the first year after the law took effect in February 2021, only 1% of people who received citations for possession sought help via the hotline, state auditors found. Critics of the law say this doesn't create an incentive to seek treatment. Republican lawmakers have urged Democratic Gov. Tina Kotek to call a special session to address the issue before the Legislature reconvenes in February. They have proposed harsher sanctions for possession and other drug-related offenses, such as mandatory treatment and easing restrictions on placing people under the influence on holds in facilities such as hospitals if they pose a danger to themselves or others. "Treatment should be a requirement, not a suggestion," a group of Republican state representatives said in a letter to Kotek. Law enforcement officials who have testified before the new legislative committee on addiction have proposed reestablishing drug possession as a class A misdemeanor, which is punishable by up to a year in jail or a $6,250 fine. "We don't believe a return to incarceration is the answer, but restoring a (class A) misdemeanor for possession with diversion opportunities is critically important," Jason Edmiston, chief of police in the small, rural city of Hermiston in northeast Oregon, told the committee. However, data shows decades of criminalizing possession hasn't deterred people from using drugs. In 2022, nearly 25 million Americans, roughly 8% of the population, reported using illicit drugs other than marijuana in the previous year, according to the annual National Survey on Drug Use and Health. Some lawmakers have suggested focusing on criminalizing public drug use rather than possession. Alex Kreit, assistant professor of law at Northern Kentucky University and director of its Center on Addiction Law and Policy, said such an approach could help curb visible drug use on city streets but wouldn't address what's largely seen as the root cause: homelessness. "There are states that don't have decriminalization that have these same difficult problems with public health and public order and just quality-of-life issues related to large-scale homeless populations in downtown areas," he said, mentioning California as an example. Backers of Oregon's approach say decriminalization isn't necessarily to blame, as many other states with stricter drug laws have also reported increases in fentanyl deaths. But estimates from the U.S. Centers for Disease Control and Prevention show, among the states reporting data, Oregon had the highest increase in synthetic opioid overdose fatalities when comparing 2019 and the 12-month period ending June 30, a 13-fold surge from 84 deaths to more than 1,100. Among the next highest was neighboring Washington state, which saw its estimated synthetic opioid overdose deaths increase seven-fold when comparing those same time periods, CDC data shows. Nationally, overdose deaths involving synthetic opioids such as fentanyl roughly doubled over that time span. Roughly two-thirds of all deadly overdoses in the U.S. in the 12 months ending June 30 involved synthetic opioids, federal data shows. Supporters of Oregon's law say it was confronted by a perfect storm of broader forces, including the COVID-19 pandemic, a mental health workforce shortage and the fentanyl crisis, which didn't reach fever pitch until after the law took effect in early 2021. A group of Oregon lawmakers recently traveled to Portugal, which decriminalized the personal possession of drugs in 2001, to learn more about its policy. State Rep. Lily Morgan, the only Republican legislator on the trip, said Portugal's approach was interesting but couldn't necessarily be applied to Oregon. "The biggest glaring difference is they're still not dealing with fentanyl and meth," she said, noting the country also has universal health care. Despite public perception, the law has made some progress by directing $265 million dollars of cannabis tax revenue toward standing up the state's new addiction treatment infrastructure. The law also created what are known as Behavioral Health Resource Networks in every county, which provide care regardless of the ability to pay. The networks have ensured about 7,000 people entered treatment from January to March of this year, doubling from nearly 3,500 people from July through September 2022, state data shows. The law's funding also has been key for providers of mental health and addiction services because it has "created a sustainable, predictable funding home for services that never had that before," said Heather Jefferis, executive director of Oregon Council for Behavioral Health, which represents such providers. Horvick, the pollster, said public support for expanding treatment remains high despite pushback against the law. "It would be a mistake to overturn 110 right now because I think that would make us go backwards," Lieber, the Democratic state senator, said. "Just repealing it will not solve our problem. Even if we didn't have 110, we would still be having significant issues."
Drug Discoveries
Matthew Fowler, who lost his father Ian to Covid in April 2020, has told the Covid Inquiry that he has received abuse online after speaking about the virus. He is co-founder of Covid-19 Bereaved Families for Justice, which campaigns to learn lessons from the pandemic. Mr Fowler spoke of how people from his organisation have been "stalked via social media". He added that others had been "threatened". Tuesday marks the final day of witnesses giving evidence to the first part of the inquiry, which has focused on resilience and preparedness. It has been hearing from groups representing bereaved families across the four UK nations. What is the UK Covid-19 inquiry? - It is about going through what happened and learning lessons - No-one will be found guilty or innocent - Any recommendations made do not have to be adopted by governments - The inquiry has no formal deadline but is due to hold public hearings until 2026 - Scotland is holding a separate inquiry in addition to the wider UK one Mr Fowler's father, Ian, first developed symptoms of Covid in late March 2020 and was taken into hospital, where he tested positive and had to be intubated. Ian died on the 13 April, with Mr Fowler explaining how restrictions meant his father had to be cremated in his hospital gown: "It's not dignified for someone making their final journey." Mr Fowler, who appeared as England's representative, spoke of "Covid denial or scepticism" and said: "Anti-mask protesters, vaccine sceptics, those people have often targeted me and members of the group that I represent. "Sometimes they have gone out of the way to seek people out." He emphasised that people who had lost loved ones to Covid were treated differently, and often questioned. "Had my dad died from something else, say cancer, people wouldn't be coming to me and saying 'well, was it really cancer?'. "It's something that has been very unique to our loss to be targeted in that way." Inquiry chairwoman Baroness Heather Hallett responded by saying such abuse was "plain cruel". "Your father was obviously a very special man and his death a great loss to you, your family and - by the sounds of it - the local community," she said. "So you've done him honour in the work that you've done. And I promise I will answer as many of the questions and learn any lessons that I can in the course of this inquiry." The inquiry also heard from Jane Morrison, who represents Scottish Covid Bereaved. She lost her wife Jacky in 2020, five days after she caught Covid in hospital. Ms Morrison began her evidence by thanking key workers, who took that "extra, often small, compassionate step". "It's a moment of kindness in a dark world," she added. There is currently a separate Scottish Covid-19 Inquiry going on, but it is yet to hold any public hearings. Ms Morrison said one of the main concerns for her organisation was infection control in hospitals - describing it as "close to my heart". She also said the handling of funerals by government officials was traumatic. She went into hospital to say goodbye to her wife - but then had to immediately isolate after her death. "If someone had been with a loved one at the end, they had a choice," she said. "You can either come in and be with them at the end or you can go to the funeral. But you can't do both, because you need to be in isolation." Anna-Louise Marsh-Rees also gave evidence, as leader of Covid-19 Bereaved Families for Justice Cymru. She said her father Ian died aged 85, after catching the virus in hospital - he had originally been admitted in October 2020 for gallbladder problems. The health board told her 13 patients on Mr Marsh-Rees's ward tested positive during his time there, as well as 14 members of staff. Ms Marsh-Rees said it was "awful" to watch her father, who had been shielding at home for months to protect himself, "die gasping for breath". She added that many members of her group are "haunted" by the idea of going to hospitals and no longer feel they are a safe place. "People used to say they're in the right place when they go to hospital. I'm not sure if they would say that any more." She said that after his death he was "zipped away", and his belongings put in a Tesco carrier bag. She now wants to change the way deaths are handled by health boards. She said it was important to prepare families before and support them after the death of a loved one, from palliative care to dignity in death. "Once somebody with Covid dies, they are almost treated like toxic waste. "They are zipped away and nobody told us that you can't wash them, you can't dress them, you can't do any of those things. The funeral, the ceremonies you can't do anything," she said. The last person to give evidence to the inquiry was Brenda Doherty, whose mother Ruth Burke was the first woman to die in Northern Ireland with Covid, at the age of 82. Ms Doherty says she has many regrets, including not being able to kiss her mother one last time, or being able to bury her in her favourite red dress. Her mother died in March 2020 after being admitted to hospital after a routine X-Ray appointment. "I had been very vocal about mum's death and that she wouldn't become a statistic," she said. "Everybody will know who she was, the life she had and not just how she died."
Epidemics & Outbreaks
Two of Wales' most senior Labour ministers, including Mark Drakeford, have admitted failings over the country's planning for a pandemic. The former health minister Vaughan Gething said Wales was not prepared enough to deal with excess deaths. Plans that did exist for pandemic flu would have also left Wales vulnerable, Vaughan Gething told the Covid inquiry. Meanwhile the first minister said the Welsh government was not as prepared as it could be. However he suggested it was "unduly bleak" to suggest the problems were significant. Mr Drakeford defended the fact resources were diverted from pandemic plans to readying for a no-deal Brexit. The chief medical officer Sir Frank Atherton said on Monday that plans for the possibility of leaving the EU without a deal held up work to prepare for a flu outbreak. Vaughan Gething is currently economy minister but served as health minister from 2016 to 2021. Questioned by a barrister for the Welsh Covid bereaved families group, Mr Gething said: "One of the things I found most difficult was the dignity in death and knowing what a bad death is, and understanding that has a real impact on people left behind." He said work to increase capacity at mortuaries and crematoria "was not fully completed". "That meant that when Covid came we were not as prepared as we could and should have been, and that does⦠lead to additional pain for bereaved families," he said, adding he accepted responsibility. 'We went through PPE fast' Mr Gething appeared to agree, when it was put to him by the inquiry's counsel Kate Blackwell, that Wales' PPE stockpile had been "woefully inadequate" to deal with the pandemic being planned for. "We would go in through PPE at a much faster rate than our planning assumptions assumed we would, so actually, we found that our stockpile that should have lasted for a whole wave didn't," he said. He then added: "I think it's fair to say that the plan for an influenza pandemic would still have had challenges. "I hesitate to say it was inadequate because it's such a loaded term but certainly with all the evidence that I've seen⦠the planning for an influenza pandemic was not complete, and we would have had vulnerabilities if it had been an influenza pandemic." Under examination, the health minister said he did not question the assumption in plans for a pandemic that flu was the biggest risk. Mr Gething made the comment after he confirmed that he had not read documents, guidance and plans looking at civil emergencies and pandemic flu. "I did not read those on my entry into the post," Mr Gething said, saying they were not for ministers to read through. He did say that he received briefings on the Welsh government's preparedness for a pandemic, though. Mr Gething later added: "I didn't question the assumption that an influenza pandemic was the most likely of the pandemic risks." Minister could have spent more time planning The minister said he could have "sped up" preparedness for a pandemic if he had put more time into it. He also admitted that he had not read the report that resulted from the Cygnus exercise into preparing for pandemic flu. The counsel to the inquiry, Kate Blackwell, read out a part of the conclusions that found the UK's plans, policies and capabilities were not sufficient to cope with the severe demands of an extreme pandemics. He said if he had read it he would "have asked extra questions about what was taking place". Advisers had fed back that there was a need for improvements, and he said he had received briefings. But he added: "Looking back, I think it is fair to say that if I had put more ministerial time into this, then I may well have sped-up preparedness." In his evidence, Mark Drakeford also admitted failings but defended the work the Welsh government did do. The lead counsel to the inquiry, Hugo Keith, said that "in the round there were and there continued to be significant failings" on government preparedness for a pandemic. He cited a lack of resilience in planning, a lack of resources and a lack of updating policies. Mr Drakeford admitted that Welsh government was not as prepared as it could be, and that there were failings, but said the counsel was being "unduly bleak" . Mr Keith pressed him, asking if Mr Drakeford agreed "in terms of the consideration of whether or not structurally the system of preparedness in advance of the pandemic was simply not as good as it should have been". The first minister responded: "Put like that, I would agree. Yes." 'Dangers in front of us' He told the inquiry resources across Welsh government had to be diverted from preparing for a pandemic "into dealing with the dangers that are sitting right in front of us of leaving the European Union without a deal". He said: "At the point when the UK government decides to institute operation Yellow Hammer, and we are now facing the reality of leaving the European Union without a deal, with all the consequences that would have had for Wales, I am making a decision along with my colleagues to divert resources to deal with that. "The number of people we have in the Welsh government who have genuine expertise in civil contingency matters is relatively modest, and their skills are particularly relevant to preparing for leaving the European Union without a deal." He told the inquiry that when he became first minister in 2018 he did not receive advice from civil servants that he needed to be aware of difficulties with pandemic planning. Separately, he said the Welsh government also did not feel a need to create a Wales-specific risk assessment document to set out the risks facing the Welsh government. Asked about the principle that all risk is local, Mr Drakeford said that, at the time, "I'm not sure we would have felt there was a huge advantage to be gained from deducing Welsh specific risks when the UK government process looked like one that had the expertise to deliver it". He went on to say that "for certain purposes it is sensible from a Welsh perspective to rely on the expertise and capacity that the UK government has and we were content at this point to do so" and that creating a Welsh intermediate tier for a national risk register "did not justify the resources." But he added that there was a "community risk register" in the four local resilience forums, for things such as local-specific potential vulnerabilities such as explosions in oil refineries.
Epidemics & Outbreaks
Republican presidential candidate Vivek Ramaswamy is breaking with his party when it comes to the drug epidemic gripping communities across the nation by supporting the decriminalization, and eventual legalization, of certain hard drugs. While on the campaign trail in recent weeks, Ramaswamy frequently addressed the issue surrounding the war on drugs and the tragic prevalence of fentanyl deaths, and has offered what he's called a "bold" willingness to cross boundaries to address the demand side of the drug market to prevent such tragedies. "You don’t hear me talk about the war on drugs. I’m not a war on drugs person," Ramaswamy said while appearing at a Free State Project event in New Hampshire in June. At the event, Ramaswamy said he was "probably the only person in the modern history" of the Republican Party open to a conversation about providing "off ramps" for people to access certain hard drugs, such as "psychedelics, from ayahuasca to ketamine." Although he specifically mentioned veterans and those dealing with Post Traumatic Stress Disorder (PTSD), Ramaswamy suggested others could eventually have the same access to certain drugs, citing people who died as a result of ingesting fentanyl that he said could have survived if they had "an alternative path." "I’m eyes wide open and willing to be bold in crossing boundaries we haven’t yet crossed to address the demand side of this as well," Ramaswamy said. "I think in the long run, and I'm talking about over a long run period of time, decriminalization, serially, is an important part of the long run solution here. … That's gotta be part of the solution," he later added. Ramaswamy went on to stress the need to use the U.S. military to secure the border and combat the Mexican drug cartels enabling the importation of fentanyl, a policy point he has often touted. He repeated his stance toward drugs during an appearance on the Liberty Lockdown podcast in July, saying that rather than being "a war on drugs guy," he was "actually a path to legalization guy for a lot of different drugs, and a path to reasonable decriminalization." In the conversation, Ramaswamy noted his distinguishing of fentanyl from other illicit drugs, describing it as a poison people unknowingly take with their drug of intention. "Many veterans are dying of fentanyl. I think fewer would be dying if there was access to ayahuasca, if there was access, legal access, to psychedelics more broadly. We can talk about, we can have a reasonable conversation about ketamine and others. So, I'm in that direction," he said. In an interview the following day, Ramaswamy also argued marijuana "should be decriminalized." "We got to catch up with the times. It's not a popular position in the Republican Party, but I'd just, again, I guess I’m going to speak the truth. Whether you vote for me or not is your choice. I think the time has come to decriminalize it," he said. Opponents of the legalization of hard drugs often point to Portugal as an example of when such policies have adverse affects that some would argue end up being worse than before. Last month, The Washington Post published a story on "doubts" Portugal was now having after the nation decriminalized all drug use in 2001, citing rises in crime, the litter of drug paraphernalia, the spread of homeless encampments, year-long waits for those wishing to undergo drug rehab and overdose rates hitting a 12-year-high. When reached for comment, Ramswamy's campaign said, "The current state-level ‘legalization’ farce contributes to the culture of lawbreaking. It's literally against the law. For us to pretend otherwise only undermines the rule of law in this country. For that reason, Vivek is in favor of federal legalization of marijuana." They did not specifically address his comments on hard drugs.
Health Policy
The UK’s largest nursing union warned of a workforce “exodus” with tens of thousands of young staff leaving the profession, as NHS bosses backed calls for ministers to meet unions to agree on a pay deal and avoid further strike action. Nearly 43,000 nurses across the UK in the early stages of their careers have quit over the past five years, figures from the Royal College of Nursing (RCN) show – almost equal to the record 47,000 nursing posts now vacant in NHS England. The RCN said the loss of nurses aged 21 to 50 and midwives was “extremely concerning”. Many of those leaving between 2018 and 2022 variously said stress, burnout, inability to deliver adequate care, poor workplace culture, the pandemic and being underpaid were behind their decisions to leave. The RCN’s report, Valuing Nursing in the UK, comes as the union plans to escalate its pay dispute by withdrawing staff from emergency departments, intensive care and cancer wards in the next round of industrial action. Dates for the next strikes by nurses in England are expected to be announced within days, with the action expected to take place within a couple of weeks. The RCN is understood to be considering action across three separate days and throughout the night. The strikes, which would probably have the biggest impact on patients so far, could be compounded if junior doctors also vote to strike from next month, said NHS Providers, which represents NHS bosses. “Plans to escalate strikes even further is alarming given the significant impact they’ve already had on patients,” said Saffron Cordery, the deputy chief executive of NHS Providers. “The walkouts have led to 137,000 appointments being postponed so far, with nearly 50,000 of those being from Monday and Tuesday last week alone.” The RCN has demanded a 19% pay rise for this year, but its general secretary, Pat Cullen, has said she will call off action if ministers prove willing to discuss matching the 7% offer made by the Welsh government. Nurses in England have so far been given 4%, as recommended by the NHS pay review body, and ministers have refused to offer more. “Neither trust leaders nor their staff want patients to be impacted, but frontline workers feel they’ve been pushed to take action due to their challenging working conditions and pay levels,” Cordery said. “The only way to avert more disruption is to bring the strikes to an end, which means the government must talk to the unions now about pay for this financial year.” The RCN’s report, which draws on data from the Nursing and Midwifery Council, shows that many early-stage nurses who have quit since 2018 have left health and social care work completely. The findings build on analysis from the King’s Fund thinktank last year which found that two-thirds of nurses leaving the NHS were under the age of 45. One student nurse quoted in the RCN report spoke of no longer wanting the career. “The reality feels as though I must sacrifice my own health and wellbeing, for a less than satisfactory wage, in order to do half the job I would like to. I see nurses crying, extremely stressed but wanting to do good and yet are not given the opportunity to,” they said. The report says better pay, improved opportunities to reach leadership roles, and career progression are all important for retaining young nurses. But keeping staff from leaving might not be enough. Figures from Ucas last week pointed to an 18% fall in the number of students applying for nursing courses in England in the past year. Cullen said: “That nurses aren’t just choosing to retire early but are quitting, and not just the NHS but the profession entirely, when they’re only a few years into their career, is deeply worrying. It speaks volumes about the dire state that ministers have allowed nursing to fall into through years of underfunding and neglect. The prime minister needs to get round the negotiating table and offer a fair pay rise to stop the exodus.”
Health Policy