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Register now for FREE unlimited access to Reuters.comBRUSSELS, June 14 (Reuters) - The European Union signed on Tuesday an agreement with Bavarian Nordic (BAVA.CO) for the supply of about 110,000 doses of vaccines against monkeypox, the EU Commission and the company said.The vaccines will be bought with EU funds and delivered to EU states, EU health commissioner Stella Kyriakides said. Doses are to be delivered in proportion to the population, starting with states with the most urgent needs.Deliveries will start immediately and will be completed in the coming months, the company said. It raised its outlook for this year's financial results after the deal with the EU and other smaller deals for the supply of its vaccine.Register now for FREE unlimited access to Reuters.comAbout 900 cases of monkeypox have been reported in 19 EU countries and also in Norway and Iceland, which will be entitled to receive doses despite not being EU members, the Commission said.Test tubes labelled "Monkeypox virus positive and negative" are seen in this illustration taken May 23, 2022. REUTERS/Dado Ruvic/Illustration/File PhotoDanish biotech Bavarian Nordic's vaccine, known as Imvanex in Europe and Jynneos in the United States, has been approved against smallpox.The vaccine is not authorised yet in the EU against monkeypox, the EU Commission said."However, the smallpox vaccine also protects people from monkeypox, since this virus is closely related to the smallpox virus," the Commission said.The EU drugs regulator is currently in talks with Bavarian Nordic for a speedy approval of the vaccine also against monkeypox, the Commission said.Some EU states, including Germany and Spain, have already made their own orders for monkeypox vaccines. read more Register now for FREE unlimited access to Reuters.comReporting by Francesco Guarascio @fraguarascio, Anna Ringstrom and Bart Meijer; Editing by Ed Osmond, Kirsten DonovanOur Standards: The Thomson Reuters Trust Principles. | Vaccine Development |
Hannah Barnes’s book about the rise and calamitous fall of the Gender Identity Development Service for children (Gids), a nationally commissioned unit at the Tavistock and Portman NHS Foundation Trust in north London, is the result of intensive work, carried out across several years. A journalist at the BBC’s Newsnight, Barnes has based her account on more than 100 hours of interviews with Gids’ clinicians, former patients, and other experts, many of whom are quoted by name. It comes with 59 pages of notes, plentiful well-scrutinised statistics, and it is scrupulous and fair-minded. Several of her interviewees say they are happy either with the treatment they received at Gids, or with its practices – and she, in turn, is content to let them speak.
Such a book cannot easily be dismissed. To do so, a person would not only have to be wilfully ignorant, they would also – to use the popular language of the day – need to be appallingly unkind. This is the story of the hurt caused to potentially hundreds of children since 2011, and perhaps before that. To shrug in the face of that story – to refuse to listen to the young transgender people whose treatment caused, among other things, severe depression, sexual dysfunction, osteoporosis and stunted growth, and whose many other problems were simply ignored – requires a callousness that would be far beyond my imagination were it not for the fact that, thanks to social media, I already know such stony-heartedness to be out there.
Gids, which opened in 1989, was established to provide talking therapies to young people who were questioning their gender identity (the Tavistock, under the aegis of which it operated from 1994, is a mental health trust). But the trigger for Barnes’s interest in the unit has its beginnings in 2005, when concerns were first raised by staff over the growing number of patient referrals to endocrinologists who would prescribe hormone blockers designed to delay puberty. Such medication was recommended only in the case of children aged 16 or over. By 2011, however, Barnes contends, it appeared to be the clinic’s raison d’etre. In that year, a child of 12 was on blockers. By 2016, a 10-year-old was taking them.
Clinicians at Gids insisted the effects of these drugs were reversible; that taking them would reduce the distress experienced by gender dysphoric children; and that there was no causality between starting hormone blockers and going on to take cross-sex hormones (the latter are taken by adults who want fully to transition). Unfortunately, none of these things were true. Such drugs do have severe side effects, and while the causality between blockers and cross-sex hormones cannot be proven – all the studies into them have been designed without a control group – 98% of children who take the first go on to take the latter. Most seriously of all, as Gids’ own research suggested, they do not appear to lead to any improvement in children’s psychological wellbeing.
So why did they continue to be prescribed? As referrals to Gids grew rapidly – in 2009, it had 97; by 2020, this figure was 2,500 – so did pressure on the service. Barnes found that the clinic – which employed an unusually high number of junior staff, to whom it offered no real training – no longer had much time for the psychological work (the talking therapies) of old. But something else was happening, too. Trans charities such as Mermaids were closely – too closely – involved with Gids. Such organisations vociferously encouraged the swift prescription of drugs. This now began to happen, on occasion, after only two consultations. Once a child was on blockers, they were rarely offered follow-up appointments. Gids did not keep in touch with its patients in the long term, or keep reliable data on outcomes.
A lot of this is already known, thanks largely to a number of whistleblowers. Last February, the paediatrician Dr Hilary Cass, commissioned by the NHS, issued a highly critical interim report into the service; in July, it was announced that Gids would close in 2023. But a lot of what Barnes tells us in Time to Think is far more disturbing than anything I’ve read before. Again and again, we watch as a child’s background, however disordered, and her mental health, however fragile, are ignored by teams now interested only in gender.
The statistics are horrifying. Less than 2% of children in the UK have an autism spectrum disorder; at Gids, more than a third of referrals presented with autistic traits. Clinicians also saw high numbers of children who had been sexually abused. But for the reader, it is the stories that Barnes recounts of individuals that speak loudest. The mother of one boy whose OCD was so severe he would leave his bedroom only to shower (he did this five times a day) suspected that his notions about gender had little to do with his distress. However, from the moment he was referred to the Tavistock, he was treated as if he were female and promised an endocrinology appointment. Her son, having finally rejected the treatment he was offered by Gids, now lives as a gay man.
As Barnes makes perfectly clear, this isn’t a culture war story. This is a medical scandal, the full consequences of which may only be understood in many years’ time. Among her interviewees is Dr Paul Moran, a consultant psychiatrist who now works in Ireland. A long career in gender medicine has taught Moran that, for some adults, transition can be a “fantastic thing”. Yet in 2019, he called for Gids’ assessments of Irish children (the country does not have its own clinic for young people) to be immediately terminated, so convinced was he that its processes were “unsafe”. The be-kind brigade might also like to consider the role money played in the rise of Gids. By 2020-21, the clinic accounted for a quarter of the trust’s income.
But this isn’t to say that ideology wasn’t also in the air. Another of Barnes’s interviewees is Dr Kirsty Entwistle, an experienced clinical psychologist. When she got a job at Gids’ Leeds outpost, she told her new colleagues she didn’t have a gender identity. “I’m just female,” she said. This, she was informed, was transphobic. Barnes is rightly reluctant to ascribe the Gids culture primarily to ideology, but nevertheless, many of the clinicians she interviewed used the same word to describe it: mad.
And who can blame them? After more than 370 pages, I began to feel half mad myself. At times, the world Barnes describes, with its genitalia fashioned from colons and its fierce culture of omertà, feels like some dystopian novel. But it isn’t, of course. It really happened, and she has worked bravely and unstintingly to expose it. This is what journalism is for. | Mental Health Treatments |
CDC warns of drug-resistant, deadly fungus: How is it spread?
(NEXSTAR) – The Centers for Disease Control and Prevention has identified Candida auris as an “urgent” threat as it spreads rapidly through U.S. hospitals, tripling in just three years. The fungus is spreading “at an alarming rate,” the CDC says, but how exactly is it spreading?
This fungus likely originated in a health care setting, explained Melissa Nolan, an assistant professor of epidemiology and biostatistics at the University of South Carolina. Counterintuitively, because hospitals are disinfected so frequently, they can be the birthplace of bacteria or fungus that are resistant to antimicrobial cleaning products and to treatments.
“If you think about the amount of cleaning that we do in the hospital versus what you do at home, it’s significantly greater in a hospital setting. So every time we’re spraying Clorox … that just creates the opportunity for more resistance,” Nolan explained. “Over time, those pathogens have been able to evolve and adapt to resistance.”
Candida auris is especially good at developing on surfaces, Nolan explained. Once it grows and populates in a hospital room, for example, it is most likely to infect a patient through a medical device, like a catheter or a PICC line that delivers medicine or fluids straight into the bloodstream.
“Imagine a patient that’s been in the hospital for two weeks, for example. Even though they’re cleaning those lines regularly, you still have the opportunity for this pathogen to get on that piece of plastic equipment and then get into your bloodstream,” said Nolan.
The fungus can also enter somebody’s system through ears or wounds, the Associated Press reports.
It could transmit by touch if someone touches an infected surface, then touches a piece of medical equipment that would enter a patient’s body. But people who are just visiting a loved one in the hospital or in a nursing home, for example, are not likely to become infected.
“It’s not highly transmissible the way that SARS-CoV-2 would be,” Nolan explained. “You really have to have that long extenuated exposure that has that direct access into your skin.”
However, Candida auris is still very dangerous for those who do catch it because it is resistant to anti-fungal drugs, making it hard to treat. An infection can cause severe illness or death.
“If you get infected with this pathogen that’s resistant to any treatment, there’s no treatment we can give you to help combat it. You’re all on your own,” Nolan said.
To make matters worse, the ones who are most likely to be infected with Candida auris – people with extended stays in the hospital – are likely already immunocompromised, so their systems may not be strong enough to fight off the infection.
The fungus was first detected in the United States in 2016, but it started spreading especially fast between 2021 and 2022. Since then, Candida auris has been found more than 8,000 times in at least 28 states, according to CDC tracking.
“The rapid rise and geographic spread of cases is concerning and emphasizes the need for continued surveillance, expanded lab capacity, quicker diagnostic tests, and adherence to proven infection prevention and control,” CDC epidemiologist Dr. Meghan Lyman said in a press release.
“It really highlights the fact that we need more antibiotics, more antifungals to come on the market,” Noland added. “For the most part – with the exception of the antivirus that came out for SARS-CoV-2 – we haven’t had a new antimicrobial treatment come out in over 30 years. And that’s a real concern for us.”
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. | Epidemics & Outbreaks |
WASHINGTON, Nov 16 (Reuters) - The Biden administration on Thursday removed the Chinese Ministry of Public Security's Institute of Forensic Science from a trade sanction list, part of a bid to convince Beijing to do more to halt the flow of the synthetic opioid fentanyl into the United States.
Washington put the institute on the list in 2020 over alleged abuses against Uyghurs and other minority groups, effectively barring it from receiving most goods from U.S. suppliers.
Former Chinese ambassador to the U.S. Qin Gang last year described it as "shocking" that the U.S., which had expressed frustration over Beijing's lack of cooperation on fentanyl, would sanction an institute he described as essential to controlling the drug.
The Chinese embassy in Washington did not immediately respond to a request for comment.
Reuters had previously reported the institute would be removed as Biden sought more cooperation from Beijing on fentanyl in a meeting with China's President Xi Jinping on Wednesday in San Francisco at the Asia-Pacific Economic Cooperation (APEC) forum.
As part of the meeting, the men agreed to create a working group on counter-narcotics cooperation. The White House's National Security Council did not respond to a request for comment on what, beyond creating the working group, China pledged to do to stem shipments of the deadly narcotic.
The move was criticized by human rights activists and Republicans, who accused the Biden administration of going soft on Beijing over its treatment of Uyghurs.
Rayhan Asat, a human rights lawyer of Uyghur heritage, said she recognized the pressing issue posed by fentanyl, but that the U.S. decision raised questions about U.S. commitment to addressing China's rights abuses.
"The United States has a legal obligation, under federal law, to address atrocity crimes once they have been determined as such. The question then arises: should addressing one issue take precedence over addressing the genocide? Can't we address both?" she said.
Blocking fentanyl "precursor" chemicals has been a priority for Washington as the rate of overdose deaths involving the drug more than tripled from 2016 through 2021, according to the U.S. Centers for Disease Control and Prevention (CDC).
The removal, according to a notice posted in the Federal Register, came after a "removal proposal" was received and reviewed, the department said in the posting, by a committee composed of representatives of the departments of Commerce, State, Defense, Energy, and sometimes, the Treasury.
Reporting by Alexandra Alper, Michael Martina and Paul Grant; Editing by Doina Chiacu, Chizu Nomiyama and Josie Kao
Our Standards: The Thomson Reuters Trust Principles. | Drug Discoveries |
Scores of local pharmacies closing across England
- By Hugh Pym and Natalie Wright
- BBC News
The number of pharmacies in England has fallen by 160 over the last two years, BBC analysis shows.
There are now 11,026 community chemists, according to data from NHS Business Services Authority - the lowest number since 2015.
Rising operational costs, staff shortages and reduced government financial support have been blamed.
This is despite rising patient demand, and plans for pharmacists to provide more services to ease pressure on GPs.
Pharmacists are warning that many more local businesses could close, without help.
Online services are available, but many rely on a local chemist for advice and to pick up prescriptions.
On Tuesday, the government will publish a primary care access plan designed to improve and extend availability of consultations by GPs. Ministers have also announced £240m ($303m) for practices to replace old phones with more modern call systems and online tools to make it easier for patients to get in contact.
Part of the primary care plan is expected to include an expanded role for pharmacists, but there are concerns about their feasibility.
Many pharmacists feel they have been taken for granted and expected to offer more services, even though their real-terms funding has fallen. They estimate there has been a 30% cut in government funding over the last seven years, after taking account of inflation.
Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said there was a shortfall of £1.1bn in funding for independent pharmacies every year.
"This has led to many pharmacies severely struggling with cashflow problems," she told BBC Radio 4's Today programme, adding that because most of their work is NHS-funded, the pharmacies cannot pass on rising costs to customers.
"On top of that, we've got the workforce challenges that we have been struggling with for so many years," she said, warning "many more" pharmacies could close this year unless increased support was given.
"We are urgently needing the government to step in and provide that funding," she said.
Sanjeev Panesar owns Pan Pharmacy in Birmingham. The business was set up by his parents, and has just celebrated its 40th anniversary, but he fears services might have to be cut back, and staff numbers may also have to be reviewed.
"Things are in serious jeopardy. It's our worst year ever, where we've made a loss. We have to make some really tough calls and decisions now," he said.
Mr Panesar says he would love to support the government by helping the NHS and GP services, but said it is not possible with current financial constraints.
The workload has grown steadily, with more patients, some frustrated over lack of GP access, coming in for consultations and advice. That comes on top of the core function of dispensing medicines and treatments, while there is increasing demand for home delivery of medication.
Janet Morrison, chief executive of the Pharmaceutical Services Negotiating Committee, hopes the new plan will address long-standing problems in the sector.
"What everyone learnt during the pandemic was one of the two places that will stay open was the pharmacy - lots more people come in for advice and support that we're not paid to provide. What we've been saying to ministers is we're part of the solution because we can provide access."
Scotland scheme 'more patient-focused'
Pharmacists in England look to Scotland, where a scheme called Pharmacy First includes a contract between the sector and the Scottish government setting out what services are expected, with payment for every consultation.
These cover minor ailments and illnesses, some of which might once have been dealt with at GP practices. In England there is a less formal arrangement, with some consultations by pharmacists not remunerated. There is also more prescribing of medicines by pharmacists in Scotland.
George Romanes, who owns a chain of local pharmacies in the Scottish borders, believes the new structure works better than the arrangements south of the border.
"I used to have an English pharmacy but I sold it, and all the outlets we have now are in Scotland. I think the Scottish contract is much more patient-focused," he said.
"The fact you can come in and see a pharmacist there and then as it were, rather than needing an appointment, is very beneficial for patients, they like to get a problem sorted as quick as they can."
A Department of Health and Social Care spokesperson said an extra £100m was invested in the sector last September.
"We are supporting pharmacies to provide a range of clinical services and we are increasing the services pharmacists - who are degree-qualified medical health professionals - can provide to their community, including managing oral contraception," they said.
Mr Panesar called for political leaders, including Prime Minister Rishi Sunak, whose mother ran a pharmacy, to visit local pharmacies to see first-hand the pressures they face.
"I'd love him to come and see what we do, how patients feel about what we offer and actually, that this is serious, and that the sector is crumbling, and is going to fall down like a stack of dominoes, if there's not intervention urgently."
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Actor Kento Nagayama, 34, was arrested on Friday by the Tokyo Metropolitan Police Department on suspicion of violating the Cannabis Control Law, according to a source involved in the investigation. Nagayama is suspected of having had cannabis at his apartment in Meguro Ward, Tokyo, reported The Japan News. As part of a search carried out by agents of the Tokyo Metropolitan Police Department on Thursday night, the police found the cannabis in Nagayama's room. He is being investigated by the police for how he obtained the drug. In 2007, Nagayama made his acting debut. Since then, he has appeared in a number of movies and television dramas, including the 2010 film Sofutoboi (Softball Boys), for which he received the Japan Academy Film Award for the best new actor award. In addition, he will play the character of Keisuke Baji in the live-action film "Tokyo Revengers 2: Bloody Halloween – Destiny," which is based on the popular manga series "Tokyo Revengers." The film is scheduled for release on June 30, 2014.
In 2021, marijuana use was criminalized under revisions to Japan's cannabis control law. In 2022, the National Police Agency (NPA) reported that the number of arrests for marijuana-related incidents in Japan dipped for the first time in nine years, but remains relatively high, according to The Mainichi. During 2022, the NPA reported that 5,342 people were arrested, a decrease of 140 compared to the previous year. Among those arrested, 912 people were younger than 20, a decrease of 82 from the year prior. 53.4% of the arrests were young people in their 20s, and 17.4% were young people in their 30s. Since those under 30 made up 70% of the arrests, there are fears that the use of this drug is on the rise among young people. Of those, 160 of those arrested were university students, 150 were high school students, and 11 were in junior high school.
Japanese actor Kento Nagayama arrested on suspicion of marijuana possessionhttps://t.co/QeCtfEgiFK— The Mainichi (Japan Daily News) (@themainichi) June 17, 2023
A total of 4,054 of those arrested for marijuana possession were first-time offenders, accounting for around 75% of the total number of arrests. Of those arrested for distribution of marijuana, 225 were arrested for cultivating, 184 for receiving, and 74 were arrested for smuggling marijuana into the country. Based on the NPA's analysis of 911 suspects arrested between October and November 2022 for simple possession, 52.1% began using marijuana before they turned 20, up from 36.4% in 2017. The study also revealed that 59.6% of people who used marijuana started out of curiosity or amusement, while 18.4% used marijuana in "the mood of the moment." Furthermore, 79.5% said that marijuana has virtually no or absolutely no negative side effects. Young people may be easily able to make use of social media in order to get marijuana, according to the NPA. The agency promises to continue to remove social media posts that advertise the sale of marijuana and educate the public about the drug's harmful effects.0comments | Drug Discoveries |
Big Pharma Wants To Use AI To Increase Diversity In Clinical Trials
A medicine's effectiveness can vary across racial and ethnic groups, and drugmakers such as Johnson & Johnson are hoping to expand participation beyond the overwhelmingly White populations in current testing.
(Bloomberg Businessweek) -- Black Americans are twice as likely as their White counterparts to develop multiple myeloma, but their participation rate in clinical trials of treatments for the bone marrow cancer is a dismal 4.8%. Now drug giant Johnson & Johnson says it’s had success increasing that share by using an untraditional tool: artificial intelligence.
Algorithms helped J&J pinpoint community centers where Black patients with this cancer might seek treatment. That information helped lift the Black enrollment rate in five ongoing studies to about 10%, the company says. Prominent academic centers or clinics that have traditionally done trials are often not easily accessible by minority or low-income patients because of distance or cost.
J&J is now using AI to increase diversity in 50 trials and plans to take that number to 100 next year, says Najat Khan, chief data science officer of its pharmaceutical unit. One skin disease study that used cellphone snapshots and e-consent forms to enable patients to participate in the trial remotely managed to raise enrollment of people of color to about 50%, she says.
“You have claims data, connected to electronic health records data, connected to lab tests, and all of that de-identified and anonymized,” Khan says. “The machine-learning algorithm computes and creates a heat map for you as to where the patients eligible for that trial are.”
In recent decades, evidence has been growing that medicines don’t affect all people the same way. And the Covid-19 pandemic highlighted deep ethnic disparities in access to health care. In response, regulators and advocacy groups have been pressuring drugmakers around the world to include underrepresented racial and ethnic groups in new treatment trials, not only to improve biomedical knowledge but also to build trust in medical systems among minority groups. Many companies are turning to AI for help.
The industry could certainly use some. A recent analysis in the journal found that fewer than 20% of drugs approved in 2020 had data on treatment benefits or side effects for Black patients. Financially and socially, the lack of diversity in trials will cost the US “billions of dollars” over the next three decades, according to a 2022 report by the National Academies of Sciences, Engineering and Medicine, which pointed to factors such as premature deaths and a lack of effective medical intervention. The report also said trials that aren’t inclusive hinder innovation, fail because of low enrollment rates, undermine trust and worsen health disparities.
About 75% of participants in clinical trials for new drugs approved in 2020 were White, 11% Hispanic and 8% Black. But research shows people can react differently to medicines depending on their race, ethnicity, age, gender and sex. For example, researchers have said since the 1980s that White patients tend to have a better response to a type of antihypertensive drugs called beta blockers and a widely used class of medicines for cardiovascular disease called ACE inhibitors than Black patients. Other studies have shown that Asian cancer patients who are treated with immune checkpoint inhibitors called PD-1 and PD-L1 have significantly improved survival rates compared with non-Asians.
Regulators increasingly want drugmakers to consider such disparities when vetting new treatments. In 2014 the European Medicines Agency introduced guidance requiring drugmakers drugmakers to justify nonrepresentative clinical trials. Australia’s Therapeutic Goods Administration’s 2022 guidelines say drug study populations should represent the makeup of the broad population. And the US will soon require diversity action plans for clinical trials submitted to the Food and Drug Administration, a provision that was included in the 2023 government spending bill enacted in December.
Clinical trials are hard to run because they involve coordinating with multiple parties: patients, hospitals and contract research companies. So pharma companies have often simply relied on well-established academic medical centers, where populations may not be as diverse. But computer algorithms can help researchers quickly review vast troves of data on past medical studies, search through zillions of patient medical records from around the world and quickly assess the distribution of disease in a population. That data can help drugmakers find new networks of doctors and clinics with access to more diverse patients who fit into their clinical trials more easily—sometimes months faster and much more cheaply than if humans were reviewing the data.
“They [pharmaceutical companies] have to ask physicians to think about a patient when they see them and then think about ethnicity and race—it’s just making a difficult task even more difficult,” says Wout Brusselaers, founder of Deep 6 AI, a startup that sells AI-powered software that matches patients and trials.
AI poses new challenges for drugmakers, though, because the technology carries the risk of making things worse than they already are by introducing what’s known as algorithmic bias.
In 2019, for instance, academics said they uncovered unintentional racial bias in one software product sold by Optum Inc., a major health services company, which health centers across the country used to predict which patients needed high-risk care. The algorithm based its predictions on patients’ health-care spending, rather than the severity or the needs of their illness. Only 18% of Black patients ended up getting additional help, rather than the 47% who needed it, according to a study of the algorithm’s effects at one institution that was published in the journal . Its authors say that skew is typical of risk prediction tools that medical centers and government agencies use to service 200 million people nationwide, and that such bias likely operates in other software as well.
Optum, a unit of UnitedHealth Group Inc., says the rules-based algorithm is not racially biased. “The study in question mischaracterized a cost prediction algorithm used in a clinical analytics tool based on one health system’s incorrect use of it, which was inconsistent with any recommended use of the tool,” the company said in a response to questions.
The FDA is considering drafting recommendations for companies that are submitting AI applications for drug development to ensure their models don’t inadvertently discriminate against underserved patients.
“Additional regulatory clarity may be needed in the future, especially as we see the emergence of new AI technologies,” says Tala Fakhouri, associate director for policy analysis at the FDA. Such regulatory clarity would “take into consideration algorithmic bias.”
Some critics point out other problems. Running trials remotely or providing transportation or parking vouchers for participants would draw more minorities into trials than using AI, says Otis Brawley, a professor of oncology at Johns Hopkins University. Black populations in the US are disproportionately poor, and the hospitals looking after them often don’t have the bandwidth for extra projects such as clinical trials, he says.
“AI could do that, but I could do it, too, as long as I were allowed to pay for people’s parking—as long as I did it in resourced wealthy places,” says Brawley, who previously worked at Grady Memorial Hospital in Atlanta, where, he says, he didn’t have resources to run clinical trials. Even at Johns Hopkins, he loses minorities more so than Whites because of parking costs, he says.
Walgreens Boots Alliance Inc.—which began running clinical trials for drugmakers in 2022—has a different approach to encouraging equity in studies. It uses AI tools to locate eligible patients from diverse groups quickly, but it relies on local pharmacists at its almost 9,000 stores across the US to recruit individuals from underrepresented groups, says Ramita Tandon, who heads the clinical trial business at the pharmacy chain. “We have posters, flyers,” with information about trials, she says, or simply “pharmacists that are having the dialogue with the patients when they pick up their scripts.”
This method helped improve participation of Black patients in one cardiovascular study to 15%, Tandon says, a number that exceeds the percentage of Black people in the general population. The new FDA diversity requirements have generated lots of interest from large pharmaceutical companies in Walgreens’ clinical trials business, she says.
Elsewhere, the use of AI is going well beyond race and ethnicity. Japan’s Takeda Pharmaceutical Co. uses AI to help attract and retain diverse populations in its clinical trials, says Andrew Plump, the drugmaker’s head of research and development. AI has helped the company personalize complicated letters of consent to patients in minority groups such as in the LGBTQ community. Technology can adjust wording to correspond to how people identify themselves by gender and sexual orientation, which engenders greater trust in the process, he says.
New York-based H1, which uses generative AI to help match drugmakers with trial sites, says it’s working to remove bias from the data it collects. For example, its data on race and ethnicity can be derived from credit card and bank statements, which means it might not be capturing people who are less well off financially, says Ariel Katz, H1’s chief executive officer.
“We are doing a lot of work to make sure that we feel like our data sets are comprehensive, not biased, but there’s more work to do there,” he says.
J&J now has an AI ethics council, which includes input from academics, and it’s monitoring trials to remove data bias while increasing representation, Khan says. “We always have a human in the loop,” she says. “My team probably spends 60% or 70% of the time on this aspect versus anything else, which is making sure data is fit for purpose and appropriate and representative, and if not, procuring other data sets to make it more representative.”
©2023 Bloomberg L.P. | Drug Discoveries |
Alicia Graf Mack was about 10 years old the first time doctors had to drain fluid from her knee. It would be more than a decade of pain, surgeries, and time stolen from her career as a professional dancer before she finally learned the cause: ankylosing spondylitis (AS), an immune system condition thatâs a form of arthritis.
Some days, her knees would swell up like a grapefruit. It was hard just to walk. To perform in pointe shoes was out of the question.Â
âThereâs no way Iâll be a dancer anymore,â Graf Mack says she once thought.
Now the dean and director of the Dance Division at the Juilliard School â and the first Black person and the youngest person to hold that role â Graf Mack says AS has shaped her life in surprising ways. And she has advice to help other people get diagnosed sooner and manage it.
'I Was Training Like an Olympic Athlete'
As a teen in the Dance Theatre of Harlem, Graf Mack had symptoms that were easy to dismiss. âI was training like an Olympic athlete, so you expect aches and pains,â she says. âMost dancers have that every day.â
But her symptoms got worse. Even after surgery and rehab for a small knee cartilage tear, the pain didnât quit. She couldnât even walk to the subway to go to follow-up visits.Â
âFor 6 months or so after the surgery, no one could give me any answers,â Graf Mack says. âMy whole dream for my life was wrapped up in the health of my body. I really hit rock bottom.â
She reached out to her cousin, Jonathan Graf, MD, a rheumatology professor at the University of California San Francisco. He reviewed her medical records, concluded that she had reactive arthritis, and prescribed anti-inflammatory medication.Â
Graf Mackâs knee swelling began to ease. But over time, more problems followed. She consulted knee and ankle specialists, had more operations, and did physical therapy constantly.
With an extremely demanding physical career looking out of reach, Graf Mack started to imagine a different life. She enrolled at Columbia University, aiming for a career in arts administration. She kept going to PT and taking medication. She was even able to join a student-led praise dance ministry. By senior year, she was strong enough to be back in classical dance classes just because she loved it.
With a corporate job on the horizon, she had one last summer free after college. She reached out to New Yorkâs Complexions Contemporary Ballet, hoping for a summer job in arts administration or marketing.Â
But the founders of Complexions, dance icons Dwight Rhoden and Desmond Richardson, had another idea. âWe hear youâre dancing again,â they told her. âWe have a tour of Italy this summer, and one of our dancers is injured. Can you come back?âÂ
Back to the Stage
Graf Mack was apprehensive. She hadnât danced full-time or performed in a long time. But it might be her last chance.Â
âI said, âIâm going to be doing a desk job for the rest of my life. Let me do this.â â
Graf Mack ditched the corporate path and danced for famed companies including the Dance Theatre of Harlem, the San Francisco-based Alonzo King LINES Ballet, and Alvin Ailey.Â
Meanwhile, she still had her chronic condition, which she still thought was reactive arthritis. She remembers switching to a new disease-modifying antirheumatic drug, or DMARD, called adalimumab (Humira), when it came on the market in 2003 â and the challenges that came with it.
âI had to figure out how to travel with the syringes, keeping them cold during 18-hour international travel days, finding out which hotels had refrigerators in them, ensuring that medications were shipped to hotels on the right schedule,â she says. âThat was choreography in itself!â
The Right Diagnosis, at Last
Blurry vision, along with pain and redness in her eyes, was how Graf Mack learned that she had AS.
Her eye problem was uveitis, an inflammatory condition. Graf Mackâs rheumatologist told her that uveitis pointed toward AS. Itâs common in people with AS, but not in those with reactive arthritis, Caplan says.
Her doctors got the uveitis under control, and Graf Mack was able to keep dancing as a pro.Â
âI had another 5 or 6 more years of dancing, a blessing that I never expected would happen,â she says.Â
After yet another knee surgery, she moved to St. Louis with her now-husband, Kirby Mack, to get a masterâs degree in arts management.Â
She would still perform and even returned to Alvin Ailey for 3 more years. She finally retired in 2014 after surgery for a herniated disk. Sheâs since become a mom to a son and daughter, the host of a dance podcast called Moving Moments, and the founder of a comprehensive wellness program for young dancers at Juilliard.Â
âIâm still taking Humira, with a round of prednisone every so often for flare-ups,â she says. Although her back and hips are âreally stiff most days,â she stays very active and still performs on occasion.Â
âI consider myself super blessed because I know so many people with AS are in an extreme amount of pain,â Graf Mack says. In hindsight, without AS, âI never would have discovered my love for teaching or realized that I wanted to work in a university setting,â she says. âItâs strange, but I never would have had such a full life if I hadnât been stopped in my tracks by my body.â
Tips for Managing AS
Graf Mack has this advice for people facing an AS diagnosis:
Find a supportive doctor. âAt first, I was seeing doctors who didnât fully believe me, and that made it so much harder,â she says. âWith this disease, flare-ups can happen at any time and can get bad fast, and you should have a doctor who can be reached quickly and not make you wait 3 months for an appointment.â
Manage it one day at a time. âThis is a condition that is not going to go away,â Graf Mack says. âYou have to be proactive in taking charge of your condition and working with your doctor and other members of your care team. Find a great doctor and take it day by day.â
Be patient with yourself. âSome days are going to be really bad,â she says. âIâd allow myself that. âToday is a bad day. Iâm going to allow myself to be angry and cry and do all the things. But thatâs all I get, and tomorrow Iâm going to get up and do something that makes me feel good.â â | Disease Research |
The numbers are striking in their enormous size: 7.6 million people are now on waiting lists in England, a figure that has been growing in recent years, breaking records in all but three of the last 30 months.
He also claimed that long waiting lists were far worse elsewhere, telling the BBC on Monday: “In England, we have virtually eliminated waits of over 18 months, whereas in Wales, for example, there are over 70,000 patients waiting more than 18 months.”
Where are waiting lists worst?
While the different systems make comparisons difficult, Barclay is right that there are disparities in waiting times across the four UK nations. The 7.6 million waiting list for England roughly speaking translates to one in seven of the population (although some individuals will be waiting for more than one treatment).
While Wales has the most comparable system to England, its waiting lists contain some patients that the English count does not (diagnostics, for example). That’s one outstanding treatment or test for every four people in Wales, with Digital Health and Care Wales estimating that one in six people are on waiting lists.
While Scotland and Northern Ireland differ in how they define their waiting lists, the best broadly equivalent figure is that one in nine people in Scotland are awaiting care, rising to a whopping 36% of people in Northern Ireland (although the latter figure includes some duplication, meaning the true number is lower). So, based on the available figures, England is doing better on this metric than Wales and Northern Ireland, but worse than Scotland.
What about long waits?
There is also wide divergence in the number of patients waiting more than a year for treatment.
England has made a concerted effort to eliminate very long waiting lists, resulting in a 99% fall in those waiting more than two years since January 2022. While 18-month waits are also falling significantly, yearlong waits are harder to unpick. About one in 20 people on a waiting list in England in June were not getting treatment for at least 52 weeks.
But while this equates to about one in every 150 people in England, things are worse elsewhere. Keeping the above disclaimers about comparability in mind, you are roughly twice as likely to have to wait a year or more in Scotland and Northern Ireland, where the best comparable figures stand at one in 80 and much worse in Wales, where one in 20 are waiting more than year for treatment.
Why are the differences so stark?
A spokesperson for Nuffield Trust said differences in demographics, resources and policy all fed into the disparities in waiting lists across the four nations.
“There are many differences across the devolved nations which might be relevant here, notably an older population in Scotland and Wales with more deprivation; higher nurse staffing and higher spending in both Scotland and Wales; and more doctors in Scotland,” they said.
“Although the NHS model remains recognisable in all countries, health policy has been slightly different, with England featuring more competition and private-sector involvement. Patients appear to spend slightly longer in hospital in Scotland compared with England, and quite a bit longer in Wales, which may make it difficult to treat as many patients with an equivalent number of beds and staff”.
How do health services work in the UK?
In the UK, health services are largely autonomous in each nation, since powers were devolved to Scotland, Wales and Northern Ireland in 1999. Each country controls its own health systems and the provision of health services, with Westminster retaining responsibility for England.
In Northern Ireland, the health services are integrated with social care and the system has been called Health and Social Care (HSC) since 1973.
How are they funded and how autonomous are the different health systems?
In all four nations, general taxation accounts for the majority of NHS funding, with the Treasury collecting revenues for the whole UK and agreeing the budgets for Whitehall departments and devolved administrations.
In the other nations, virtually all the funding comes from the Treasury; health spending is financed via the annual block grant funding from the UK government. The amount Scotland, Wales and Northern Ireland receive is calculated using the Barnett formula, which means the devolved governments get a set proportion of what goes to England. So if UK government ministers decide to increase the NHS budget in England, they must also fund an equivalent increase for Scotland and Wales.
Health expenditure in the United Kingdom in 2021/22 (of which NHS spend is the lion’s share) was highest in Scotland at £3,490 per person and lowest in England at £3,192 per capita.
Although the overall health budget is constrained to an extent by what the UK government decides to spend on the NHS in England, the Scottish, Welsh and Northern Irish administrations have a large amount of autonomy over how they run their health services.
In addition, England also raises some health income from patient fees, such as charges for prescriptions and some other services. Scotland, Wales and Northern Ireland have all abolished prescription charges, leaving England the only UK country where patients have to pay for prescriptions. And Scotland has some tax-raising powers. | Health Policy |
HONG KONG — Hospitals in northern China appear to be “overwhelmed with sick children” as the country grapples with a surge in respiratory illnesses and clusters of pneumonia, prompting the World Health Organization to ask Beijing for more data.
At the Beijing Children’s Hospital in the capital, long lines of people were waiting to register during a visit by NBC News on Thursday. Waiting rooms were crowded with parents and children, some of them on IV drips.
In a review of China’s data, the World Health Organization said that the increase in cases came earlier in the season, “but not unexpected given the lifting of Covid-19 restrictions, as similarly experienced in other countries.”
According to the WHO, Chinese health authorities did not detect new or unusual pathogens, and the rise in respiratory illnesses has not resulted in patient loads that exceed hospital capacities.
There was no indication that the outbreak in China poses any global threat, and the WHO advised against any travel restrictions “based on the current information available on this event.”
Since mid-October, the WHO said, northern China has reported an increase in respiratory diseases compared with the same period in the previous three years. The increase coincides with the end of China’s National Day holiday week, one of its busiest travel periods.
This is also China’s first full flu season since the lifting late last year of some of the world’s most stringent Covid-19 restrictions, which minimized many people’s exposure to a wide range of pathogens for three years.
Countries such as Australia and New Zealand that also had “zero-Covid” restrictions experienced similar surges in respiratory diseases when they were lifted, and the United States had its own “tripledemic” of respiratory viruses last year.
Something similar is most likely happening in China, said Jin Dong-yan, a virologist at the University of Hong Kong.
“We don’t think there is a major issue there or there is some unknown disease or something that is hidden,” he told NBC News in a phone interview Thursday. “We have no evidence for that.”
The WHO said Wednesday that it had asked China to provide detailed information on an increase in respiratory illnesses and reported clusters of pneumonia in children.
That followed an alert on Tuesday by ProMED, a publicly available reporting system for emerging diseases and outbreaks, saying that hospitals in Beijing and elsewhere in China were “overwhelmed with sick children” amid outbreaks of pneumonia.
Both China and the WHO have been criticized over their transparency in reporting the initial cases of Covid-19, which was first detected in the central Chinese city of Wuhan in late 2019.
Chinese health officials said last week that the country was experiencing a seasonal increase in overlapping respiratory diseases, including influenza, respiratory syncytial virus (RSV) and the virus that causes Covid-19, attributing it in part to the lifting of Covid-19 restrictions.
They said there had also been a surge in cases of mycoplasma pneumonia, a common bacterial infection that usually affects young children and is also known as “walking pneumonia” because it rarely requires hospitalization.
Emma Wang, whose 7-year-old daughter had mycoplasma pneumonia, said the hospital they went to in Beijing was “very crowded.”
“It took us two or three hours to see the doctor, whereas normally the wait time is only half an hour,” said Wang, 39.
“I know four or five families with this situation,” she added. “I am very worried the virus will keep spreading.”
Mycoplasma pneumonia tends to spread in settings such as schools, dormitories and military barracks, with common symptoms including cough, sore throat, fever and headache. Most people have mild or no symptoms, while a “small subset” may develop severe pneumonia, Jin said.
“It’s not like Covid, it’s not like flu, and there are very effective antibiotics,” he said.
But China has reported limited data so far, Jin said, making it difficult to know the full extent of the outbreak of various respiratory illnesses.
“They need to tell the general public whether this is extremely high everywhere or just in one place,” he said.
Compared with pre-pandemic years, China’s current levels of respiratory disease may not be that unusual, Jin said, but more people may be going to hospitals “because they don’t know and because they are panicking.”
Social media users visiting hospitals in Beijing, where a cold snap is expected to send temperatures well below zero by Friday, have posted photos in recent days of long lines and high ticket numbers, with some saying they were told to come back the next day.
“Most people are rather sensitive to pneumonia and epidemic infections after Covid,” said Zhang Li, a doctor in the city of Dalian, in China’s northeastern Liaoning province, whose 14-year-old daughter recently recovered from mycoplasma pneumonia. “Parents might get anxious if their children don’t get better after one or two days.”
She said she had initially treated her daughter at home, but took her to the hospital when her symptoms persisted. “Other parents told me about their children’s pneumonia and their situations when we were chatting, so I became a little more cautious,” Zhang said.
Further pressure is created by the nature of the Chinese health care system, where it is common for people with mild illnesses to go straight to a hospital rather than a doctor’s office.
“Most people with mycoplasma infection should just stay home,” Jin said.
In an interview Thursday with Xinhua, China’s state-run news agency, the National Health Commission similarly advised parents whose children have mild cases to avoid going to hospitals, citing long wait times and the risk of cross-infection.
The WHO advised people in China to reduce their risk of respiratory illness by getting recommended vaccinations, ensuring good ventilation, wearing masks as needed and washing their hands regularly, among other measures.
“Mycoplasma pneumonia is actually something we already know. It is not a new virus like Covid,” Jin said. “We have established protocols to deal with this and if we do it carefully, then it would be put under full control. It’s not a big deal.”
Jennifer Jett, Lena Li and Jiaxin Liu reported from Hong Kong, and Dawn Liu from Beijing. | Epidemics & Outbreaks |
Philip Morris International (PMI), the tobacco and vaping company behind Marlboro cigarettes, is waging a big lobbying campaign to prevent countries from cracking down on vapes and similar products as part of a global treaty, a leaked email reveals.
The company, which has been increasingly focusing on smoke-free products as governments tighten regulations on cigarettes, made $10.19bn (£8.3bn) in revenues from products such as heated tobacco and electronic cigarettes in 2022.
In a message sent by the PMI’s senior vice-president of external affairs last month and seen by the Guardian, staff were told to find “any connection, any lead, whether political or technical” before a meeting of delegates from 182 countries. He described the agenda for the meeting of the World Health Organization as a “prohibitionist attack” on smoke-free products.
There is growing scrutiny of vaping products, with ministers in the UK taking the first step towards banning candy-coloured disposable e-cigarettes in England. A consultation has been launched on plans to crack down on vaping by young people and ban smoking altogether, to create the first “smoke-free generation”. The health secretary, Steve Barclay, said this month he was concerned about figures that showed the number of children who vaped had tripled in the past three years.
The WHO framework convention on tobacco control (FCTC), which takes place next month in Panama, will discuss possible regulation, including taxation, on smoke-free products.
In the email, PMI suggested it had seen the agenda for the convention, which focused on smoke-free products. In 2016, the tobacco company announced a transformation of its business away from cigarettes and set itself an objective to replace them with heated tobacco products, e-vapour products and nicotine pouches.
In 2022, PMI shipped 621bn cigarettes, according to its annual results. However, about a third of its revenues were derived from smoke-free products, while the volume of combustible tobacco products decreased by 27%.
Its vaping and heated tobacco brands include IQOS, Bonds and Veev and it launched its first disposable device in the UK this year, the Veeba.
The email sent on 22 September by Grégoire Verdeaux, the senior vice-president of external affairs at PMI, said: “The agenda and meeting documents have been made public for the main part. Unfortunately they reconfirmed every concern we had that this conference may remain as the biggest missed opportunity ever in tobacco control’s history … WHO’s agenda is nothing short of a systematic, methodical, prohibitionist attack on smoke-free products.”
Without “reasonable, constructive outcomes” , Verdeaux wrote, the “WHO will have irreversibly compromised the historic opportunity for public health presented by the recognition that smoke-free products, appropriately regulated, can accelerate the decline of smoking rates faster than tobacco control combined”.
He said that for the last 18 months his company had worked to “leverage the right support” at the meeting, but added: “At this stage we are not where we would like to be – in terms of intelligence, positions and delegations.” Verdeaux said that when they were “truly determined” then they managed to “move the needle”. He urged: “There is still time.”
The email continued: “So this message to ask you, as lead of the EA [external affairs] function, to do that last-minute effort. Every country, regardless of its size, matters”. Verdeaux said it was ready “to put up any connection, any lead, whether political or technical, including those from our local business partners” who often were “mission critical in our smaller markets”.
Tobacco companies are not invited to the event and Verdeaux said despite this he would be in Panama “to publicly denounce the absurdity of being excluded from it while PMI today” was “undoubtedly the most helpful private partner WHO could have in the fight against smoking”. He ended the email: “Whatever happens we are on the right side of history. But it will be a small comfort if we let prohibitionists have it their way.”
“Time is of the essence”, he said, and the consequences for adult smokers and “our business would be material”.
Asked about the leaked email, Verdeaux said in a statement: “What I say publicly and what I say to our employees is exactly the same: I am proud to make the case to governments and media that innovation drives down smoking rates faster and for that reason should be supported and regulated. The WHO FCTC conference is held behind closed doors but should be an open forum where scientists, consumers and companies are also heard. I’ll be on site in Panama and gladly invite anyone to discuss this publicly with me.”
There has been growing concern about the rising number of young people using e-cigarettes. In the UK, leading doctors and councils have welcomed reports that ministers are preparing to ban single-use vapes.
Prof Steve Turner, registrar for the Royal College of Paediatrics and Child Health, said his UK colleagues were “really worried” about young people vaping. He added that vapes were an “effective entry into nicotine addiction and smoking”. The situation was “a public health disaster” and “children should not be becoming addicted to nicotine”, he said.
Australia has banned all vaping without a prescription, Germany prohibited flavoured e-cigarettes and New Zealand outlawed most disposable vapes and put curbs on marketing to children. This month, France also announced it is planning to ban all disposable e-cigarettes. | Health Policy |
Leigh Paterson/KUNC
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Zack Dorsett, the operations manager of Wonderbags, a company that sells mushroom starter kits, at his company's booth at the "Psychedelic Science 2023" conference in Denver on Wednesday, June 21, 2023
Leigh Paterson/KUNC
Zack Dorsett, the operations manager of Wonderbags, a company that sells mushroom starter kits, at his company's booth at the "Psychedelic Science 2023" conference in Denver on Wednesday, June 21, 2023
Leigh Paterson/KUNC
Crowds are gathering in downtown Denver this week to learn about the future of psychedelics like magic mushrooms and MDMA. The five-day Psychedelic Science 2023 event, attracting medical professionals, politicians, celebrities and practitioners, covers a wide variety of subjects from the business of psychedelics to therapeutic uses for these substances.
"We are facing very difficult challenges in mental and behavioral health and we're very excited about the opportunities that psychedelics offer to break cycles of addictions for opioids, to deal with severe depression and anxiety," said Colorado Gov. Jared Polis during his opening address on Wednesday.
Hosted by the non-profit Multidisciplinary Association for Psychedelic Studies (MAPS), more than 11,000 people have registered for the event which the organization describes as "the largest psychedelic conference in history." This conference is the fourth of its kind, the most recent gathering took place in California in 2017.
"It's really exciting to see just how lively the showing is here in Denver ," Boulder resident Ramzy Abueita said. "The fact that...we are freely walking around in the city being ourselves shows just how much the zeitgeist has shifted and how much psychedelic culture has become normalized and de-stigmatized in our society."
Events include sessions for veterans struggling with PTSD, and researchers discussing a new clinical trial that examines psychedelic therapy for hospice patients. Speakers like musicians Melissa Ethridge and football player Aaron Rodgers are talking publicly about their experiences.
"The beauty in these journeys is to find that self-love because the greatest antidote to the anti-you is unconditional self-love and its been a beautiful journey to try and find that," Rodgers said of using psychedelics.
More mainstream acceptance
The conference represents increasing cultural awareness and acceptance of plant medicine, following recent efforts to bring psychedelics into the mainstream.
In 2020, Oregon became the first state in the nation to allow psilocybin-assisted therapy. Last fall, Colorado voters approved Proposition 122, which decriminalizes psilocybin and creates a framework for some psychedelics to be used in therapeutic settings. In recent years, officials in Massachusetts, Michigan, New Jersey and California have loosened penalties or decriminalized some psychedelics.
Immediately following the passage of Proposition 122, Zach Dorsett founded Wonderbags, a Colorado Springs-based company that sells mushroom starter kits which customers then grow at home. During the conference, he stood answering questions at Wonderbag's booth, flanked by clear humid bags filled with mushrooms, at various stages of growth.
"So it's basically ready to grow. The bag itself doesn't contain any psilocybin, which allows us to sell it," Dorsett said of the starter kits. "You know where your mushrooms are coming from, You know how they're grown. You put that energy into them."
Dorsett says psychedelics have helped him with depression and motivation.
"When the industry started to evolve and we had Prop 122 pass, we were just looking for ways to like, add value to the community, and help others have some of these life changing experiences," Dorsett said.
Still, many of these substances are illegal at the federal level. After widespread use in the 1960s, the federal government classified some psychedelics, including psilocybin, as Schedule 1 drugs, meaning they lack an accepted medical use and have a high potential for abuse.
Eventually, researchers began requesting licenses from the federal government to study some psychedelics. After encouraging results, the Food and Drug Administration (FDA) has allowed some of this work to move ahead more quickly by granting "breakthrough therapy" status to MDMA and psilocybin-assisted therapies.
Many medical professionals say more research is needed to better understand the risks of these substances as well as the appropriate dosages and number of sessions. Certain groups are excluded from some clinical trials including kids, pregnant people and those with a history of psychosis because the risks of using psychedelics in these populations are not fully understood.
Joe Moore, the Breckenridge-based co-founder of Psychedelics Today, an educational organization that produces a twice-weekly podcast, pointed out that this big, visible conference likely feels risky for some, given the legal issues around these substances.
"A lot of people are really spooked, you know, for all sorts of reasons," Moore said.
He points to medical professionals in attendance who could risk their licenses and to people who are part of the underground psychedelics movement.
"This conference to me is a sort of coming out moment for this movement, saying, we're here... We're going to be doing our thing and we're doing it in a lot of different ways," Moore said. "And we're all brave enough to be here together." | Mental Health Treatments |
Sarah Ferguson revealed over the weekend that she is undergoing treatment for breast cancer and has already received surgery.
The Duchess of York received the diagnosis during a routine mammogram and “was advised she needed to undergo surgery which has taken place successfully”.
Sarah Ferguson undergoes mastectomy surgery for breast cancer
In an episode of her podcast “Tea Talks with the Duchess and Sarah” released Sunday on Spotify, Ferguson opened up about her diagnosis and the surgery. Ferguson talked about how she was feeling ahead of her surgery. “Of course, the doubting mind comes in you know, I think that you just … when it comes in shine light on it and say ‘no, no, I got this,'” Ferguson said.
She repeatedly advised listeners to get screened for breast cancer and for other cancers.
The duchess is said to have returned home to Windsor this weekend, where she is now recovering.
She revealed details of the procedure in an interview for her new podcast, Tea Talk, recorded ahead of the operation.
Sarah discussed her recent diagnosis, urging others to take advantage of cancer screening programmes.
“I want every single person that is listening to this podcast to go and get checked,” she said.
“I’m taking this as a real gift to me to change my life, to nurture myself,” said the duchess, adding she would “stop trying to fix everyone else” and start “taking myself seriously”.
“Now is my chance,” she said. “This extraordinary position I’m in right now – it means there’s no choice.
“I can’t make another excuse. I have to go through this operation and I have to be well and strong. And therefore no choice is the best choice.”
Fergie also referenced her father, who had died of prostate cancer and also spoke about the importance of early detection.
“I don’t mind if no one wants to hear from me. Because I’m telling you that I am doing this. I am telling people out there because want every single person that is listening to this podcast to go get checked, go get screened and go do it,” Ferguson said.
She started by giving some background to her volunteering for the Teenage Cancer Trust more than 30 years ago.
She also introduced her daughters — Princess Beatrice and Princess Eugenie — to it, celebrating their respective 18th birthdays with it and teens in the hospital.
And Fergie is looking ahead — she says she will start writing her third book. | Women’s Health |
The health secretary has invited the Welsh and Scottish governments to discuss how best to tackle NHS waiting lists, as millions wait for hospital treatment across the UK.
Steve Barclay accused them of having worse delays than England in some cases - but they disputed the figures.
Hospital waiting lists in England hit a record 7.57 million people in June.
Mr Barclay also said he was open to Scottish and Welsh patients being treated in England.
NHS services are devolved, meaning Scotland, Wales and Northern Ireland control them in those nations, while the UK government runs them in England.
Prime Minister Rishi Sunak has made cutting waiting lists one of his "five priorities", and he's said people should hold him to account if NHS waiting lists in England do not fall by January 2025.
So far the numbers are not moving in the right direction.
Knowing this could bite when it comes to an election campaign, UK government ministers are keen to argue things wouldn't be better under Labour or the SNP.
The government said under Labour in Wales more than 73,000 people have been waiting at least 77 weeks for treatment, and under the SNP in Scotland more than 21,600 people have been waiting over 78 weeks for outpatient, day-case or inpatient appointments.
But both Scottish and Welsh governments have hit back, saying it isn't comparing like-for-like figures.
Scottish health minister Michael Matheson said: "Rather than attempting to involve themselves in devolved areas, the UK government would be well-served focusing on tackling the many issues in the health service south of the border."
He added that after the Scottish government negotiated with junior doctors, Scotland was the only part of the UK to avoid NHS strike action this year.
And a Welsh government spokesperson said: "Long waiting times are falling every month in Wales and have more than halved in the past year.
"The overall growth in waiting lists... has been smaller in Wales than in England over the last 12 months."
In England, the waiting list for hospital treatments in June was more than three million higher than it was before the pandemic, hitting 7.57 million people.
Of those on a waiting list, more 383,000 people have been waiting longer than a year.
Official counterparts in Northern Ireland have also been invited to the meeting in the absence of a functioning government.
Mr Barclay has asked UK health ministers to discuss how health data can be made more comparable, and what "lessons can be learnt" from different approaches taken in each nation.
While there may be merits in discussing shared challenges and solutions, health has been used as a political attack line ever since the pandemic.
As it's run by different parties in each part of the UK, seemingly well-meaning letters and meetings between the governments have often been used to take a veiled pop at each others' approach.
For years, UK government insiders have mulled the idea of creating more centrally held, comparable data on NHS performance across the UK. If this happened, it may be easier to see which of these attacks - or not - are really justified.
Labour's shadow health secretary Wes Streeting said: "What's next, the Conservatives offering advice on bringing mortgage costs down?
"The only advice the Tories are qualified to offer is how to wreck the NHS and cause the biggest strikes in its history." | Health Policy |
Covid-related precautions helped minimize the spread plenty of other communicable diseases. But now, those bugs are back, along with some new challenges. The CDC reports that strep A infections (a.k.a strep throat), caused by a bacterium known as A Streptococcus, have surged from covid lows to above pre-pandemic levels in 2022 and 2023. And the recent spike in strep cases coincides with a shortage of one of the medicines most commonly used to treat the infections, particularly in children, as pointed out in a Monday NPR report.
Nationwide, the biggest sustained increase in the number of the most severe strep cases (known as invasive group A strep infections) has been observed in children, according to the CDC. And kids are the group most affected by ongoing antibiotic scarcity.
Currently, many dosages of liquid amoxicillin, the goopy bright pink drug of choice for pediatric strep infections, are in short supply, according to the Food and Drug Administration. And it’s been this way for months. Many forms and brands of the powders used in liquid amoxicillin formulas have been under an official FDA shortage since October 2022. Most of the pharma companies that manufacture the stuff have listed “demand increase for the drug,” as the reason behind its limited availability.
Though higher than the past normal, strep infection levels haven’t appeared to reach any sort of record levels in recent months. However, as NPR notes, companies often rely on recent sales data to inform their production. In using pandemic years as data points, these pharmaceutical manufacturers many have miscalculated.
“Companies typically look to see what their sales were the prior year. They might make a little bit of an adjustment,” Erin Fox, a medication use and policy researcher at the University of Utah, told NPR. “With the really severe respiratory season we’ve had this year, it just simply was a mismatch between what people manufactured and what was available,” she added.
There are alternative options for treating strep infections. Doctors can prescribe other dosages or pills over certain liquid forms of amoxicillin. However, getting kids to swallow pills or larger volumes of liquid medicine can be a challenge.
Doctors may prescribe a medicine unaware it’s in short-supply, putting the onus on the patient or patient’s family to navigate the pharmacy system and find what they were told they need. Caitlin Rivers, a Johns Hopkins University epidemiologist, told NPR she had to go to multiple pharmacies in order to find a prescribed antibiotic for her own child. “It just adds another burden on what’s already been a really difficult winter respiratory season for families,” she said to the outlet.
But despite the inconvenience, getting proper medication for strep is critically important. Untreated, strep A infections can lead to serious, long-term consequences like organ damage or rheumatic fever.
The worst time of year for strep infections is often December through April, so the spike in cases and concurrent struggle to find meds could settle down soon. But years of pandemic threw many seasonal infection cycles out of whack, and there’s no guarantee that next month will bring relief, Rivers said.
Over the past year, the FDA has declared shortages on many commonly prescribed medications, including other antibiotics. Other shortages include certain types of ADHD medications like immediate release Adderall and multiple brands of a newer class of diabetes drugs that are also often used for weight loss. Supply chain disruptions, increases in demand, and a mix of other factors are to blame.
Regardless of the causes, drug shortages can have significant negative impacts on medical care, quality of life, and health. Out of desperation, some people have sought out unsafe sources of medication, like pharmacies outside of the U.S., which may not be selling things exactly as labeled. | Drug Discoveries |
The world must urgently prepare for a global “tsunami” of millions of older cancer patients or risk healthcare systems being unable to cope, leading doctors have warned.
With life expectancy increasing and a rapidly soaring population of older people, a looming increase in elderly patients with cancer was now a “serious public health concern”, the American Society of Clinical Oncology (ASCO) said in a report. Cancer centres must prepare for “the silver oncologic tsunami”, the experts added.
At ASCO’s annual meeting in Chicago, the world’s largest cancer conference, Dr Andrew Chapman, the director of the Sidney Kimmel Cancer Center-Jefferson Health and a specialist in geriatric oncology, said: “As the population expands and the incidence goes way up, are we really prepared to deal with those needs? I think globally, we’re not prepared.”
Older age is a well-established risk factor for cancer but the importance of incorporating older-adult–specific assessments into cancer diagnosis, care and treatment has been under-recognised for years.
“We know cancer is a disease that is associated with ageing, and there are a number of biological mechanisms as to why that is,” Chapman said. “What is often times missed is that the older adults’ goals, wants, needs, preferences, and issues are much different than those of the average adult.
“Sometimes there’s a nihilism – ‘if you’re older we’re not going to bother’ – which is horrible,” he added.
Older patients often prioritise maintaining independence rather than seeking curative treatments, Chapman says. They care about being able to perform activities such as driving, spending time with family, and hobbies like golf and gardening, he added.
“If you’re going to give somebody treatment that’s going to take that away, they may not want it. Much different than somebody who’s 45 who wants to live for another 40 years,” he said.
Dr Julie Gralow, the chief medical officer and executive vice-president of ASCO, said healthcare systems should act immediately to avoid being overwhelmed by the dramatic rise in older cancer patients. “By 2040, the global burden is expected to grow to 27.5m new cancer cases and 16.3m cancer deaths simply due to the growth and ageing of the population.”
According to estimates from the International Agency for Research on Cancer (IARC), in 2018 there were 17 million new cancer cases and 9.5 million cancer deaths worldwide.
Workforce barriers such as a lack of widespread geriatric training and global staff shortages could make adopting models of care to better suit older patients even more challenging, Gralow said.
Diversifying clinical trials would also help, she added. “Most clinical trials data comes from younger patients – very few older patients are included. We need to include older patients in trials so that we can understand the toxicities and efficacies of therapies on this population.”
In the US, the National Cancer Institute projects that by 2040, nearly three quarters (73%) of people living with cancer will be over the age of 65.
In Britain, the number of people diagnosed with cancer will rise by a third by 2040, taking the number of new cases every year from 384,000 to 506,000 for the first time, according to analysis by Cancer Research UK. Most of those affected will be 70 or over – 60% of cases and 76% of deaths.
“There will be more elderly people with cancer diagnoses and of course they require multidisciplinary care,” said Prof Charles Swanton, Cancer Research UK’s chief clinician. “They often have comorbidities and other diseases like cardiovascular disease, heart or respiratory problems.”
Speaking in Chicago, Swanton said older patients were also more likely to be taking medicines for other ailments, making cancer treatment more complicated.
“The question is, ‘how is the health system going to cope with that?’ It’s a major concern when it comes to workforce planning. If we’re dealing with 30% more cancer diagnoses, and those cancer diagnoses are more complex, we’re going to need at least 30% more oncologists, surgeons and pathologists to cope with the caseload.”
Caroline Abrahams, the charity director at Age UK, said many elderly patients were “already waiting longer than they would like” for treatment. | Global Health |
A new study done by addiction recovery resource Addiction Treatment Magazine has revealed the states that have the highest and lowest prevalence of underage drinking.
Researchers looked at the number of young people between the ages of 12 and 20 who had consumed an alcoholic drink within the last month and had participated in binge-drinking, which is classified as consuming four or more drinks in one sitting, according to a press release on the publication’s website.
The data was drawn from the Substance Abuse and Mental Health Services Administration (SAMHSA) based on the 2021 National Survey on Drug Use and Health.
The study determined that the state of Vermont has the highest prevalence of drinkers between the ages of 12 and 20 in the U.S., according to the release.
Nearly 25% of minors in the state had consumed alcohol, and more than 14% had participated in binge-drinking.
Other states with high rates include Rhode Island, New Hampshire and Massachusetts.
In Rhode Island, nearly 22% of young people between the ages 12 and 20 consume alcohol monthly, and 12% of minors consume four or more alcoholic drinks in one sitting, the study found.
In New Hampshire, 20.6% of people between the ages 12 and 20 had consumed alcohol in the last month.
The share was 20.4% for Massachusetts.
Rounding out the top 10 are the states of Oregon, Iowa, Wisconsin, Colorado, Maine and North Dakota.
At the other end of the spectrum, Mississippi has the lowest prevalence of underage drinking, with only 9.7% of underage people consuming alcohol.
It also has the lowest binge-drinking rate, at only 5.4%, according to the study.
Utah is the second-lowest, at 11% for alcohol consumption and 6.8% for binge-drinking among the underage population.
Coming in at third lowest is North Carolina, where 11.3% of underage people consumed alcohol in the last month.
Alabama is also on the lower end at 12%, followed by Arkansas at 12.3%.
Rounding out the lower 10 are Indiana, Georgia, Idaho, Tennessee and Texas.
"It's no secret that underage drinking is a major concern in the United States, as it can pose several significant risks to the well-being of young people, including health risks, impaired judgment and the risk of dependency and addiction," said a spokesperson for Addiction Treatment Magazine in the release.
"These findings provide an intriguing insight into where underage drinking is the most prominent throughout the country, with Vermont coming out on top. While progress has been made in reducing underage drinking rates, it is still a matter of concern, and ongoing efforts are necessary to address this issue and protect the health and safety of young people," the spokesperson continued.
Dr. Chris Tuell, clinical director of addiction services for the Lindner Center of HOPE in Ohio, was not involved in the study, but said he wasn’t surprised by the findings.
"A parent’s position on underage drinking is paramount and is one of the strongest protective factors against underage drinking."
"The Northeast has had a history of higher rates of underage drinking for the past 20 years," he told Fox News Digital in an interview. "There continues to be no definitive reason why these rates are the way they are."
One possible reason for Vermont's topping the list, he said, is that it is a rural state with many colleges and universities — the highest number per capita of any state.
Overall, the findings indicate that the use of alcohol in young people continues to be a concern, Tuell said.
"The research is crystal-clear that early alcohol use before the age of 15 raises the risk of lifelong problems of addiction and alcoholism," he warned.
"Early alcohol use — drinking at age 14 or earlier — [means a] 7 times greater risk for developing an alcohol problem than someone who begins drinking at age 21."
Other possible reasons for the high rates in some states may be related to how the packaging of alcohol is geared toward youth, such as flavored drinks, and the association of alcohol use with sporting events, the expert noted.
"This promotes alcohol use in young people as a necessary part of having fun," Tuell said.
"A parent’s position on underage drinking is paramount and is one of the strongest protective factors against underage drinking," he also said. | Epidemics & Outbreaks |
Polygenic risk scores, which estimate a person's disease risk based on thousands or millions of common genetic variants, perform poorly in screening and prediction of common diseases such as heart disease, according to a new study led by UCL (University College London) researchers.
It has been claimed that polygenic risk scores will transform the prediction and prevention of common diseases. Companies have already been established that sell polygenic risk score testing services. Polygenic risk score testing is also one of the aims of the nationwide Our Future Health project.
The new study, published in BMJ Medicine, looked at 926 polygenic risk scores for 310 diseases. It found that, on average, only 11% of individuals who develop disease are identified, while at the same time 5% of people who do not develop the disease test positive. Unaffected people usually outnumber those affected which results in far more false than true positive predictions.
Lead author Professor Aroon Hingorani (UCL Institute of Cardiovascular Science) said: "Strong claims have been made about the potential of polygenic risk scores in medicine, but our study shows that this is not justified.
"We found that, when held to the same standards as employed for other tests in medicine, polygenic risk scores performed poorly for prediction and screening across a range of common diseases."
For the new study, researchers looked at data available in an open-access database, the Polygenic Score Catalog, to determine what the detection rate and false positive rate of the scores would be if used in screening.
For breast cancer and coronary artery disease, the risk scores identified only 10% and 12% of eventual cases respectively, using a cut-off that resulted in 5% of unaffected individuals testing positive.
The researchers also investigated how polygenic risk scores would perform if used alongside conventional screening methods.
They found that, if used alongside conventional risk factors, several thousand people would need to have a polygenic risk score done to guide statin prescriptions to prevent one additional heart attack or stroke. The researchers noted that using age alone as a guide to statin prescription would be simpler and more effective at preventing heart attacks and strokes without the need for genetic testing.
They also found that adding polygenic risk scores as first stage screening to determine who should be prioritised for mammography would miss most women who later develop breast cancer and generate many false positives, adding to the burden on healthcare systems.
Co-author Professor Sir Nicholas Wald (UCL Institute of Health Informatics) said: "It has been suggested that polygenic risk scores could be introduced early on to help prevent breast cancer and heart disease but, in the examples we looked at, we found that the scores contributed little, if any, health benefit while adding cost and complexity."
In the paper, the researchers suggest regulation of commercial genetic tests based on polygenic risk scores to "protect the public from unrealistic expectations and already stretched public health systems from becoming overburdened by the management of false positive results."
The researchers said consumers of commercial polygenic risk score tests should be informed of the detection rate and false positive rate of the polygenic risk scores as well as the absolute risk with and without a polygenic score result so they can better judge whether the test is useful.
Co-author Dr Jasmine Gratton (UCL Institute of Cardiovascular Science) said: "Polygenic risk scores seem attractive because genotyping is now inexpensive, the same for all diseases and is performed only once because a person's genotype does not change. However, these features are irrelevant if the test is not useful."
Professor Sir Nick Wald said: "Our results build on evidence that indicates that polygenic risk scores do not have a role in public health screening programmes."
The researchers said the performance of polygenic risk scores was unlikely to change much as the variants with the strongest effect had already been identified.
Polygenic risk scores should not be confused with genetic testing for certain single gene mutations such as BRCA1 and BRCA2 which have an important role in screening for breast and ovarian cancer.
Discovering variants that are associated with a higher risk of disease is still crucial for drug development, the team emphasised, as the variants encode proteins that can be targeted with drugs that would be useful for everyone regardless of their genetic makeup.
The study was supported by the British Heart Foundation, UK Research and Innovation (UKRI), National Institute for Health and Care Research (NIHR), and the NIHR Biomedical Research Centre at UCLH and UCL.
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Veterinarians developing frailty instrument to personalize canine geriatric care
In human medicine, the ability to measure frailty is a vital aspect of geriatric care. Doctors may recommend one treatment over another based on an elderly person's frailty score, and nursing homes may adjust care protocols as frailty increases.
Soon, however, frailty will be an important consideration in caring for pets as well, thanks to the Dog Aging Project, a collaborative program led by the Texas A&M School of Veterinary Medicine & Biomedical Sciences (VMBS) and the University of Washington School of Medicine.
By working with tens of thousands of dog owners across the United States, the Dog Aging Project is creating a frailty instrument that can be used to make health decisions and personalize geriatric veterinary care for dogs of all shapes and sizes.
In an article recently published in Frontiers in Veterinary Science, the project's veterinary team laid out its plan for developing the instrument by using a variety of simple tests and questionnaires that can be performed by dog owners and veterinarians.
"Dogs are living longer and longer because of the improving health care system and better nutrition," said Dr. Rachel Melvin, a Dog Aging Project research team member and VMBS clinical trials intern. "We now have a bunch of old dogs whose owners want to do the best by them, and frailty scores help us do that by improving the personalized veterinary care those dogs receive."
What is frailty?
Frailty is a complex syndrome associated with aging. Because it considers physical, mental and emotional changes associated with aging, it is a better indicator of the body's condition and overall health than age by itself.
"Age is just a number, but it is a number that can carry a lot of baggage," Melvin said. "Frailty is a way for us to measure aging more accurately, which we only could measure with years before.
"The higher their frailty score, the more likely a person is to fall down, need to be hospitalized, or to have complications while in a hospital," she said. "Likewise, a dog with a higher frailty score may be more at risk for complications after surgery and take longer to recover than a less-frail dog."
Frailty is especially important in veterinary medicine because dogs can vary greatly in size depending on their breed.
"A 12-year-old Great Dane and a 12-year-old Chihuahua are two vastly different animals in terms of health and body condition," Melvin said. "Knowing a dog's frailty score helps us measure and explain things like prognosis to owners, which then helps with making medical decisions."
How to measure frailty
Turning an objective description of health into a numerical score is a challenging concept that requires finding tests or measurements that are indicative of an individual's risk of death.
"In human medicine, grip strength is one common measurement used because losing strength is a good indication that your body is aging," Melvin said. "In dogs, it gets a little more difficult because we can't ask them to do a simple, repeatable task like gripping something. So, our surveys will have lots of questions that correlate with some of the common measurements used in human frailty scales."
To begin the process, Melvin and her colleagues are considering many measurements that will be narrowed down once the team determines which are the most indicative of frailty.
Some of the factors being considered include body condition score, thigh girth deterioration, unintentional weight loss, gait speed, ability to climb stairs and willingness to participate in customary activities, like going on walks.
"We're very passionate about the idea that these are simple, easy measurements that don't require blood work or diagnostic tests," Melvin said. "We want everyone to be able to know if their dog is frail without there being a cost or technical limitation."
In addition to physical measurements, the surveys will include questions that cover the mental and emotional changes associated with aging.
"In human medicine, they've found that including psychological and social domains can lead to a more sensitive scale," Melvin said. "There are lots of ways that the body manifests frailty beyond physical changes, and we want to make sure we cover every category."
Some of the non-physical measurements being considered are a dog's short-term memory, recall of learned behaviors, general anxiety and social avoidance. These would be measurable with simple tests and based on an owner's interpretation of their dog's behavior.
What the scale will look like
Once the team has narrowed down the questions that most effectively determine a dog's frailty, they will develop a numerical frailty scale that general veterinary practitioners can use. After that, they plan to expand the scale into a full Frailty Instrument for Dogs (FIDo) to increase its usefulness in real-life situations.
"Our plan is to develop a three-tiered frailty instrument," Melvin said. "There will be a screening portion with questions for the owner, a scale for general practitioners and a triage scale for emergency veterinarians and specialists. They won't be interchangeable; they will be designed to work together."
Especially in an ER setting, knowing a dog's frailty score will help manage owner expectations and ensure that the medical decisions being made accurately consider the dog's prognosis and quality of life.
Ultimately, measuring frailty is an important part of the Dog Aging Project's overall mission of helping dogs live longer, healthier lives.
"To be able to fight frailty, you have to be able to detect frailty," Melvin said. "If we can identify dogs that are frail, there are potentially steps we can take to prevent or delay progression and help them stay healthier longer."
In addition to Melvin, the Texas A&M researchers working on this project are clinical trials intern Dr. Elizabeth Pearson and Dr. Kate Creevy, a VMBS professor and the chief veterinary officer for the Dog Aging Project. Other collaborators include Dr. Audrey Ruple, from the Virginia-Maryland College of Veterinary Medicine; Dr. Natasha Olby, from the North Carolina State University College of Veterinary Medicine; and Dr. Annette Fitzpatrick, from the University of Washington.
More information: Rachel L. Melvin et al, A review of frailty instruments in human medicine and proposal of a frailty instrument for dogs, Frontiers in Veterinary Science (2023). DOI: 10.3389/fvets.2023.1139308
Provided by Texas A&M University | Medical Innovations |
A group of United Nations (UN) experts is calling for an end to the global war on drugs—and a separate drug policy commission comprised of presidents and prime ministers from around the world is advocating for legal and regulated access to currently illicit substances.
UN’s coalition of “special rapporteurs” appointed by the Human Rights Council—as well as the independent Global Commission on Drug Policy—marked Monday’s International Day Against Drug Abuse and Illicit Trafficking by pushing for comprehensive reform.
“The ‘war on drugs’ may be understood to a significant extent as a war on people,” the UN experts said in a statement on Friday. “Its impact has been greatest on those who live in poverty, and it frequently overlaps with discrimination directed at marginalised groups, minorities and Indigenous Peoples.”
“Drug use and possession for personal use should be decriminalised as a matter of urgency,” they said.
The rapporteurs also noted racial disparities in drug criminalization enforcement worldwide, arguing that the drug war “has been more effective as a system of racial control than as a tool to reduce drug markets.”
Members made clear they believe the international community should depart from criminalization and embrace “life-saving harm reduction interventions, which are essential for the protection of the right to health of people who use drugs.”
The statement also condemns the use of aerial fumigation to disrupt the production of plants like coca that are used by certain indigenous communities and are also key to the manufacturing of cocaine. Some U.S. lawmakers have worked to eliminate federal funding of such controversial eradication efforts in Colombia.
UN-appointed experts also said that drug criminalization contributes to harmful stigmatization of drug use that “results in significant barriers to access to health services (including those for HIV and palliative care) and in other human rights violations.”
“Drug use or dependence are never a sufficient justification for detaining a person,” they said. “Compulsory drug detention and rehabilitation centres need to be closed and replaced with voluntary, evidence-informed, and rights-based health and social services in the community.”
“We urge Member States and international bodies to supersede their current drug policies with ones grounded in the principles of the application of a comprehensive, restorative and reintegrative justice approach,” the statement concludes. “Effective, community-based, inclusive, and preventive measures are equally important. Now more than ever, the international community must replace punishment with support and promote policies that respect, protect and fulfill the rights of all.”
Separately, UN Secretary General António Guterres, who oversaw the enactment of a national drug decriminalization law when he served as Portugal’s prime minister, called out the discrimination that drug consumers experience.
“Drug users are doubly victimized: first by the harmful effects of the drugs themselves, and second by the discrimination they face,” he tweeted on Sunday. “As we mark #WorldDrugDay, we continue our work to end drug abuse, illicit trafficking & stigma endured by drug users worldwide.”
Drug users are doubly victimized: first by the harmful effects of the drugs themselves, and second by the discrimination they face.
— António Guterres (@antonioguterres) June 26, 2023
In 2019, the UN Chief Executives Board (CEB), which represents 31 UN agencies including the UN Office on Drugs and Crime (UNODC), adopted a position stipulating that member states should pursue science-based, health-oriented drug policies—namely decriminalization.
Meanwhile, the Global Commission on Drug Policy is advocating for broader reform on the International Day Against Drug Abuse and Illicit Trafficking, calling for the legalization and regulation of currently prohibited substances.
The commission—whose members include former Colombia President Juan Manuel Santos, former New Zealand Prime Minister Helen Clark, former Brazil President Fernando Henrique Cardoso and other world leaders—said that the drug war has “repeatedly demonstrated that punitive drug policies systematically lead to human rights violations and abuses.”
The statement released by the commission on Monday also takes note of international drug policy reform developments, including efforts to legalize marijuana in Colombia and Germany, and the enactment of drug decriminalization in a key Australian territory last year.
“The Global Commission on Drug Policy calls for more of such constructive actions in policy and practice by national and local governments,” it says. “The consequences of unjust drug policies are widespread in most aspects of individual and collective life. It is a common responsibility for all committed to health, social wellbeing, economic integration and development, to overcome discrimination and stigmatization, and uphold human rights for all.”
The specific policies that the commission, of which Virgin Group Founder Richard Branson is also a member, is championing are to “put health first, guarantee access to controlled medicines, decriminalize the consumption and the possession of drugs for personal use, focus law enforcement on the persons running criminal organizations and, last but not least, legally regulate drug markets in order to disempower organized crime. Legal regulation is both a public health imperative and a necessary step to advance drug policy reform.” | Health Policy |
Scientists seem to have found a kink in the armor of super gonorrhea. In a large-scale clinical trial reported this week, the experimental drug zoliflodacin was found to be just as effective as other frontline antibiotics at treating the stubborn bacterial infection. The results will pave the way for zoliflodacin to become a crucial tool in the never-ending arms race against antibiotic resistance.
Gonorrhea, caused by the bacteria Neisseria gonorrhoeae, is one of the most commonly reported sexually transmitted infections worldwide. Not everyone who catches it will become sick, but its symptoms can be plenty disturbing and include puke-colored genital discharge, bleeding urination, swollen testicles in men, and further bleeding between periods for women. If left untreated, it can also cause infertility, raise the risk of catching other STIs, and even lead to complications like blindness in newborns who get the infection from their mothers.
The disease was once easily treatable with penicillin. But over the years, gonorrhea has steadily evolved to resist nearly all antibiotics commonly used against it. More recently, doctors have started to encounter cases of gonorrhea that show resistance to even these last remaining drugs. There are many other drug-resistant germs out there, but gonorrhea could become one of the first superbugs to widely spread among the community in the not-so-distant future.
The ongoing crisis of antibiotic resistance has left many scientists and research organizations scrambling to develop new drugs for infections like gonorrhea. Ideally, these drugs would not only work as intended but also attack infections in a way that’s different from existing antibiotics, extending the time it would take for the bacteria to develop resistance to them. And it seems that zoliflodacin has fulfilled both these criteria.
The drug is being developed by the non-profit organization Global Antibiotic Research & Development Partnership (GARDP), in collaboration with Entasis Therapeutics, an affiliate of the drug company Innoviva. On Wednesday, GARDP announced the results of their latest and largest study of zoliflodacin, a Phase III clinical trial.
The trial involved over 900 people in five countries, including the U.S., who were diagnosed with uncomplicated gonorrhea, or an infection without other relevant risk factors for serious illness, like pregnancy. These patients were randomly assigned to receive a single oral dose of zoliflodacin or a combination of the two antibiotics ceftriaxone and azithromycin, a common frontline treatment for gonorrhea (Some countries like the U.S. have started to only recommend ceftriaxone as a treatment for gonorrhea, thanks to growing azithromycin resistance).
The trial met its primary goal, with zoliflodacin appearing to clear these infections just as well as ceftriaxone and azithromycin. The drug also seemed to be well-tolerated and there were no serious adverse events or deaths linked to its use reported. Other research has found that zoliflodacin uses a novel mechanism to kill gonorrhea bacteria and that it can fend off drug-resistant strains, meaning these results are even better than they might look at first glance.
“The outcome of this study is a potential game changer for sexual health,” said Edward W. Hook III, protocol chair of the study and an emeritus professor of medicine at the University of Alabama, in a statement provided by GARDP. “In addition to the potential benefits for patients with infections with resistant strains of Neisseria gonorrhoeae, the potential lack of cross-resistance with other antibiotics and the oral route of administration will simplify gonorrhea therapy for clinicians worldwide.”
The findings will have to be vetted by outside scientists and regulatory agencies. But assuming everything is validated, zoliflodacin should be on the fast track to drug approval. From there, it would become the first new drug for gonorrhea successfully developed in decades. It’s also been studied as a treatment for other STIs like chlamydia.
GARDP has already obtained rights to commercialize the drug in three-quarters of the world, including most low- to middle-income countries, while Entasis will hold rights in the major markets of the rest, including the U.S. Ideally, this would mean that zoliflodacin will be relatively affordable in the places where it’s needed most. Another important consideration will be the need to ration the drug and use it only when other treatments won’t work, in order to ensure that resistance to it stays low for as long as possible.
“We cannot deprive people who need this treatment around the world,” Manica Balasegaram, GARDP’s executive director, told Nature. | Drug Discoveries |
"Snorting kits" for drug users will soon be distributed in Portland, Oregon, and its surrounding county as part of a harm reduction plan that even the city's Democratic mayor opposes.
The Multnomah County Health Department announced the plan Friday and said it will expand available drug paraphernalia for users to adjust for alternative methods of fentanyl use beyond injection. This will include tin foil, straws and "snorting kits."
Democratic Portland Mayor Ted Wheeler announced his opposition to the county's plan, which he said encourages drug use.
"I adamantly oppose distributing paraphernalia to encourage using a drug that is the leading cause of death for Americans under 50 and responsible for 190 fatal overdoses a day in the US," Wheeler tweeted Friday.
Portland City Commissioner Rene Gonzalez, another Democrat, also criticized the plan.
"Multnomah County handing out tin foil sends a horrific message in a community that is working hard to restore livability, public safety, and its reputation. Heavy drug use is killing too many, driving crime, deeply damaging livability and devastating our 911 system," she said in a statement. "Thoughtful harm reduction may have a place in addressing substance use disorder, but handing out tinfoil/straws in a community ravaged by fentanyl is reckless."
Drug overdoses in the U.S. hit more than 100,000 in 2022, the first time in history it hit six figures. The overdoses spiked amid the COVID-19 pandemic, going from 71,000 in 2019 to more than 90,000 in 2020.
"Snorting kits" have been distributed in different cities by harm reduction groups in recent years. The kits often include a straw, plastic razor and flat surface to assist drug use through the nostril. Harm reduction groups say the kits reduce bacteria exposure from reusing paraphernalia and encourage users to stop injecting.
Needle exchange programs, which provide clean syringes for drug users, remain largely popular and operate in 38 states, according to the American Civil Liberties Union. However, harm reduction efforts beyond syringes have sparked backlash.
The Department of Health and Human Services announced last year that its first ever federal harm reduction grant program would fund "smoking kits" but would ensure they do not include pipes used to smoke drugs. | Drug Discoveries |
Story Highlights
- 62% of adults under age 35 say they drink, down from 72% two decades ago
- Conversely, drinking has increased among adults aged 55 and older
- Young adults also drinking less frequently, less likely to drink to excess
WASHINGTON, D.C. -- Young adults in the U.S. have become progressively less likely to use alcohol over the past two decades, with the percentages of 18- to 34-year-olds saying they ever drink, that they drank in the past week and that they sometimes drink more than they should all lower today. At the same time, drinking on all three metrics has trended up among older Americans while holding fairly steady among middle-aged adults.
These findings come from an analysis of Gallup trends on Americans’ self-reports of their alcohol drinking habits. To allow for reliable analysis of the trends by age, the data are reviewed in three three-year time periods: 2001-2003, 2011-2013 and 2021-2023.
Young Adults Now Vie With Elders for Lowest Drinking Rate
Gallup’s long-term measure of alcohol consumption asks U.S. adults whether they “ever have occasion to use alcoholic beverages.” While the national average has been steady in the low 60% range for over 40 years, the age trends reviewed for this report show that the rate has declined 10 percentage points over the past two decades among younger adults, aged 18 to 34, falling from 72% to 62%. Meanwhile, the percentage of drinkers has increased by 10 points among older adults, those 55 and older, going from 49% to 59%.
While these groups on either end of the age spectrum now report similar drinking rates, those in the middle, aged 35 to 54, maintain a higher drinking rate, at 69%, on par with the prior 67% readings for this age group.
Fewer Younger Drinkers Drink Regularly
Younger adults who drink are also less likely than they were in the past to say they had an alcoholic drink within the past seven days -- an indication of being a regular drinker. The 61% who most recently reported having a drink in the past week is down from 64% in 2011-2013 and 67% in 2001-2003.
Again, older Americans’ reports have gone in the other direction, with a six-point increase since 2001-2003 in drinkers aged 55 and older saying they consumed alcohol in the past week, while middle-aged adults’ drinking reports have been steady.
The net result is that among all Americans (encompassing drinkers and nondrinkers), fewer than four in 10 young adults (38%) now appear to be regular drinkers, on par with older adults (40%) but trailing middle-aged adults (48%). This pattern is a change from two decades ago when younger adults were the most likely to be regular drinkers and older adults the least.
Reported Overdrinking Also Less Common Among Those Under 35
Furthermore, fewer young drinkers today (22%) than in the 2000s or 2010s (28%) report they sometimes drink “more than they think they should.”
Combined with the decline in the percentage of young people who ever drink, this means the rate of overdrinking among all 18- to 34-year-olds is now 13%, down from 21% in 2001-2003. The percentage drinking to excess is essentially unchanged among middle-aged adults, while it has increased slightly among the older group.
The decline in young adults’ self-reported overdrinking is supported by their shrinking estimate of the number of drinks they had in the past seven days. This number has fallen from an average 5.2 drinks in 2001-2003 to 3.6 drinks in 2021-2023. Meanwhile, it has been steady among both older age groups.
Why Are Fewer Young Adults Choosing Alcohol?
There could be several reasons why today’s young adults are less likely to drink than the same age group a decade or two ago.
Demographics: The main reason for the decline in drinking among young adults may be the much greater diversification of their racial/ethnic makeup than has occurred among middle-aged and older adults.
- The percentage of 18- to 34-year-olds who are Black, Hispanic, Asian or another racial minority has nearly doubled over the past two decades, making up just under a third of the age group in Gallup’s 2001-2003 data to about half of it today.
- Non-White Americans have persistently been less likely than White Americans to use alcohol, and this is seen across all age groups. In 2021-2023, there is a nine-point difference among the youngest group: 57% of non-White 18- to 34-year-olds drink, compared with 66% of White young adults.
Given this, the overall drinking rate among 18- to 34-year-olds has naturally fallen as the proportion who are non-White has increased.
Health concerns: Although demographic changes explain some of the decline in young adults’ drinking, Gallup still finds fewer young people reporting they use alcohol than did in the past, regardless of race. The percentage who ever drink alcohol has come down 10 points since 2001-2003 among those who are non-Hispanic White and has fallen seven points among those who are non-White.
Growing public concern about the health risks of drinking, particularly among young adults, could be behind these shifts.
- Gallup’s latest update on Americans’ drinking habits, from a July 3-27 poll, found a marked increase from earlier readings in Americans’ belief that even moderate drinking is bad for one’s health.
- Young adults are particularly concerned that moderate drinking is unhealthy, with 52% now holding this view, up from 34% five years ago. That 18-point increase in concern compares with a 13-point increase among middle-aged adults and little change among those aged 55 and older.
Marijuana: Although less evident in the data than the generational shift, young adults’ increased use of marijuana in recent years could be a factor in their declining interest in alcohol.
Marijuana use has almost doubled among adults aged 18 to 34 since Gallup first measured whether Americans smoke it in 2013, rising 11 points to 25% in 2021-2023. However, this isn’t unique to young adults, as marijuana usage has increased just as much over the same period -- up 13 points from 4% to 17% -- among middle-aged adults.
Still, it’s possible young marijuana users smoke it (or use it in other ways) more often than middle-aged users, making marijuana more of a replacement drug for alcohol for them.
Generational Change Behind Uptick Among Older Americans
And why are today’s older Americans drinking more than the same age group two decades ago? The reason seems to be rooted in generational change.
- Baby boomers (those born between 1946 and 1964) have consistently been more likely to drink alcohol than the Silent Generation (born before 1946).
- Baby boomers’ drinking rate has been fairly steady over the past two decades, near 65%, but as they replace the Silent Generation as America’s oldest age group, the drinking rate among older adults has increased.
Bottom Line
The overall rate of drinking in the U.S. has been generally steady in recent decades, but that masks shifts by age, with older Americans having become more likely to drink and younger Americans less likely. The net result is that after years when younger adults were the biggest drinkers among age groups, they have grown closer to older adults in their drinking habits, leaving middle-aged adults as today’s leading alcohol consumers.
To stay up to date with the latest Gallup News insights and updates, follow us on Twitter.
Learn more about how the Gallup Poll Social Series works. | Stress and Wellness |
Dustin Jones/NPR
toggle caption
Adam Kaye and his mother, Marti Kaye, spend every Sunday together. Adam normally plays some of her favorite songs on his guitar, with Marti whistling or humming along. But he recently had shoulder surgery and won't be able to strum a guitar for a while.
Dustin Jones/NPR
Adam Kaye and his mother, Marti Kaye, spend every Sunday together. Adam normally plays some of her favorite songs on his guitar, with Marti whistling or humming along. But he recently had shoulder surgery and won't be able to strum a guitar for a while.
Dustin Jones/NPR
Eighteen years ago, Adam Kaye was hosting a family barbecue at his home in Del Mar, Calif., when his mother, Martha Kaye, broke the news. At 71 years old, she realized that she was becoming forgetful. While working in the kitchen, she would ask herself out loud, "What am I doing?" Martha — better known as Marti — started calling everyone "Darling" because names had begun to slip her mind.
Adam had suspected something was wrong. So when Marti told him she had Alzheimer's disease, the diagnosis didn't come as a surprise. "But that didn't mean that it wasn't very difficult to hear," he says. "It was something upsetting for my young daughter, who had never seen her grandma cry at the time."
Well aware that Alzheimer's is an irreversible disease, a "one-way street," Adam didn't feel the need to bury himself in research. He had two young children to raise, and his father, Peter Kaye, had already decided he would be the one to care for his wife of 50 years.
But almost a decade passed, and Peter was diagnosed with bone cancer in 2014. He soon became unable to tend to Marti's needs, and the family decided to bring on professional caregivers. When Peter passed away in 2015, Adam and his older brothers, Loren and Terry Kaye, had to sell their parents' house to help pay for their mother's care.
Marti had always supported Adam in life's endeavors: buying him guitars, driving him to music lessons and helping with school. Watching his mother deteriorate was painful, Adams says, seeing her go from being the woman who would light the room to a shadow of her former self. And when his mother had to leave her home and move in with full-time caretakers in the summer of 2015, he was determined to be there for her.
As a lifelong musician, Adam has always enjoyed playing for his mother. Before the onset of Alzheimer's, Marti would sing along, and the pair would perform as a duet for family and friends.
So every Sunday for the past eight years, Adam has packed his guitar and made the short drive to visit with his mother. Once there, he plays some of her favorite songs: tunes from the metaphorical pages of the Great American Songbook, like 20th-century rock standards and folk and jazz tracks. When he plays for her, he sees a glimpse of the woman he has known his entire life.
A musical bond between mother and son
Back in February 2019, Adam posted a video to his band's Instagram account of him playing "Blue Bossa," by Kenny Dorham, for Marti. Recording their performances since then makes their time together more fun, he says, and the videos give him something he can look back on and smile. They also seemed to strike a chord with his followers, especially those with a loved one with Alzheimer's.
"Some of the posted comments touched upon how these videos and the togetherness brings tears to their eyes and makes them think of their own loved ones and their own stories and what they go through," Adam says.
He has since posted more than 100 recordings of him and Marti performing together.
"That is why I feel really good about doing this. I know that Marti, with her forever benevolent heart, would want to do anything ever within her means to help people."
At first, Marti would sing along with Adam. But as the disease inevitably progressed, the words to her favorite songs began to slip away. By 2018, her speech was limited to one-syllable words that made little sense.
But when the lyrics were long gone, Marti began to whistle along as her 57-year-old son strummed the chords to the songs she'd always loved — like those of the Beatles, jazz legend John Lewis and Elvis Presley.
Somehow, she still knows the melodies to the songs she had listened to 70 years ago.
"Alzheimer's disease has crushed Marti's memory. At this stage, she cannot form a word. But somehow the pathway to musical melodies remains clear," Adam says. "And it is along this pathway that she and I are able to communicate."
The link between music and memory with Alzheimer's
When Marti was first diagnosed, Adam visited the Alzheimer's Association — the world's leading nonprofit that studies the disease — to look into what care options were available for his ailing mother.
But he was unaware of the link between music and memory when he first started making his weekly visits to play for Marti eight years ago. However, he noticed early on in his visits that when he played a song from her past, her eyes would light up, and she would smile and try to sing along with him. Adam says some visiting professionals were also unaware of that connection and were shocked when they listened to the Marti and Adam show.
"I've seen some visiting caregivers who didn't know that we did this ... turn their heads, amazement in their eyes, when she's doing this, like, 'What am I hearing? What? How is she doing this?' Because these same caregivers know the severity of her condition and know that she can't do anything," Adam recalls. "They were dumbfounded when they would hear her whistling along to a tune."
Carmela Abraham, a professor emeritus at Boston University's School of Medicine, has studied Alzheimer's disease for over 30 years in hopes of better understanding the disease and developing treatment options. She says 6 million people in the U.S. have the incurable and irreversible disease, which makes up approximately 70% of all dementia cases.
The disease is a heartbreaker for everyone involved, she says. That begins with the patient, who has to come to terms with the fact that their memory and cognitive abilities are in decline.
"But after a while, they don't suffer anymore. They have no pain, and they just don't know what's going on. They don't recognize their family members, their loved ones, so they really don't suffer," Abraham says. "They can live like this [for] 10 to 15 years. And the suffering, which is both emotional and then financial, is on the family."
The disease affects short-term memory in the beginning, leaving long-term memories intact for a period of time. That's why music from Marti's past has stuck with her for so long, Abraham says.
"If the person, in the past, knew certain tunes and they hear them again, so such long-term memory can still be there," she says. "They can recognize the tune and enjoy it and even maybe smile, you know, give a sign that they are still there."
According to a study from Northwestern University, many Alzheimer's patients can still recall melodies from their past because the cerebellum, where musical memories are processed, is affected later in the disease. This allows patients like Marti to recognize and enjoy the music they've always loved, even after they can no longer speak.
Enjoying what little time is left
A series of new treatment options in 2023 has shown promise for the millions of Americans with Alzheimer's. This July, the Food and Drug Administration gave full approval for Leqembi, the first drug shown to slow the disease. And a new experimental drug called donanemab, which was found to slow Alzheimer's progression by about 35%, has been submitted to the FDA for approval. A decision is expected by the end of 2023.
However, both of these new drugs can only slow the disease, not stop or reverse it.
And unfortunately for Marti, many of today's disease detection and treatment methods weren't available when her doctor told her she had Alzheimer's back in 2005. Adam says his mother participated in a clinical trial through the University of California San Diego a few years after she was diagnosed, but nothing ever came from it.
Ultimately, family members have decided to make the most of their remaining time with Marti, instead of burying themselves in research and additional studies. In 2013, the whole family made a trip to Yosemite National Park, the beauty of which Adam says brought Marti to tears. And Adam continued to host family barbecues at his home in Del Mar every Sunday until his father passed away in 2015.
As Marti's condition advanced, Adam's visits replaced the Sunday barbecues, but the time they spend together is still cherished. They performed together at a holiday party at the Del Mar Civic Center in December 2021, their first and last show together.
Marti had some teeth removed 10 months ago, so her whistling isn't what it used to be. And Adam had shoulder surgery in late August, so he won't be able to strum a guitar for a while. But he still carves time out of every Sunday to see his mom — the best part of his week.
"It gives me a lift every time. I love my mom so much. I miss her. I miss her great, loving, caring heart, and I miss her ability to think and I miss her ability to remember and I miss how sweet and unconditionally loving she always was for me, especially during times when I might not have deserved it," he says. "So it means everything for me to be able to bring her a little bit of joy with my guitar and my visits and playing along together." | Disease Research |
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The popular weight-loss drug Wegovy reduced the risk of serious heart problems by 20 percent in a large, international study that experts say could change the way doctors treat certain heart patients.
The research is the first to document that an obesity medication can not only pare pounds, but also safely prevent a heart attack, stroke or a heart-related death in people who already have heart disease — but not diabetes.
The findings could shift perceptions that the new class of obesity drugs are cosmetic treatments and put pressure on health insurers to cover them.
“It moves from a kind of therapy that reduces body weight to a therapy that reduces cardiovascular events,” said Dr. Michael Lincoff, the study’s lead author and a heart expert at the Cleveland Clinic.
Wegovy is a high-dose version of the diabetes treatment Ozempic, which already has been shown to reduce the risk of serious heart problems in people who have diabetes. The new study looked to see if the same was true in those who don’t have that disease.
WATCH: Patients say drugs like Ozempic help with ‘food noise.’ Here’s what that means
Experts have known for years that losing weight can improve heart health, but there hasn’t been a safe and effective obesity medication proven to reduce specific risks, said Dr. Francisco Lopez-Jimenez, a heart expert at the Mayo Clinic. He expects the new findings to change treatment guidelines and “dominate the conversation” for years to come.
“This is the population who needs the medicine the most,” said Lopez-Jimenez, who had no role in the study.
In the U.S., there are about 6.6 million people like those tested in the study, experts said.
The results were published Saturday in the New England Journal of Medicine and presented at a medical conference in Philadelphia. Novo Nordisk, the maker of Wegovy and Ozempic, has asked the U.S. Food and Drug Administration to include the heart benefits on Wegovy’s label, like on Ozempic’s.
The new study, paid for by the company, included more than 17,500 people in 41 countries. Participants were age 45 and older, had a body mass index of 27 or higher and were tracked for more than three years on average. They took typical drugs for their heart conditions, but they were also randomly assigned to receive weekly injections of Wegovy or a dummy shot.
The study found that 569, or 6.5 percent, of those who got the drug versus 701, or 8 percent, of those who received the dummy shot had a heart attack or stroke or died from a heart-related cause. That’s an overall reduction of 20 percent in the risk of those outcomes, the researchers reported.
The drop appeared to be fueled primarily by the difference in heart attacks, but the number of serious health complications reported were too small to tell whether the individual outcomes were caused by the drug or by chance.
Study volunteers who took Wegovy lost about 9 percent of their weight while the placebo group lost less than 1 percent.
The Wegovy group also saw drops in key markers of heart disease, including inflammation, cholesterol, blood sugars, blood pressure and waist circumference, noted Dr. Martha Gulati, a heart expert at Cedars-Sinai Medical Center in Los Angeles. Changes in those markers began early in the study, before participants lost much weight.
“It means to me that it’s more than just weight loss, how this drug works,” said Gulati, who had no role in what she called a landmark study.
Still, “it remains unclear” how much of the results were a benefit of losing weight or the drug itself, an editorial accompanying the study noted.
About a third of all study volunteers reported serious side effects. About 17 percent in the Wegovy group and about 8 percent in the comparison group left the study, mostly because of nausea, vomiting, diarrhea and other stomach-related problems.
Nearly three-quarters of participants were men and nearly 84 percent were white. Gulati and others said future research needs to include more women and racial and ethnic minorities.
Wegovy is part of a new class of injectable medications for obesity. On Wednesday, the U.S. Food and Drug Administration approved Eli Lilly’s Zepbound, a version of the diabetes drug Mounjaro, for weight control.
Both carry high price tags — monthly costs are about $1,300 for Wegovy and about $1,000 for Zepbound. And both have been in shortage for months, with manufacturers promising to boost supplies.
The medications are often not covered by private health insurance or subject to strict preauthorization requirements. Medicare, the government health plan for older Americans, is prohibited from covering drugs for weight loss alone. But drugmakers and obesity treatment advocates have been pushing for broader coverage, including asking Congress to pass legislation to mandate that Medicare pay for the drugs.
Results from the latest study and others that show the obesity drugs have a direct effect on costly health problems could be a factor in shifting the calculus of coverage, said Dr. Mark McClellan, former chief of the Centers for Medicare and Medicaid Services and the FDA. In 2006, Medicare was allowed to cover weight-loss surgery to treat the complications of severe obesity, if not obesity itself, he noted.
That approach “may end up being relevant here,” he said.
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Lead is bad news for the healthy development of children, and lead-poisoning cases are most common on the South and West sides. [month] [day], [year], [hour]:[minute][ampm] [timezone] Peeling lead paint in a viaduct at 65th Street and Central Park Avenue, a dividing line between Chicago Lawn and West Lawn on the Southwest Side,Tyler Pasciak LaRiviere/Sun-Times City health officials say toxic levels of lead found in the peeling paint in the ceilings of five Southwest Side viaducts are not much of a hazard to the children who walk through them on a daily basis.Most lead poisoning cases involving children stem from flaking paint in homes where they spend hours on end, a health department spokesman told Sun-Times reporter Brett Chase. who wrote about the discovery of the dangerous levels of the metal in the walkways beneath the CSX Transportation-owned rail tracks.That may be true.But given that lead is bad news for the healthy development of children and lead-poisoning cases are most common on the South and West sides, it would be prudent for the city to keep tabs on and officially test the viaducts that run along Central Park Avenue from 63rd to 67th streets.Or at least help clean them up, which is what Ald. Silvana Tabares (23rd) has asked.Tabares found out about the lead three years ago when sixth-graders at Eberhart Elementary School concluded a project on the viaducts with the encouragement and assistance of their teacher, Alejandra Frausto.The children, through Tabares, had hoped to meet with Chicago Public Health Commissioner Dr. Allison Arwady so they could express their concerns. The meeting never happened. Neither did any city-based testing by the Chicago Department of Transportation, Chase found. CDOT and CSX officials have agreed to speak with Tabares in the near future. When that discussion does take place, Tabares should bring along Frausto and her former students who worked on the 2019 school study. Frausto, now a doctoral student at Northwestern University, did additional tests on the lead paint in the viaducts last year and shared the results with Tabares. Frausto is the expert and her apprehension is legitimate, environmental specialists and others agreed.Anyone walking under the viaducts is bringing remnants of the lead on their shoes, strollers or elsewhere into their homes, pointed out Dr. Helen Binns, director of the lead evaluation program at Ann & Robert H. Lurie Children’s Hospital of Chicago.The city’s health department has certainly made a difference in it efforts to eliminate lead exposure to children: In the 1990s, one in four children tested had elevated lead levels. Today, that figure is less than one in 100.It wouldn’t hurt for the health and transportation departments to look over what residents found, publicly address their uneasiness and fix the viaducts to eliminate those feelings of being unsafe. Want to write a letter to the editor or an op-ed? Check out our guidelines. The Sky’s turnovers and second-chance points allowed have contributed significantly to their four losses. They’re averaging 17.5 turnovers and giving up a league-worst 21.8 points off turnovers in those games. Eating nutrient-dense sprouts and microgreens would be especially helpful for the 9 in 10 U.S. adults who, based on federal survey data, don’t consume adequate amounts of vegetables. By American Heart Association News [month] [day], [year], [hour]:[minute][ampm] [timezone] Bloomington state Rep. Dan Brady and former federal prosecutor John Milhiser each say they’ve demonstrated the ability to rack up bipartisan support during lengthy, distinguished careers in central Illinois political circles. A Y shape that symbolizes the Chicago’s River’s split at Wolf Point anchors the new flag. Its green outline symbolizes nature and the county’s forest preserves. By Mitch Dudek [month] [day], [year], [hour]:[minute][ampm] [timezone] The veteran actor does nuanced work as usual, but the FX series takes too many ridiculous turns. By Richard Roeper [month] [day], [year], [hour]:[minute][ampm] [timezone] | Epidemics & Outbreaks |
Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide and Crisis Lifeline, or visit the hotline’s website.
Every night that Dr. Jennifer Hoffmann works as an attending physician in the pediatric ER, she says, at least one child comes in with a mental or behavioral health emergency. Over the span of her career, she’s seen the number of young people needing help grow enormously.
“The most common problems that I see are children with suicidal thoughts or children with severe behavior problems, where they may be a risk of harm to themselves or others,” said Hoffmann, who works at Ann & Robert H. Lurie Children’s Hospital of Chicago. “We’re also seeing younger children, especially since the pandemic started. Children as young as 8, 9 or 10 years old are coming to the emergency department with mental health concerns.
“It’s just mind-blowing.”
The surge of children turning up in emergency departments with mental health issues was a challenge even before 2020, but rates soared during the Covid-19 pandemic, studies show.
ER staffers may be able to stabilize a child in a mental health care crisis, but research has shown that timely follow-up with a provider is key to their success long-term. Unfortunately, there just doesn’t seem to be enough of it, according to a new study co-authored by Hoffmann. Without the proper follow-up, these children too often wound up back in the ER.
For their study, published Monday in the journal Pediatrics, Hoffmann and her co-authors looked at records for more than 28,000 children ages 6 to 17 who were enrolled in Medicaid and had at least one trip to the emergency department between January 2018 and June 2019. They found that less than a third of the children had the benefit of an outpatient mental health visit within seven days of being discharged from the ER. A little more than 55% had a follow-up within 30 days.
Research has shown that follow-up with a mental health care provider lowers a person’s suicide risk, raises the chances that they will take their prescription medicine and decreases the chances that they will make repeated trips to the ER.
The new study found that without a follow-up, more than a quarter of the children had to go back to the ER for additional mental health care within six months of their initial visit.
“The emergency department is a safety net. It’s always open, but there’s limited extent to the types of mental health services we can provide in that setting,” Hoffmann said. “This really speaks to inadequate access to services that these kids need.”
This dynamic can be “devastating” for parents and emergency department staff alike, she said.
“We know what a child needs, but we’re just not able to schedule follow-up due to shortages among the mental health profession. They’re widespread across the US,” she said.
A lack of professional help is a problem for many children. Before the Covid-19 pandemic, the US Centers for Disease Control and Prevention found that 1 in 5 children had a mental health disorder, but only about 20% got care from a mental health provider.
Children’s mental health has become such a concern in the US that the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association declared a national emergency in 2021.
Hoffmann’s study found that Black children fared worse than their peers. They were 10% less likely to have timely follow-up than White children – “which is very concerning, given that there are many disparities in access to care in our mental health system,” Hoffmann said.
The study can’t pinpoint why there is this racial disparity, but Hoffmann thinks there may be a few factors at play.
Black children are more likely to live in neighborhoods that have shortages of mental health professionals. There is also limited diversity among the mental health work force. Studies show that nearly 84% of psychologists are White, as are nearly 65% of counselors and more than 60% of social workers. And Black children more often rely on school-based mental health services, studies show.
Although the number of school counselors has been increasing over the years, few schools meet the National Association of School Psychologists’ recommended ratio of one school psychologist to 500 students. The national ratio for the 2021-22 school year was 1,127 to 1, the association found.
The new study found that the children who did not have mental health help before their ER visits had the most difficulty finding timely care afterward.
Dr. Toni Gross, chief of the Emergency Department at Children’s Hospital New Orleans, said she wasn’t entirely surprised by the study findings. Her hospital’s beds for with mental health concerns are “always busy,” she said.
“I’m well aware of the fact that we need more providers for these services. We deal with it every day,” said Gross, who was not involved in the new research.
The lack of providers who can do follow-up is a real source of concern. It’s not ideal to hand a phone number to a parent and hope they can arrange care, she said. It often takes weeks or even months to get a first appointment with a child and adolescent psychiatrist.
“It leaves a lot of us feeling like we wish we could do more,” Gross said. “When you always leave asking yourself at the end of the day, ‘did I really do what I set out to do, and that is to help people,’ it’s one of our biggest frustrations, and it may be one of the biggest reasons people in my group of physicians feel burnout.”
Like many children’s hospitals, hers has an active partnership with local school health programs that can provide some mental health care.
Hoffmann said that the amount of support varies by emergency department. Lurie has 24/7 coverage by mental health workers who can do an evaluation and provide recommendations for appropriate care, but not all areas do. For example, many rural emergency rooms don’t have pediatric mental health providers and may have few resources in the community, if any.
Several US counties have no practicing child and adolescent psychiatrists. Primary care physicians can help, but some patients would benefit from more specialized care, Hoffmann said.
President Joe Biden’s administration announced in August that plans to make it easier for millions of children to get access to mental health services by allowing schools to use Medicaid dollars to hire additional school counselors and social workers. He even mentioned the issue in his State of the Union address Tuesday.
But even more will need to be done. Hoffmann hopes her study will prompt policy-makers to invest more so children can access care no matter where they live. Investing in telehealth could also bridge the gap, she said, as would increasing Medicaid reimbursement rates for mental health services and more funding to pay for people to train to work with children as a mental health professional.
In a commentary published alongside the new study, the authors say their research shows that the US “is not meeting the behavioral health needs of our young people.”
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“EDs are the last stop when all else has failed, and they, too, lack the resources to support, or even discharge, these patients,” the commentary says.
It points out that research has found this lack of access as far back as 2005.
“This new analysis adds to the overwhelming evidence that there is an urgent need for a dramatic change in our pediatric mental health care system,” the commentary says. “We believe it is time for a ‘child mental health moonshot,’ and call on the field and its funders to come together to launch the next wave of bold mental health research, for the benefit of these children and their families who so desperately need our support.” | Mental Health Treatments |
A woman who was diagnosed with HIV seven years ago has welcomed a "long overdue" television campaign that will see the first new advert raising awareness of the virus in 40 years.
The first major TV advert on HIV to air in Scotland since the UK government's Don't Die Of Ignorance campaign featuring falling tombstones 40 years ago launches at 7.58pm on Monday evening on STV.
It will be a departure from the message in the 1980s, telling viewers HIV was a "deadly disease" with no known cure and will instead inform viewers that those with the disease can live a healthy and happy life.
Emma McAnally, 34, from Glasgow, said she hoped it would help others living with the virus to come to terms with their diagnosis.
She said: "When I was diagnosed with HIV in 2016 I was in total disbelief as I thought this was something that would never affect me.
"But I was reassured by the doctor that medication would allow me to live a normal, healthy life, and this would also mean I would not be able to pass the virus on to others.
"HIV hasn't limited my hopes and aspirations in any way but the stigma has been the single biggest barrier of my diagnosis.
"Unfortunately, this stigma deeply affected me, my family and friends didn't know how to respond and it was pretty horrific for me.
"Eventually, I became determined not to let that shame define me - having children was the biggest turning point for me as I became so confident in my body and by being on effective treatment, knew I could give birth to my son and daughter and they would be HIV negative.
"It's incredible to see a long overdue TV advert on the reality of HIV in 2023 and how stigma is now more harmful than the virus itself.
"I hope it helps people living with HIV who are struggling to come to terms with their diagnosis feel a little bit less alone and also educates and raises awareness."
The TV advert will be accompanied by a wider campaign on billboards, newspapers and online.
It is informed by Scottish government-funded research from YouGov into attitudes and beliefs about HIV and produced by the Terrence Higgins Trust, the UK's leading HIV and sexual health charity.
The campaign aims to send the message that stigma is more harmful than the virus itself.
Read more:
HIV stigma remains 'all these years on', poll reveals
A&E testing scheme finds thousands of people with HIV and hepatitis
Richard Angell, chief executive of the Terrence Higgins Trust, said: "The government's AIDS awareness advert in the 1980s undoubtedly saved lives, but it also cast a long shadow by terrifying a generation about HIV.
"That's why it is high time we update everyone's knowledge about the incredible progress that's been made in the fight against HIV over the last 40 years by bringing it back into millions of living rooms.
"Our new film is based on the direct experiences of people living with HIV in Scotland who shared how much of a challenge the stigma still surrounding HIV is in their day-to-day lives.
"I hope millions will see our advert in the weeks ahead and be motivated to learn the facts and ditch the fiction about HIV." | Epidemics & Outbreaks |
Excluding regional mayors from key meetings harmed the UK's response to the pandemic, Sadiq Khan and Andy Burnham have told the Covid inquiry.
The Labour mayors of London and Greater Manchester said their repeated requests to join emergency Cobra meetings at the start of the pandemic were refused.
London mayor Mr Khan said "lives could have been saved" if he had been allowed to attend earlier.
Greater Manchester's Mr Burnham said decision-making was "London-centric".
Cobra meetings, which were held throughout the pandemic, bring together a mixture of ministers and officials from relevant departments and agencies to coordinate the government's response to national emergencies.
Despite London facing higher rates of Covid than other parts of the country in early 2020, Mr Khan said he was not allowed to attend any Cobra meetings until 16 March.
The inquiry heard that his earlier requests to attend were rejected by No 10 on the grounds that other regional mayors would then need to be invited.
"I was told the pandemic was having an impact on London ahead of the rest of the country," Mr Khan said.
"The government was aware of the challenges in ICU [intensive care units], the challenges in our hospitals, and the government was aware of community transmission in London."
He added: "In this particular case, I can see no explanation at all⦠why the Greater London Authority, the mayor of London were not around the table.
"I think lives could have been saved if we were there earlier."
He said there was also no reason other mayors could not have joined meetings virtually.
Mr Khan told the inquiry he was "kept in the dark" by the government and if he had been given a fuller picture he would have taken more action, including lobbying the prime minister for a lockdown earlier.
In his evidence to the inquiry, Mr Burnham said he "repeatedly" asked to attend Cobra meetings but was not invited to a single one during the pandemic.
The mayor of Greater Manchester said London-centric decision-making meant his region was "stuck" with higher Covid rates for the whole of 2020.
Mr Burnham said there was "zero consultation" with him over easing the national lockdown in May 2020, which he argued was "too early" for Greater Manchester.
He added that as Covid had spread from the south to the north of England, the north was closer to a peak in cases than the south of the country at that time.
Mr Burnham told the inquiry he was "astonished" by the "massively centralised" response to the pandemic.
In the summer of 2020, Mr Burnham said he was given only an hour's notice to discuss the imposition of local restrictions in Greater Manchester with local leaders before they were announced.
He described the situation as "chaotic" and said he was "inundated" with questions from residents about whether they could go to work the following day.
In October 2020 a formal three-tier system was introduced, which imposed varying levels of restrictions in different regions of England depending on local Covid rates.
However, the system did not bring rising cases and deaths under control and in November a four-week national lockdown was introduced.
Mr Burnham said he repeatedly asked for more financial support for businesses and workers affected by tougher restrictions.
He accused the government of discussing a "punishment" for his region, because he had "stood up" for people who would have struggled with lockdown measures without extra financial support.
The mayor read out a minute of a meeting of the government's "Covid-O" committee that said: "Lancashire should have a lighter set of measures imposed than Greater Manchester since they had shown a greater willingness to co-operate."
Asked to respond to criticism that he was "obstructive" in discussions over financial support, Mr Burnham said it was the government which behaved "appallingly" by imposing a policy which he claimed ministers knew would not work.
Quoting from written evidence submitted by former Health Secretary Matt Hancock, Mr Burnham said: "He says in his evidence about tier three, 'I was in despair that we had announced a policy that we knew would not work'."
Giving evidence to the inquiry later, Liverpool City Region mayor Steve Rotheram also criticised the government's communication with local leaders during the pandemic.
The Labour mayor said his team had been left to wait for the evening news bulletin to find out "nearly every major announcement".
He highlighted discussions around moving his area to tier three, saying he had previously agreed with then-Prime Minister Boris Johnson that they should work together on announcing the move in autumn 2020.
However, later the same day Mr Rotheram said the PM independently announced the restrictions "without any notification to me".
"Then we had to try and pick up the pieces," he added.
Mr Rotheram said the confusion and anger around the announcement resulted in him receiving "direct threats" and needing 24-hour police protection.
The inquiry is taking witness evidence in London until Christmas, before moving to Scotland, Wales and Northern Ireland. | Epidemics & Outbreaks |
Children's services could be forced to close at a hospital that is accused of leaving young patients traumatised and sick through poor care.
The care regulator said it had taken action to "ensure people are safe" on Skylark ward at Kettering General Hospital (KGH) in Northamptonshire.
Thirteen parents with serious concerns after their children died or became seriously ill have spoken to the BBC.
The hospital said it was "very sorry" to families who felt let down.
A BBC Look East investigation has heard allegations spanning more than 20 years about the treatment of patients on Skylark ward, a 26-bed children's unit.
The claims include repeated failures to diagnose life-threatening illnesses and the regular discharge of patients who require urgent care.
Skylark came under scrutiny in 2019 after an inquest found five major errors led to the death of baby Jorgie Stanton-Watts.
The hospital's trust said it implemented a series of changes as a result, including "significant extra training".
However, the BBC has since discovered:
- An independent report found staff left a 12-year-old boy - who died at KGH in December 2019 - for four hours suffering seizures, and suggests little effort was made to obtain critical care support.
- In April 2019, nurses allegedly dragged a "traumatised" four-year-old girl down a corridor in agony, insisting that she could walk. Medics are accused of refusing to carry out an MRI scan, which would have detected a dangerous cyst on her spine.
- Mothers claim to have been threatened with safeguarding referrals, with one stating a referral was made against her after she complained her son was struggling to breathe, while another likened it to blackmail.
Michaela Stevens has complained about the treatment of her son Archie, who has suffered with croup - a common infection that affects children's airways from birth.
In November, when 17 months old, he was admitted to Skylark after a spell in the emergency department in respiratory distress, said 33-year-old Ms Stevens.
She said Archie took a bad turn and was struggling to breathe, but she was told to "calm down" when she raised the alarm.
"They refused to check him... they kept saying, 'it's viral, he'll be fine by tomorrow'. I don't think anyone had the experience to know what to do.
"I asked six people to check for sepsis and still nothing was done."
Eventually Archie was started on a sepsis pathway and the following day he was diagnosed with invasive group A Strep, a severe infection.
But Michaela said doctors struggled to keep him cannulated - when a tube is inserted into a vein for fluids or drugs - and after four days on intravenous antibiotics, Archie was discharged.
Ms Stevens said the next day she took her son to the GP, who called Skylark because he felt hot, but they were not concerned about him.
So she decided to drive him to Addenbrooke's Hospital, in Cambridge, where staff "immediately started intravenous fluids and antibiotics".
Archie was admitted on to a ward that night and remained in hospital for two weeks, having lost 500g (1.1lbs) on Skylark.
"Archie hadn't eaten for a week and they hadn't put a drip into that boy. I had him christened because I was worried he was going to die," said Ms Stevens.
"I think Archie's quite lucky to be alive. At Skylark ward we were let down at every opportunity and felt completely disempowered as parents."
She raised her concerns with the CQC in late November.
The next month, following "concerns about the safety and quality of care provided", the CQC carried out a focused inspection of KGH's children's services and the paediatric emergency department.
"Inspectors took enforcement action to ensure people were safe and to give the trust the opportunity to make the necessary improvements," a spokeswoman added.
The KGH February board meeting papers stated there was a "significant risk that the trust has the potential to lose its paediatric services, if it fails to make the improvements required and give the assurances needed to keep children safe".
Later this year, the hospital is expected to pay out a multimillion-pound financial settlement to Clare Lester's son Luke, after his treatment in 2015.
Ms Lester took her then three-year-old to KGH suspecting a serious chest infection.
But for 24 hours, staff neglected to test his blood or urine when he was in fact in need of urgent treatment for sepsis, she said.
By the time he was seen by a consultant he was in septic shock, and Ms Lester said she later learned staff "didn't have the things they needed to sedate and ventilate" her son.
He was transferred to Leicester Royal Infirmary but suffered a cardiac arrest en route and was clinically dead for 18 minutes.
Ms Lester was given a few seconds to see him in the intensive care unit.
"I just whispered in his ear, 'You know you do as mummy tells you, well you need to fight.' And he did."
Luke survived, but has lasting signs of brain damage and he lost his right leg below the knee and his left toes.
An internal review found failures and KGH said lessons would be learned, but Ms Lester said: "Even now I'm still angry. I don't think I ever won't be.
"I've had counselling. But I keep going back to 'this should never have happened'."
In response to the BBC investigation, KGH's director of nursing, Jayne Skippen, said: "To any families who feel we did not deliver the best care we could have done, I'm very sorry.
"We know there are some areas we need to improve on and we are working really hard to improve those areas."
She said KGH had made changes, including introducing a larger paediatric emergency department, adding: "We are really committed to making this a better pathway for all of our children."
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Strictly Come Dancing professional Amy Dowden has revealed she contracted sepsis after her first round of chemotherapy earlier this month.
The 33-year-old was diagnosed with stage three breast cancer in May and underwent a mastectomy.
In July, the dancer from Caerphilly, South Wales, told fans she had received a second diagnosis of "another type of cancer".
The dancer, who has also presented a BBC documentary on her battle with Crohn's disease, has now opened up about her ordeal with sepsis that happened just two days after starting chemotherapy.
"I wasn't feeling too bad that day, just sick, but a couple of hours later I started having a temperature of 37.7C," she told Hello! Magazine.
"At the time, I didn't realise that having a temperature of 37.5C or above could be fatal for a chemo patient. I just thought it was my reaction to chemo, but as it turned out, I had already got an infection."
Over the next day, she improved.
"The Strictly producers were checking in on me, and I was sending videos of me on my walk. I couldn't believe how good I was feeling."
But she quickly deteriorated. Her mother Gillian said: "Amy's symptoms got worse very, very quickly. At one point she felt ok, then suddenly she felt very ill - it happened in an instant."
"She went to stand, then just sort of crumpled back on to the settee."
Amy added: "I felt freezing cold but I was all clammy and shaking. My mum and dad rang my red card [which provides the chemotherapy team's contact details and current treatment information] and they said to hang up and ring the ambulance."
She was rushed to hospital where she was treated in an intensive care unit (ICU) for sepsis and dangerously low pressure.
After changing the type of antibiotic, Amy recovered but her memory of the period remains hazy.
"The doctors and nurses were telling me I had sepsis and that it was life-threatening but I wasn't taking it in. I didn't become properly aware until later. I told my dad: 'I've got sepsis' and he said: 'I know!'."
She has since been able to continue with chemotherapy.
Sepsis is a life-threatening reaction to an infection which happens when someone's immune system overreacts to an infection and starts to damage their body's own tissues and organs.
Dowden, who married fellow professional dancer Ben Jones in July last year, previously said she had found a lump in her breast the day before she planned to go on her belated honeymoon this year.
She joined BBC's Strictly Come Dancing in 2017, and has had celebrity partners including comedian Brian Conley, Red Dwarf's Danny John-Jules and McFly's Tom Fletcher.
According to reports, Dowden will not be partnered with a celebrity for the upcoming series of Strictly Come Dancing while she undergoes treatment. | Disease Research |
09 January 2023 Smallpox was once one of humanity’s most devastating diseases, but its origin is shrouded in mystery. For years, scientific estimates of when the smallpox virus first emerged have been at odds with historical records. Now, a new study reveals that the virus dates back 2,000 years further than scientists have previously shown, verifying historical sources and confirming for the first time that the disease has plagued human societies since ancient times. The paper appears in the journal Microbial Genomics, published by the Microbiology Society. Smallpox, caused by the variola virus, is perhaps best known for being the only infectious human disease to be eradicated worldwide. But the disease was a major cause of death until relatively recently, killing at least 300 million people in the 20th century. This is roughly the equivalent of the population of the United States. Until relatively recently, the earliest genetic evidence for smallpox was only from the 1600s. Then in 2020, a study that sampled skeletal and dental remains of Viking-age skeletons recovered multiple strains of variola and confirmed the virus’ existence at least another 1,000 years earlier. However, some historians believe that smallpox has been around since long before the Vikings. Suspicious scarring on ancient Egyptian mummies (including the Pharoah Ramses V who died in 1157 BC) leads some to believe that the history of smallpox stretches back at least 3,000 years. So far, the missing piece of scientific evidence to support this theory has remained hidden. By comparing the genomes of modern and historic strains of variola virus, researchers at the Scientific Institute Eugenio Medea and University of Milan in Italy have traced the evolution of the virus back in time. They found that different strains of smallpox all descended from a single common ancestor and that a small fraction of the genetic components found in Viking-age genomes had persisted until the 18th century. They also worked out an estimate for when the virus originated. In their estimate, the researchers accounted for something called the ‘time-dependent rate phenomenon’. This means that the speed of evolution depends on the length of time over which it is being measured, so viruses appear to change more quickly over a short timeframe and more slowly over a longer timeframe. The phenomenon has been well-documented in DNA viruses like variola. Using a mathematical equation, scientists can account for the time-dependent rate phenomenon to give more accurate dates for evolutionary events, such as the appearance of a new virus. This gave the team a new estimate for the first emergence of smallpox: more than 3,800 years ago. Just as historians have long suspected. The researchers hope these findings will settle a longstanding controversy and provide new insight into the history of one of humanity’s deadliest diseases. “Variola virus may be much, much older than we thought,” said Dr Diego Forni, first author of the study. “This is important because it confirms the historical hypothesis than smallpox existed in ancient societies. It is also important to consider that there are some aspects in the evolution of viruses that should be accounted for when doing this type of work.” NOTES FOR EDITORS The paper, Analysis of variola virus molecular evolution suggests an old origin of the virus consistent with historical records by Diego Forni, Cristian Molteni, Rachele Cagliani, Mario Clerici and Manuela Sironi is published in Microbial Genomics at the following URL: https://www.microbiologyresearch.org/content/journal/mgen/10.1099/mgen.0.000932 DOI: 10.1099/mgen.0.000932 For more information please contact [email protected] The Microbiology Society’s principal goal is to develop, expand and strengthen the networks available to its members so they can generate new knowledge about microbes and share it, driving us towards a world in which microbiology provides the maximum benefit to society. Find out more at microbiologysociety.org. Image: iStock/Peddalanka Ramesh Babu. | Disease Research |
Climate change threatens human life in many ways but one of the less obvious could be a rise in pandemics.
A warming climate could release ancient pathogens, such as bacteria and viruses, that have been frozen in permafrost in the polar regions for millennia, Jean-Michel Claverie tells ABC RN's Future Tense.
"We know for certain that bacteria can remain dormant but alive for probably up to 500,000 years in permafrost. And so at that point, this is the very beginning of Homo sapiens. Our species was just emerging [at that time]," says the emeritus professor of medicine at France's Aix Marseille University.
He says scientists don't yet know exactly how ancient diseases could impact living species today – animals or humans. In 2021, it was reported that more than 100 ancient strains of bacteria found in Siberia's permafrost were resistant to antibiotics.
The professor says that if an ancient disease – like a virus that was lethal for a woolly mammoth – did spread across the world, it could have dangerous implications for humans.
"This is, I think, very dangerous because mammoths are [genetically] very close to elephants. [And] elephants are [genetically] very close to humans."
Rising exposure
Dr Claverie says the risk is complex because even if an ancient pathogen is released from permafrost, it needs a host to infect. In inhospitable polar regions, he says, this isn't much of a concern at the moment.
But with a warming climate, these regions may become more hospitable, opening them up to an increased human presence.
"The danger is not so much the fact that those particles are released, but the fact that there will be more exposure to those particles by humans or animals," Dr Claverie says.
More humans in these areas risk new diseases and potentially future pandemics.
Dr Aaron Bernstein is the director of the Center for Climate, Health, and the Global Environment at Harvard University's School of Public Health in Massachusetts in the US.
He says our increasing proximity to animals is increasing zoonotic spillover, which is when pathogens evolve to infect humans.
It's been said that there could already be up to 850,000 viruses that have the potential to evolve from infecting animals to also infecting humans.
Dr Bernstein says deforestation and the wild animal trade are increasing the risks of zoonotic spillover.
"A huge [risk] is livestock and the fact that we have just immense concentrations of animals now in many places around the world, with relatively limited, if any, biosurveillance for potential spillover [being] a real challenge for us. "
The cost of pandemics
There are countless discussions underway about how to respond to future pandemics, particularly after the devastating impact of COVID-19.
However, Dr Bernstein says the focus should be on preventing the spread of potentially zoonotic diseases in the first place.
Responsive measures like vaccines may be effective at reducing harms, but Dr Bernstein doesn't believe they're the best approach to limiting the spread of disease.
He says if you prevent a pathogen from emerging in the first place, "then you get immense benefits where you don't worry about the efficacy of a vaccine, or people taking it, and the ethics that come up with who gets the vaccine and who has access to it".
He says there are also global cost benefits to focusing on prevention.
In October 2020, it was estimated the total cost of the COVID-19 pandemic was roughly US$16 trillion ($24.2 trillion) in the US alone.
Other virus outbreaks have also been costly. It's been estimated that the 2014 West African Ebola outbreak had a total cost of US$53.19 billion ($80.5 billion), while the 2003 SARS epidemic cost up to US$100 billion ($151.39 billion).
"If you look at all of the viruses that have caused 10 or more deaths in an outbreak roughly over the past century that are zoonotic … you're looking at [a cost of] roughly potentially like half a trillion dollars a year."
Dr Bernstein says there are other wider financial costs to a pandemic.
"If you look at the economic losses – meaning, how much did these emerging infectious diseases contribute to economic decline – that's another $300 billion a year every year from these diseases," he says.
"That [cost] gives you a sense of how much we're losing and how much might be justified in spending and prevention.
"But the question really comes down to: How effective do these interventions need to be?"
Working together will help
Dr Bernstein says one way to prevent these viruses early on could be more collaboration between sectors that don't regularly cross paths, for example, between animal conservationists or veterinarians working with public health officials.
"The folks who know the most about how animals live and how to conserve them have not been effectively engaged with the folks who are charged with addressing human disease risk," he says.
He's not alone. Others have said more collaborations between governments, scientific bodies and non-government organisations to ensure the health of the planet and its inhabitants – sometimes known as the "One Health" concept – could help prevent pandemics.
Dr Christine Prat, the director of operations at the European Virus Archive (EVA), is one of them.
"It is reported that 60 per cent of emerging diseases in the world are zoonosis … so in terms of virus research and pandemic preparedness and response, it's very important to have the smoothest collaboration across research organisations and in different countries," she says.
The EVA often shares virus strains with researchers from the world's scientific communities, which can be very helpful when new diseases emerge.
"During the Zika outbreak, it was very striking to us to see that scientists not only order the Zika virus [from the EVA] but they also needed to compare it to other clinically or epidemiologically relevant viruses," Dr Prat says.
"Those scientists ordered a lot of arboviruses at the same time, because the studies needed those kinds of comparisons," she adds.
"So we strongly believe that having an archive – the largest possible – is a strong pillar in pandemic preparedness."
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Mice eating less of specific amino acid — overrepresented in diet of obese people — live longer, healthier
There’s a popular saying in some circles that “a calorie is a calorie,” but science shows that it may not be true. In fact, it may be possible to eat more of some kinds of calories while also improving your health.
“We like to say a calorie is not just a calorie,” says Dudley Lamming, a professor and metabolism researcher at the University of Wisconsin School of Medicine and Public Health. “Different components of your diet have value and impact beyond their function as a calorie, and we’ve been digging in on one component that many people may be eating too much of.”
Lamming is the lead author of a new study in mice, published recently in the journal Cell Metabolism, showing that cutting down the amount of a single amino acid called isoleucine can, among other benefits, extend their lifespan, make them leaner and less frail as they age and reduce cancer and prostate problems, all while the mice ate more calories.
Amino acids are the molecular building blocks of proteins, and Lamming and his colleagues are interested in their connection to healthy aging.
In earlier research, data from UW–Madison’s Survey of the Health of Wisconsin showed the scientists that Wisconsinites with higher body mass index measurements (higher is more overweight or obese) tend to consume more isoleucine, an essential amino acid everyone needs to eat. Isoleucine is plentiful in foods including eggs, dairy, soy protein and many kinds of meat.
To better understand its health effects, Lamming and collaborators from across disciplines at UW–Madison fed genetically diverse mice either a balanced control diet, a version of the balanced diet that was low in a group of about 20 amino acids, or a diet formulated to cut out two-thirds of the diet’s isoleucine. The mice, which began the study at about 6 months of age (equivalent to a 30-year-old person) got to eat as much as they wanted.
“Very quickly, we saw the mice on the reduced isoleucine diet lose adiposity — their bodies got leaner, they lost fat,” says Lamming, while the bodies of the mice on the low-amino-acid diet also got leaner to start, but eventually regained weight and fat.
Mice on the low-isoleucine diet lived longer — on average 33% longer for males and 7% longer for females. And, based on 26 measures of health, including assessments ranging from muscle strength and endurance to tail use and even hair loss, the low-isoleucine mice were in much better shape during their extended lives.
“Previous research has shown lifespan increase with low-calorie and low-protein or low-amino-acid diets starting in very young mice,” says Lamming, whose work is supported by the National Institutes of Health. “We started with mice that were already getting older. It’s interesting and encouraging to think a dietary change could still make such a big difference in lifespan and what we call ‘healthspan,’ even when it started closer to mid-life.”
The mice on the low-isoleucine diets chowed down, eating significantly more calories than their study counterparts — probably to try to make up for getting less isoleucine, according to Lamming. But they also burned far more calories, losing and then maintaining leaner body weights simply through adjustments in metabolism, not by getting more exercise.
At the same time, Lamming says, they maintained steadier blood sugar levels and male mice experienced less age-related prostate enlargement. And while cancer is the leading cause of death for the diverse strain of mice in the study, the low-isoleucine males were less likely to develop a tumor.
Dietary amino acids are linked to a gene called mTOR that appears to be a lever on the aging process in mice and other animals as well as to a hormone that manages the body’s response to cold and has been considered a potential diabetes drug candidate for human patients. But the mechanism behind the stark benefits of low-isoleucine intake is not well understood. Lamming thinks the new study’s results may help future research pick apart causes.
“That we see less benefit for female mice than male mice is something we may be able to use to get to that mechanism,” he says.
While the results are promising, humans do need isoleucine to live. And winnowing a significant amount of isoleucine out of a diet that hasn’t been preformulated by a mouse chow company is not an easy task.
“We can’t just switch everyone to a low-isoleucine diet,” Lamming says. “But narrowing these benefits down to a single amino acid gets us closer to understanding the biological processes and maybe potential interventions for humans, like an isoleucine-blocking drug.”
The Survey of the Health of Wisconsin showed that people vary in isoleucine intake, with leaner participants tending to eat a diet lower in isoleucine. Other data from Lamming’s lab suggest that overweight and obese Americans may be eating significantly more isoleucine than they need.
“It could be that by choosing healthier foods and healthier eating in general, we might be able to lower isoleucine enough to make a difference,” Lamming says.
This research was funded in part by grants from the National Institutes of Health (AG056771, AG062328, AG081482, AG084156, DK125859, F31AG066311, R01AG062328-03S1, F31AG081115, F31AG082504, T32AG000213, F32AG077916, RF1AG056771-06S1, K01AG059899, R01DK133479, P30DK020579, K12HD101368, R01AA029124, P30 CA014520, P50DE026787, U54DK104310, R01DK131175 and P30CA014520) and the U.S. Department of Veterans Affairs (I01-BX004031). | Nutrition Research |
Scientists are setting out to collect genetic material from 500,000 people of African ancestry to create what they believe will be the world’s largest database of genomic information from the population.
The hope is to build a new “reference genome” — a template to compare to full sets of DNA from individuals — and better understand genetic variants that affect Black people. It could eventually translate into new medicines and diagnostic tests — and help reduce health disparities.
The initiative was launched Wednesday by Meharry Medical College in Nashville, Tennessee, as well as Regeneron Genetics Center, AstraZeneca, Novo Nordisk and Roche. The pharmaceutical companies are providing the funding, while the data will be managed by a nonprofit started by Meharry, called the Diaspora Human Genomics Institute.
Organizers said there’s a clear need for the project, pointing to research showing that less than 2% of genetic information being studied today comes from people of African ancestry.
“We are going to bridge that gap, and this is just the beginning,” said Anil Shanker, senior vice president for research and innovation at Meharry.
Scientists have long known that the reference they compare to individual genomes has serious limits because it mostly relies on genetic material from one man and doesn’t reflect the spectrum of human diversity.
Although any two people’s genomes — that is, a set of instructions to build and sustain a human being — are more than 99% identical, scientists say they want to understand the differences.
The project is not connected with related research already underway. In May, scientists published four studies about building a diverse reference genome that they call a “pangenome.” At that point, it included the genetic material of 24 people of African ancestry, 16 from the Americas and the Caribbean, six from Asia and one from Europe.
In the new project, Meharry, a historically Black academic health sciences center, will recruit patients from the Nashville area to donate blood, then send it to the Regeneron Genetics Center, which will do the genetic sequencing for free.
Other historically Black colleges and universities in the U.S., and the University of Zambia in Africa, will also recruit volunteers. Project organizers said they are also open to working with other universities in Africa, as well as medical centers and health departments there. Organizers expect enrollment to take about five years. All information will be kept anonymous.
After the genetic sequencing, the data will go into a repository at the Diaspora Human Genomics Institute, and the database will be provided exclusively to HBCUs and the institutions involved in Africa. Outside researchers can access the information through those institutions.
“You can imagine if these schools have such a resource, other academic institutions are going to want to collaborate with them,” said Lyndon Mitnaul, executive director for research initiatives at Regeneron Genetics Center.
Corporate partners will be able to use the data for research and to develop medicines and diagnostic tests.
The 10-year initiative also involves establishing a grant program to support research and education in genomics and related fields at Meharry, plus broader STEM programs for grade-school children in diverse communities. Each of the pharmaceutical companies involved intends to contribute $20 million toward the genetic and educational parts of the effort.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content. | Disease Research |
Doctors in England have been told not to prescribe ADHD drugs to new patients because of a national shortage, as charities warn that the supply problems are devastating for people living with the condition.
A national patient safety alert from the Department of Health and Social Care said the shortages were down to a combination of manufacturing issues and increased global demand, and could last until the end of the year.
ADHD, which stands for attention deficit hyperactivity disorder, is described by the NHS as a condition that can make it hard to concentrate and may mean people act on impulse.
Prescriptions for ADHD have been rising in recent years. Figures for April to June 2023 show that about 202,000 individuals in England received one, up from 103,000 in the same period in 2018-19.
Now prescribers have been told not to start new patients on medications affected by the shortages until the supply issues have been resolved.
The medications affected include methylphenidate prolonged-release capsules and tablets, lisdexamfetamine capsules, and guanfacine prolonged-release tablets.
“Other ADHD products remain available but cannot meet excessive increases in demand,” the DHSC alert states. “At present, the supply disruptions are expected to resolve at various dates between October and December 2023.”
Advice has also been given that healthcare professionals should identify all patients currently prescribed these products, check how much supply they have remaining and contact various dispensing pharmacy services or the patient’s specialist team for advice should their supplies be running low.
Henry Shelford, the CEO and a co-founder of ADHD UK, said: “ADHD is a disability and the sudden removal of medication is akin to removing a wheelchair from a disabled person that needs it. The NHS should have realised that this was happening and had a plan in place. Instead, people are only finding out when their pharmacy can’t supply. They’ve been left stranded with no support. It is an abject failure, but sadly this lack of care is something we’ve come to expect with our stigmatised condition.”
Shelford criticised the DHSC advice. “The Department of Health and Social Care sticking-plaster memo with the suggestion that GPs ‘reach out to a patient’s specialist team’ is laughable,” he said, adding that patients often waited years to meet the medication team.
“Medication is carefully given with dosage and type worked out over months. The idea it can be chopped and changed is wrong. The idea that specialist teams have the capacity to do medication reviews in this quantity is wrong,” he said.
“This is devastating for individuals across the country and will be life-changing for some. People with ADHD are being let down by the NHS. This is just the latest way in which we are being failed.”
Shelford said the situation was also of concern for those hoping to start treatment for ADHD. “It’s going to be devastating for those diagnosed [who are] waiting to receive medication now knowing they have to wait even longer,” he said.
The current shortages are not the first to affect ADHD drugs this year. The DHSC previously warned of a shortage of atomoxetine capsules, a situation that is not expected to be resolved until next month.
Dr Andrew Hill, a senior visiting research fellow in the department of pharmacology and therapeutics at the University of Liverpool, said the problem lay in how medicines were sourced.
“The NHS often depends on only one or two foreign suppliers for key medicines. If these factories fail to supply, there is a high risk of shortages,” he said. “We had many problems during Covid when drug production was suspended in China and India. Last year there was a major shortage of amoxicillin to treat respiratory infections.”
He said a new approach was needed. “The European Union is passing new laws to safeguard supplies of critical medicines. Manufacturers need to send alerts if their supplies are at risk. It is time for the UK to do the same.”
A Department of Health and Social Care spokesperson said: “We are aware of supply issues affecting medicines used for the management of ADHD due to increased global demand, and we have issued communications to the NHS to advise healthcare professionals on management of patients during this time.
“We continue to work closely with the respective manufacturers to resolve the issues as soon as possible and to ensure patients have continuous access to ADHD medicines in the UK.”
• This article was amended on 1 October 2023 to correct one misspelling of Henry Shelford’s surname. | Epidemics & Outbreaks |
The lifestyle contributor recently shared she has been diagnosed with breast cancer.
"I had always feared this day would come," she wrote in an essay published to Today.com on July 17, "but I never really thought it would."
As Martin explained in the piece, this looming fear stemmed from her own family's experience with the disease, including her grandmother dying from breast cancer. She added that her "mother—who is healthy now—had a double mastectomy in her late 40s after being diagnosed with ductal carcinoma in situ often referred to as stage 0 breast cancer."
The Shop Today with Jill Martin host cited her family's history as the reason she stayed up to date on her screenings. In fact, she noted in her essay that she had her last mammogram in January and that it came back as normal. However, Martin said her doctors advised her to do genetic testing just in case.
"That suggestion saved my life," she wrote. "On June 20, I got a call from Dr. Susan Drossman telling me that I was BRCA2 positive. And as it turns out, my father is BRCA2 positive, too. And because of those positive tests, which I will be forever grateful we took, my father will get screened and stay vigilant about breast, prostate and pancreatic cancer, which he now knows he's at a higher risk for. And because of that test, I had a sonogram and an MRI and it turns out...I have breast cancer."
Martin—who noted her mother tested negative for BRCA gene mutations—wrote in her essay that she will undergo a double mastectomy and then begin reconstruction.
"My treatment plan will also be informed by the results from my surgery," she continued. "My OB-GYN, Dr. Karen Brodman, has advised that, in a few months, I will also need my ovaries and fallopian tubes taken out as part of the preventative surgery process, as my chances of getting ovarian cancer are now 20% higher, according to my doctors. That is not a percentage I am willing to live with."
During an interview on Today, Martin—who said she's undergoing her first surgery this week—expressed how she wanted to share her experience to encourage other people to talk to their doctors and learn more about genetic testing.
"I don't know what's going to happen," the author explained, "but I know that while I'm healing and while I'm resting and while I prep for the second surgery, everyone could go out and get their genetic testing and their families can know."
And Martin knows she's entering her breast cancer battle with loads of support.
"I feel devastated and sad and scared, but I feel empowered and strong and my dad said, 'We got this,'" she said. "My husband's right there and I have the best doctors and my family and I got this. I got this. Just please see your doctors and see if genetic testing is appropriate."
(E! and NBC News are both part of the NBCUniversal family). | Women’s Health |
7 Significant Health Issues Every Off-Planet Astronauts Endure During Space Missions
Published on December 5, 2023
Imagine you’ve just stepped off a plane after a grueling 10-hour flight. Your body feels weary, your muscles ache, and you can’t shake off the fatigue that clings to you. This is a sensation many of us have experienced and can easily relate to. Now, let’s take a giant leap from this familiar scenario to the realm of astronauts orbiting our planet. Here, in the vast expanse of space, the absence of gravity presents an entirely different set of challenges.
In the microgravity environment of space, the human body undergoes changes that no commercial airline passenger would ever encounter. While a long flight might leave us feeling tired and stiff, prolonged exposure to space can have profound and lasting effects on the human body. From the weakening of muscles to the alteration of bodily fluids, the impact is far-reaching.
In this article, we’ll be looking at the long-term health impacts of space travel, and talk about how the human body adapts, or struggles to adapt, to this extraordinary environment. But before we get into this, let’s mention the main reasons for these health concerns.
The Triple Threat in Space Travel
Radiation Exposure
In space, astronauts are exposed to higher levels of cosmic rays and solar radiation, as Earth’s atmosphere provides a protective shield against these on the surface. Despite the ISS being equipped with specialized radiation shielding materials, astronauts are still exposed to a larger amount of radiation than most people do. Overtime, this exposure can increase the risk of cancer, damage the nervous system, and cause other health issues.
Microgravity Effects
The microgravity environment in space can lead to various health problems. Our body are adapted to function under the gravity pull of the Earth. Once that gravity is no longer affecting our bodies, its normal functions are thrown out of balance and can cause various effects. These include muscle atrophy, bone density loss, and fluid redistribution in the body, which can affect vision and other bodily functions.
Psychological Stress
Being in a confined space for extended periods, away from family and familiar surroundings, can lead to psychological stress and issues like depression and anxiety. The isolation and unique stressors of space travel can significantly impact mental health. Now, it’s one thing to be in a space station orbiting the earth, its another to be in a transit between Earth and Mars, which takes about 6 months to complete. On the ISS, you can see our beautiful from the windows, whilst on your way to mars, astronauts will onlybe able to see distant stars.
Bone & Muscle Loss
In the microgravity environment of space, astronauts experience reduced mechanical strain on their skeletons compared to Earth. This leads to bone demineralization and loss of strength. Astronauts can lose 1-2% of their bone mass each month in space, which is significantly faster than the 0.5%-1% annual loss experienced by older adults on Earth.
Over a six-month period, this can accumulate to a 10% loss in bone mass. This rapid demineralization increases their risk of fractures and prolongs healing time. It can take up to four years for astronauts to regain normal bone mass after returning to Earth.
Similarly, muscles also deteriorate in space due to lack of use and resistance they would normally encounter on Earth. This muscle atrophy contributes to overall weakness and can complicate physical tasks and re-adaptation to Earth’s gravity. This is the main reason why astronauts cannot walk when landing on Earth and are carried by support staff or assisted with mobility aids until they regain their strength and adapt back to Earth’s gravitational forces.
Current solutions to mitigate these effects
To mitigate these effects, astronauts on the International Space Station (ISS) engage in 2.5 hours of daily exercise, including strength training exercises like squats, deadlifts, rows, and bench presses using a resistive exercise device. They also use a treadmill and an exercise bike for cardiovascular workouts. Lastly, astronauts take dietary supplements to maintain bone health, which is a critical aspect of their carefully planned space food menu.
Fluid Redistribution and Vision Impairment
Another significant issue astronauts face in microgravity is the redistribution of bodily fluids. On Earth, gravity pulls fluids downwards, but in space, these fluids tend to move towards the head. This can cause facial puffiness and increased intracranial pressure, leading to vision problems known as spaceflight-associated neuro-ocular syndrome (SANS). These vision changes can include flattening at the back of the eye, inflammation of the optic nerve, and changes in refractive error.
Current solutions to mitigate these effects
Regular monitoring of eye health through visual acuity tests, intraocular pressure measurements, and imaging techniques like optical coherence tomography (OCT) and MRI. Medical therapies may include medications like acetazolamide for managing cerebral pressures.
Nutritional supplements are provided to address potential enzymatic deficiencies. Targeted exercise regimes are used to maintain physical health and influence fluid dynamics. Simulating Earth-like gravitational environments through methods like lower body negative pressure helps counteract the effects of microgravity. “Space Anticipation Glasses” are provided to manage vision changes.
Ongoing research, including Earth-based studies, continues to inform new mitigation strategies. Additionally, operational adjustments on the ISS, such as reducing ambient CO2 levels and exploring remote medical procedures, are part of the comprehensive approach to managing SANS.
Breakdown of the immune system
Space travel also affects the human immune system. Research indicates that the stress of spaceflight can alter immune cell function, potentially making astronauts more susceptible to infections. The closed environment of spacecraft and space stations can also facilitate the spread of microbes.
In a recent study led by Daniel Stratis and Guy Trudel, researchers explored how long-duration space missions aboard the International Space Station (ISS) impact astronauts’ immune systems. The team closely monitored 14 astronauts, collecting blood samples during pre-flight, in-flight, and post-flight phases of their six-month missions.
Through RNA sequencing of leukocytes, significant transcriptome changes were observed. The study found 276 transcripts that varied notably, grouped into two clusters with distinct expression profiles correlating with the transition into and return from space. Initially, there was a notable decrease in immune-related gene activity, followed by a reactivation upon Earth re-entry.
These findings suggest a rapid adaptation of leukocytes to the unique conditions of space, characterized by an initial suppression of immune functions, followed by their reactivation upon return.
Current solutions to mitigate these effects
Addressing the issue of immune system modulation in space, scientists are now investigating potential strategies to counteract these effects. While the specific measures being explored by the team were not detailed in the study, it’s known in the broader scientific community that such strategies might include personalized medicine approaches, enhanced nutrition plans, targeted exercise regimes and a high level of cleanliness inside the spacecraft.
Sleep Disruption
Astronauts in space often face sleep disruption due to several unique challenges. In orbit, especially on the International Space Station, they encounter multiple sunrises and sunsets within 24 hours, disrupting natural circadian rhythms. This absence of a regular day-night cycle makes it hard to maintain a consistent sleep schedule.
Spacecraft noise and confined living spaces also contribute to sleep difficulties, along with the effect of microgravity on the body makes it very difficult for astronauts to achieve the restful sleep necessary for optimal health.
Sleep is vital for maintaining good health, as it allows the body to repair and regenerate. This restorative process includes healing damaged cells, boosting immune function, and regulating key hormones.
During sleep, the brain consolidates memories and processes information, crucial for cognitive functions like learning, problem-solving, and decision-making. Lack of sleep can lead to various health issues, including weakened immunity, increased risk of chronic diseases, and mental health problems like depression and anxiety. New parents will know this very well.
Current solutions to mitigate these effects
To mitigate sleep deprivation in space, space agencies have developed several strategies.
- They use specially designed sleep quarters that offer a dark, quiet environment to promote better sleep.
- Lighting systems that mimic the natural progression of daylight help regulate astronauts’ circadian rhythms.
- Scheduled sleep periods are strictly followed to ensure astronauts get enough rest.
- Astronauts are trained in relaxation techniques and sometimes use sleep aids under medical supervision.
- Agencies also monitor sleep patterns and adjust schedules accordingly to optimize rest.
Psychological and Mental Health Issues
Isolation and confinement are major factors contributing to psychological stress in space. Astronauts are separated from their families and usual social networks, living in a confined space with the same individuals for extended periods. This can lead to feelings of loneliness, interpersonal tension, and decreased motivation.
The absence of natural environmental cues in space, such as changes in weather and the day-night cycle, can disrupt circadian rhythms. This disruption often leads to sleep disturbances, impacting mood, cognitive function, and overall mental health.
Workload and monotony also play significant roles. While astronauts have busy schedules, the repetitive nature of tasks, coupled with the lack of new stimuli, can lead to boredom and a decrease in task engagement.
The stress of constant vigilance, especially during critical mission phases or spacewalks, adds to the psychological burden. Astronauts must constantly be alert to potential emergencies or technical issues, leading to increased stress and anxiety levels.
A sense of distance from Earthly concerns and a feeling of disconnection, sometimes referred to as the “overview effect,” can lead to existential reflections, both positive and negative. While some astronauts report profound awe and a renewed perspective on life, others may feel an increased sense of vulnerability or philosophical angst.
Current solutions to mitigate these effects
To address these issues, space agencies provide comprehensive psychological support. This includes pre-mission training to equip astronauts with coping strategies, regular communication with family and mental health professionals, and post-mission debriefing and counseling.
Astronauts are also trained in group dynamics and conflict resolution to manage interpersonal issues that may arise within the crew. Team-building exercises and regular communication help maintain group cohesion.
Monitoring mental health is an ongoing process. Astronauts regularly complete psychological evaluations, and support is readily available if issues are identified.
Technological solutions, like virtual reality, are being explored to provide mental stimulation and a temporary escape from the confines of the spacecraft. This can offer a sense of normalcy and relaxation. Finally, off-world astronauts can bring a few personal items with them and they can video call their loved ones regularly.
Cardiovascular Changes
In microgravity, astronauts experience a shift of bodily fluids towards the head. This headward fluid shift can cause facial puffiness and increased pressure on the brain and eyes. In response to this fluid redistribution, the body often decreases its total blood volume, as it perceives an overload of fluids. This reduction in blood volume, combined with changes in red blood cell production, can affect cardiovascular health.
The heart also undergoes changes. Typically, in microgravity, the heart doesn’t have to work as hard to pump blood throughout the body, which can lead to a decrease in overall heart muscle mass. This condition, known as cardiac atrophy, can impact the heart’s effectiveness in pumping blood, particularly once astronauts return to Earth’s gravity.
Current solutions to mitigate these effects
Astronauts maintain cardiovascular health through rigorous daily exercise, using specialized equipment designed for microgravity. Treadmills, stationary bikes, and resistance machines help preserve heart and blood vessel function, counteracting the effects of reduced gravity on muscle and bone density.
To manage fluid shifts in the body, astronauts may use lower-body negative pressure devices. These devices create a vacuum effect around the lower body, drawing fluids back towards the feet, and simulating the gravitational pull experienced on Earth. An experimental pair of pants was designed for this very purpose by a team of researchers.
Diet and hydration are carefully monitored and regulated. Ensuring adequate fluid intake and a balanced diet rich in nutrients supports overall cardiovascular health and helps mitigate some of the effects of microgravity.
Before space missions, astronauts undergo extensive cardiovascular screening. This ensures they are in optimal health before encountering the unique stressors of space travel. Post-flight rehabilitation is crucial for returning astronauts. This includes a structured program of exercises and medical monitoring to help their bodies readjust to Earth’s gravity, especially to manage orthostatic intolerance.
Cosmic rays can impair the function of erectile tissues
In a recently published white paper by a team of scientists from Florida State University, it has been discovered that astronauts could face an increased risk of erectile dysfunction from long-duration space missions.
Their study, involving 86 rats, shows that the unique conditions of space, like microgravity and cosmic radiation, can significantly harm vascular tissues vital for erectile function. This revelation is particularly timely as agencies gear up for extended Moon and Mars missions.
Current solutions to mitigate these effects
While these findings add a layer of complexity to space travel’s health impacts, they also offer a silver lining. The study suggests antioxidants and enzyme inhibitors might help mitigate these effects, a crucial insight for future space explorers’ well-being.
Conclusion
In the pursuit of expanding human knowledge and exploring the unknown, astronauts willingly subject themselves to a multitude of risks and challenges. They face not only the immediate dangers of space travel but also long-term health effects that can linger for years after their return to Earth.
This leads us to an important consideration: the compensation and recognition these space explorers receive. Astronauts are often celebrated as heroes, pioneers venturing into the final frontier. However, when we consider the sheer magnitude of the risks they bear – both known and unknown – we must ask ourselves: Is the salary and prestige associated with being an astronaut truly reflective of the sacrifices they make?
As current space agencies’ plans involve going further into the solar system, these questions are becoming increasingly relevant, not just for current and future astronauts but for all of us as a society. How we value and support these brave individuals in their endeavors is a reflection of our commitment to understanding more about our place in the universe.
As a child, I always dreamed of becoming an astronaut and walking on the Moon, but now that I am a 36-year-old man with a wife and two young daughters, I am not so sure if this dream is worth the potential sacrifices and risks involved.
Now I ask you, would you consider the potential health risks, the time away from family, and the intense physical and psychological demands to be a worthy trade-off for the chance to be part of space exploration history?
Space exploration has been a fascinating subject for me since a very young age. As a child, astronauts were my heroes, so it was inevitable that a part of my website would be dedicated to astronauts and their space missions.
In the age of commercial space travel, the line between astronauts and space tourists has become increasingly blurred. | Medical Innovations |
Patients who take blockbuster drugs like Wegovy or Ozempic for weight loss may face life-threatening complications if they need surgery or other procedures that require empty stomachs for anesthesia. This summer's guidance to halt the medication for up to a week may not go far enough, either.
Some anesthesiologists in the U.S. and Canada say they’ve seen growing numbers of patients on the weight-loss drugs who inhaled food and liquid into their lungs while sedated because their stomachs were still full — even after following standard instructions to stop eating for six to eight hours in advance.
The drugs can slow digestion so much that it puts patients at increased risk for the problem, called pulmonary aspiration, which can cause dangerous lung damage, infections and even death, said Dr. Ion Hobai, an anesthesiologist at Massachusetts General Hospital in Boston.
“This is such a serious sort of potential complication that everybody who takes this drug should know about it,” said Hobai, who was among the first to flag the issue.
Nearly 6 million prescriptions for the class of drugs that include Wegovy and Ozempic were written between January and May in the U.S. for people who don't have diabetes, according to Komodo Health, a health care technology company. The drugs induce weight loss by mimicking the actions of hormones, found primarily in the gut, that kick in after people eat. They also target signals between the gut and the brain that control appetite and feelings of fullness, and by slowing how fast the stomach empties.
In June, the American Society of Anesthesiologists issued guidance advising patients to skip daily weight-loss medications on the day of surgery and hold off on weekly injections for a week before any sedation procedures. Dr. Michael Champeau, the group’s president, said the action was based on anecdotal reports of problems — including aspiration — from around the country.
It's not clear how many patients taking the anti-obesity drugs may be affected by the issue. But because the consequences can be so dire, Hobai and a group of colleagues decided to speak out. Writing in the Canadian Journal of Anesthesia, they called for the drug to be stopped for even longer — about three weeks before sedation.
That accounts for how long semaglutide, the active medication in Wegovy, remains in the body, said Dr. Philip Jones, a Mayo Clinic anesthesiologist who is also deputy editor-in-chief of the journal.
“When 90% of it is gone, which is after three weeks, hopefully everything should go back to normal,” Jones said.
Champeau and Jones both acknowledged there’s not enough evidence to say for certain how long semaglutide should be held to make anesthesia safe. Many patients won’t see providers far enough in advance to stop the drug three weeks before procedures, Champeau noted.
Aspiration occurs in one of every 2,000 to 3,000 operations that require sedation, and almost half of patients who aspirate during surgery develop a related lung injury. But case reports show recent patients on semaglutide had problems even when they stopped food as long as 20 hours before their procedures.
“There’s nothing that says if you fast twice as long, it will be OK,” Champeau said.
Among the several reports detailing potentially serious problems was one of Hobai's patients, a 42-year-old man in Boston who recently began taking Wegovy, had to be intubated and suffered respiratory failure that put him in intensive care. He aspirated food that remained in his stomach despite fasting for 18 hours.
In Chapel Hill, North Carolina, a 31-year-old-woman on a low dose of Ozempic had fasted for 10 hours before a routine endoscopy prior to bariatric surgery last fall. The procedure had to be stopped because solid food remained in her stomach and she was at high risk for aspiration, the report said.
Since then, doctors have seen dozens of similar cases as use of the weight-loss medication has grown, said Dr. Elisa Lund, an anesthesiologist at the University of North Carolina at Chapel Hill School of Medicine. “It has exponentially increased,” she said.
Hobai is completing a retrospective study of almost 200 patients taking semaglutide. While it'll be published later this year, the work so far appears to confirm a small study from Brazil, he said. In that study, about a quarter of patients taking semaglutide had residual food in their stomachs during procedures requiring sedation — even after stopping the drug for 10 days.
The American Society of Anesthesiologists advises doctors who are in doubt to treat patients who haven't paused the drug as if they have full stomachs, which can mean using different types of sedation protocols or delaying procedures, if possible. Jones added that research is urgently needed to update guidelines for doctors and patients.
Novo Nordisk, which makes Ozempic, Wegovy and similar drugs, said the firm’s clinical trial and post-marketing safety data did not show that the medications led to aspiration. But the drugmaker noted that the medications are known to cause delayed emptying of the stomach and that the labels warn of possible gastrointestinal side effects.
Stopping the medications for three weeks can cause problems, too. Patients with diabetes will need another way to control their blood sugar and those seeking to lose weight may regain some, Hobai said.
Hobai suggests that people using Wegovy and similar drugs tell their doctors before sedation and discuss the risks and benefits.
“If you’re taking this drug and you need an operation, you will need to have some extra precautions," he said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content. | Drug Discoveries |
WASHINGTON -- The Food and Drug Administration on Friday laid out a proposal to begin regulating laboratory medical tests, a multibillion-dollar industry that the agency says poses a growing risk to patients because of potentially inaccurate results.
The proposed rule would end decades of regulatory ambiguity and formally bring thousands of tests performed in large laboratories under FDA oversight. FDA Commissioner Robert Califf said the change will help ensure tests used to diagnose cancer, heart disease and thousands of other conditions are safe, accurate and reliable.
“A growing number of clinical diagnostic tests are being offered as laboratory developed tests without assurance that they work," Califf said in a statement. He added that the agency has long worried that many tests offered by laboratories are not as accurate or reliable as those that undergo FDA review.
Here's a look at the history and background of the testing issue:
Most Americans are familiar with medical tests like those used to screen for COVID-19, strep throat and other health conditions. Those tests are developed by a handful of large manufacturers that undergo FDA review before selling their test kits to hospitals, doctors offices or pharmacies.
The tests targeted by the FDA's latest action are developed and used by high-tech laboratories, including those at academic medical centers and companies such as Quest Diagnostics. They include tests for complex diseases like cancer, as well as simpler conditions like high cholesterol and sexually transmitted infections.
In the 1970s and '80s, most lab-based tests were “lower risk, small volume” products used mostly for local patients, the FDA noted Friday.
Over time, laboratory-developed tests have grown into a multibillion-dollar nationwide business, with labs processing thousands of blood, urine and other samples per week from hospitals and clinics. Others advertise directly to consumers — including some claiming to measure the risk of developing ailments like Alzheimer’s and autism.
Laboratory-developed tests have long skirted FDA oversight, though the agency has always maintained that it has the authority to step in. Debate over regulating the space stretches back to the 1990s, with several government advisory groups recommending greater FDA oversight.
Many lab-developed tests are staples of medical care, used to make important decisions about pregnancy, nutrition and many other health issues.
FDA officials have long voiced concerns about the accuracy of some tests, pointing to patients who have received inaccurate results for heart disease, Lyme disease, cancer and other conditions. Inaccurate tests can lead to patients getting an incorrect diagnosis, skipping treatments or receiving unnecessary medication or surgery.
More than a decade ago, the agency drafted tougher guidelines for the industry, but they were never finalized.
The tests attracted new scrutiny with the downfall of Theranos CEO and founder Elizabeth Holmes, who was sentenced to prison last year for misleading investors about the potential of her company's blood testing technology.
During the pandemic, the FDA also flagged accuracy problems with dozens of COVID-19 tests that were rushed out by U.S. laboratories without federal oversight.
Recent scrutiny has focused on pregnancy tests that purport to screen for mutations that can lead to Down syndrome, cystic fibrosis and genetic defects. Several studies and reports have identified tests that misstate or exaggerate the risks of those problems.
The laboratory industry has long argued that FDA regulation would stifle their ability to quickly innovate and develop new tests. They also say that additional federal regulation is unnecessary because it would duplicate existing requirements.
Under a quirk of federal law, testing laboratories are currently overseen by the same agency that runs Medicare and Medicaid, the government health plans for seniors, the disabled and the poor. Inspectors evaluate the general conditions and procedures at labs, but not specific tests or the claims used to market them.
Lawmakers in Congress drafted a bill last year — backed by FDA officials — that would have given the FDA explicit authority to regulate high-risk tests. But the measure failed to pass the House or the Senate amid opposition by testing industry lobbyists.
Under the new proposal, FDA would gradually phase in tighter regulation of lab tests over five years. The agency is considering exempting some existing tests already on the market from review but is seeking public input on its approach. At the end of the process, most new tests would be subject to FDA standards and regulatory review.
The new regulations should reduce health care costs due to fewer “unsafe or ineffective tests, including tests promoted with false or misleading claims,” the agency says.
The agency will take comments on its proposal for 60 days before beginning to draft a final rule. There is no deadline for completion and the process can typically take months or years.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content. | Health Policy |
The abortion drug mifepristone should be more tightly regulated than it is now, with limits on the drug at seven weeks of gestation and requirements that patients obtain the pill in person instead of through the mail, a federal appeals court ruled Wednesday.
The decision by the 5th U.S. Circuit Court of Appeals won't have an immediate impact on access to the drug, at least for now. But the ruling paves the way for the case to land before the U.S. Supreme Court in coming months as expected, putting the hotly contested question of abortion rights before the high court ahead of the 2024 election.
In a statement, drugmaker GenBioPro noted that the medication remains accessible and legal.
"We remain concerned about extremists and special interests using the courts in an attempt to undermine science and access to evidence-based medication, as well as attempts to undermine the US Food and Drug Administration's regulatory authority," the company wrote. "We will continue to use our company's legal and regulatory tools to ensure access to mifepristone, which is essential to the health of many in the United States."
White House press secretary Karine Jean-Pierre said Wednesday evening, the White House "strongly disagrees" with the ruling from the Fifth Circuit Court of Appeals on mifepristone.
"Due to the Supreme Court's stay, mifepristone remains broadly available for now. But if the Fifth Circuit's ruling stands, it will significantly roll back the ability for women in every state to get the health care they need, and undermine FDA's scientific, evidence-based process for approving safe and effective medications that patients rely on," Jean-Pierre said in the statement.
Vice President Harris has also issued a statement on the 5th Circuit Court ruling, reiterating the White House's phrasing that she "strongly disagrees" with the ruling.
"As I have continually said, this lawsuit is a threat to a woman's freedom to make decisions about her own body and another step towards the ultimate goal of a nationwide abortion ban. It endangers our entire system of drug approval and regulation by undermining the independent, expert judgment of the FDA. Americans across the country should be able look in their medicine cabinets and know that FDA-approved medication prescribed by a doctor will remain available. This decision stands between doctors and their patients," Harris wrote.
The VP continued, "The Biden-Harris Administration will continue our efforts to protect access to abortion and defend the FDA in the courts. The President and I remain committed to protecting a woman's right to make decisions about her own health care."
At issue is the U.S. Food and Drug Administration's oversight of abortion medication, which has grown in popularity in recent years and is now used in more than half of all abortions. Under FDA rules, the brand name drug Mifeprex by Danco Laboratories and its generic counterpart by GenBioPro can be used up to 10 weeks of gestation and provided via mail after a telehealth appointment so long as the clinician follows certain rules.
After the Supreme Court overruled Roe v. Wade, the drug became illegal in states that banned abortion. Still, anti-abortion rights groups say access has been difficult to regulate because the medication remains so widely available in other parts of the country and around the world.
In a bid to curb access, at least within the U.S., a conservative-backed group known as Alliance for Hippocratic Medicine filed a lawsuit arguing that FDA approval of the drug should be suspended entirely, and that if that doesn't happen, access to the drug should at least be severely restricted. A Trump-appointed judge in Amarillo, Texas, sided with the plaintiffs, although his ruling was ultimately put on hold by the Supreme Court which wanted to give the case a chance to be heard in full by the 5th U.S. Circuit Court of Appeals.
On Wednesday, the appeals court said it didn't think the FDA's 2000 approval could be eliminated entirely because too much time had passed. The judges also upheld the FDA's approval of the generic version of the drug in 2019.
But the appeals court three-judge panel said it did believe the FDA should impose the same restrictions on the drug as when it first hit the market in 2000, including a seven-week gestation limit and a prohibition on mailing the drug.
"The scientists at the FDA deserve our respect and our gratitude, but not our blind deference," the judges wrote.
The FDA cites more than two decades of safety data in defending its decision in recent years to ease access to the drug.
Kirsten Moore, director of an advocacy group focused on expanding abortion medication access called the EMAA Project, said politically appointed judges shouldn't get to replace FDA judgment on drug safety.
"While the court has acknowledged that mifepristone – both brand and generic versions – can stay on the market, they are insisting we should roll back the clock to 2000 and put the medication under lock and key," Moore said in a statement. "The extremist judges ignored the FDA, our basic rights, and more than 20 years of scientific evidence showing mifepristone is safe and effective, rolling back decades of advancement in the standard of care."
The Justice Department said it would appeal to the Supreme Court.
"As the Attorney General has said before, the Justice Department is committed to defending the FDA's scientific judgment and protecting Americans' access to safe and effective reproductive care. The Department strongly disagrees with the Fifth Circuit's decision in Alliance for Hippocratic Medicine v. FDA and will be seeking Supreme Court review of that decision," a spokesperson said.
ABC News' Alexander Mallin contributed to this report. | Women’s Health |
It may very well be possible to grow new teeth sometime in the future. In fact, a Japanese company working on a tooth-growing drug is just now slated to enter clinical trials, making it the world’s first drug of its type to make it this far.
The new drug was developed by Toregem Biopharma, a pharmaceutical company based out of Japan. The treatment is an antibody drug that stops the proteins in the mouth that typically suppress tooth growth. The first human clinical trials will kick off in July of 2024, so we still have a few months to wait before we see this in action.
The drug could come to the market as early as 2030, according to how the trials play out, the Japan Times has reported. The company says its “final goal is to offer advanced and scientifically driven clinical solution for the growth of teeth derived from their own tissues.”
The tooth-growing drug works by inhibiting a gene known as USAG-1. This gene typically stops “tooth buds” from developing into baby or permanent teeth. As such, the gene inhibits the growth of new teeth once they have been lost. By stopping the gene completely, the researchers say the new drug will stimulate and allow the growth of these buds.
This should let patients regrow lost teeth. Research on animals was conducted back in 2018, and the drug showed that new teeth were able to grow successfully. In 2025 the company hopes to be able to start up a second round of trials for the tooth-growing drug, which will focus on children between the ages of 2 and 6 who have anodontia. This genetic disorder stops them from developing their permanent teeth.
There’s a good bit riding on how well these drugs do during these trials, so it will be interesting to see where things go from here. | Drug Discoveries |
"I don't know if I can ever fully forgive him for everything... I'm still in that process now."
Essence Gayle still speaks regularly to her older brother Garvey, two years after he killed their father Michael.
Their mother, who was also injured in the attack, believes her partner's death could have been avoided if her son had been given more support.
This case will be one of the first of its kind to be reviewed under a new system in Wales by the government.
For that reason, South Wales Police and Cardiff and Vale University Health Board said they could not comment on the case.
The health board said its thoughts remained with the family.
Garvey Gayle later admitted manslaughter due to diminished responsibility and the attempted murder of his mother. He is being held indefinitely under the Mental Health Act.
On 16 October 2020, Garvey, then 21, stabbed his 54-year-old father Michael 17 times. He was pronounced dead at their home in the St Mellons area of Cardiff.
During the same attack, he also stabbed his mother Amanda Brookes Gayle in the arm, stomach and side.
More than two-and-a-half years on, Amanda said they were yet to receive any satisfactory answers about what went wrong and whether the killing could have been avoided.
She is worried other families could be let down before any lessons identified in the case are eventually published.
"I'm appalled really at the time it's taking," said Amanda.
"I don't think it's fair on the family at all... I don't understand why all these things have taken so long."
The reviewers told BBC Wales Investigates they were sorry for the delay and any learning would be shared as it emerges.
'Held the family together'
Amanda remembers Michael as a loving father to their four children - Garvey, Essence, Marlon and Marysia - and said he always put his family first.
"I know that all parents love their kids and their children and they do their best, but our children were our life, our focus - it wasn't about nine to five, it was about our family, that was our job, that was our work. That was our life," she said.
Essence said of her father: "He was a typical family man... always picking us up from school, taking us to school.
"He had to ride the bike to take us because he couldn't drive so I would be sat on the handlebars, Garvey would be sat on the pegs and Dad would ride to the school...
"We were just a very solid unit."
Essence said she and her brother Garvey, who are 16 months apart, were "inseparable" growing up, but after he left college things started to change as his mental health deteriorated.
"We weren't as close and he'd shut himself off more," she said.
"Things he was saying just didn't really add up - he just wasn't making sense, there was just a drastic change in his behaviour."
As parents, Amanda and Michael also noticed changes in Garvey.
"He sat there and he cut himself out of every family photo precisely," said Amanda.
"He said we weren't his family any more and he was going to disappear, which didn't make sense at the time. It's just crazy."
She said on another occasion he sliced up their sofa and her bed and referred to himself as Jesus Christ.
He also began chanting or reading the Bible and would be up all hours in his bedroom.
"He'd be putting lit cigarettes in his pockets and I'd have to say, 'like your clothes are on fire, literally'," she said.
In June 2019 Garvey started to become violent towards Amanda, was prosecuted and jailed for 10 weeks.
"I was hoping he was going to get help for his mental health but he was just released, came back home to me, broke police bail because he wasn't supposed to come to me," she said.
"Police officers, when they were coming, I was explaining 'it's not a criminal matter, he's genuinely mentally unwell'."
Eventually Garvey became so unwell as he was sectioned and held in psychiatric units.
Six months later he was discharged but he was not able to live with Amanda and Michael as he had previously been assessed as posing a high risk to them.
Garvey was sent to live in a homeless hostel in Cardiff but Amanda said it was clear to her that he could not look after himself in the hostel.
"He was known as Jesus Christ. I would go to visit my son and I'd go 'Garvey?' and they'd go 'Oh, Jesus, I'll go get Jesus for you, he's upstairs'."
She said he continually told her did not want to stay there and she would have to video call him to ensure he had taken his mediation.
Three months before Garvey killed his dad, South Wales Police, probation and mental health staff were meant to discuss the risks he posed at a special meeting but failed to do so.
"It was like they weren't joining up the dots, lack of communication or something, something wasn't working properly obviously," said Amanda.
"I just kept saying, 'please get him the mental health help that he needs'.
"It was just an ongoing cycle basically...until that tragic night...when our lives were changed forever."
Amanda said it was not until after Garvey had killed his father that he was diagnosed with paranoid schizophrenia.
"If Garvey had got this intense help back then Michael would still be here and Garvey would have been getting the help he needed," she said.
"But we had to lose Michael for Garvey to get the help he needed. It's backwards."
"I don't think it really registered that dad was gone," said Essence.
"Everything was still in place, his drink was still there where he left it when he went out earlier - it was like nothing's been touched, dad will be back soon.
"I don't think I'll ever get over that my dad's not here.
"Garvey did that, even though you could say it wasn't him at the time."
Essence is still in touch with her brother.
"We speak now every so often, twice a week maybe, some days he's like Garvey again - he's asked me questions about what have I been up to, then other days he doesn't sound well again, so it's still a work in progress," she said.
Amanda has received a letter from Garvey but had only felt able to speak to him over the phone once.
"I told him how much I loved him. I told him I have forgiven him and I'm sure his dad's forgiven him as well," she said.
"I know he has."
Cardiff and Vale University Health Board has been reviewing the care it provided Garvey but Amanda does not yet have the findings.
For now, the family continues to wait for answers.
"I can just pray that lessons are learnt and something good comes out of this horrific thing that has happened to our family," said Amanda.
"I hope my son gets well and doesn't spend the rest of his life in hospital and he has some kind of future." | Mental Health Treatments |
June 14, 2023 â Doctors often note that patients with dry eye disease (DED) report low moods. Now, new research shows that the connection between dry eye disease and depression may actually be quite common.
Itâs estimated that 5% to 50% of people globally have DED; more than 16 million Americans have been diagnosed with the condition. Dry eye disease happens when you donât have enough tears covering your cornea, or your tears evaporate too fast, according to the Cleveland Clinic.Â
A relationship between depression and dry eye disease has been previously established, but the specifics of patients' symptoms is now becoming more clear. A Â new study from Saudi Arabian researchers found that out of 401 people surveyed, 36.7% had DED, and 23.7% were diagnosed with depression, stress, or anxiety.
A recent study also found that patients who have been diagnosed with depression have more severe symptoms of dry eye, which can in turn upset them emotionally.Â
âDepression isnât simply âin the mindâ â itâs a multi-system condition that can affect many systems in the body, and disrupts their normal functioning,â said Howard L. Forman, MD, a psychiatrist with Montefiore Health System and an associate professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine in New York City.Â
Twenty-nine percent of U.S. adults surveyed this year said theyâve been diagnosed with depression at one point in their lives.
âDry eye disease can hinder the daily enjoyment of life, which can worsen the symptoms of depression,â said Deepinder K. Dhaliwal, MD, a licensed acupuncturist and a professor of ophthalmology at the University of Pittsburgh School of Medicine. âWhether dry eye disease causes depression or depression causes dry eye disease is a chicken-or-the-egg, but the two conditions are definitely related.â
Patients with these conditions can work with their doctors to make the changes they need to improve depression and DED symptoms.Â
What Are the Symptoms of Depression?
Symptoms of depression can range from mild to severe, and they may indicate the condition if they last 2 weeks or longer, according to the American Psychiatric Association. Signs include:Â
- Sadness
- Losing interest or joy in things you like to do
- Eating too much or too little
- Feelings of guilt or worthlessness
- Other people noticing you appear either restless or lethargic
- Thinking or decision-making difficulties
- A lack of mental focus
- Thinking about suicide or deathÂ
- Sleep disturbances.   Â
âDepression can be worsened by lack of sleep, as can dry eye,â said  Dhaliwal, who's also director of refractive surgery and director of the Cornea Service at UPMC Vision Institute, and founder and director of Center for Integrative Eye Care at the University of Pittsburgh. A Chinese study found that during the stressful days of the COVID-19 pandemic, lack of sleep increased DED symptoms in the people being studied, which in turn made them feel more depressed and anxious.Â
What Are The Symptoms of Dry Eye?Â
According to the National Eye Institute, dry eye may cause:Â
- A gritty or scratchy feeling in your eye
- A sensation of something lodged in your eye
- Burning or stinging
- Red eyes
- Blurred visionÂ
- Light sensitivity
What Is the Physical Link Between Depression and Dry Eye Disease?Â
The exact mechanism has not been fully established. But inflammation in the body may be one key cause.Â
âInflammation on the ocular surface can indicate a higher risk of depression,â Â Dhaliwal said.Â
âSome antidepressant medications work by blocking signals between nerve cells, which can reduce the eyeâs natural response to proper tear film production," said Jennifer, Tsai, OD, a board-certified optometrist and founder of LINE OF SIGHT, an eye care practice in New York City. âAs a result, this reduces the amount of tears produced, and leads to dry eye.â
Lifestyle may be another important factor. Â
âDepression and dry eye can often be linked due to external changes,â  Tsai said. âDepression can change your habits, resulting in increased screen time and poor eating habits, for example. These changes can lead to increased tear evaporation and, inevitably, dry eye.âÂ
Research has also found that depression can cause changes in the way a patient processes pain, leading to more severe DED symptoms. This can create chronic physical discomfort, which also impacts your emotional state.Â
âExperiencing difficulty keeping your eyes open, or experiencing blurry vision, can hold you back from activities that bring you joy,â said Forman. âThis can lead to more social isolation, and less fulfilling days.âÂ
What Can You Do to Improve Symptoms When Depression and Dry Eye Disease Happen at the Same Time?Â
Take note of the circumstances that seem to make you feel worse. Talking with a therapist about emotional frustration you feel can be very helpful. Also, âif you develop dry eyes shortly after starting a medication, absolutely let your doctor know about it,â said Forman.Â
You wonât need to discontinue medication you need, however.Â
âWe never stop antidepressants, because depression is a debilitating disease,â said Dhaliwal. Instead, a new type of medication may be warranted. And your doctor can help you focus on improving ocular symptoms. Â
âNon-pharmaceutical treatments for dry eye â such as warm compresses and lid hygiene â can help a lot,â Dhaliwal said. âOmega-3 fatty acid taken by mouth can not only help with dry eye, but with mood, too.âÂ
Blinking exercises can help lubricate the surface of your eyes. You can also reduce stress through acupuncture, staying physically active, and eating a healthy, balanced diet.Â
As Dhaliwal sums it up: âAll of these steps can help you feel better, and take better control of your life.â | Mental Health Treatments |
Jill Biden will lead new initiative to boost federal government research into women's health
The White House says Jill Biden will be in charge of a new initiative to help the federal government spend more time and money on research into women's health issues
WASHINGTON -- The Biden administration on Monday announced a White House initiative to improve how the federal government approaches and funds research into the health of women, who make up more than half of the U.S. population but remain understudied and underrepresented in health research.
That underrepresentation can lead to big gaps in research and potentially serious consequences for the health of women across the country, Biden administration officials and others told reporters during a White House conference call to announce the new effort.
The White House Initiative on Women's Health Research will be led by first lady Jill Biden and the White House Gender Policy Council.
President Biden said he's long been a believer in the “power of research” to help save lives and get high-quality health care to the people who need it. He was to sign paperwork Monday directing federal departments to get to work on the initiative.
“To achieve scientific breakthroughs and strengthen our ability to prevent, detect and treat diseases, we have to be bold," the president said in a written statement. He said the initiative will "drive innovation in women's health and close research gaps.”
Jill Biden said during the conference call that she met earlier this year with former California first lady and women's health advocate Maria Shriver, who “raised the need for an effort inside and outside government to close the research gaps in women's health that have persisted far too long.”
“When I brought this issue to my husband, Joe, a few months ago, he listened. And then he took action,” the first lady said. “That is what he does.”
Jill Biden has worked on women's health issues since the early 1990s, after several of her friends were diagnosed with breast cancer and she created a program in Delaware to teach high school girls about breast health care.
Shriver said she and other advocates of women's health have spent decades asking for equity in research but that the Democratic president and first lady “understand that we cannot answer the question of how to treat women medically if we do not have the answers that only come from research.”
Shriver said women make up two-thirds of those afflicted with Alzheimer's disease and multiple sclerosis, and represent more than three-fourths of those who are diagnosed with an auto-immune disease.
Women suffer from depression and anxiety at twice the levels of men, and women of color are two to three times more likely to die of pregnancy related complications than white women, she said. Millions of other women grapple daily with the side effects of menopause.
“The bottom line is that we can’t treat or prevent them from becoming sick if we have not infested in funding the necessary research," Shriver said on the call. “That changes today.”
Jennifer Klein, director of the White House Gender Policy Council, said the leaders of agencies important to women's health research will participate in the initiative, including those from the Departments of Health and Human Services, Veterans Affairs, Defense and the National Institutes of Health, among others.
Biden's memorandum will direct members to report back within 45 days with “concrete recommendations" to improve the prevention, diagnosis and treatment of women's health issues. It also asks them to set “priority areas of focus,” such as research ranging from heart attacks in women to menopause, where additional investments could be “transformative.”
The president also wants collaboration with the scientific, private sector and philanthropic communities.
Carolyn Mazure will chair the research effort. Mazure joined the first lady's office from the Yale School of Medicine, where she created its Women's Health Research Center. | Women’s Health |
Another day, another warning from the pharmaceutical sector that ministers’ ambitions to make the UK “a life sciences superpower” are in danger of falling flat. The comments from Sir Pascal Soriot, chief executive of AstraZeneca, were different in one important respect, however. He offered a concrete example of how the UK is already losing out as an investment venue.
AstraZeneca had wanted to build a new $360m “state-of-the-art” manufacturing plant in the north-west of England near its existing facilities in Warrington and Speke. Instead, said Soriot, Ireland got the nod on account of the “discouraging” tax rate in the UK.
The gist of his remarks, though, indicated there was more to the decision than just the rise in the rate of corporation tax from 19% to 25%. Like the rest of the pharma industry, he’s unhappy with the pricing agreement known as VPAS that caps the increase in the NHS’s budget for such treatments at 2% a year. The formula was designed in pre-Covid days, but the surge in prescriptions that arrived with the pandemic has seen the industry pay a heftier percentage of its UK revenues to the government as a rebate. The ratio for 2022 was 26.5%. In the recent past, 8% was considered a par figure.
One could take the view that AstraZeneca, reporting annual revenues of $44.4bn on Thursday and with a booming pipeline of drugs that will sell around the world, is rich enough to take it one the chin. A deal’s a deal, after all, and the current VPAS formula expires anyway at the end of this year. Equally, though, one can’t blame Soriot for feeling sore about picking up an unexpected pandemic bill: his company, after all, led the development of a vaccine in Britain on a profit-free basis.
Soriot also mentioned access to green energy as a factor in Ireland’s favour. And, like others, he referenced how an overstretched NHS isn’t delivering on its traditional strength in running clinical trials. The UK has slumped in international league tables, as mentioned here a couple of weeks ago. There is an accumulation of negatives, in other words, in the loosely defined pharma “ecosystem”.
The good news is that the quality of UK science still seems superb. There was no hint that AstraZeneca regrets building its £1bn research and development centre in Cambridge. The point, though, is that big pharma has choices about where to make new investments and, increasingly it seems, it is not choosing Britain like it used to.
“It’s all very nice to discover something in the lab,” said Soriot. “At some point you need other types of people to progress the project.” Dame Emma Walmsley, Soriot’s counterpart at GlaxoSmithKline, argued along the same lines last week in warning of “a tipping point” for UK life sciences. A more scathing version came from Dame Kate Bingham, former vaccines tsar, who in a FT piece recently said the short-term pressures in the UK are crowding out long-term solutions and the life sciences sector is “still the object of suspicion and incomprehension within parts of government”.
Do ministers get it? One assumes they do because the chief executives have been making their case directly to Downing Street. The government may have good reasons not to negotiate in public on the terms of the next VPAS deal: being more generous (possibly) to big pharma is not a good look while there is an unresolved pay dispute in the NHS. Meanwhile, cogs may be turning to fix day-to-day challenges; it is understood that Lord (James) O’Shaughnessy, a former health minister, has quietly been recruited to work on improving clinical trials.
All the same, one cannot recall an equivalent period in which the entire pharma industry, more or less, has openly criticised the gap between the government’s rhetoric and the reality of policymaking. This has now been going on for six months, with the volume rising steadily. AstraZeneca has a fair claim to being the UK’s most successful major company of the last decade, as well as being one of its biggest domestic spenders thanks to the Cambridge facility. If it can’t sound enthusiastic about investing in the UK, there is a serious problem. | Health Policy |
Some find conversations with cab drivers to be awkward and unpleasant, but a man's life was saved when he struck up a conversation with his Uber driver one fateful day in Vineland, New Jersey.
That driver donated a kidney two months later, forever changing the trajectory of an elderly dialysis patient's life.
In October 2021, Bill Sumiel was in need of a ride home from his dialysis center and Tim Letts arrived in an Uber to pick him up, according to local news source ABC6.
Sumiel, in his 70s, has Type 2 diabetes and was suffering from kidney failure, getting dialysis treatments three times a week according to a report from the University of Delaware Daily, a publican from the institution where Sumiel received his rehab treatment after the replacement.
The right place at the right time
“I was coming from Cape May and was way north of Vineland already when I got the ride request, and not only did this trip bring me backward in the opposite direction but also further out of my way,” Letts told the Daily. “In retrospect, it was an absolute God moment. There’s no question about why the Uber app that has an algorithm designed to make things convenient took me so far out of my way.”
The Daily also explained that Sumiel was not originally scheduled to be in the dialysis center that day. He had had a complication requiring him to come in and have a clot removed from his dialysis port.
The two struck up a conversation during the 40-minute ride, and Sumiel told Letts of his medical woes. Letts, a US Army veteran in his 30s, then offered Sumiel his kidney.
"He says, 'If you'll take my name and number, I'll give a kidney to you," Sumiel told ABC6. "I was shaking so hard I couldn't even write down his name and number."
Sumiel had been on the transplant list for years, the Daily reported. However, due to his age and overall health status, getting a kidney from the United Network of Organ Sharing (UNOS) was unlikely. He even shared his story on social media to try and track down a donor, but had no luck.
A successful operation and lifelong friendship
The two turned out to be a match and the operation took place just a few weeks later. Because of Sumiel's age, ABC6 reported, he was told he needed a kidney immediately.
According to local media reports, the two men became "lifelong friends" and according to ABC6, Letts has moved to Germany but still keeps in touch with Sumiel on Facebook.
Sumiel celebrated his one-year kidney replacement anniversary in December 2022, and has been faithfully attending rehab sessions at the University of Delaware Health Exercise Counseling Clinic for nearly as long.
"Giving a kidney is the gift of life and I feel so fortunate to have that gift," Sumiel told ABC6 in January. "I can almost live my life back to normal, and this work (at the University of Delaware's Exercise clinic for renal rehab) is getting me closer to that every day." | Medical Innovations |
Electricity Saved My Brain
This is the second part in a series on deep brain stimulation for depression. Read from the beginning.
[Content note: This story contains discussion of suicide.]
Jon Nelson’s depression was poison. “I had poison in every single bit of my body. It literally ran throughout every cell in my body. My blood carried the poison, and it crushed everything in me.”
Melancholia, one of depression’s early names, comes from the ancient Greek word for “black bile,” a diseased liquid believed to flood a body. It was once thought that bloodletting and other ways to let the corrupting fluids out could ease people’s minds.
Today, doctors have much better options to treat depression. Antidepressant drugs and talk therapy can be effective for many people. But these options don’t help everyone.
Jon has treatment-resistant depression. So does Amanda, an app and web designer and artist in her 30s who lives in New York City. Amanda can also rattle off a long list of therapies she has tried for the deep depression she’s felt since she was 13. She has been on 21 different antidepressant drugs. Her brain has been zapped with powerful magnets in a therapy called transcranial magnetic stimulation. She has had IV infusions of ketamine.
Amanda, who to protect her privacy requested her last name not be used, has also had 40 rounds of electroconvulsive therapy, or ECT. The “gold standard” treatment for people who aren’t helped by other therapies, ECT is often done several times a week for three or four weeks. For unknown reasons, the resulting mini-seizures in the brain can sometimes provide relief.
“The electroconvulsive therapy helped a little bit,” Amanda says. “But for it to help, I had to do it so frequently that I got memory damage. I was like, ‘Whoa, whoa, whoa, I don’t remember where my sock drawer is. I don’t remember what subway stations are near my apartment. I don’t remember how to use the software I’ve been using for 10 years,’” she told me. “I have to stop.”
Jon’s depression was poison; Amanda’s was a vortex. And when ECT was no longer an option, that vortex nearly consumed her. After a suicide attempt, she spent six weeks in the hospital and then another six weeks receiving outpatient care. “It was at that point that [doctors] were like, ‘There’s nothing else we can do for you. You’ve tried literally everything that’s out there. If ECT doesn’t work, that’s it,’” Amanda says.
As with Jon and others I talked with, her doctors had given up, Amanda says. “When you get to that place where they say there’s nothing else we can do for you, and yet you have to keep living your life, that’s a hard place to get to.”
The last hope
Desperate for help, Amanda called the treatment-resistant depression program at Mount Sinai. After describing all of her unsuccessful treatments, Amanda was once again passed along to different doctors. “They had decided that you really have tried everything,” she says.
That last handoff is what delivered Amanda to the DBS research program. As Martijn Figee, a psychiatrist and DBS researcher at the Icahn School of Medicine at Mount Sinai, explained the procedure, the research and the risks, Amanda listened carefully. She arrived at appointments prepared with an eight-page-long list of questions that covered the practical (“What should I avoid forever once I have it? Running? Hanging my head upside down? Trampolines?”) and the profound (“What makes a person want to be alive?”). Questions answered and fully informed, Amanda agreed to have DBS surgery.
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The DBS program that Amanda and Jon are a part of looks vastly different from earlier iterations. In 2008, neurologist Helen Mayberg and many colleagues around the country had just begun a large, double-blind DBS clinical trial to test the technique. Called the Broaden trial, the six-month study followed people with depression, some of whom had electrical stimulation on and others who were implanted with electrodes but had the stimulation off.
All told, 90 people with severe depression were implanted with brain stimulation devices in the trial. But in 2013, testing stopped early because of poorer-than-expected results. The sponsor and maker of the DBS device, St. Jude Medical Inc., determined that the trial wasn’t likely to hit its goals. Along with another unsuccessful trial, which included 30 people who received stimulation in a different part of the brain, those lackluster results represented a real setback for DBS as a treatment for depression.
Those disappointing findings fueled criticisms of the method, underscored by stories of people who had negative experiences with DBS. And potential conflicts of interest exist, as they do for many medical treatments that depend on medical device companies. Mayberg, for instance, receives fees for consulting and licensing intellectual property from Abbott Laboratories, the company that bought St. Jude Medical.
Despite setbacks and criticism though, the research didn’t stop; it matured. Brain-imaging methods got better, allowing researchers to see exactly which highways of white matter fibers, message-sending bundles that emanate from nerve cells, are influenced by the electrodes. Other aspects of care, including follow-up sessions with mental health experts and therapists, have evolved. In a small trial of 11 people with severe depression, for instance, nine had their symptoms improve, researchers reported in 2018. And DBS as a depression treatment has been able to borrow heavily from progress in treating other disorders.
How widespread is DBS?
Globally, DBS electrodes have been implanted in an estimated 230,000 people’s brains. DBS was approved by the U.S. Food and Drug Administration in 1997 to treat tremor, and in 2002 to treat Parkinson’s disease. DBS is also used by doctors for severe cases of epilepsy, obsessive-compulsive disorder and dystonia, or involuntary muscle contractions.
DBS’s reach is expanding fast. In smaller experimental trials, people have been implanted with electrodes for pain, eating disorders, addiction, traumatic brain injuries and post-traumatic stress disorder. Researchers are working on stimulation systems to restore movement to paralyzed people and speech to people unable to talk.
Jon heard about the procedure in 2021. He called the Mount Sinai program from a residential treatment facility, only to learn that he didn’t qualify because, at the time, he hadn’t yet tried ECT. So he did 12 rounds of the therapy in early 2022. ECT helps many people. But it didn’t help Jon, and the experience shook him. “It was horrific. Zero relief. My memory loss is still pervasive to this day,” he says. It was utter misery, but he qualified for the DBS trial.
And with that, Jon’s surgery date was set: August 22, 2022.
In the run-up to the surgery, Jon’s wife, Barbara, worried about both the surgery and the outcome. “What if they slip or they sneeze and they ruin his brain?” she recalls wondering. “What if it doesn’t work? What do we do next? This was so much like the last resort that if it didn’t work, then we were going to be looking at potentially years more of trying.”
She adds, “And there’s no option of giving up.”
Even so, Barbara didn’t fully believe the surgery was going to happen until it was right around the corner. “I think my brain just did not catch up to the reality of it until we were very close to the actual surgery,” she told me. “A couple of days before, I was like, ‘Oh I’m a mess.’ I do weird things when I’m really that stressed out, rearranging furniture, doing things that seem to take too much energy.”
Jon, however, was not worried. “I didn’t care that I was having my head cut open,” he says. “I had the same level of anxiety that you would have if you were getting your teeth cleaned.”
If you or someone you know is facing a suicidal crisis or emotional distress, call or text the 988 Suicide & Crisis Lifeline at 988.
In the next article in the series, read about Jon’s surgery and the big changes that followed for him and his family.
This series was made possible with funding from the Alfred P. Sloan Foundation. | Mental Health Treatments |
Patients will be encouraged to use an NHS app to book treatments in private hospitals in an attempt by Rishi Sunak to cut down on waiting times.
Dozens of private diagnostic centres will also offer checks for cancer and other conditions to try and alleviate pressures on NHS staff, The Times reported.
More than 7.3 million people are now on NHS waiting lists in England, up from 4.4 million before the pandemic.
The Prime Minister is expected, in the coming weeks, to launch an initiative promoting patient choice with the NHS app at its focus.
Ministers hope the app will help patients shop around for private companies offering potentially shorter waiting times.
Upon assuming office in October last year, Mr Sunak vowed to "give patients genuine choice about where and when to access care”.
A spokesman for the Department of Health told The Times the NHS app had “a vital role in giving patients greater control over their own care . . . We have already started to implement the elective recovery task force’s work and a full plan will be published soon, outlining how we can go even further to unlock the independent sector.”
However, last week it emerged that private healthcare companies are struggling to cope with demand amid record NHS waiting lists.
The Sunday Telegraph disclosed how Bupa customers have complained of “outrageous” waits for their calls to be answered as growing numbers turn to insurance schemes in the wake of the pandemic.
The company said it had taken action to improve call waiting times, recruiting hundreds more call-handlers after customers complained of delays of three hours in April and 90 minutes this month.
In March, the company issued an apology on social media, saying: “We’re currently experiencing high volumes making waiting times longer than usual.
Amanda Madden, a businesswoman from Cheshire, said she had been left waiting three hours on April 13 to speak to someone for just three minutes.
Another customer complained of a three-hour wait on March 30, reporting that they found it “impossible to get through”.
Bupa said it had taken steps to shorten waiting times, which had improved in recent weeks.
Kirk Bradley, customer service director at Bupa UK Insurance said: “We’re very sorry to any customers who, for a short time, had to wait longer than usual to speak to us. | Health Policy |
Thousands of children with severe developmental disorders have finally been given a diagnosis, in a study that found 60 new diseases.
Children, and their parents, had their genetic code - or DNA - analysed in the search for answers to their condition.
There are thousands of different genetic disorders.
Having a diagnosis can lead to better care, help parents to decide whether to have more children, or simply provide an explanation for what is happening.
Taken individually the disorders are rare, but collectively they affect one in every 17 people in the UK.
The Deciphering Developmental Disorders study, conducted over 10 years, was a collaboration between the NHS, universities and the Sanger Institute, which specialises in analysing DNA.
Among the findings, researchers discovered Turnpenny-Fry syndrome. It is caused by errors in one genetic instruction within our DNA and leads to learning difficulties. It also affects growth, resulting in a large forehead and sparse hair.
Jessica Fisher's son, Mungo - who took part in the study - was diagnosed with the syndrome.
At the time, he was one of only two people in the world to be diagnosed with it. The other child was in Australia, but Jessica recalls that the Australian child's physical similarities to Mungo were so strong they "could have been his sibling".
Jessica subsequently started an online support group, which is now made up of 36 families from around the world, including America, Brazil, Croatia and Indonesia.
"It's devastating to learn that your child has a rare genetic disorder, but getting the diagnosis has been key to bringing us together," said Jessica.
The study analysed the genetic code of 13,500 families with unexplained disorders - and was able to give a diagnosis to 5,500 of them.
The results, published in the New England Journal of Medicine, revealed 60 of those disorders were new conditions. Most were errors that had occurred spontaneously at conception, rather than being inherited.
Prof Caroline Wright, from the University of Exeter, told the BBC: "We were able to find new genetic conditions, which means that not only people in the study benefit, but there are huge benefits to future generations.
"Getting a genetic diagnosis is hugely important to families. It allows them to speak to other families who might be affected by the same condition, and hopefully target much more personalised management and ultimately treatment."
Around a quarter of children in the study had their treatment changed once a clear diagnosis was given.
This kind of genetic analysis is becoming more routine within NHS care.
The discovery of Turnpenny-Fry syndrome meant Dasha Brogden's daughter, Sofia, was diagnosed when she was just one month old.
Her diagnosis made everyone aware heart conditions were a possibility, and a scan led to Sofia - now aged nearly three - having surgery when she was two months old.
Dasha, from Oxfordshire, said: "For us, getting a diagnosis really helped us to understand what to expect. Compared to families who came before the condition had an official diagnosis, we were lucky.
Follow James on Twitter. | Disease Research |
Revealed: Government knew it had prioritised NHS ‘to detriment of care homes’
Explosive admission made in top secret Covid ‘lessons learned’ review obtained by openDemocracy after two-year battle
The UK government knew as early as September 2020 that its desire to free up hospital beds in the early stages of the pandemic had been “to the detriment” of care homes, openDemocracy can reveal.
It is one of a number of explosive admissions in a highly secret Covid “lessons learned” review document that was released tonight following a two-year transparency battle between the Department of Health and Social Care (DHSC) and openDemocracy.
Ministers have publicly maintained they “threw a protective ring” around adult social care and “specifically sought to safeguard care homes” even after losing a high-profile court case last year over their failures. But behind closed doors, the department admitted the “operational response centre” (ORC) at the heart of the government’s Covid response had prioritised hospital capacity and failed to fully understand social care.
“The unprecedented speed with which this new virus emerged inevitably focused attention primarily on how the NHS would be able to cope,” reads the draft document, which is marked “OFFICIAL SENSITIVE”. “This prioritisation of the protection of hospital capacity, without adequate acknowledgement of key interdependencies, was to the detriment of ASC [adult social care].”
The Covid-19 public inquiry is a historic chance to find out what really happened.
The review also reveals the precarious staffing levels of the ORC itself as the disease crept towards Britain. As late as February 2020, 37% of shifts in the unit – also called the “incident response team” – were unfilled because civil servants who had received special training for emergencies could not get permission from their bosses to be released from regular work.
The DHSC carried out the review, dated September 2020, “as an informal, internal-only” overview of the first wave of the pandemic.
It used a “mixture of interviews with senior figures”, including “stakeholders” outside the department, and a survey that received 276 responses from across the DHSC. According to the DHSC, the review was not intended for publication, was not finalised, and “remains in draft form”.
Under the heading ‘Organisation’, the review says staff worked slower because the department did not have the right software: “The lack of a collaboration document management system, such as SharePoint or Google Drive, impacted teams’ ability to work at pace.”
In a passage that is likely to catch the eye of data privacy campaigners, the review also criticises Foundry, the controversial database software provided to the NHS by digital giant Palantir – saying even health secretary Matt Hancock was unable to use it.
“There is no single departmental overview of the range of available [DHSC] datasets, their origins, ownership and structure and the governance arrangements relating to access to those datasets,” the review states. “NHSE created the ‘Foundry’ data sharing platform to partially address these issues but staff (and the Secretary of State) experienced access issues and its utility as a central resource was limited.”
Palantir initially offered its services to the NHS for just £1, openDemocracy investigations revealed at the time, but subsequently won contracts worth £22m after getting its foot in the door. openDemocracy successfully sued the government over the deal and secured a vow that it would not work with the CIA-backed ‘spy tech’ firm again without consulting the public – a promise that was not kept.
The ‘lessons learned’ review also reveals that documentation about key early decision-making may not exist – something that is likely to create a headache for the official Covid-19 inquiry, which began taking evidence this week, as well as the government itself, which has already been hauled over the coals for its refusal to release unredacted information.
“Due to the dynamic situation,” the document says, “complex discussions were sometimes taken in senior meetings without a formal submission to set out accountability. While this assisted decision-making at pace, it meant there was not always a clear audit trail for rapidly evolving strategy.”
Care homes
Ministers have been heavily criticised for not doing more to protect care homes, where more than 20,000 residents died in the first wave of the pandemic.
Respondents to the survey criticised “glaring omissions in strategic direction of integration and preparedness” within the sector, “meaning that the social care system was not able to respond to a major health emergency”.
Indeed, some said they had not anticipated that the government would need to have a centralised role with care homes at all, assuming – wrongly – that the largely privatised care sector would be “responsible for their own response” to Covid.
The review also admits that putting a hold on routine care home inspections by the Care Quality Commission watchdog “removed one of the department’s lines of sight into ASC [adult social care] and limited its direct knowledge of what was happening on the ground”.
The DHSC says in the document that it “would have benefitted from a fuller understanding of the response by Asian countries (recognizing the contexts are very different) earlier in our planning, which might have enabled us to start to build testing systems earlier in January 2020”, but does not go into detail about what information officials lacked, or why it was unavailable. It also notes there was an “absence of a unified leadership for Test and Trace” at the start of the pandemic, but again stops short of going into detail.
On the subject of personal protective equipment (PPE) such as masks, gowns and gloves, the review recommends “more rigorous… vetting of PPE suppliers” in future. During the pandemic, the government set up a so-called ‘VIP’ lane for suppliers of the kit – a separate channel for politically connected firms.
But PPE supplied through the government’s VIP lane was three times more likely to be useless to the NHS than normally procured PPE, according to analysis by openDemocracy. The total value of contracts awarded to suppliers through the high-priority lane was £1.7bn. Some £4bn of unusable PPE bought by the government in the first year of the pandemic later had to be burnt.
The existence of the ‘lessons learned’ review was first revealed by HuffPost UK in May 2021. The DHSC refused openDemocracy’s request to see a copy, but the information rights watchdog – the Information Commissioner’s Office – ruled in our favour. The DHSC initially appealed against the ruling, threatening to take the ICO to court, but has now handed it over.
The ICO held that there were “significant public interest arguments in favour of disclosure”.
A Department of Health and Social Care spokesperson said: “We have always said there are lessons to be learnt from the pandemic and we are committed to learning from the COVID-19 Inquiry’s findings which will play a key role in informing the government’s planning and preparations for the future. We will consider all recommendations made to the department in full.”
openDemocracy hopes to cover every day of the UK Covid inquiry. It’s a huge undertaking, but we can do it with your support. Please click here to make a donation.
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Patients will be able to receive prescription medicines and oral contraception without seeing a GP under new plans to ease the strain on surgeries.
It is hoped the measures - which could be rolled out as soon as this winter - will help to free up 15 million slots at doctors' surgeries over the next two years.
Under the proposals, pharmacists will be able to write prescriptions for common conditions including including earache, sore throat and urinary tract infections without needing the approval of a GP.
The measures - which are part of what ministers are calling an "overhaul of primary care" - are backed by £645m of spending over two years and come alongside efforts to end the 8am "rush" for appointments.
They are being announced just days after the Conservatives suffered from a punishing set of local election results on the back of high inflation, a cost of living crisis and record high levels of unhappiness with the NHS.
Ministers hope almost half a million women would no longer need to speak to a nurse or GP to get oral contraception under the new plans and that the number of people able to access blood pressure checks in pharmacies would be more than doubled to 2.5 million a year.
PM promises to 'work day and night' after Tories lose over 1,000 seats - politics latest
Self-referrals will also be increased for services including physiotherapy, hearing tests and podiatry, bypassing the need to see a GP.
The proposals could be in place this winter pending a consultation with the industry.
The prime minister said "transforming primary care is the next part of this government's promise to cut NHS waiting lists".
"I know how frustrating it is to be stuck on hold to your GP practice when you or a family member desperately need an appointment for a common illness," he added.
"We will end the 8am rush and expand the services offered by pharmacies, meaning patients can get their medication quickly and easily."
NHS chief executive Amanda Pritchard said the reforms would "help us to free up millions of appointments for those who need them most, as well as supporting staff so that they can do less admin and spend more time with patients".
Steps are being taken to make it easier for patients to see GP - but they may feel short-changed The government's Primary Care Plan wants to do two things at once: make it easier for patients to access their GP and to take pressure off GPs so they can manage their patient lists better. But by doing the former they might be making the latter worse - unless the workforce crisis in primary care is resolved. A recent survey said seven out of ten GPs found their jobs to be extremely stressful and another found that more than a third of GPs want to quit within five years. This recruitment and retention issue needs to be addressed urgently. The government says it will provide £240m for primary care to update existing telephone systems so more calls can be taken, clinically assessed and directed to most appropriate treatment. This will not always be a GP. It might be a practice nurse or speciality inside a community health team. There is a perception that GPs do not see enough patients. But the data for March shows 70% of GP appointments were seen face to face. And primary care doctors will tell you they are seeing more patients than ever before as patient lists continue to grow. Another step will be to train GP receptionists to become 'clinical navigators' so they can field calls and clinically assess the patient and refer the caller to the best service. This might ease some patient anxiety but it will require a cultural shift in mindset. People expect to see a doctor and feel short-changed if they do not.
Labour's Shadow Health Secretary Wes Streeting criticised the announcement as "merely tinkering at the edges" and said it did not deliver the "fundamental reform" the NHS needs.
It pointed to figures from the Chemists' Association which reveal that 670 pharmacies and 343 surgeries have closed since 2015.
The idea of giving pharmacists the power to prescribe without GP approval is not new.
Therese Coffey, who was health secretary during the short period of Liz Truss's premiership, floated plans to enable pharmacies to manage and supply contraception prescriptions last September.
She also pledged that patients would see a GP within two weeks of making an appointment - although she did not set a target for when that should be achieved by.
Read more:
Unite starts 'escalation' of strike action
Minister admits local election results 'not good' for Tories
Mr Streeting said: "13 years of Conservative failure has seen hundreds of pharmacies close and 2,000 GPs cut.
"Now millions of patients are waiting a month to see a GP, if they can get an appointment at all. Expecting the Conservatives to fix this is like expecting an arsonist to put out the fire they started.
"Rishi Sunak is completely out of touch with the problems facing patients and the NHS. He has no plan to address the shortage of GPs, or to reverse the cut in the number of doctors trained every year.
"The Conservatives' announcement is merely tinkering at edges, in contrast to the fundamental reform the NHS needs and Labour is offering."
Mr Streeting said Labour would abolish the non-dom tax status and use the proceeds to train an extra 7,500 doctors and 10,000 nurses every year. | Health Policy |
Zohreen Shah is a Los Angeles-based national reporter for ABC News. Below, she shares the story of a medical journey she faced both on and off-camera.
At first, I thought I was having a stroke last month.
I didn't recognize myself in the mirror. It looked like the left side of my face had gone "offline." Half my face was totally frozen.
I screamed, cried, and called 9-1-1.
EMT's arrived, telling me what a doctor would later confirm: I was actually suffering from Bell's palsy, a rare nerve disability where half the face stays temporarily frozen for weeks - sometimes months. The onset is often confused for a stroke.
It can feel traumatizing. The instinct is to throw on a mask or hide at home.
But I'm a national television reporter. My face is a big part of my job.
Within hours, I was supposed to be in front of many cameras, crisscrossing the country for an interview, and shooting segments with my frozen face that would forever live online.
Bell's palsy can 'suddenly activate'
Every year, Bell's palsy suddenly activates in roughly 40,000 Americans, according to the National Institutes of Health.
Anecdotally, nearly all my friends knew at least one person who has been through it.
George Clooney and Angelina Jolie have shared their own experiences with the condition -- pretty solid proof that you can be totally ok after going through this. Justin Bieber also recently suffered from a nerve paralysis which made half his face freeze, an even more severe condition called Ramsay Hunt syndrome.
Doctors believe Bell's palsy may be caused by a viral infection.
With Bell's palsy, the nerve that allows muscles to control facial expression stops communicating with the brain - giving the appearance of half the face being frozen. It can't move, and so for many people, it sags. The eye on the frozen side often bulges.
Many of these symptoms, including the initial ones I first experienced, are really similar to a stroke, so the EMTs that arrived at my doorstep, and my mom, encouraged me to go to a hospital so it could be ruled out.
After two hours in an emergency room, a doctor ran a couple tests to see if my arms and legs were moving ok and he asked me to lift my forehead. Only one side could move.
He confirmed I had Bell's palsy and prescribed steroids and eye drops.
He also assured me that for most people, within two weeks to six months, their face returns to normal. I made myself believe mine would too.
Can you keep working with a severe nerve condition?
Medically speaking, there was no reason for me not to work.
And that was good news, because in just a few hours - that very next morning, I had a shoot for an episode of our new ABC News/Hulu show called "Impact X Nightline."
But should I do it? Was I making the shoot harder or easier for the team? Was I setting an unfair bar for future female reporters? Would they be expected to work through a facial paralysis?
I was aching to connect with another reporter who understood my job and could guide me through these questions, but I didn't know anyone with this type of nerve condition who had continued to work on-camera. "Good Morning America" co-anchor Robin Roberts often says "make your mess, your message," and I made a pact with myself that when I recovered, I would write something to help the next person like me.
But at this very moment, I had an urgent problem: Much of our piece had already been shot and my face was all over it. There were two big interviews left.
I proposed a plan.
I would go to the shoots, and have our team shoot just my right profile, the side with movement, in frame.
If I wasn't a distraction, the team could use the shots. If it was, they could cut my face and my questions out of the piece entirely. At least that gave everyone options.
I got to the shoot and tried my hardest to not smile at anyone. My wonky half smile was a dead giveaway that something was wrong. This was so hard. I broke into an involuntary grin every time someone looked at me with their smiling face.
I took a seat at the interview and focused on the face sitting in front of me instead of my own, and let 14 years of reporting muscle memory guide me.
During a lunch break, my camerawoman uploaded the clips onto her computer. I wasn't sure if I'd look normal. I've been in front of TV cameras for 11 years. I've watched countless hours of tight camera angles on my face and scrutinized every inch. And I know cameras capture literally everything. A smallest muscle shift can convey a totally different emotion: hesitation, happiness, grief. Half my damn face was frozen.
But I was relieved when I saw the shots. I couldn't tell anything was off. Nothing in my tone or body language revealed my secret. If I couldn't see the problem - others likely wouldn't either.
Unfortunately, I wasn't out of the woods. What I strangely learned is that this journey would get harder.
Bell's palsy isn't just about appearance
I attracted concerned glances from every stranger who saw me and eventually started wearing a mask.
But Bell's palsy is actually more than what you look like.
A few hours after that first shoot, I was on a red-eye flight to New York for a final interview. But when you have Bell's palsy - your eye on your frozen side remains wide open - all the time. I looked like an extra from "Thriller." You can't blink to naturally keep your eye watery. I had to manually pull my eyelid down with my hand or douse it with water drops. So sitting up while sleeping isn't easy. I tried pressing my face in every way I could against the airplane's tray to keep it shut. Eventually, I fell asleep - with one eye wide open.
Over the next few weeks, I would struggle at moments to see clearly out of it. My eye doctor ran tests, and said a lot of Bell's palsy patients will have dry eyes, and there was nothing to worry about.
It also affected how I spoke.
Days after the shoot when I went to track the voiceover to my story, I had lost the ability to easily say many words with "b" "m" "p" or "w"- because those letters required my full face to pronounce. Our "Impact" producers listened through the phone so they could catch any small slurs and help coach me. In some cases, I felt like I was re-learning how to speak with half my facial muscles.
There were a lot of other surprises: When I tried to take a gulp of water, half ended up on the ground. I couldn't use a straw. And showering was difficult because I couldn't close my eye to keep out water.
Gratitude versus grief
Despite all of this, I was actually "net happier" after my Bell's palsy diagnosis. After all, it wasn't a stroke — which would have been life-threatening and could have much more serious long-term effects.
I felt like I had a second shot at life, and that gratitude kept me going for a while.
But even within those first few weeks - sometimes it was hard to brush off the grief. It would often hit me after holding up my phone to document my condition. My husband would hug me and we'd both break down.
The face in the frame just could not function the same way it used to. I knew that in the smallest chance I didn't recover, my career as an on-air reporter would never be the same. Just like singers can't perform without their voice, on-air reporters can't go long without their whole face.
I wouldn't be able to improvise too long.
Facing recovery
But luckily, things got better.
After we finished the story, I took a break. I embraced all the Western medicine my doctor prescribed, including steroids, and Eastern medicine -- my friend Chrysten's consistent acupuncture and herbs, and everything my chiropractor's office offered.
I also knew I wanted to keep my spirits up. I constantly reminded myself that this was one of the easiest things I could be diagnosed with: it was likely temporary. Speaking to our ABC News producer Jenna who had recently gone through the diagnosis, and spending time with friends who dropped by also helped.
Eventually, something started to connect, and my face slowly began coming back online.
On day five, I could somewhat control my left eye and almost shut it all the way.
On day seven, I felt pulsing on my lower left face, a feeling that maybe it was trying to move.
By day 14, it would have been hard for a stranger to know something was wrong with my face.
And by day 19, it was hard for me to notice my face was asymmetrical - and I was ready to return to work.
I still haven't watched that 30-minute "Impact" episode. I will. Right now, it feels like watching it means having to re-live those first few days of having Bell's palsy.
But I did face the cameras again for an interview.
Just this time, it was a heck of a lot easier. I had my entire working face, and a heart full of gratitude. | Disease Research |
If one clear lesson is to be taken from our response to the arrival of Covid-19 three years ago, it is an appreciation of the highly effective role played by scientists in fighting the pandemic. Within weeks of the Sars-CoV-2 virus emerging, researchers had sequenced every one of its genes and had pinpointed the cells through which Covid-19 enters the body. By the end of the year, they had used that knowledge to create a safe, tested vaccine that played a crucial role in ending the pandemic. More than 7 million people across the planet have died of Covid-19 but the death toll would have been far higher had researchers not acted with such speed and potency.
Yet it is also becoming clear that on many occasions scientists were not listened to by national leaders. Economics and short-term political considerations were often given greater priority than scientific concerns. These resulted in failures to limit the spread of Covid-19. It is for this reason that the UK inquiry into the nation’s pandemic response, chaired by Heather Hallett, should be followed with rigorous attention.
The government had said it would always be guided by the science when it came to dealing with Covid. It is a claim that now looks distinctly hollow. Consider the “eat out to help out” scheme launched by the government, at the Treasury’s behest, in summer 2020. Pubs and restaurants had just been allowed to reopen but the public were, unsurprisingly, reluctant to mingle there. So people were bribed to eat out by the government.
The scheme allowed diners to claim 50% off more than 160m meals in August at a cost to the Treasury of about £850m. In the process it also drove up new infections by between 8% and 17%, according to one study carried out a few weeks later.
Crucially, it now appears scientists had not been asked their views about the scheme as it was being set up. Had they been allowed to express their views, their responses would probably have been robust. As one member of the Scientific Advisory Group for Emergencies (Sage) that was dealing with the pandemic has put it, the scheme was “spectacularly stupid and an obscene way to spend public money”. These are harsh words to describe a policy that was the brainchild of the then chancellor of the exchequer, and our current prime minister, Rishi Sunak. His reluctance to cooperate with the inquiry should be judged in this light.
The crucial point is that No 10 and the Treasury not only disregarded scientists, but ministers and officials too. According to Anthony Seldon and Raymond Newell’s book Johnson at 10, former health secretary Matt Hancock first learned about the scheme when the press release announcing its implementation was published. This is silo governance at its worst. Nor is it the only example of the government’s marred responses to the arrival of Covid-19.
So we should be clear about the need to expose the follies and failures that bedevilled our response to Covid. The nation has faced past examples of medical disasters and scandals. The contamination of blood supplies with HIV and hepatitis C in the 1970s and 1980s affected thousands and killed hundreds, for example. However, Covid-19’s impact on Britain was of a different order of magnitude. It led to the deaths of more than 225,000 individuals, produced lockdowns that tarnished the lives of virtually everyone, and has left thousands suffering from clinical depression and the effects of long Covid.
Another outbreak of a new disease on this scale would be devastating. Hence the need to examine the government’s response to Covid-19 in scrupulous detail and to pinpoint where and when it went wrong. Only then will we have a chance to build effective defences against future emerging pandemics.
And we should be clear about this last issue. Covid-19 will certainly not be the last zoonotic disease to ravage the world. Indeed, all evidence suggests the risk of more pandemics is rising as more wildernesses are ripped up and more disease-carrying animals are disturbed from their homes as cities and farms spread and human numbers soar.
Last week, the idea that Covid-19 was not due to natural disturbances but was the result of a laboratory leak was resurrected after vague remarks were made by George Gao, a leading Chinese scientist. Most western experts dispute this idea, however. The virus was natural in origin, they insist. It is crucial we face up to the implications of this assertion. Future pandemics will continue to emerge from the constant habitat disruptions we impose on the planet and we will never be safe until we realise that fact.
Claiming the pandemic was due to a one-off laboratory mistake – an assertion often influenced by political considerations – is to fail to face up to the fact that human-induced ecological destruction is the real risk. It is unclear when we will learn this lesson. In the meantime, we need to unravel the failures that blighted our past pandemic responses. Only then will we have a hope of avoiding the worst consequences of the next pandemic and a repeat of the Covid-19 nightmare from which we have only just emerged. | Epidemics & Outbreaks |
As the United States reckons with a burgeoning sexually transmitted disease crisis, a broadening chorus of public health experts are calling for the Centers for Disease Control and Prevention to endorse prescribing a preventive antibiotic pill to gay and bisexual men and transgender women at high risk of STDs.
But while a growing body of research shows that taking doxycycline after sex substantially lowers STD infection rates in this population — though not in cisgender women, according to the findings of a highly anticipated new study — some experts remain concerned that widespread use of the antibiotic for this purpose could do more harm than good by fueling the global crisis of antibiotic-resistant infections and harming people’s microbiomes.
“There’s going to be a very rigorous debate about whether this is a good idea, and for whom,” said Dr. Matthew Golden, director of the HIV and STD program in Seattle’s health department.
That debate has been at the forefront of the annual Conference on Retroviruses and Opportunistic Infections, which started Sunday in Seattle, with new findings from several studies of doxycycline for STD prevention unveiled Monday.
This includes the third randomized trial to find that instructing gay and bi men (one of the previous trials also included trans women) to take the antibiotic within 72 hours of sex without a condom — a protocol known as doxycycline post-exposure prophylaxis, or doxyPEP — lowers the risk of bacterial STDs. The new study, conducted in France, randomized about 500 gay and bi men to receive doxyPEP or no antibiotics and found doxycycline lowered the rates of gonorrhea, chlamydia and syphilis by 51% to 89%.
Another study found that in one of the other major doxyPEP trials, there was no marked increase in doxycycline resistance among three key bacteria, including gonorrhea and staph. However, this is not likely to resolve the ongoing debate on the matter.
Less controversial among public health experts is the potential for using a vaccine for STD prevention. The French study further found that a meningococcal B vaccine halved new gonorrhea infections.
The Seattle conference also saw findings from a randomized study of cisgender women in Kenya in which doxyPEP had no impact on their STD rates. Calling the study’s results “very disappointing,” its director, Dr. Jenell Stewart, an infectious disease physician at the University of Minnesota, said differences in anatomy, antibiotic resistance and adherence to the medication protocol could each at least partially explain the lack of efficacy in women while doxyPEP has consistently worked well in gay men in Western nations.
The new efficacy research shared Monday builds on previously released findings that in recent years have fueled increasing excitement within the infectious disease field over doxycyline’s promise as an answer to out-of-control STD transmission.
One study, conducted in Seattle and San Francisco and presented at a July conference, saw about a two-thirds overall reduction in STDs among gay and bi men and trans women. A previous French study, published in 2017, found the intervention dramatically cut syphilis and chlamydia infections, but did not affect gonorrhea.
“The data show in men a consistent benefit in terms of reducing the incidence of bacterial STIs,” Dr. Jean-Michel Molina, the lead author of both of the French studies and an LGBTQ health researcher at the Université Paris Cité, told NBC News, referring to the term sexually transmitted infections. He added that more research is needed to confirm the efficacy of the vaccine for gonorrhea.
Paul Marcelin, 48, a software engineer living in Alameda, California, participated in the Seattle-San Francisco study and was randomized into the control group that did not receive the antibiotic. After the study was discontinued early due to high efficacy, he was offered doxyPEP last summer.
“It’s been very, very positive, having that as an extra source of peace of mind,” Marcelin said of his experience taking doxycycline for prevention, noting that he typically contracts an STD about once every two years and has had none since starting doxyPEP. “It’s just part of my health routine.”
Gay and bi men, plus transgender women, have been the focus of most of the recent research into pharmacological prevention of STDs, because they have a higher rate of such infections than cisgender heterosexual people (lesbians, meanwhile, have lower rates than heterosexual people). Men who have sex with men, for example, comprise less than 2% of the U.S. adult population but, according to the CDC, account for more than 40% of U.S. syphilis diagnoses.
Over the past two decades, gonorrhea, chlamydia and syphilis have soared, to 2.5 million cases in 2021. The CDC estimates this has saddled the nation with $1.1 billion in direct medical costs.
Most critically, syphilis — a scourge that was nearly eliminated in late 1990s but that the CDC reports skyrocketed by 68% between 2017 and 2021, to 171,000 cases — poses a potentially fatal threat to infants born to undiagnosed women. In rare cases, it can also harm vision or even cause blindness.
David Harvey, executive director of the National Coalition of STD Directors, said the overall infection surge is driven, in part, by federal cuts to state STD programs.
Condom use among gay and bisexual men in particular has also seen a long decline since HIV became treatable, and thus less frightening, in 1996, and with the advent a decade ago of the HIV prevention pill, known as PrEP.
Harvey, like many other public health experts, is looking to doxycycline, which typically costs pennies per pill, as a potent tool that could help turn the STD tide.
DoxyPEP concerns
Some infectious disease experts, however, remain gravely concerned that doxyPEP adoption could fuel the emergence of drug-resistant pathogens, especially staph.
“Overall, my biggest fear is they’re not thinking about global antimicrobial resistance,” Fabian Kong of the University of Melbourne said of doxyPEP’s champions. “They’re just thinking about the STI world.”
The World Health Organization lists antimicrobial resistance as one of the top 10 global public health threats facing humanity.
Approved in the 1960s, doxycycline is prescribed widely to treat acne and rosacea, to treat or prevent Lyme disease, and to prevent malaria among travelers and the military. Other tetracyclines, the antibiotic class to which doxycycline belongs, have long been used in livestock production — to the concern of many infectious disease experts, who worry this fuels drug-resistant infections that can affect humans.
For doxyPEP, such concern is perhaps less crucially relevant to the three major STDs themselves. There is no evidence that chlamydia has acquired resistance to tetracyclines and only scant evidence that syphilis has. Plus, the drug class is not used to treat gonorrhea. However, some experts believe it is possible that doxyPEP’s use could drive up the existing resistance in gonorrhea strains, potentially making the intervention’s ability to prevent that STD short-lived.
But by reducing the spread of STDs, some experts argue, doxyPEP could also lead to less antibiotic use to treat such infections and less spread, possibly mitigating the emergence of drug-resistant strains.
The CDC has issued increasingly urgent warnings in recent years about gonorrhea’s potential for evading the last remaining simple and effective antibiotic treatment for the infection.
Dr. Annie Luetkemeyer, a professor of medicine at the University of California, San Francisco, presented findings at the retrovirus conference regarding a subset of the 637 participants in the Seattle-San Francisco study. The researchers did not find marked increases among them in doxycycline resistance to three bacteria: Neisseria gonorrheae, Staphylococcus aureus and non-pathogenic Neisseria. These findings are limited by the fact that the participants were followed for no more than a year, there were not many samples of gonorrhea to test, and some of those in the control group received doxycycline to treat STDs.
“I don’t think any of the resistance findings are a showstopper yet for doxyPEP,” Luetkemeyer said. “However, we will need to thoughtfully monitor for resistance in STIs and off-target bacteria like Staph aureus to understand doxyPEP’s impact over time.”
Luetkemeyer and her colleagues also found that those who were given doxyPEP ultimately received 50% less of the standard antibiotic treatment for gonorrhea, ceftriaxone, due to fewer infections.
Kong and other experts are also concerned about the impact routine doxycycline use may have on people’s microbiomes. Luetkemeyer said this is a challenging question to answer, and one that she and her colleagues are continuing to study, along with the antimicrobial resistance concern.
The future of doxyPEP
Concerns about drug resistance and the microbiome notwithstanding, some infectious disease experts say the time is ripe for the CDC to endorse a rollout of doxyPEP among certain gay men and trans women.
Dr. Jeffrey Klausner is an infectious disease expert at the University of Southern California and an author of several papers on doxycycline as STD prevention. Proposing providing doxyPEP only to those most at risk of STDs, he said, “It’s really a drop in the ocean of tetracycline use, but it could have a substantial benefit on sexually transmitted infections.”
A 2018 study found that over a two-year period, only 0.1% of those 13 to 65 years old in Massachusetts had more than one STD, and this small group of only 7,000 people accounted for 28% of all STDs in the state during this time period.
Michael Traeger, a research fellow at Harvard Medical School, presented a modeling study at the Seattle conference in which he and his colleagues reviewed patient data at the LGBTQ-focused clinic Fenway Health in Boston and identified what they characterized as an efficient prescribing strategy to minimize antibiotic use while maximizing impact: Give doxyPEP for 12 months to gay and bi men who had recently had an STD. This, they projected, could prevent up to 42% of subsequent STDs in the overall patient population.
Even in the absence of formal CDC guidance, some gay men are already taking doxycycline for STD prevention. And in October, the San Francisco Department of Public Health became the first in the nation to establish interim doxyPEP guidelines. Plus, certain LGBTQ-focused clinics, including Howard Brown Health in Chicago and the Los Angeles LGBT Center, have recently adopted such protocols, or will soon.
“We should not conflate antibiotic prophylaxis with antibiotic misuse,” said Dr. Anu Hazra, a physician at Howard Brown who is among those in the public health field calling for the CDC to establish doxyPEP guidelines. “We use antibiotics as prophylaxis for many different diseases and conditions where data support its use.”
According to Dr. Leandro Mena, the CDC’s director of STD prevention, the agency has already begun laying the groundwork for potentially establishing doxyPEP guidelines. He said that once the Seattle-San Francisco study is published, likely by spring, this effort will advance and will include a review of the relevant science as well as expert and community input — likely a monthslong process.
“We know that it works,” Mena said of doxyPEP. He said the CDC is concerned with assessing the intervention’s safety, deducing “which populations can benefit the most” and addressing equity concerns, considering that people of color contract STDs disproportionately. | Epidemics & Outbreaks |
The combination of soaring heat and smothering fine particulate pollution may double the risk of heart attack death, according to a new study of more than 202,000 heart attack deaths in China. The study published today in the American Heart Association's flagship journal Circulation.
"Extreme temperature events are becoming more frequent, longer and more intense, and their adverse health effects have drawn growing concern. Another environmental issue worldwide is the presence of fine particulate matter in the air, which may interact synergistically with extreme temperatures to adversely affect cardiovascular health," said senior author Yuewei Liu, M.D., Ph.D., an associate professor of epidemiology in the School of Public Health at Sun Yat-sen University in Guangzhou, China. "However, it remains unknown if and how co-exposure to extreme temperatures and fine particulate pollution might interact to trigger a greater risk of death from heart attack, which is an acute response potentially brought on by an acute scenario and a great public health challenge due to its substantial disease burden worldwide."
To examine the impact of extreme temperatures with and without high levels of fine particulate pollution, the researchers analyzed 202,678 heart attack deaths between 2015-2020 that occurred in Jiangsu province, a region with four distinct seasons and a wide range of temperatures and fine particulate pollution levels. The deaths were among older adults with an average age of 77.6 years; 52% were older than age 80; and 52% were male. Particulate exposure on the day of each death and one day before death were included in the analysis.
Extreme temperatures were gauged according to the daily heat index (also referred to as apparent temperature) for an area, which captures the combined effect of both heat and humidity. Both the length and extremeness of heat waves and cold snaps were evaluated. Heart attack deaths, or case days, during these periods were compared with control days on the same day of the week in the same month -- meaning that if a death occurred on a Wednesday, all other Wednesdays in the same month would be considered control days. Particulate levels were considered high on any day with an average level of fine particulate matter above 37.5 micrograms per cubic meter.
"Our findings provide evidence that reducing exposure to both extreme temperatures and fine particulate pollution may be useful to prevent premature deaths from heart attack, especially for women and older adults," Liu said.
Compared with control days, the risk of a fatal heart attack was observed at the following levels:
The researchers estimated that up to 2.8% of heart attack deaths may be attributed to the combination of extreme temperatures and high levels of fine particulate pollution (> 37.5 micrograms per cubic meter), according to WHO targets.
"Strategies for individuals to avoid negative health effects from extreme temperatures include following weather forecasts, staying inside when temperatures are extreme, using fans and air conditioners during hot weather, dressing appropriately for the weather, proper hydration and installing window blinds to reduce indoor temperatures," said Liu. "Using an air purifier in the house, wearing a mask outdoors, staying clear of busy highways when walking and choosing less-strenuous outdoor activities may also help to reduce exposure to air pollution on days with high levels of fine particulate pollution. To improve public health, it is important to take fine particulate pollution into consideration when providing extreme temperature warnings to the public."
In a 2020 scientific statement and a 2020 policy statement, the American Heart Association details the latest science about air pollution exposure and the individual, industrial and policy measures to reduce the negative impact of poor air quality on cardiovascular health. Reducing exposure to air pollution and reversing the negative impact of poor air quality on cardiovascular health, including heart disease and stroke, is essential to reducing health inequities in Black and Hispanic communities, those that have been historically marginalized and under-resourced, and communities that have the highest levels of exposure to air pollution.
The investigators recommended additional research about the possible interactive effects of extreme weather events and fine particulate pollution on heart attack deaths in areas with different temperature and pollution ranges to confirm their findings. The study did not include adjustments for any adaptive behaviors taken by individuals, such as using air conditioning and staying indoors, when temperatures are extreme or pollution levels are high, which could cause misclassification of individuals' exposure to weather and alter their risk patterns. These results also may not be generalizable to other regions in China or other countries due to potential variations of adaption capacity and temperature distribution.
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Meningitis cases more than doubled in a year in England, a charity has warned.
Meningitis Now analysed UK Health Security Agency (UKHSA) figures and found cases of invasive meningococcal disease (IMD) in England increased from 80 in 2020-2021 to 205 in the 12 months from July 2021 to June 2022.
The charity said the country was in lockdown for much of that time and cases rose as restrictions eased.
The UKHSA said it could not confirm or refute the figures because it had not yet published its latest annual health protection report, which is due to be released in a few weeks.
Meningitis Now appears to have added up the data from the UKHSA's four published quarterly reports to get its figures.
UKHSA recorded 28 cases in July to September 2021, 65 in October to December 2021, 57 in January to March 2022 and 55 in April to June 2022.
In its most recent report it noted the 55 cases of IMD reported were "triple the number of cases in the equivalent period in 2021 when 17 cases were reported and double the 29 cases reported in 2020".
But the UKHSA added: "However, IMD cases in April and June 2022 were 55% lower than in the same, pre-pandemic, period in 2019 when 122 cases were reported.
"This relatively low number of confirmed meningococcal cases between April and June 2022 was observed across all capsular groups."
According to the NHS, symptoms of meningitis and sepsis include: a high temperature; cold hands and feet; vomiting; confusion; breathing quickly; muscle and joint pain; place, mottled or blotchy skin; spots or a rash; headache; a stiff neck; a dislike of bright lights; being very sleepy or difficult to wake; and seizures.
Meningitis Now said the UKHSA data shows 179 of the cases were caused by MenB (meningococcal group B), with 84 of those cases occurring in those aged 15 to 24.
The figures indicate nearly a third of MenB cases occurred in children under five and 32% of MenB cases affected adults, it said.
The charity's chief executive, Dr Tom Nutt, said: "These new figures are very concerning and indicate that there is still some way to go in our battle to defeat this disease.
"For much of this time the country was still in lockdown when many of us were isolating or practising social distancing.
"As these restrictions eased, meningitis cases have in turn risen from what had been an historic low in the previous year.
"We did expect that cases of meningitis would increase following the pandemic, but these new figures indicate that there is still more to be done.
"We all need to remain aware of the signs and symptoms of meningitis so that people know to act quickly and to seek urgent medical help to save lives."
Dr Shamez Ladhani, consultant epidemiologist at UKHSA, said: "As expected, there has been an increase in the number of meningococcal cases reported in April to June 2022 compared to the very low numbers reported the previous year, following the fall in cases seen whilst COVID-19 restrictions were in place.
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"The restrictions introduced during the pandemic and social distancing measures impacted the spread of many infections, including meningococcal disease.
"Surveillance is ongoing, and the risk of meningococcal disease continues to be very low. We strongly encourage parents, teenagers and young adults to ensure they are aware of the symptoms and signs of meningitis and septicaemia." | Epidemics & Outbreaks |
"We were neglected," says the husband of 37-year-old Allison Holthoff, who died in the hospital after not receiving treatment for 7 hours Published on January 10, 2023 03:33 PM Photo: Ali Holthoff/Facebook A Canada woman has died after a seven-hour wait in the emergency room, which family members call "heartbreaking" and "so unfair." Allison Holthoff, a 37-year-old from Nova Scotia, had an upset stomach on Dec. 31 and went to the emergency room the following morning when the sickness worsened. Her husband, Gunter Holthoff, told CBC News that he had to carry her on his back into the Cumberland Regional Health Care Centre in Amherst, Nova Scotia, before finding a wheelchair. "She was obviously in pain," he told the outlet. "I was rolling her in the wheelchair and she could hardly sit up." Gunter explained that they arrived around 11 a.m., and while Allison was triaged pretty quickly, she then spent hours in the waiting room before she was seen. "I told the nurses and the lady at the desk there a couple of times, 'It is getting worse,' and nothing happened," he said. "So the security guards, in time, they brought a couple blankets out and they brought us a cup of water and I used it to put some ice on her lips." Ali Holthoff/Facebook "I think that she actually started saying that she thought she was dying in the waiting room outside," Gunter continued. "But she kept saying it more and more. She said, 'I think I'm dying. Don't let me die here.' And I said, 'No, that's why I've got you in the hospital.' " After hour six, he said his wife was taken from the waiting room into a unit with no medical equipment. It was 6 p.m. by the time Allison finally saw a doctor and received pain medication. While prepping for an X-ray, Gunter recalled her condition getting worse to the point where she couldn't breathe. "The next thing is [her] eyes rolled back in her head and her chest started rising. Something started beeping," he told CBC. "The next thing you hear is over the PA, 'code blue, code blue in X-ray.' " Never miss a story — sign up for PEOPLE's free daily newsletter to stay up-to-date on the best of what PEOPLE has to offer, from juicy celebrity news to compelling human interest stories. Ali Holthoff/Facebook Gunter recalled that he was quickly asked to leave the room while medical staff attempted to resuscitate Allison three times. However, she ultimately died. He noted that although the family is still waiting on an autopsy, he believes the healthcare system has a serious problem that needs to be addressed. "We need change, the system is obviously broken. Or if it's not broken yet, it's not too far off," he said. "Something needs to improve. I don't want anybody else to go through this." He added to Global News that he just wishes they weren't "neglected" by the hospital and that their children got to say goodbye to their mother. "Unfortunately, I feel like we were neglected until it was to a point they couldn't ignore us anymore," Gunter said. "At that point, it was just too late." | Health Policy |
Even patients already on blood pressure medication can bring theirs down further by not adding additional salt above a certain limit to their food, scientists from a trio of universities found in a new paper.
Consuming one less teaspoon of salt a day resulted in a systolic blood pressure decline comparable to the effect achieved with medications, proving that prevention often does beat a cure.
Furthermore, the study of American participants is the first to show that people already on blood pressure drugs could further lower the crucial reading by reducing salt consumption.
The research was conducted by Northwestern Medicine, Vanderbilt University Medical Center, and the University of Alabama.
“We found that 70 to 75 percent of all people, regardless of whether they are already on blood pressure medications or not, are likely to see a reduction in their blood pressure if they lower the sodium in their diet,” said Professor Norrina Allen of Northwestern University, a co-principal investigator on the study who added that they didn’t know beforehand if people already on blood pressure medication could lower it further by reducing sodium intake.
The study is one of the largest to investigate the effect of reducing salt in the diet on blood pressure to include people with high blood pressure, also known as hypertension, and already on medications. It was a randomized controlled trial, the gold standard of research, and one that’s often difficult to use in dietary interventions.
Professor Allen said the total daily sodium intake recommended by the American Heart Association (AHA) is less than 1,500 milligrams, and the study was designed to decrease it even lower than that.
“High blood pressure can lead to heart failure, heart attacks, and strokes because it puts extra pressure on your arteries. It affects the heart’s ability to work effectively and pump blood,” said Allen’s colleague Deepak Gupta, associate professor of medicine and director of the Vanderbilt Translational and Clinical Cardiovascular Research Center.
Just putting table salt on your food is a difficult way to create these outcomes, especially if balanced out by exercise, and most of the risk associated with high sodium intake comes from salt’s hidden presence in packaged and processed foods.
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Participants in their 50s, 60s, and 70s from Birmingham, Alabama, and Chicago were put on either a high-sodium diet (2,200 mg per day on top of their usual diet) or a low-sodium diet (500 mg in total per day) for a week, after which they crossed over to the opposite diet for a week.
On the day before each study visit, participants wore blood pressure monitors and collected their urine for 24 hours.
Among the 213 participants, systolic blood pressure was “significantly lowered” when they were on the low-sodium diet compared with the high-sodium diet.
“Just as any physical activity is better than none for most people, any sodium reduction from the current usual diet is likely better than none for most people with regards to blood pressure,” said Professor Gupta.
The blood pressure-lowering effect of dietary salt reduction was achieved rapidly and safely within one week, according to the research team; a real strong point of the study because it means folks interested in lowering their blood pressure can go out and make the consumer choices to do so immediately.
SHARE This One Step One Outcome Research With Your More Senior Friends… | Nutrition Research |
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Blue Flowers salesman Nick Davenport said his customers are "100 percent" stunned to see the intoxicating hemp products he sells.
Steve Harrison/WFAE
Blue Flowers salesman Nick Davenport said his customers are "100 percent" stunned to see the intoxicating hemp products he sells.
Steve Harrison/WFAE
In North Carolina, recreational marijuana is illegal. So is medical marijuana.
But you wouldn't know that when you go to Blue Flowers, a hemp store in one of Charlotte's most upscale areas, next to a Whole Foods.
Approaching the store, you quickly notice the smell.
"It's almost like the scent trail of a pie hanging out in a window, you know those little scent lines waving around," said Nick Davenport, a Blue Flowers salesman.
He's standing in front of several large mason jars of hemp flower, with names for different strains like Bruce Banner and Karma 20/20. His store looks just like a California marijuana dispensary.
"I've got things from sativa to hybrid to indica strains where those will still give you your uplifting, your relaxing, your kind middle-man effects," Davenport said.
He's skilled in hyping what he's selling.
"Or an indica if they want a more sedating relaxing experience. Something more couch-lockey. Indica is In Da Couch for my people because you should expect that kind of effect," Davenport said.
There are pre-rolled joints next to the register.
"That one on the right is a lemon drop strain. It has a nice citrus hint to the flower," he said. "Just a nice smooth smoke. And you'll be in a nice spot afterwards that's for sure."
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Blue Flowers sells pre-rolled hemp cigarettes.
Steve Harrison/WFAE
Blue Flowers sells pre-rolled hemp cigarettes.
Steve Harrison/WFAE
Often people are stunned at the extent of products that can get them high.
"100 percent. 100 percent," he said. "People come in here and are like, I had no idea it was this far along. I didn't even know I could get this kind of stuff."
Nearly half of states have legalized recreational marijuana, with most being blue states run by Democrats.
But in many Republican-controlled states, there has been an increase in hemp products that also have psychoactive effects, like Delta 8 and the newest arrival, THC-A, which is sold by Blue Flowers. Those products have quietly become the red state way to get high.
The 2018 Farm bill removed hemp as a controlled substance, so long as it has less than .3 percent Delta 9 THC. That's the active ingredient in marijuana that produces intoxicating effects.
After that law, the market found new ways to make hemp mimic marijuana.
One of the first products was Delta 8.
It has psychoactive effects that exist only in very small quantities in hemp, says Ryan Dills, who co-owns the Georgia Hemp Company.
"But if you can extract it, you know, from millions of pounds of plants or however many plants you got then you can have as much Delta 8 as you want," Dills said.
The concentrated Delta 8 is placed in gummies or sprayed on hemp flower. Some users have said that Delta 8's high is more enjoyable than regular Delta 9 THC, with less side effects like anxiety and paranoia.
The FDA, however, has said it has not evaluated Delta 8 nor approved it for safe use. It has also sent warning letters to businesses across the country, citing them for claiming their Delta 8 products were treatments for various medical conditions or could be used for other therapeutic uses. The letters also cited companies for not labeling food items with Delta 8 properly.
And some states, like New York, have banned Delta 8, even while making recreational marijuana legal.
Delta 8 became popular during the pandemic.
Last year, another hemp product hit the market: THC-A.
Eating a piece of hemp flower with THC-A, won't get you high.
But that changes when it's burned, Dills said.
"It becomes Delta 9 once you combust it, once you smoke it. So it's kind of a loophole if you will," he said.
Recreational marijuana is illegal in Georgia. Dills stressed that he's not selling the illegal Delta 9 THC, but unheated THC-A.
"So people that come in and know, and ask about it, we'll educate them," he said. " We'll say 'hey this is the same thing as regular THC. Buying a joint in Colorado is the same thing as buying this THCA joint.' "
Stores in marijuana-restrictive states like Florida, Tennessee, Texas, Wisconsin, Alabama and Nebraska also sell THC-A hemp flower and pre-rolled joints.
That surprised Erica Stark, executive director with the National Hemp Association.
"I don't know how that's legal," she said.
She noted that the 2018 bill requires states to test hemp for its Delta 9 THC content "post-decarboxylation."
In other words, after it's been burned.
"So a 21 percent THC-A flower would never meet the hemp standard of any state," Stark said.
But Rod Kight, an Asheville, N.C. attorney who represents the hemp industry, said U.S. Department of Agriculture guidelines on hemp production from 2021 allows growers to test a plant's total THC content 30 days before the plant is harvested.
"That's a time when decarboxylated THC content is much lower," he said.
Kight added that "once harvested, the sole metric for distinguishing between lawful hemp and unlawful marijuana is the concentration of delta-9 THC, and the concentrations of other cannabinoids, including THC-A, are immaterial."
Some states, like Louisiana, have already banned smokable hemp.
Many others have not regulated it, says Phil Dixon Jr. at the University of North Carolina Chapel Hill's school of government.
"It's kind of the wild west right now," he said.
Though many hemp stores ask for ID and won't sell to minors, there are often no laws prohibiting sales to minors. That's the case in North Carolina.
"There's no age limit on this stuff," Dixon said. "I have prosecutors calling me all of the time saying, 'Hey I have a kid with a bag of Delta 8 gummies in middle school and I want to charge him.' And...it's not a crime".
North Carolina lawmakers introduced a bill this year that would add an age requirement for these hemp products, but it's stalled.
Meanwhile, Blue Flowers - that hemp store near the Whole Foods - now has a billboard on Interstate 85. | Drug Discoveries |
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In a women’s shelter in suburban Australia, Iranian resident Shayda takes a pair of blunt scissors to her long hair. Her young daughter watches in delight.
It’s a powerful moment in the feature film “Shayda” that represents the titular character’s increasing independence from her abusive husband, Hossein.
Although “Shayda” was written four years ago and set in the Australian coastal city of Brisbane three decades ago, the scene mirrors one of the enduring symbols of the ongoing protests against repression of women’s rights by Iranian theocratic authorities. Along with marches, university protests, and the burning of headscarves, Iranian women across the world have broadcast images across social media of cutting their hair.
The act shows solidarity with the Kurdish-Iranian woman, Mahsa Amini, 22, whose killing last September at the hands of Iran’s so-called “morality police” sparked the protests. Cutting one’s hair is also a traditional Kurdish symbol of mourning, said Noora Niasari, the film’s Tehran-born director.
“It was chilling to realize how much it resonates with what is happening today,” she said.
Niasari’s film recently won the Audience Award in the World Cinema Dramatic Competition at the Sundance Film Festival, which featured the works of three women filmmakers of Iranian descent this year. Although the films vary by tone and genre, they all focus on women and are united by the geopolitical backdrop of the current protests and the Iranian government’s brutal crackdown against demonstrators.
The travails of the protagonist in “Shayda” are based on the experiences of Niasari’s family. She, too, was raised by a single mother after living in a shelter in Australia at the age of five. In Iran, a husband’s permission is required to seek divorce; so Niasari’s mother became a permanent exile for fear of losing custody of her children if she returned to Iran.
Years later, the circumstances remain – “it’s still the same fight for these women,” Niasari said of Iran’s protesters.
The Iranian government has long targeted members of the country’s film industry for their art and political views, including renowned director Jafar Panâhi, who has been held since July 2022 on charges of “propaganda against the system.”
Filmmaker Maryam Keshavarz, who also premiered a film at Sundance, grew up in New Jersey and visited Iran as a child during breaks in the Iran-Iraq war in the 1980s. But she’s been banned from the country since the 2011 release of her debut feature film “Circumstance,” about youth underground culture and two young Iranian women in love. Keshavarz said that the current uprising has brought decades of struggle by Iranian women to a head.“This new generation is amazing. I’m terrified for them, and I’m in awe of them,” she said.
Keshavarz said her comedy, “The Persian Version” is a “maybe more than semi-autobiographical,” multigenerational retelling of her family’s journey to the United States. Leila, the film’s lead and Keshavarz’s stand-in, works to find her place between American and Iranian culture, even as both countries are at odds with each other. In the second half of the film, the narrative flips to her mother, Shirin, who is revealed to be a character far more complex than the conservative, disapproving matriarch seen in her daughter’s eyes.
Actors Layla Mohammadi (left) and Niousha Noor in “The Persian Version.” Image courtesy of Sundance Institute. Photo by Andre Jager
Keshavarz said narrating her family’s story from both Leila and Shirin’s perspectives helped her recognize her own mother’s strength and vulnerability. While the daughter in the film is a literal writer, her mother is also “a writer of her own destiny as an immigrant,” the director and screenwriter said.
“The film was an ode to my mother and her story and her voice and her desire to speak,” Keshavarz said.
Keshavarz wrote “The Persian Version” while the Trump era’s so-called “Muslim travel bans,” were in effect, saying the script was a “refuge.” “The xenophobic rhetoric is so against what it means to be American,” she said.
Writing the film enabled her to reflect her own experience in the Iranian diaspora, as well as her mother’s life in Iran.
“I’d never seen something that bridges those two worlds … that has both Iran and both America,” Keshavarz said. “So I kind of just wrote the thing I’ve always wanted to see.”
By following her instinct, “The Persian Version” ended up resonating with audiences and critics alike at Sundance. The film won both the audience award and the Waldo Salt Screenwriting Award in the U.S. dramatic competition.
Unlike Niasari and Keshavarz, Iranian-American filmmaker Sierra Urich has never been to Iran. Her debut documentary, “Joonam,” which was also shown at Sundance, follows Urich as she dives into the culture on the maternal side of her family by spending a summer in her childhood home in rural Vermont with her mother Mitra and grandmother Behjat.
Urich said she made the film for people like her, who aren’t first-generation immigrants and “were longing to have more of a connection to their ancestral lands or to their families identity, but didn’t necessarily feel it themselves.”
One way Urich builds ties to her Iranian heritage is by learning Farsi online. Another is through conversations with Mitra and Behjat, in which viewers learn about the murder of Behjat’s grandfather. In the film, Mitra contends with the post-traumatic stress caused by this traumatic moment in the family’s history, among other violence the family has endured.
Much like “The Persian Version,” Urich’s documentary amplifies the voice and agency of both the filmmaker and her mother. Urich uses footage that her mother, an artist, filmed in college in the U.S. about being separated from Iran because of the Iranian Revolution in 1979.
“I think this film at its heart is really about loss of home and how that experience is different for each generation,” Urich said.
While the mothers of Urich, Niasari, and Keshavarz all left Iran in different eras for different reasons, Niasari said the filmmakers are connected through the shared experience of displacement.
“There isn’t a family that hasn’t experienced trauma who’s living outside of Iran,” she said.
Nevertheless, the directors all tell stories of Iranian women who show resilience and resolve while celebrating their cultural identity.
Keshavarz, who has elevated Iranian women’s stories through film for decades, said she’s optimistic about the spotlight now being shone on the treatment and experiences of women in her homeland.
“I never thought there would be a day I would see so many people around the world marching for something that we’ve known existed for decades,” she said of the protests. “That’s what storytelling does. It brings a face to big issues, and it lets us connect.”
Maea Lenei Buhre is a general assignment producer for the PBS NewsHour.
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It is 1.35pm and I’m having to explain coronavirus transmission to a nurse. I am due an appointment at 2.30, and I’ve been phoned because I say I’m clinically vulnerable. I ask whether the nurse has an N95 mask (as they’re proved to be most effective). She does not. I ask whether she and the team are taking weekly lateral flow tests, like her colleague said. She is not, and is unsure why that was promised.
“We don’t need to do that any more,” she says breezily. What she means is: she has no official duty to do so any more. Clinically vulnerable (CV) patients still “need” the Covid-19 protections. They just don’t get them.
We don’t really talk about this. We don’t really talk about coronavirus at all. More than three years on from the start of the pandemic, there’s understandably a desire to “move on”, to bury painful memories of lockdowns and watching loved ones dying on iPads. This has only been encouraged by the government, which has honed the message “Covid is over”, as if saying this somehow makes it so.
Since February last year, when Boris Johnson removed all protections, such as the legal obligation for people with coronavirus to isolate and most free testing, there’s been no official strategy or guidance on reducing transmission of the virus. The result is a kind of mass denial – an agreed forgetting. The subject crops up from time to time. A breaking news banner announces a new variant. A friend texts that she’s stuck in bed “with the worst summer cough”. Then we carry on – until we are forced to remember once again.
Watching coronavirus make a return to the headlines in recent days has subsequently felt like a weird deja vu, like the return of your least favourite guest star in a long-running television show. First, the vaccine rollout in England was hastily brought forward in light of concerns over the new variant BA.2.86, which recently caused an outbreak in a care home in Norfolk. Then it was announced that testing and monitoring would be scaled up again after scientists warned the country was nearly “flying blind”.
That sound you can hear is a stable door closing and the horse bolting. Though cases and hospitalisations are thankfully significantly lower than at the height of the pandemic, the daily number of positive coronavirus tests in England has been increasing since the end of June – a trend that is likely to grow in the coming weeks, as we socialise more indoors and children mix at school. It’s hopeful that many cases of Covid-19 are now mild, but that isn’t true for everyone: at last count, 1.5 million people were experiencing long Covid symptoms that adversely affected their daily activities, and the virus still poses a significant risk of death to many people with pre-existing health conditions.
Not that you’d know it. When was the last time you heard a minister even say the word “coronavirus”? As Rishi Sunak’s government lurches from crisis to crisis, Covid is labelled as “job done” because it is simply more convenient that way. Britain’s “Covid policy” in 2023 is effectively King Canute’s courtiers watching another wave coming and insisting sheer will alone can stop the tide.
Take immunisation. This week, the vaccine rollout for people at the highest risk (over-65s, some clinically vulnerable people, and health and care staff) begins – but 12 million fewer people are eligible for a jab compared with last year, as part of plans for the NHS to “get back to normal”. On Friday a group of MPs called on the government to extend the booster programme, but currently those outside the slim eligibility criteria won’t even be able to buy a vaccine privately. This winter, it will be possible to pop into Boots to buy a flu jab – but not a Covid jab. This is clearly dangerous (even many clinically vulnerable people don’t qualify for protection), but it’s also a false economy. Fail to fund vaccines and the taxpayer pays more in the long term, from ICU beds in a buckling NHS to more long Covid patients falling out of the workforce.
Or consider the lack of support for clinically vulnerable people. The 3.7 million high-risk people previously asked to shield at home – including 500,000 immunocompromised people who get little to no protection from vaccines – have effectively been abandoned to survive alone. With nationwide coronavirus precautions removed, many disabled people I’ve spoken to feel forced to avoid shops, pubs and public transport. Others who previously stayed safe by working at home are being told to return to packed offices as the shift to WFH is reversed. The so-called return to normal has always been one-sided: while non-disabled people rightly enjoy freedom, clinically vulnerable people are told to accept indefinite isolation.
Just look at the way the NHS has dropped many of the rules for staff that were meant to protect vulnerable patients. While some healthcare workers are taking precautions at their own discretion, NHS staff in England don’t have to wear a mask, and the majority who have respiratory symptoms are no longer asked to test for Covid. That means a patient with lung disease could be forced to get treatment from a nurse with a Covid cough.
A new poll shown to me by Clinically Vulnerable Families, a support group involved in the coronavirus inquiry, finds 69% of CV people surveyed said they had cancelled or not made a medical appointment due to concerns over lack of Covid precautions; 80% said this was having an impact on their physical health.
Still, best not mention it. Time to move on. The trouble is, denial is not a long-term plan. Coronavirus is effectively a fire. Ignoring it doesn’t stop the virus – it just lets the damage spread. The paradox of the pandemic has always been that the only way to “move on” is to actually engage with it. That means embracing smart, non-invasive public health measures such as masks in hospitals, a thorough vaccination programme, ventilation in public spaces and sick pay to help workers isolate.
But it also means confronting our impulse to believe that all of this is unnecessary and arduous. Even the phrase “Covid restrictions” – a term used by almost every media outlet – is loaded, suggesting low-key mitigations are heavy burdens rather than simple ways to free clinically vulnerable people. That the virus primarily “only” affects those with underlying health conditions has always been the unspoken excuse for indifference.
After three years, hundreds of thousands of deaths and a shared national trauma, there is something to be said for not only building a better relationship with Covid but with each other. In the meantime, millions of people at the highest risk will be left to shrink their lives or leave the house afraid – and ministers will do nothing to help. But why does it matter? We don’t need to do that any more.
Frances Ryan is a Guardian columnist | Epidemics & Outbreaks |
Oct. 17, 2023 â A process your body uses to stay warm in cool weather could one day lead to new therapies for obesity.
Scientists have, for the first time, mapped the precise nerve pathways that activate brown fat, or brown adipose tissue (BAT), a specialized fat that generates heat. Low temperatures kick brown fat into gear, helping the body keep its temperature and burning calories in the process.
âIt has long been speculated that activating this type of fat may be useful in treating obesity and related metabolic conditions,â said Preethi Srikanthan, MD, an endocrinologist and professor of medicine who oversaw the research at the UCLA School of Medicine. âThe challenge has been finding a way of selectively stimulating [it].â
Brown fat is different from the fat typically linked to obesity: the kind that accumulates around the belly, hips, and thighs. Thatâs white fat. White fat stores energy; brown fat burns it. Thatâs because brown fat cells have more mitochondria, a part of the cell that generates energy.Â
After dissecting the necks of eight human cadavers, Srikanthan and her team traced the sympathetic nerve branches in the fat pad above the collarbone â where the largest depot of brown fat in adults is stored. They stained the nerves, took samples, and viewed them under a microscope.Â
They found that nerves from brown fat traveled to the third and fourth cranial nerves of the brain, bundles of nerve fibers that control blinking and some eye movements.
In a previous case study, damage to these nerves appeared to block a chemical tracer from reaching brown fat. The evidence suggests that changing this nerve supply could alter brown fat activity, potentially leading to new treatments for obesity and metabolic diseases like type 2 diabetes, Srikanthan said.
A Possible Mechanism for Ozempic?
Brown fat has already been linked to at least one breakthrough in obesity treatment. Some evidence suggests that popular medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) may affect brown fat activity. These belong to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists. They work by mimicking the hormone GLP-1, which is released in the gut and brain in response to eating glucose (sugary foods or drinks).
âGLP-1 agonists have been shown to increase [brown fat] activity in rodents and humans, but likely indirectly, via activation of specific regions in the brain,â explained Varman Samuel, MD, PhD, an associate professor of medicine at the Yale School of Medicine, and chief of endocrinology for the VA Connecticut Healthcare System.Â
The scientific literature is divided on this, but there is enough evidence to support further inquiry, Srikanthan said. Her team has begun a study to examine that link.
Opening the Door to Future Obesity Treatments
But their discovery means other new treatments could be on the horizon.Â
Previous research had shown that the sympathetic nervous system, which controls your body's stress response, drives brown fat activity. But now that the UCLA scientists have revealed the exact nerves connecting brown fat to the sympathetic nervous system, we could find ways to stimulate those pathways to activate brown fat â without stimulating the many organs (such as the heart and stomach) also connected to this vast network of nerves, Srikanthan said.Â
Methods for doing that could include medication, electrical stimulation, or heat therapy, according to the study.Â
Still, there is reason to temper expectations. â[Brown fat] depots, while highly metabolically active, are quite small,â Samuel said. âSo, the overall contribution to whole-body energy balance in humans will likely be small.â
On the other hand, that prediction doesnât account for what we donât know.Â
âWeâre learning more about how tissues communicate with each other, beyond the release of hormones or metabolites,â Samuel said. Activating brown fat could trigger âsignals that help coordinate whole-body energy metabolism.â | Disease Research |
The Buffalo Bills have confirmed safety Damar Hamlin has returned home to continue his recovery after spending nine days in hospital.The NFL and fans around the world were left in shock when the 24-year-old suffered a cardiac arrest after he completed a seemingly routine tackle on January 2 during a match against the Cincinnati Bengals.Hamlin was resuscitated on the field and a second time later before he was admitted to the intensive care unit at the University of Cincinnati Medical Centre.He was then transferred to Buffalo General Medical Centre on Monday where he has since been released following a comprehensive medical evaluation, the Bills confirmed on Tuesday morning (local time)."We have completed a series of tests and evaluations, and in consultation with the team physicians, we are confident that Damar can be safely discharged to continue his rehabilitation at home and with the Bills,” Dr Jamie Nadler, Hamlin's care team lead, said.Stream more sports news live & on demand with Flash. 25+ news channels in 1 place. New to Flash? Try 1 month free. Offer ends 31 October, 2023Bills head coach Sean McDermott said the club was “grateful” Hamlin was finally back at home with his family after the incident."I'm sure it's felt like a long time since he's been able to be home naturally there, and I'm sure it's a great feeling," he said on Wednesday.There was no word on his return to the football field but McDermott said Hamlin would decide when he felt ready to go."His health is first and foremost on our mind as far as this situation," McDermott said."And then when he feels ready, we will welcome him back."Hamlin had remained in intensive care for several days before he was slowly able to breathe on his own and to resume a normal diet and complete some physical therapy.On Wednesday last week he was woken from his sedation and was able to hold visitors’ hands. By Friday he was able to breathe without a ventilator and even addressed the Bills through a video call.Doctors presiding over Hamlin’s recovery said he had begun walking and eating normally since the ventilator was removed.The Bills game against the Bengals was immediately stopped when Hamlin collapsed after a tackle just six minutes into the first quarter. The match was postponed and then later cancelled when the seriousness of the incident came to light.Medical staff immediately rushed onto the field after Hamlin suddenly collapsed and began CPR and provided oxygen.Hamlin’s sudden cardiac arrest visibly affected staff and players from both teams, with many holding their heads in their hands and seen comforting each other.Hamlin’s uncle Dorrian Glenn spoke outside the hospital at the time and revealed to CNN the 24-year-old had to be resuscitated twice when his heart "went out".“They resuscitated him on the field before they brought him to the hospital and then they resuscitated him a second time when they got him to the hospital,” he said.Mr Glenn thanked the medical staff and admitted it was heartbreaking to see his nephew so close to death.“I’m not a crier, but I’ve never cried so hard in my life. Just to know like my nephew basically died on the field and they brought him back to life,” he said“They sedated him just to give a better chance for him to just continue to heal better. We are just taking it day by day. It seems like he’s trending upwards in a positive way.”There has not been an explanation for what caused Hamlin’s sudden cardiac arrest but cardiologist Jason Kovacic suggested the safety may be a victim of bad timing.“The normal cause of unexplained cardiac death on the sports field is undiagnosed genetic heart disorders but Damar Hamlin suffered a blow right on the sternum as he was running and collapsed soon after that,” he told Sky News Australia on Thursday.“There is a condition called commotio cordis which is a blow to the sternum timed at precisely the wrong moment of the heart’s cycle. So it’s only a 20-millisecond window but it’s a well-documented cause of sudden cardiac death in otherwise healthy people that have normal hearts.“It’s a very well described but rare event and it’s while the heart is actually relaxing and recharging its electrical circuits, a blow at that time when the heart’s particularly vulnerable can put the heart at a lethal rhythm and all hearts are susceptible to that.”Following the incident there was an outpouring of support from NFL fans worldwide and the entire competition changed their social media pictures to Hamlin’s number three jersey with text reading: "Pray for Damar".Football stadiums around the US were lit up in the Bills’ blue and red, while players and thousands of fans tweeted and shared tributes to wish Hamlin a speedy recovery. | Medical Innovations |
When Deanne Bhamgara took a tumble off her electric scooter on a pier in San Diego, she didnât make much of it at first. The fall left her sore, but she felt only little pain.
But over the next several days, she slowly began to hurt more and more.
"What started as a tingling sensation in my thighs had soon become sensitive to touch,â says Bhamgara, 28. The San Francisco resident later learned that the fall affected her lower back, tailbone, pelvic areas, and her hip joints. In a few days, Bhamgaraâs pain had radiated to the rest of her back and to the thighs as well.
Almost all Americans get back problems at one time or another. You might sleep awkwardly or wrench your back while lifting something heavy. Or, like Bhamgara, you might hurt your back in an accident. But often, says physical therapist Eric Robertson, DPT, the culprit is too much sitting and not enough moving.
âWe're largely a sedentary society, and so that sedentary lifestyle is the primary thing that we have to work on,â says Robertson, who also is a spokesperson for the American Physical Therapy Association (APTA). âSo any sort of movement exercise, walking, working with a physical therapist to give you an individualized customized program is a great idea.â
When Bhamgara went to doctors, physical therapists, and chiropractors about what to expect with her recovery, they gave her conflicting opinions. It might take 6-12 weeks, she heard, or it could take a full year before she was back to normal.
âI was mostly in bed after the pain started,â Bhamgara says. She had inflammation on her thighs right up to behind the knees, groin, butt, lower back, and sometimes in her shoulders.
Bhamgara is now on the mend. She understands itâll take time and effort to fully heal and to keep her inflammation in check.
Robertson of the APTA says feeling better with back pain doesnât have to be complicated. Here are some effective steps:
Avoid bed rest. Studies show that lying down too much can slow recovery and raise the pain.
âOver the last 25 years or so, probably the one thing we've learned definitively about back pain and bed rest is that is not OK,â says William Lauretti, DC, an associate professor at New York Chiropractic College and a spokesperson for the American Chiropractic Association. Instead, âyou want to be as active as you can be with your back pain.â
Move. You may not want to move when youâre in pain, but itâs important to do as much as you can handle.
Robertson says most back pain isnât serious, even if it may be very painful. "So not being afraid of motion and continuing to move despite the pain is something that's really important,â he says. Walking is a good choice you can do on your own. You also can work with a physical therapist to learn how to spot dangerous levels of pain and which moves are best for you.
Keep good posture. Pay attention to the way you hold your back when you sit, stand, walk, sleep, or do day-to-day activities. Good posture is when all the bones in your spine are correctly aligned. Poor posture can leave your back stiff and tense. This often to leads to back pain.
Lauretti offers these tips on posture:
Donât sit up in your bed hunched over your laptop. Thatâs a surefire recipe for back pain over time.
If you must sit for a long time, use cushioned chairs. Hard seats wonât support your back and may prevent you from sitting up straight.
Use a comfortable desk and chair if you need them while working.
Here are some general tips to maintain good posture:
Sleep smart. The ideal bed, Lauretti says, is one thatâs âcomfortable for you.â As for the best sleep posture, he says on your side or back is easier on your back than sleeping on your belly. If youâre face down, your head will be turned all night so you can breathe, which can lead to neck pain.
Bhamgara says tucking a pillow between her legs to help align her hips lessens her back pain.
Relax. Back pain can be linked to stress, tension, and other non-physical problems, Robertson says. Massages and acupuncture may help loosen muscles. Yoga, meditation, and other mindfulness practices may help lift your mood, stretch your muscles, and make you relax so you can better manage your back pain.
Bhamgara says mediation made her feel alive, especially when her back pain made it painful to move freely.
âI would think about healing every inch of my body,â she says. âThere were times I would imagine myself walking in a park with my headphones on and just dancing! That brought me life.â
Call your doctor. If your back pain doesnât go away after 4 weeks or if you have long-term pain that lasts beyond 12 weeks and keeps you from carrying on with your daily activities, see your doctor. They can help pinpoint the cause of your pain and may suggest new therapies. Get medical attention right away if your legs tingle, feel numb, or weak. | Stress and Wellness |
By Margret Krakauer, as told to Keri WigintonÂ
Iâve recently switched hobbies from painting to writing. One of the first things I wrote for my memoir was: Itâs a race between losing my vision and my hearing.
Iâm 79 and had cataract surgery a decade ago. Thatâs when my doctor diagnosed me with age-related macular degeneration (AMD). I started to show signs of geographic atrophy (GA) probably 5 years later.
Iâve been legally blind in my left eye since childhood, which has nothing to do with GA. But I learned to adapt to vision loss early on. I always wonder if my early sight struggles helped me adapt to living with AMD. Â
But I think I reacted to my diagnosis like anyone else: I was shocked. I was scared. I didnât understand it.Â
I still get anxious about vision loss, but Iâm doing well. I feel mentally prepared for the future, one that until recently didnât include GA treatment. And maybe something will come along in my lifetime thatâll be even better than this newly approved drug or the ones that may soon follow.Â
Plus, people who lose central vision in both eyes can still travel, work, bicycle, and maintain independent lives. Just knowing that other folks with GA do all those things is reassuring.Â
And who knows whatâll happen for me in the years to come. I might not go back to painting, which I used to do for hours, but maybe Iâll return to sculpting. It just feels good to be able to have that to think about.
Life Through My EyesÂ
I have no problems cooking on my own. Menus can be tricky, though I havenât eaten in a restaurant at night since before the pandemic. But I can enlarge to-go menus on the computer or ask my husband to tell me the choices.Â
I can read most things with my regular glasses. Iâm learning about non-fiction and fiction mysteries in a 10-week lifelong learning course. I found all the books but one electronically.
And while I prefer e-books, I can still read print articles. Iâll just need a lot of light.
I find it hard to see in any low-light situation, inside or outside. Weâve started brightening up the house, especially in the areas where I spend a lot of time. But I donât drive after the sun goes down. Thatâs because itâs dark but also because of how glare from other light sources hits my eyes.
Iâve slowly started losing my ability to discern between certain colors. For instance, not all yellows are a problem. But pale yellow looks white to me.
Sometimes letters disappear on the right side of my field of vision if Iâm reading or watching TV. I guess thatâs because I have more damage in that part of my macula. Sometimes, if I blink or move my head, letters will reappear. But thatâs a little disconcerting to know I have holes in my vision.
And when I look at the Amsler grid -- an eye chart I use at home to test vision changes caused by AMD -- I can see wavy lines. Â
Many people with wet or dry AMD talk about seeing dark blobs. I see something similar if Iâm in a room and the TV is on but the overhead lights are off. Iâll see a cloud of electrical noise or tiny dots that move a little.
But like everyone, I have good days and bad days. And my eyes get tired a lot faster than they used to. Some days I canât read at night, so instead, I watch some dumb thing on TV. And thatâs fine.Â
Where I Find Support
Iâve been married for 53 years, and my husband helps me in all sorts of ways.Â
For example, I wear hearing aids. Heâll clean them or change the filters for me because I canât see fine details enough to do it without a magnifier. Maybe thatâs lazy of me, but he doesnât complain.Â
Heâll thread needles for me because even though my acuity is 20/30, which is pretty good, small things are hard to see. The eye chart they use at the doctorâs office isnât a good gauge of how I see everyday life with AMD or GA.Â
When we walk outside, my husband will point out steps, stones, or other things I might not notice. And he always holds onto me in the dark.Â
We also have this unusual flashlight that we use. It has several lightbulbs that shine a wide angle of light. We keep it in the car so we can grab it if we walk somewhere at night.Â
I also feel comfortable asking my doctor about GA or any low-vision services I might need. Though heâs not one for chitchat. And Iâm OK with that because I can come home and connect with people through my Facebook community.Â
Iâm part of a group called Our Macular Degeneration Journey. People are kind as can be. And Iâve learned all sorts of things about the world of GA in discussions with other members, which includes low-vision specialists like optometrists or occupational therapists.
Facebook is where I first heard that new drugs were coming down the line. And like other people in the GA community, that news felt monumental. I know thereâs no way to reverse my vision loss, but knowing thereâs a new treatment out there has given me a new lease on life.
Iâm not saying I ever gave up on living well with low vision. But I did give in to the idea that my sight would only worsen. Maybe now thereâs a good chance Iâll have good eyesight for the rest of my healthy life.
Hope for the Future
My retina specialist thinks Iâm a good candidate for pegcetacoplan (Syfovre) injection, the new drug approved to treat GA. Iâm eager to start getting the shots quickly because Iâve noticed more blind spots that come and go in my left eye.Â
Iâm also excited to start treatment soon because Iâm almost 80, and I know people my age are more likely to progress faster than younger folks. I donât know if thatâs just because of GA or because the aging process causes us to lose more rods and cones.Â
I want to slow vision loss as fast as possible because itâs not like I have two âgoodâ eyes. And Iâll be much more handicapped if I lose more sight in my right eye. But Iâm much more hopeful about my future with GA. I feel this way not only because this new treatment exists, but because I know many researchers are studying this disease.Â
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Photo Credit: fstop123 / Getty Images
SOURCE:
Margret Krakauer, 79, age-related macular degeneration advocate, Wayland, MA. | Disease Research |
Hollywood actor Zac Efron has joined Kodiak Cakes as Chief Brand Officer and board member. Kodiak Cakes Zac Efron’s down-to-earth approach to health and sustainability is Kodiak Cakes. The former “High School Musical” star has officially joined the whole grain, protein-packed food company that was scooped up by private equity group L Catterton in a rumored $800 million deal in 2021 as its Chief Brand Officer and new board member. Kodiak Cakes started when current cofounder and CEO Joel Clark began selling homemade pancake mixes out of a little red wagon as an eight-year-old, and has quickly grown to be one of the most renowned bakery brands in the U.S. with annual sales hitting $200 million in 2020, according to PitchBook. With earlier backing from Sunrise Strategic Partners and Golub Capital, the company has branched out into several adjacent categories, including oatmeal and nutrition bar, over the years. During an exclusive Zoom interview recently, Efron told me how he’s been a long-time Kodiak fan, actively incorporating its products into his regular diet and fitness routine even on outdoor adventures. “Kodiak Cakes is an incredible company that offers comfort food made with good ingredients,” he said. “The fact that they’ve made a lot of efforts in wellness, wildlife conservation, and sustainability connects with me. It feels like food with a purpose.” Kodiak Cakes has previously led a fundraise campaign for several Vital Ground Foundation projects to conserve grizzly bear habitat and movement areas for other wildlife.
Business Plans Upon The Partnership Over the past several years, the Hollywood actor has built a reputation for helping preserve the environment with the Netflix NFLX series “Down To Earth With Zac Efron” he executively produced alongside his wellness expert friend Darin Olien, in which the pair explores various environmental issues across the world. Upon coming back to California from filming season 2 in Australia, Efron said he plans to build Kodiak Cakes not only from marketing, but potentially helping launch new products as well. Cofounder and CEO Joel Clark (left) expects Kodiak Cakes's growth in 2022 to outpace last year. Kodiak Cakes “One of the coolest things about our partnership is I’m not just lending my name to the brand; they’re actually giving me the opportunity to roll up my sleeves and collaborate on everything from new products to ideas like branded apparel and several give-back initials, which are all really fun,” Efron told me. Efron has so far attended at least two Kodiak Cakes’ board meetings, and he describes the team as “a solid squad with the best vibe ever,” promising to continue advocating healthy and active living for consumers with busy schedules.
“I’m constantly on the go — that's the truth. I’m lucky that a huge portion of my job is just taking care of myself, so I spend a lot of time prioritizing my adventures in the wild and also fitness,” Efron told me. “If I'm not in front of the camera, or if I'm not on set, I’m usually traveling and finding solace in nature. That's where Kodiak fits well.”
Future Growth Outlook
Kodiak Cakes is in the process of launching a Cubs line for kids, including frozen waffles and oatmeal, in hopes to compete with a growing numbers of emerging better-for-you products entering the center aisle, according to Clark.
With the onboarding of Efron, the company’s plan is to further penetrate more categories while leading the core pancake mix market, where Kodiak Cakes is currently the number-two brand.
“We saw an opportunity to bring more better-for-you desserts made with real ingredients, fresh butter, whole grains, added protein that taste awesome,” Clark said. “For the foreseeable future, where we want to lead is pancake mix where we're only about one and half market share points away from becoming the number one brand.”
Kodiak Cakes’ overall business has grown by 20% in revenue last year, and Clark expects a faster growth pace and significantly increased revenue by 2022. | Nutrition Research |
Obesity Causes Inflammatory Responses in Fat Tissue
A new study has uncovered a complex inflammatory response that occurs in fat tissue during obesity progression.
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A new study, published in JCI Insight, has uncovered a complex inflammatory response that occurs in fat tissue during obesity progression.
In both adults and children, rates of obesity are increasing in an issue of “epidemic proportions” according to the World Health Organization. The increase in obesity rates is coupled with a corresponding increase in type 2 diabetes and cardiovascular disease cases.
In obesity, adipocytes – cells that store energy in the form of lipids – expand to store excess energy from the diet. When the adipocytes reach capacity, cell death and inflammation can occur.
To understand the link between fat accumulation and poor health outcomes for obese individuals, researchers are exploring how adipose tissue is structured and the mechanisms behind the inflammatory response.
Immune cells in adipose tissue
The researchers behind the new study used single-cell and spatial analyses to understand the different immune cell types in adipose tissue and where they are in relation to each other as obesity progresses.
The team fed mice a high-fat diet for 14 weeks, then collected fat tissue for analysis. Using a clustering computer model, they grouped the cells that had a similar genetic makeup.
From this analysis, they identified five subtypes of macrophages, a type of immune cell involved in clearing dead cells and cellular debris. “We knew going in that macrophages would likely have multiple subtypes… what surprised us were the number that came out that were highly different from each other and coming up at different times and becoming more dominant over time,” Dr. Lindsey Muir research assistant and professor of Computational Medicine and Bioinformatics at the University of Michigan Medical School and lead author of the study, said.
Changes over time
The five subtypes of macrophage identified in the study have been named Mac1, 2, 3, 4 and 5.
Mac1 was found in adipose tissue in both obese and normal mice, whereas levels of Mac2 and Mac3 cells – which both expressed pro-inflammatory genes – were at their highest after the mice had been fed a high-fat diet for eight weeks.
Once the mice had been on the high-fat diet for 14 weeks, the numbers of Mac4 and Mac5 cells – which were characterized by lower pro-inflammatory gene expression – began to increase and the numbers of Mac2 and Mac3 cells declined.
“The thinking in the field has been that the type of macrophages that accumulate in obesity are promoting an inflammatory state. Based on these data there’s a lot more to the story,” said Muir.
She hypothesized that Mac4 and Mac5 cells are lipid-associated macrophages (LAMs), which are a subset of macrophages primarily found in adipose tissues of obese individuals. Here, they appear to play a protective role to counteract adipocyte growth, inflammation and metabolic dysfunction.
Spatial analysis brings new insights
The team conducted spatial transcriptomics analyses to capture gene expression across a thin section of fat tissue taken from the mice, mapping the locations of mRNA and imaging the tissue just before capturing the mRNA. This enabled the visualization of crown-like structures; macrophages surrounding dying fat cells in a crown-like pattern that indicate adipose tissue dysfunction.
The team identified the macrophages within the crown-like structures as being from the Mac4 and Mac5 subtypes.
The research provides new insights into the cellular makeup and spatial organization of adipose tissue in obesity, but more work is needed to understand the cell signaling processes needed to trigger the development of LAMs, and how they contribute to metabolic disorders.
Reference: Stansbury CM, Dotson GA, Pugh H, Rehemtulla A, Rajapakse I, Muir LA. A lipid-associated macrophage lineage rewires the spatial landscape of adipose tissue in early obesity. JCI Insight. 2023;8(19). doi: 10.1172/jci.insight.171701
This article is a rework of a press release issued by the University of Michigan. Material has been edited for length and content. | Disease Research |
After spending decades on pharmacy shelves, the leading nasal decongestant in over-the-counter cold and allergy medicines has met its downfall.
Advisers for the Food and Drug Administration this week voted unanimously, 16 to 0, that oral doses of phenylephrine—found in brand-name products like Sudafed PE, Benadryl Allergy Plus Congestion, Mucinex Sinus-Max, and Nyquil Severe Cold & Flu—are not effective at treating a stuffy nose.
The vote was years in the making. In 2007, amid doubts, FDA advisers called for more studies. With the data that has trickled in since then, the agency's own scientists conducted a careful review and came to the firm conclusion that oral phenylephrine "is not effective as a nasal decongestant."
Looking back, the FDA noted that key data supporting its original acceptance of phenylephrine in 1976 was likely "too good to be real." And looking forward, the agency saw a bleak future for the drug. While this week's vote concluding ineffectiveness applies only to the oral dosages currently approved for use, the FDA found that higher, potentially more effective doses of the drug could significantly increase blood pressure, posing a safety risk. "[T]here may be no path to evaluating higher doses," the agency concluded.
To be clear, the advisers did not discuss phenylephrine-containing nasal sprays, which do appear to have some efficacy. And, most importantly, the safety of phenylephrine-containing products is not in question; the FDA and its advisers did not raise any safety concerns. It's safe, just useless.
Rise and fall
It's still unclear how the FDA will proceed following the advisory panel's vote, which it is not obligated to heed but usually does. But it's certainly possible that widely used phenylephrine-containing medicines could eventually disappear from drug store aisles.
In a clarifying statement Thursday, the FDA noted there will not be a swift blowout of the popular decongestant. If the agency acts on the advisers' votes and decides to wipe it off its list of effective over-the-counter drugs (the "OTC monograph"), the agency would first have to propose the removal from the monograph, then provide a public comment period, issue a final ruling, and work with manufacturers to reformulate products.
Still, however slow the process, if the FDA strips phenylephrine from the monograph, it will undoubtedly upend the over-the-counter cold and allergy medicine market. Popularity of phenylephrine skyrocketed after 2006, when its leading competition moved behind the pharmacy counter. The "Combat Methamphetamine Epidemic Act of 2005" went into effect that year, restricting sales of the more effective drug pseudoephedrine, which could be diverted to making methamphetamine. As pseudoephedrine use dropped, phenylephrine's rose. By 2022, the FDA estimates that Americans bought 242 million phenylephrine-containing products, taking the lion's share of the decongestant market and generating nearly $1.8 billion in sales.
Given phenylephrine's overwhelming market success and complete clinical failure, it's worth revisiting how we got here—and the FDA provides a deep dive on just that. The agency notes that the original 1976 acceptance of phenylephrine was based on just 14 studies—only 12 of which included efficacy data, and of those, only seven reported some level of positive efficacy data (though most were weakly positive). Eleven of the 14 studies were sponsored by a drug maker. Last, all of the studies used a dubious measure of nasal airway resistance to assess effects on congestion. This is a highly variable, unvalidated method that is no longer accepted by the FDA in clinical trials. | Drug Discoveries |
A father has been left with a “death sentence” because delays caused by the record NHS backlog meant his tumour grew too big to operate on.
Professional musician Don Jackson was diagnosed with liver cancer last June but was reassured his tumour was small and that he could expect a liver transplant in two to three months.
The father-of-five says he faced repeated delays for seven months for scans during which he was belatedly informed he could use a live donor from his own family.
Repeatedly delayed scans and checks eventually showed his relative was a good match and would donate half his liver, but after a scan last month he was given the devastating news his cancer was now 5mm too big for NHS rules to allow the op.
Don, in his 50s, was told the news in a phone call from the hospital and informed he had just months to live.
He said: “The NHS is on its back. They could have saved me half a year ago if it was running correctly. They said my cancer was very, very small.
“I was told it would be ‘two to three months’. If you look at the NHS website it says it should be 65 days. I waited seven months and now they say they’re going to leave me to die.
“I asked the hospital ‘what’s the delay with all the scans?’ They said they’ve a massive waiting list and they haven’t got the staff and only so many specialists can do them. They’ve just got no resources.”
It comes amid record waits for treatment after a decade of Tory underfunding which has left seven million people in England on the NHS waiting list.
Don is one of the best-known songwriters and record producers in his home city of York, having starred in bands including The Crowmen as well as digitally remastering albums for other bands.
When diagnosed with the cancer last June his NHS doctors told him to have his bag packed, because the surgery could happen at a moment’s notice.
Then he had one tumour that was 3cm big and “completely manageable”.
"Every time I saw doctors they just said I can't believe you haven't had it yet,” he said. "One doctor said 'I bet all the money I've got in the world you'll have that transplant within a week'.
“Over Christmas I heard nothing about the scans and they admitted they had forgotten me.”
By the time the NHS was ready to carry out his operation Don had two tumours in the liver, which combined came to just over 5cm.
NHS rules state that if the total size of the tumours combined is more than 5cm they will not operate.
Don, whose youngest child is just two years old, said: “When they called me in January I was just devastated.
“They’ve left me for dead and given me a few months to live. I had to wait for my kids to come home from school and tell them. We thought it was game over.”
Other countries operate on tumours up to 7cm including Turkey and Don is now trying to raise £80,000 in a matter of weeks to have the transplant there before it is too late.
A local appeal has raised half the funds so he is currently in Istanbul undergoing the first tests on a ‘pay as you go’ basis, while his family and friends at home desperately attempt to raise the remaining sum.
Dr John Adams, from Leeds Teaching Hospitals NHS Trust, said: "The safety of our patients is our top priority. Our specialist clinical teams individually assess the suitability of each patient waiting for a liver transplant."
He continued that the eligibility criteria for liver transplants in the UK "is based on nationally agreed guidelines, administered through the Liver Advisory Group, and aligned with international practice".
A spokesperson for the NHS Blood and Transplant said: "Hospital transplant units have the responsibility for making decisions whether an individual should be listed for transplant based on the policy for each organ.
"If a patient does not meet the criteria, the transplant unit can appeal to the National Appeals Panel for that organ, which includes clinicians from other transplant centres." | Disease Research |
Doctors should weigh prescribing some of their patients a pill of a powerful antibiotic, doxycycline, to prevent the spread of released Monday by the Centers for Disease Control and Prevention., according to new draft recommendations
Officials say the approach, dubbed doxycycline post-exposure prophylaxis, or Doxy-PEP for short, could mark a turning point in the nation's fight against the ongoing epidemic of sexually transmitted infections, or STIs.
It comes after growing early research has found that doxycycline could prevent bacterial infections from taking root when taken in the days soon after potential exposure during sex, instead of reserving pills of the antibiotic only for doctors treating diseases after they are diagnosed.
"It's going to take game-changing innovations for us to turn the STI epidemic around. And Doxy-PEP is the first major new prevention intervention we have for STIs in decades," Dr. Jonathan Mermin, head of the CDC's National Center for HIV, Viral Hepatitis, STD, and TB Prevention, said in an interview.
Mermin, who co-authored the draft, estimated that implementation of their Doxy-PEP recommendations could lead to tens of thousands of infections prevented.
The recommendations will remain open for comments for 45 days. After incorporating that feedback, Mermin said he expects a final version to be published in the first quarter of next year.
"We think this is the right step right now, even though science is still evolving," he said.
Who should take Doxy-PEP?
For now, the CDC's draft recommendations for offering the antibiotic are limited to the groups of Americans hardest hit by the: gay, bisexual and other men who have sex with men, as well as transgender women.
Among those communities, the CDC further narrowed the scope of its recommendation to those who have been diagnosed in the past year with at least one STI caused by bacteria, such as gonorrhea, chlamydia or syphilis. Others could be considered based on participating in events that raise the risk of exposure to STIs.
For people who the agency estimates "would benefit the most" from Doxy-PEP, the agency will tell doctors that prescribing a 200 mg dose of doxycycline "should be considered" for patients to take as soon as possible — no more than 72 hours — after oral, vaginal or anal sex.
What's known about how the antibiotic works suggests that Doxy-PEP "should be effective in other populations" as well, the agency acknowledges. However, the CDC stopped short of making a firm recommendation for or against offering it to a broader range of Americans.
A randomized trial in cisgender women had failed to show a benefit, though follow-ups suggested the results may have been muddied by many participants not actually taking the antibiotic. More data is needed before deciding on broad recommendations, officials concluded.
"The decision could still be made to take Doxy-PEP to prevent STIs. If that's done, we do recommend that they follow the same recommendations and processes that we put into place for others. So we're not saying don't do it," said Mermin.
How long will it take to roll out Doxy-PEP?
The CDC's draft comes as a growing number of health departments and sexual health clinics have already moved to start offering Doxy-PEP on their own.
"There is not a lot of money in STI care, prevention and research. So this development is profound for our field. And the community has already been working hard to implement Doxy-PEP and clinicians in some public health clinics are prescribing this widely," said David Harvey, executive director of the National Coalition of STD Directors.
Harvey's group lists 10 agencies and organizations that have already published policies and guidance on Doxy-PEP, including state health departments in California, Michigan and New Mexico.
Many more are still "desperately eager" for CDC to officially weigh in, Harvey said, and could begin offering prescriptions quickly once the guidelines are made official. An official recommendation from the CDC could also clear the way for ensuring coverage of the costs of the pills through public health budgets and insurance companies, he said.
"The good news about doxycycline though is that it is a fairly cheap drug. It's a drug that's been around for a long time. So this is unlike what we see with some HIV medications that are very, very expensive," Harvey said.
What are the risks of Doxy-PEP?
Harvey cautioned that implementing Doxy-PEP would not be without its costs for clinics.
The guidance suggests doctors can "prescribe enough doses of doxycycline to last until the next follow up visit."
A list of considerations attached to the recommendation include a plea for doctors to assess for side effects that use of Doxy-PEP could be causing, as well as to screen every 3 to 6 months for the possibility of breakthrough infections.
"Larger evaluations can sometimes show negative outcomes that have been missed in smaller randomized trials. So we are going to be continuing to monitor and evaluate the implementation of Doxy-PEP over time," said Mermin.
Officials have also wrestled with the concern that Doxy-PEP could raise the risk of bacteria developing resistance to the antibiotic.
At a meeting hosted by the National Association of County and City Health Officials last year, experts warned it was possible widespread Doxy-PEP use could also lead to "collateral damage" in raising resistance for other pathogens beyond STIs as well.
The CDC is planning multiple efforts to track real-world implementation of Doxy-PEP, Mermin said, including monitoring for drug resistance.
"Given the gaps in science, long-term monitoring, evaluation and additional studies will be key for us to update the guidelines as needed. There are important questions that remain regarding potential risks," said Mermin.
for more features. | Epidemics & Outbreaks |
WASHINGTON -- U.S. officials have approved the first over-the-counter birth control pill, which will let American women and girls buy contraceptive medication from the same aisle as aspirin and eyedrops.
The Food and Drug Administration said Thursday it cleared Perrigo’s once-a-day Opill to be sold without a prescription, making it the first such medication to be moved out from behind the pharmacy counter. The company won’t start shipping the pill until early next year, and there will be no age restrictions on sales.
Hormone-based pills have long been the most common form of birth control in the U.S., used by tens of millions of women since the 1960s. Until now, all of them required a prescription.
Medical societies and women’s health groups have pushed for wider access, noting that an estimated 45% of the 6 million annual pregnancies in the U.S. are unintended. Teens and girls, women of color and those with low incomes report greater hurdles in getting prescriptions and picking them up.
Some of the challenges can include paying for a doctor's visit, getting time off from work and finding child care.
“This is really a transformation in access to contraceptive care,” said Kelly Blanchard, president of Ibis Reproductive Health, a non-profit group that supported the approval. “Hopefully this will help people overcome those barriers that exist now.”
Ireland-based Perrigo did not announce a price. Over-the-counter medicines are generally much cheaper than prescriptions, but they typically aren’t covered by insurance.
Forcing insurers to cover over-the-counter birth control would require a regulatory change by the federal government, which women's advocates are urging the Biden administration to implement.
Many common medications have made the switch to non-prescription status in recent decades, including drugs for pain, heartburn and allergies. Birth control pills are available without a prescription across much of South America, Asia and Africa.
Perrigo submitted years of research to FDA to show that women could understand and follow instructions for using the pill. Thursday’s approval came despite some concerns by FDA scientists about the company's results, including whether women with certain underlying medical conditions would understand they shouldn't take the drug.
FDA’s action only applies to Opill. It’s in an older class of contraceptives, sometimes called minipills, that contain a single synthetic hormone and generally carry fewer side effects than more popular combination hormone pills.
But women’s health advocates hope the decision will pave the way for more over-the-counter birth control options and, eventually, for abortion pills to do the same.
That said, FDA’s decision has no relation to the ongoing court battles over the abortion pill mifepristone. The studies in Perrigo’s FDA application began years before the Supreme Court’s reversal of Roe v. Wade, which has upended abortion access across the U.S.
With some states curtailing women’s reproductive rights, the FDA has faced pressure from Democratic politicians, health advocates and medical professionals to ease access to birth control. The American Medical Association and the leading professional society for obstetricians and gynecologists backed Opill's application for over-the-counter status.
An outside panel of FDA advisers unanimously voted in favor of the switch at a hearing in May where dozens of public speakers called for Opill’s approval.
Dyvia Huitron was among those who presented, explaining how she has been unable to get prescription birth control more than three years after becoming sexually active. The 19-year-old University of Alabama student said she still isn’t comfortable getting a prescription because the school’s health system reports medical exams and medications to parents.
“My parents did not let me go on the pill,” Huitron said in a recent interview. “There was just a lot of cultural stigma around being sexually active before you’re married.”
While she uses other forms of contraception, “I would have much preferred to have birth control and use these additional methods to ensure that I was being as safe as possible.”
Huitron spoke on behalf of Advocates for Youth, one of the dozens of groups that have pushed to make prescription contraceptives more accessible.
The groups helped fund some of the studies submitted for Opill and they encouraged HRA Pharma, later acquired by Perrigo, to file its application with the FDA.
Advocates were particularly interested in Opill because it raised fewer safety concerns. The pill was first approved in the U.S. five decades ago but hasn’t been marketed here since 2005.
“It’s been around a long time and we have a large amount of data supporting that this pill is safe and effective for over-the-counter use,” said Blanchard, of Ibsis Reproductive Health.
Newer birth control pills typically combine two hormones, estrogen and progestin, which can help make periods lighter and more regular. But their use carries a heightened risk of blood clots and they shouldn't be used by women at risk for heart problems, such as those who smoke and are over 35.
Opill has only progestin, which prevents pregnancy by blocking sperm from reaching the cervix. It must be taken around the same time daily to be most effective.
In its internal review published in May, the FDA noted that some women in Perrigo’s study had trouble understanding the drug's labeling information. In particular, the instructions warn that women with a history of breast cancer should not take the pill because it could spur tumor growth. And women who have unusual vaginal bleeding are instructed to talk to a doctor first, because it could indicate a medical problem.
Common side effects of the pill include bleeding, headaches, dizziness, nausea and cramps, according to the FDA. The label also cautions that certain drugs can interfere with Opill's effectiveness, including medications for seizures, HIV and hypertension.
Perrigo executives said the company will spend the rest of the year manufacturing the pill and its packaging so it can be available in stores early next year.
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Follow Matthew Perrone on Twitter: @AP_FDAwriter
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content. | Women’s Health |
An exciting advance from Oxford Univ. has raised the prospect of tailoring stem cells quickly to treat brain injuries in humans in the future, by essentially 3D printing brain cells.
In experiments, the implanted cells integrated into the animals’ brains both structurally and functionally.
The innovative study, published in the journal Nature Communications, marks the first time neural cells have been 3D printed to mimic the architecture of the cerebral cortex.
The success of the study, part of a 10-year span of published research on 3D printing cultured cells and synthetic tissues, has increased hopes that similar technology could one day be used to treat brain injuries.
Each year, around 70 million people across the globe suffer from traumatic brain injuries (TBI), with five million of those being severe or fatal. There is no effective or reliable treatment.
However, cutting-edge tissue regenerative therapies are seen as a promising route to treatment; especially those which incorporate implants derived from patients’ own stem cells.
In this latest study, researchers used 3D printing techniques to create a two-layered brain tissue using human neural stem cells. When implanted into the brains of mice, these cells encouragingly showed convincing structural and functional integration with the host tissue, despite the species difference.
The cells were then dipped in a solution to generate two ‘bioinks’, which were then printed to produce a two-layered structure that was maintained for weeks.
The researchers used modern human pluripotent stem cells, which are created by activating genes that cause a reset into the tissue of a skin sample to a base state that can then be reprogrammed into most tissue types.
“The work will provide a unique opportunity to explore the workings of the human cortex and, in the long term, it will offer hope to individuals who sustain brain injuries,” said Dr. Yongcheng Jin, a lead author of the study from the University of Oxford’s Department of Chemistry
The implanted cells also showed signalling activity which correlated to that of the host cells—indicating that the human and mouse cells were communicating with each other and demonstrating functional as well as structural integration in the brain.
MORE STORIES LIKE THIS: 3D-Printed Ear is Made and Transplanted From Patient’s Living Cells
“Our droplet printing technique provides a means to engineer living 3D tissues with desired architectures, which brings us closer to the creation of personalized implantation treatments for brain injury,” senior author Dr. Linna Zhou, told Oxford press.
Professor Zoltán Molnár, another senior author, said though the technology was not fully advanced yet, the study shows significant promise in treating brain injuries in the future.
MORE 3D-PRINTED BIOLOGY: New Tool Can 3D Bio-Print Inside Human Body to Construct Natural Tissue-Like Structures
“Human brain development is a delicate and elaborate process with a complex choreography,” said Professor Zoltán Molnár, another senior author. “It would be naïve to think that we can recreate the entire cellular progression in the laboratory.”
“Nonetheless, our 3D printing project demonstrates substantial progress in controlling the fates and arrangements of human [stem cells] to form the basic functional units of the cerebral cortex.”
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TORY MSPs have remained silent following the revelation Rishi Sunak thought the UK Government should "just let people die" instead of going into lockdown during the Covid pandemic.
A diary entry from the Government's former chief scientific adviser, Patrick Vallance, revealed the then-chancellor and his boss Boris Johnson had been resisting closing the economy.
It showed Johnson's chief adviser Dominic Cummings thought Sunak was comfortable with keeping the economy open, even if it led to further fatalities.
Detailing how ministers were disagreeing with advisers, Vallace wrote about "a complete lack of leadership" from Johnson, with Cummings advocating for a lockdown.
In the extract, shown to the official COVID inquiry on Monday, Vallance said Johnson had argued against any lockdown, saying he was for "letting it all rip" and that those who would die from contracting the virus had "had a good innings".
Vallance also wrote: "DC [Dominic Cummings] says 'Rishi thinks just let people die and that's OK."
Since the remarks were revealed, Tory MSPs have not any comments or statements on social media nor to the press, though the party has been contacted for comment by The National.
Earlier in the hearing, Vallance also revealed the Government's scientific and medical advisers were not told about Sunak's "Eat Out To Help Out" scheme until it was announced by the then chancellor, saying their advice about the increased risk of transmission would have been "very clear".
Written evidence from Sunak to the inquiry said: "I don't recall any concerns about [the scheme] being expressed during ministerial discussions, including those attended by [Sir Patrick]."
But Vallance said: "Around that time lots of measures were being released and you will see repeated references in various minutes and notes and emails and indeed, I am sure, in my private notes, to our concern that people were piling on more and more things and this would come to drive R above one and I think that was discussed at cabinet as well.
"So I think it would have been very obvious to anyone that this was likely to cause, well, inevitably would cause an increase in transmission risk and I think that would have been known by ministers."
Vallance's diaries also showed how he thought scientific advisers were kept out of strategy meetings by both Number 10 and the Cabinet Office.
The adviser told the inquiry there were "periods when it was clear that the unwelcome advice we were giving was, as expected, not loved and that meant we had to work doubly hard that the science evidence and advice was being properly heard".
Vallance also said "pressure" was sometimes put on advisers to change advice, referencing a WhatsApp exchange with the then health secretary Matt Hancock.
"[Mr Hancock] asked me to change something and I said no, we are not going to change our advice, because that is where the evidence bit comes in," said Vallance.
"You have got to at least see that even if you disagree with it and don't want to do it."
He added: "I am absolutely sure, because politicians are politicians, that there were attempts to manage us and make sure we were not always given the access we might need." | Epidemics & Outbreaks |
Lewis Capaldi has announced he'll be taking a break from touring due to the impact Tourette's syndrome is having on him.
The Glasgow-born singer revealed his condition last year in an Instagram live and said "it's not a big a deal" but that some days are "more painful than others".
Capaldi also recently performed at Glastonbury Festival and experienced some difficulty during his performance.
The 26-year-old star repeatedly apologised after losing his voice and told fans he planned to take some more time off.
Read more:
Lewis Capaldi announces break after emotional Glastonbury set
Capaldi cancels all shows until Glastonbury due to health issues
He has since made the difficult decision to pause his tour "for the foreseeable future", saying he is "incredibly sorry" but needs "to feel well to perform at the standard you all deserve".
Here's everything you need to know about the condition.
What is Tourette's syndrome and what are the symptoms?
According to the NHS, Tourette's syndrome is a condition that causes a person to make involuntary sounds and movements - these are known as tics.
The condition usually develops during childhood, but tics and other symptoms usually improve after a few years.
Tics (twitching) is the main symptom, but some people with the condition can also have a combination of vocal and physical tics.
Some of the physical tics include:
Blinking
Eye rolling
Grimacing
Shoulder Shrugging
Jerking movements of the head or limbs
Jumping
Twirling
Touching objects and other people
Grunting
Whistling
Coughing
Tongue clicking
Animal sounds
Saying random words and phrases
Repeating a sound, word or phrase
Swearing
According to the NHS, swearing is rare and only affects about one in 10 people with the condition.
Some people with Tourette's syndrome may also experience a strong urge before a tic - the NHS has said this feeling has been compared to "the feeling you get before needing to itch or sneeze".
This is known as premonitory sensations and includes symptoms of a burning feeling in the eyes before blinking, a dry or sore throat, and an itchy joint or muscle.
There is currently no cure for the condition, but treatments may be recommended to help control the tics.
However, the NHS has said medication for Tourette's can have side effects and will not work for everyone.
Medication is only ever recommended if the case is severe or affects day-to-day activities.
Behavioural therapy is often provided as a course of treatment and has been shown to reduce tics.
There are two types of behavioural therapy treatments - these include:
Habit reversal training - this is when the therapist or trained psychologists help their patient work out the feeling which triggers the tics.
Once the health professional helps the patient locate their trigger points, the next stage is to find an alternative way to relieve the urge to tic.
The second behavioural theory is exposure with response prevention (ERP) - this method trains the patient to have better control over their urge to tic.
Techniques are often used to recreate the urge to tic in order to train the patient to tolerate the feeling without doing the tic.
What causes this condition?
The exact cause of the syndrome is not yet known, but some of the risk factors associated with it include a family history of the condition.
It is thought to be linked to a part of the brain that helps regulate the body's movements, and men are also more likely to be affected than women.
Tourettes Action, a support and research charity, says there are over 300,000 children and adults in the UK currently living with the condition. | Disease Research |
A dad who died only weeks after learning his wife was expecting twins had a 95 per cent chance of survival from the motorbike collision that killed him, an investigation found.
The death of Aaron Morris, 31, led to an internal investigation by North East Ambulance Service (NEAS) which revealed there was a "series of errors and system failures,"
Aaron was involved in a collision in the village of Esh Winning, County Durham on July 1 last year and his wife Samantha said the results of the investigation felt "like the day he died all over again."
She said: "Getting the report felt like the day he died all over again. You go numb and it's like the world is frozen around you.
"The difference this time round was I had the twins and they were screaming as I was being told all these failings that killed my husband and their dad."
A waiting time of 49 minutes and 49 seconds meant that Aaron did not get the help he needed on time and it should have come in just 18, Chronicle Live reports.
At 12.27pm, the first call was made but 10 calls in the queue meant it took a total of 98 seconds to be answered.
Six calls to the service were made on behalf of Aaron and these included calls from a police officer and an off-duty nurse who were growing increasingly concerned about his deteriorating condition.
At 12.55pm, a police officer requested an ambulance "on the hurry up," but was told that 74 outstanding emergencies meant the call was still awaiting allocation.
An Air Ambulance was then requested, but the call handler referred to earlier information that the Great North Air Ambulance Service (GNAAS) had spoken to the off-duty nurse and advised their services were not needed.
In the report, it was revealed that the clinical update from the scene and subsequent request for the air ambulance were not documented in the call notes, nor passed to the air ambulance service.
An air ambulance was available at the time if it was needed, the report found.
Samantha, 28, said: "That's one of the biggest things that gets me. I understand that there weren't many ambulances available, but knowing that an air ambulance was available and could have been on the scene if only they were aware that Aaron's condition was deteriorating.
"They could have saved his life if updates had been fed back to the air desk and that's one of the toughest things to take from the report."
An ambulance from a third-party company eventually arrived at 1.21pm along with an Emergency Care Assistant (ECA).
By this stage, an along Aaron had a weak pulse and abnormal breathing. He also was cold to the touch and had a temperature of 36C.
More horror then occurred for Samantha and Aaron when the ECA, who was "not familiar with the area," could not operate the satnav system.
It was Samantha who had to direct the ambulance to the University Hospital of North Durham. They were originally bound for the closest major trauma centre at Newcastle's Royal Victoria Infirmary but had to redirect when Aaron suffered cardiac arrest.
Samantha said the "horrific" events meant she was giving directions while she could hear her partner being given CPR.
She said: "It was absolutely horrific. I'm stuck in the front of an ambulance trying to direct it to the nearest hospital when all I can hear is Aaron being given CPR and chest compressions being given.
"All I could hear was Aaron's chest being jumped on while I'm trying to direct this driver and all I wanted to do was get in the back of the ambulance to be with Aaron. The last thing he said before he went into cardiac arrest was 'where's my wife at?'
"The paramedic said 'she's just in the front mate' and then he started saying 'Aaron, Aaron' and then he shouted 'trauma arrest, trauma arrest. Divert, divert'. He must have known he was going and wanted to know where I was and I just couldn't get to him until they slightly revived him at Durham.
Aaron didn't get to hospital until 2.14pm and he later died with Samantha at his side.
She added: "I was trapped in the front of this ambulance and he was dying in the back. It kills me thinking about it. It traumatises me and to this day I still think about it every day."
Samantha continued: "Our life was just starting when Aaron passed away and my life is so different now that he's gone. I've got these two babies that have never met their dad. My past, present and future was taken away when Aaron died."
The widowed mum said she is grateful to those who treated her husband that day and those who cared for her twins when they were born three months premature.
Aaron-Junior John Robson Morris and Ambrose-Ayren Morris were born in October.
Chief operating officer at North East Ambulance Service, Stephen Segasby, said: "Firstly, I would like to offer our sincere and heartfelt condolences to Aaron's loved ones. This was a tragic event.
"When concerns were raised with us about Aaron's treatment we reported these as a serious incident and began an internal investigation into what had happened. We have now shared the outcome of the serious incident review with Aaron's family.
"There were a number of organisations involved in this case and we unreservedly apologise for not providing the response from our service that Aaron should have received. There are a number of actions arising from the review of this incident that we are committed to taking forward to improve the coordination of our response.
"We will of course now cooperate fully with the coroner to provide all the information required to make their independent judgement and for that reason it would not be appropriate for us to comment further on the detail of this case until that process is concluded." | Health Policy |
Why does our skin feel ‘tight’ after using a facial cleanser?
A new study from Stanford University reveals the neurological mechanism behind the perception of skin tightness.
When we wash our face with a cleanser, our skin can start to feel tight. With the application of a favorite moisturizer, that feeling often goes away. This perception of our skin might seem subjective, but researchers at Stanford recently revealed the mechanism behind these feelings.
Their work, published this week in PNAS Nexus, demonstrates how mechanical changes at the outer surface of our skin translate into sensations and provides a quantitative approach for determining how people will perceive their skin after using a moisturizer or cleanser.
“This work provides a new understanding of how products affect the physical properties of our skin, which includes not just skin health, but also skin sensorial perception. That’s a significant advance,” said Reinhold Dauskardt, the Ruth G. and William K. Bowes Professor in Stanford’s Department of Materials Science and Engineering. “It provides a whole new understanding of how to design those formulations.”
Sensation prediction
Our skin is the largest organ in our body and it’s constantly exposed to the environment around us. The outermost layer of our skin – the stratum corneum – acts as a barrier to keep out unwanted chemicals and bacteria and to keep in moisture. When we use a harsh cleanser, it strips away some of the lipids that hold in moisture, causing the stratum corneum to contract. A good moisturizer increases the water content of the stratum corneum, causing it to swell.
Dauskardt and his colleagues predicted that the mechanical forces created by this shrinking or swelling propagate through the skin to reach mechanoreceptors – sensory receptors that turn mechanical force into neurological signals – below the epidermis, which then fire off signals to the brain that we interpret as a feeling of skin tightness.
To test their theory, the researchers studied the effects of nine different moisturizing formulas and six different cleansers on donor skin samples from three locations on the human body – cheek, forehead, and abdomen. They measured changes in the stratum corneum in the lab and then fed that information into a sophisticated model of human skin to predict the signals that the mechanoreceptors would send.
“We were able to rank the different formulations in terms of what subjects should say about the sensorial perception of their skin,” Dauskardt said.
The predictions from their analysis lined up almost perfectly with what people reported in human trials for each formula. Collaborators at L’Oréal Research and Innovation recruited 2,000 women in France to assess the nine moisturizers and 700 women in China to assess the six cleansers. The participants ranked their perceived feelings of skin tightness after using the formula they were given.
“We plotted what we were predicting against what human subjects were telling us, and it all fell on a straight line. In other words, we were predicting exactly what they were telling us,” Dauskardt said. “It was an absolutely remarkable correlation with a very high statistical significance.”
Shaping new developments
The ability to understand and predict how people will feel after using a skin treatment could help cosmetics companies improve their formulations before bringing in people to test them. And with such a detailed model of how mechanical stresses are transferred through skin layers, these methods could potentially be used to evaluate more than just the feeling of tightness, Dauskardt said.
“It provides a framework for the development of new products,” Dauskardt said. “If you’re doing anything to the outer layer of the skin that’s causing it to change its strain state and its stress state, then we can tell you how that information is transmitted and how it will be understood and reported by consumers.”
Dauskardt is also looking to apply this new understanding to the development of wearable devices. For example, if we know how our brains interpret minute changes in skin tension, we might be able to harness that mechanism to send intentional signals. In the same way that a person reading braille translates sensations on their fingertip into words, a device creating tiny mechanical changes on our skin might be able to convey information.
“What we’ve done is reveal how mechanical information gets from the outer stratum corneum layer down to the neurons much lower in the skin layers,” Dauskardt said. “So now, can we communicate through human skin? Can we build a device to provide information to someone non-verbally, non-visually, using our understanding of these mechanisms? That’s one of the areas we’re very interested in.”
Dauskardt is a member of Stanford Bio-X , the Cardiovascular Institute, the Wu Tsai Human Performance Alliance, and the Wu Tsai Neurosciences Institute, and an affiliate of the Precourt Institute for Energy and the Stanford Woods Institute for the Environment.
Additional Stanford co-authors of this research include doctoral students Ross Bennett-Kennett and Joseph Pace. Other co-authors are from L’Oréal Research and Innovation. This work was funded by L’Oréal Research and Innovation. | Medical Innovations |
The MIND diet — which is intended to guard against dementia, and is rich in fruits and veggies and low in saturated fats — has no short-term brain benefits beyond those seen in people who follow a standard, "suboptimal" diet, a three-year trial suggests.
The trial's results, published Tuesday (July 18) in The New England Journal of Medicine, showed that participants who followed the MIND diet for three years showed slight improvements in their overall cognition, as measured with a dozen tests. However, those mental improvements were not statistically different from those seen in people who followed their usual diets.
A subset of people from both the MIND and standard diet groups also underwent brain scans, which revealed that their brains changed in the same ways over the three-year period, regardless of the diet they followed.
"We really expected that the MIND diet would show an effect above the control group, so we were quite surprised by the outcome," Lisa Barnes, lead study author and an associate director of the Alzheimer's Disease Center at Rush University Medical Center in Chicago, told CNN.
The MIND diet, short for "Mediterranean-DASH Intervention for Neurodegenerative Delay" diet, is essentially a mash-up of two other diets hypothesized to improve brain health and reduce the risk of dementia. The broadly defined Mediterranean diet is rich in vegetables, whole grains, legumes, seafood and unsaturated fats like olive oils and low in red meat, eggs, saturated fats and sweets. The Dietary Approaches to Stop Hypertension (DASH) diet is very similar but offers specific daily and weekly nutrition goals and limitations on salt intake.
Large observational studies have linked the MIND diet to a lower rate of Alzheimer's disease and an overall slower rate of cognitive decline in older adults, according to the National Institute on Aging. However, few gold-standard clinical trials have examined this link, and the biological reasons why the MIND diet might have this protective effect have not been clearly demonstrated in humans.
The new trial included 604 adults ages 65 and older who, at the start of the trial, were cognitively healthy but had a family history of dementia. All of the study participants were also overweight and followed "suboptimal" diets, meaning diets that significantly diverged from the MIND diet, at the start of the trial.
The participants were split into two groups that were told to either stick to their usual diet with minor caloric restrictions or to adopt the MIND diet. Both groups received regular dietary counseling, as well as either MIND-compliant foods (for the first group) or money for grocery shopping (for the second). Researchers monitored the participants' weights, diet adherence and blood levels of certain metabolites.
Ultimately, participants in both groups saw similar cognitive improvements, brain changes and weight loss by the end of the study period.
It's "plausible that practice effects of repeated cognitive testing could account for improvement in both of our trial groups, as has been observed in previous randomized trials," the trial organizers noted in their report. It is also "possible that these interventions do not improve cognitive functioning or that it would take a longer period of adherence for an effect to be observed."
In short, the study has limitations but hints that, at least in the short term, the MIND diet doesn't offer huge brain benefits over a diet with minimal calorie restrictions.
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Nicoletta Lanese is the health channel editor at Live Science and was previously a news editor and staff writer at the site. She holds a graduate certificate in science communication from UC Santa Cruz and degrees in neuroscience and dance from the University of Florida. Her work has appeared in The Scientist, Science News, the Mercury News, Mongabay and Stanford Medicine Magazine, among other outlets. Based in NYC, she also remains heavily involved in dance and performs in local choreographers' work. | Nutrition Research |
When Herbert A Gilbert filed the first patent for an electronic cigarette in 1963 he was a man ahead of his time.
A two-packet-a-day smoker, working in the family scrap business in Pennsylvania, he saw his invention as a simple way of taking harmful smoke out of a habit that was then a normal part of everyday life.
It took four decades for the idea to catch on. By the early 2000s the world had woken up to the health harms of tobacco; a combination of restrictions and taxation were finally making serious inroads into the habit.
Electronic cigarettes, or vaping devices, were promoted as a far healthier alternative to tobacco, which they undoubtedly are.
Sales grew steadily but not spectacularly until the manufacturers discovered a lucrative new market. Children.
Cherry peach lemonade, watermelon bubble gum, strawberry ice cream, gummy bear... the flavours on offer for disposable vapes provide a big clue about who is being targeted.
They are typically brightly-coloured and so small they are easily concealable.
A recent survey of health-related behaviour among Scottish schoolchildren found 25% of 15-year-olds had used a vape in the past 30 days and 40% had used one in their lifetime.
There was also a gender split - 30% of girls had used one recently compared to 20% for boys.
Only about 11% of the 15-year-olds surveyed were smokers. Health professionals believe vaping is now attracting children who would never have been tempted to try smoking.
Has an invention hailed as a game changer in the battle against tobacco inadvertently created a generation of children addicted to nicotine?
How addictive are vapes?
Some experts consider nicotine to be as addictive as heroin or cocaine.
It takes just seconds for the nicotine to reach the brain where it triggers the release of dopamine - a chemical linked to feelings of pleasure.
Vaping products come in a range of nicotine strengths but almost all disposables in the UK contain the highest legally allowed amount - 20mg/ml or 2%. Illegal products available online could contain even higher concentrations.
The type of nicotine in single-use vapes is usually nicotine salt-based which has a less harsh "throat hit" than other forms, making these vapes more palatable for children.
Comparisons of the amount of nicotine absorbed though vaping vs smoking is complicated by a number of factors - but Linda Bauld, professor of public health at University of Edinburgh, believes high numbers of young people may now be dependent on nicotine.
"We've been surprised by the high numbers of young people who are now vaping due to product innovation and we need to take proportionate measures to address this," she told BBC News.
Disposable vapes come in various "puff" capacities - but some teenagers are getting through the common 600-puff variety in just a day or two.
Emily Banks, from the Australian National University, a visiting professor at Oxford University's Nuffield Department of Population Health, believes nicotine addiction is in itself a significant harm.
"We have kids who are experiencing addiction who have difficulty sitting through a lesson or sitting through a meal with a family," she told a meeting of the Scottish Parliament's health committee earlier this month.
Are vapes dangerous?
Most health professionals believe nicotine itself is relatively harmless. Lab tests on mice have found some links to cancers and respiratory ailments but there's debate within the scientific community on how much can be drawn from such research.
But there is widely-shared concern about other chemicals used in vapes - particularly the flavourings.
These are mostly substances already used as food additives but there is little research on the long-term effects of inhaling them.
Earlier this year BBC News also found that vapes confiscated from pupils contained unsafe levels of lead, nickel and chromium.
Prof Banks said analysis of some e-cigarettes had found between 900 and 2,000 distinct chemical entities, some of which are already known to be "hazardous".
Illicit vapes are a greater concern. In 2019/20 nearly 70 deaths were recorded across the USA when cannabis products were introduced to refillable e-cigarettes.
Investigations later found vitamin E acetate used in them had caused lung damage.
A head teacher in Oldham recently issued a warning that vaping could kill, after a 12-year-old pupil who had used a vape containing the illegal synthetic drug spice needed hospital treatment.
How hard is it to quit vaping?
Like many drugs, when you stop taking nicotine you can suffer withdrawal symptoms.
Headaches and dizziness could be among the first, though they taper off relatively quickly.
A bigger challenge is cravings as the brain cries out for the dopamine it has become accustomed to.
They could start within 30 minutes of quitting and while each craving typically lasts 15-20 minutes, they just keep coming. As with smoking it takes huge self discipline to resist them.
Other physical symptoms include fatigue, constipation and increased appetite - but there are also mental and emotional challenges.
After a few days without nicotine, many people report a rise in restlessness and anxiety, while others suffer depression.
Irritability is another symptom while brain fog may affect the ability to concentrate for 2-4 weeks as the nicotine wears off and leaves the body.
What can be done about it?
Education is an obvious approach. The Scottish government has just announced a new information campaign and educational materials for schools.
But campaigners argue that peer pressure and a greater inclination to take risks among young people mean that's unlikely to succeed on its own.
Some countries like Denmark have banned flavourings apart from tobacco flavours. China has also outlawed flavours for its own citizens even though it exports most of the world's flavoured disposable vapes.
One London-based tobacco firm and vape seller has now backed a ban on sweet or soft drink flavours - though there is evidence that fruit flavours are by far most popular among young people.
Australia has gone further by banning all types of vaping device, meaning they are only available on prescription.
These countries have lower vaping rates than the UK - but still significant numbers of young people are vaping, with products easily available on the internet or "under the counter".
While it is illegal to sell vaping devices to anyone under 18 in the UK, it is a hugely profitable trade and enforcement agencies are battling against overwhelming market forces.
One suggested solution is to raise prices significantly through taxation. Restrictions on bright colours and the number of places where they can be displayed is another option.
The UK and devolved governments are currently consulting on action with firmer proposals, including possible bans, likely next year, although legislation could be delayed if there is a spring general election.
How do you support a child to quit vaping?
There is currently no national strategy for helping children break free from a nicotine dependency.
Prof Linda Bauld suggests parents seek medical advice, for instance from a GP or an NHS adviser, if their child is struggling to quit.
Only one nicotine replacement product, a mouth spray, is medicinally licensed to help people quit vaping but a doctor can provide more detailed advice on other nicotine products such as nicotine chewing gum or lozenges commonly used to help those giving up tobacco.
Such products should never be used by a child aged under 12, as nicotine is considered toxic for young children.
Some disposable vapes are marketed as "nicotine-free" but tests on some of these products have found that is not true. The potentially harmful chemicals are still present and the repeated hand-to-mouth action can be a barrier to quitting completely.
In the UK, many health experts believe vaping devices are useful as a less harmful alternative for adult smokers - but some now think the early messaging on the relative safety of vaping may have backfired when it comes to young people.
England's chief medical officer Sir Chris Whitty has put his advice concisely: "If you smoke, vaping is much safer, if you don't smoke, don't vape." | Epidemics & Outbreaks |
The deaths of at least 74 people, including 19 children, from the invasive bacterial infection group A streptococcus, or strep A, are the most extreme consequences of a wave of winter infections that have seemingly left most of the country coughing and sneezing. The parlous state of the nation’s health has prompted suggestions that we are now paying an “immunity debt” incurred by the reduction of common infections during the Covid-19 lockdowns of 2020 and 2021. But experts seem divided about whether the debt concept is genuine, let alone whether it explains the prevalence of non-Covid afflictions.As with so many of the debates about the outcomes of the pandemic, there do not appear to be simple answers – but no shortage of self-proclaimed “experts” ready to give them anyway. While there are good reasons to believe that the measures taken to reduce the spread of the coronavirus have broader implications for common infectious diseases, there is no one-case-fits-all explanation for the spate of winter bugs, much less any obvious conclusions to be drawn about pandemic management.Are the infection rates really so unusual anyway? Cases of strep A and associated scarlet fever certainly seem unusually high, with 7,750 recorded cases of the latter up to 11 December, compared with 2,538 at the same point in the earlier high season of 2017-18. But whether there is an anomalous prevalence of common infections across the board is less clear. “For some of the infections, we don’t really know,” says Petter Brodin, professor of paediatric immunology at Imperial College London.Every winter, there is an upsurge in common infections such as flu, colds (caused by various viruses) and respiratory syncytial virus (RSV), which produces cold-like symptoms. Bacterial infections follow a similar seasonality, according to Michael Levin, professor of paediatrics and international child health at Imperial because they tend to take opportunistic advantage of an immune system weakened by a virus. RSV in infants and young children, for example, sometimes leads to bronchiolitis, an infection of the respiratory tract that can be serious.At this time of year, “having hospital beds filled with children and adults with viral disease and pneumonia is not unusual”, says Levin. But although there is as yet little hard data, he adds that “there is an impression that we are having an unusually severe winter with RSV, flu and adenovirus”, the last of which causes cold-like symptoms. He adds: “We’re seeing increased numbers of children with severe bacterial infections – there is definitely more streptococcal infection around.” There are similar reports across North America, while unusually high levels of RSV in children reported in Australia and New Zealand in mid-2021 provoked the first mentions of Covid immunity debt. Brodin agrees that something seems unusual both in the timing and the numbers of infections. In Sweden, where he was working until moving to Imperial in October 2021, the incidence of RSV was markedly unusual last year too.If that is the case, what is the cause? “Here we enter the realm of guessing and speculation,” says Levin. It’s not clear that there is a general answer. “Every bug has a different dynamic,” concurs Brodin. Flu surges across the globe, driven largely by temperature changes and people’s travel behaviour, whereas RSV is present all the time in the population and usually peaks about November to December in the UK. The incidence of such infections also depends on how many children are born each year, since newborns have essentially no immunity.Our immune systems need exposure to pathogens to maintain a good level of resistance. Many common infections such as colds are caused by endemic viruses and bacteria that people often carry asymptomatically because their immune systems keep the pathogen in check. For example, many people carry the meningococcal bacteria that cause meningitis, but only about one in 50,000 were, before vaccines, at risk of getting ill from them. “The normal state for most of these things is asymptomatic carriage,” says Levin.Such symptom-free, low-level infection can prime the immune system to ward off another infection months or even years later. “Children and adults do build up a repertoire of immunity from exposure,” Levin says – as every parent knows, young children in particular are constantly exchanging common pathogens. But such immunity generally wanes, so if you haven’t been exposed for some time, for example, because of social distancing and lockdowns during 2020 and 2021, you will be more susceptible. “It’s plausible that we may now have a population that has met fewer common viruses and is therefore more susceptible,” says Levin. Moreover, if fewer people have such immunity, there will be more transmission in the population.“Children normally catch scarlet fever in their first year at school, if at all,” says Shiranee Sriskandan, professor of infectious diseases at Imperial. “Scarlet fever rates plummeted during 2020-2021. Therefore, school-age children may not have built up immunity to strep A, so we now have a much larger cohort of non-immune children.” A study last June reported that, because of reduced transmission of common respiratory viruses during the pandemic, breastfeeding infants were being passed fewer protective antibodies from the mother.But whether there is a generalised immunity debt is less clear. How long post-infection immunity lasts varies from one virus to another. And for flu viruses, infection in one season may or may not offer protection in the next, depending on how closely related the two strains are. Levin says that in many cases we don’t really know how much repeated exposure is needed to sustain immunity – for some diseases, such as smallpox and measles, just one infection generally gives lifelong protection.Another reason that has been proposed for enhanced infections this season is that Covid-19, which most of the population has now experienced at least once, has itself weakened some people’s immune systems. But this will probably not be widespread, if it happens at all. While there is evidence of immune dysfunction persisting for many months in some people who catch Covid, this is not so much a weakening of immunity as a problematic overactivation. A study published last January by Prof Gail Matthews, an infectious diseases physician at New South Wales University in Australia, and her colleagues showed overactive immune function up to eight months after Covid infection in some people. “The most likely reason for this is some level of viral persistence that the immune system is recognising as foreign and still reacting to,” Matthews says. But she doubts that there is any evidence of widespread Covid-induced immune impairment.Brodin has seen similar Covid-related immune dysfunction. He and his co-workers have studied children with multisystem inflammatory syndrome, a rare but serious condition in which an extreme response a few months after infection has to be treated with immunosuppressants. He says that for some people with long Covid too: “There is clearly something wrong with the way the immune system continues to be activated.” But whether any such problems arise for the majority of people who have mild Covid symptoms is far less clear, he says. “There’s nothing that suggests that, although we can’t rule it out.”Lockdowns and social distancing do seem to have reduced infections such as flu and RSV during the pandemic. But if it turns out that those measures have contributed to higher rates of such infections now, what conclusions should we draw? Opponents of lockdowns say that it highlights another of their flaws, for which we are now paying a heavy price.That position makes little sense. There is compelling evidence that lockdowns and social distancing saved lives, especially while vaccines were still not available. A day or two in bed with a bad cold seems a small price to pay for that. A small minority of researchers have, however, questioned whether lockdowns really made much difference to the spread of Covid. Infectious-disease epidemiologist Sunetra Gupta of Oxford University asserted in the Daily Telegraph that lockdowns do little to slow the spread of an epidemic disease such as Covid-19 but have much more impact on endemic diseases such as colds and RSV. But Brodin is dismissive of such a crude division into epidemic versus endemic diseases. “It’s incredibly far-fetched to say that is the uniform solution,” he says.Besides, he adds, how then to explain that RSV is also running riot now in Sweden, which famously eschewed lockdowns and kept schools open? Those who have noisily championed the Swedish approach to the pandemic can hardly argue that it would have made any difference to our alleged immunity debt now. In short, Brodin says, it is much too simplistic to say: “What we’re seeing in children’s hospitals is simply the result of lockdown.” Besides, Levin adds: “Lockdown was an essential public health measure. It was the right strategy for a new disease with a totally susceptible population and probably saved thousands of lives.”A much more fruitful response to the surge in infections, says Brodin, is to “be thinking about how we develop better vaccines and get people to take them”. We should be developing and rolling out vaccines against flu (for which multistrain “universal” jabs are now being trialled) and RSV (for which a vaccine is on the near horizon) much faster, as well as thinking more seriously about non-pharmaceutical interventions such as wearing masks. “It seems absolutely insane to me that we should get on a packed tube at rush hour and there will be people sneezing and coughing and not wearing a mask to protect others,” says Levin. “In Asian countries, you have always worn a mask if you have a cold.” He adds that we should also stop encouraging ill people to go to work and continue to advise hand washing and good hygiene. Flu, for instance, is spread mostly by people touching infected surfaces and then their eyes. Such measures “could greatly reduce the burden of infection in the population”, he says.But vaccines are key. “Many of these severe diseases are vaccine-preventable and we should be ensuring that as many of the population as are susceptible are protected,” says Levin. If we rely on natural infection to build up immunity, though, isn’t that better than getting vaccinated? No, says Prof Peter Openshaw, who heads the infection programme of the Biomedical Research Centre at Imperial. The immune response a vaccine awakens is “just as ‘natural’ as the response you get to the virus, sometimes even better, and certainly less dangerous”.“I can’t think of an example of a viral infection being better than getting vaccinated,” Openshaw adds. What’s more, the point of a vaccine is to protect those who would otherwise probably develop severe disease – and predicting who those people are is not always possible. “We vaccinate all to protect the few, because we can’t identify the vulnerable,” says Levin. Covid should have taught us that.Casting this debate in terms of an immunity debt is therefore potentially misleading, as it implies that this is a zero-sum game: you have to keep paying with infections to stay in credit. Vaccines can simply cancel the “debt”. Who wouldn’t want that? | Epidemics & Outbreaks |
People in England aged 49 and younger are being urged to come forward for their free Covid booster if they have not yet received a full set of jabs.
The NHS has said Sunday 12 February will be the last day people in this age group can attend a vaccination site for their primary doses, while hundreds of thousands of appointments will be available for booster jabs.
After this date, the jabs will only be offered to people considered to be at risk of serious illness, as recommended by the Joint Committee on Vaccination and Immunisation.
There are 2,800 sites open across the country next week, with 391,000 appointments available before the programme scales down.
So far, 15,000 people have booked a Covid vaccine for next week, the NHS said, after 17.3 million people had a booster jab over the winter.
Overall, 144.5m coronavirus vaccine doses have been delivered across Britain since the start of the pandemic.
The health secretary, Steve Barclay, and the NHS director of vaccinations and screening, Steve Russell, urged people to take the final opportunity to get the jab.
Russell said: “There is just one week left of the autumn booster campaign and so if you are eligible for a booster but have yet to take up your latest dose, please do so before the end of next week.
“Whether you have had previous doses or a bout of Covid, we know that a booster is the best way to maintain protection against serious illness from Covid for yourself and your loved ones, so please do make the most of the offer while it is available and give yourself both protection and peace of mind for the year ahead.”
Barclay added: “Our hardworking NHS staff and volunteers have done an incredible job getting jabs into arms, and they’re on hand to top up your immunity and keep you and your loved ones protected.”
Coronavirus infections in the UK have dropped for a fourth week in a row, and are at a level last seen at the start of last autumn.
Infections are not falling across all age groups, with increases in England among primary and secondary schoolchildren and for 35- to 49-year-olds.
The recent drop in coronavirus patients in hospital has also come to a halt, as health experts said there were “concerning” signs the number may be rising.
A total of 941,800 people in private households in the UK were likely to have had Covid-19 in the week ending 24 January, down 15% from 1.1 million the previous week, according to the Office for National Statistics.
This is the lowest UK total since the week ending 14 September 2022. | Vaccine Development |
A dad who went to hospital suffering a "slight temperature" ended up in a coma for six weeks and needed to have his arm and leg amputated.
Junaid Ahmed, 35, believed he had flu symptoms when he had a high temperature so decided to go to the local A&E for the ailment before having to fight for his life.
After arriving at the hospital, the father-of-two collapsed and spent six weeks in a coma following his sepsis prognosis.
As a result he has had his right calf, left forearm and left toes amputated, and is now trying to raise more than £100,000 for a bionic arm so he can hug his two children.
Junaid said: "The last thing I remember is having something to eat with my wife as we waited to be seen.
"Apparently I passed out and the next thing I remember is waking up in hospital six weeks later.
"Waking up six weeks later was the biggest shock of my life. I was terrified and so confused.
"Shortly after medics broke the news that to give me the best quality of life, I'd have to have my right calf, left forearm and left toes amputated. In that moment, I told them to do whatever they could.
"I just wanted to live for my family, my kids and wife. I can't wait to be able to hug them properly with my new arm and I've been so overwhelmed with the support so far with the fundraiser."
In September 2021, Junaid started experiencing a tingling sensation in his right foot. He had chronic back pain and had a spinal cord stimulator inserted at a private hospital in Chigwell, Essex in May 2022.
In June 2022, Junaid went to A&E at Queen's Hospital in Romford, East London when he was diagnosed with sepsis which had caused his liver, heart and lungs to fail, and placed Junaid into an induced coma.
Two weeks later he was transferred to University College London Hospital in Euston to save his life.
Sepsis is the body's overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death.
Doctors think he caught an infection, which led to sepsis, as a result of his spinal procedure months earlier.
Medical experts explained he had hemophagocytic lymphohistiocytosis (HLH) - a rare disease caused by an overactive, abnormal response of the immune system which was further compounding his health problems.
As a result of HLH, low blood pressure and sepsis, Junaid underwent multiple blood transfusions during his coma.
They saved his life, but the blood flow to his foot, arm and toes had already dropped so low they had started to die and were subsequently amputated in two four-hour surgeries.
He got a prosthetic leg in January and was adamant he was going to walk into his home once his rehabilitation was complete for his two children and wife Rabia.
Junaid added: "I arrived at the rehab centre on a stretcher as I was unable to move at all. Within two days they had me in a wheelchair - it was incredible.
"I was determined to walk out of the physio centre for my wife and two children. My wife, Rabia, has been my rock throughout it all.
"If I can get my bionic arm, I'll be able to get back into the gym properly. I miss being active - it makes me the best version of myself for my wife and our kids."
Junaid started a GoFundMe page to buy a bionic arm and has raised over £10,000 in donations so far. | Disease Research |
World 'not yet prepared enough' as H5N1 avian flu strain keeps spreading, WHO official warns
Global influenza leaders, vaccine manufacturers met this week, discussed threat posed to human health
The world's leading experts on influenza met this week to discuss the threat posed to humans by a strain of H5N1 avian flu that has caused record numbers of bird deaths around the world in recent months.
The group of scientists, regulators and vaccine manufacturers meets twice a year to decide which strain of seasonal flu to include in the vaccine for the coming winter season, in this case for the northern hemisphere.
It is also a chance to discuss the risk of animal viruses spilling over to humans and causing a pandemic. At this week's meeting, H5N1 clade 2.3.4.4b was a key topic, the World Health Organization (WHO) and global flu experts told Reuters.
"We are more prepared (than for COVID-19), but even if we are more prepared, we are not yet prepared enough," Sylvie Briand, WHO director of global infectious hazard preparedness, said ahead of the meeting. "We need to really continue the efforts for a flu pandemic."
Briand in a briefing after the meeting said that the recent rise in cases in birds and mammals was "worrying" and that the agency was working with Cambodia after two confirmed human cases of H5N1 were found in one family there.
They are trying to determine if the family members were exposed to the virus through the environment — such as exposure to birds or other mammals — or if there was human-to-human transmission.
Threat to humans remains low, officials say
Disease experts have raised the idea that the virus would need to change for it to be conducive to human transmission.
Experts have been tracking H5N1 clade 2.3.4.4b since it emerged in 2020 and recent reports of mass deaths in infected mammals from seals to bears, as well as potential mammal-to-mammal transmission on a Spanish mink farm last year, have raised concern.
However, there have been very few human cases, and the WHO currently assesses the threat to humans as low.
"This is a natural experiment playing out in front of us, and I don't think we are complacent," said Nicola Lewis, director of the WHO Collaborating Centre on Influenza at the Crick Institute in London. Speaking before the meeting, she said it would include assessments of the situation worldwide.
WATCH | 'Explosive' avian flu surge hits global bird populations
Experts discussed vaccines, virus strains
Experts also discussed potential vaccine development.
WHO-affiliated labs already hold two flu virus strains that are closely related to the circulating H5N1 virus, which could be used by vaccine manufacturers to create a human vaccine if needed. One of them was added after the previous WHO flu meeting in September 2022, and the experts decided at this week's meeting to add another subtype that more closely matches the virus spreading among animals.
A number of companies that produce seasonal flu vaccines can also make pandemic flu vaccines. For example, GSK and CSL Seqirus are already working with the United States Biomedical Advanced Research and Development Authority (BARDA) to test shots based on one of the closely related strains.
Having these strains ready could save about two months in the development of a vaccine, said the WHO's Briand.
But getting enough vaccine developed quickly would still remain a challenge in a pandemic situation, the experts said. | Epidemics & Outbreaks |
A woman was left unable to speak and thought her lips would "explode" after she suffered a severe allergic reaction to fillers.
Emma Cornett booked an appointment at her local beautician to get lip fillers as she wanted to get a little extra plump for her pout - but the result was far from what she was hoping for.
Hours after getting the procedure, the 18-year-old claims her lips began to swell up, leaving her "terrified" and worried they would burst.
She said: "I went for just a little natural plump, that's all I needed.
"I went in and they numbed me for 30 minutes with a cream and were telling me it will hurt and so to be prepared."
Emma had the procedure on December 29 but has now decided to share her experience on TikTok, where her video has gone viral - gaining more than nine million views.
The teenager, from Kentucky, said: "I called into three different places [clinics] and figured that this one would be the cheapest, which should've been the first red flag.
"I told them I just wanted half a syringe since it was my first time, but then ended up giving me a full syringe.
"When they were injecting me it hurt so bad, that I will never get them again for that reason alone.
"The experience was horrible, I couldn't tell the difference to when they were and weren't injecting me it hurt that bad, it was so painful."
Hours later, redness set in and severe swelling followed soon after.
Emma added: "They started to swell, but I didn't pay any kind of attention [to it at first] because they told me before that they would do that.
"Time goes by and they just kept getting bigger and bigger, then my boyfriend woke me up from an hour nap, freaking out and telling me to go to the hospital.
"It felt like my lips were going to explode and it was very hard to talk, I was terrified and my family were very worried.
"I tried to shake it off and was stubborn not wanting to go to the hospital, so I went back to sleep.
"But when I woke up the next day my whole face was [so] swollen I couldn't even open my eyes.
"I called the lip filler place and told them what was going on and they just told me it was normal."
In panic, Emma rang the hospital but claims she was told it was likely an allergic reaction and instructed to take allergy medication.
She added: "Luckily a couple of days later the swelling went completely down and you couldn’t even tell anything happened."
After telling her about negative experience on TikTok, several people commented with a person named Rhi saying: "Girl ain't no way. that’s scary!"
"I should not be laughing this hard," wrote Mark.
"This is so funny for no reason," added Sally.
Another user said: "It's important to go to the hospital when this happens! They can hit a blood vessel!"
"Ouch I'm sorry you went through that," commented someone else.
The TikToker hopes her video will serve as a warning to others.
Emma added: "I did not expect my video to go viral whatsoever, but I'm so thankful it did.
"To anyone wanting lip injections, I advise you to please check for any allergies.
"Be very cautious and be prepared for the pain!" | Medical Innovations |
Thousands of pin badges ordered for Scottish NHS staff who pledged to 'respect the identity' of trans people are lying unused after health workers ignored the 'ideological' scheme.
The SNP Government launched the initiative with NHS Scotland in 2021 to encourage staff to 'respect the identity' of trans people and adopt 'inclusive language'.
Those who agreed were to be given a badge which they were asked to wear as an 'ally to progress' for trans people and other minorities.
But more than 10,000 of the badges have gone unclaimed as NHS workers failed to sign up, the Daily Telegraph reported.
NHS Scotland ordered 27,940 badges across 13 of 14 health boards and forty per cent, or 11,131 of the badges, remain in storage.
NHS Lothian, Scotland's second largest health board, only gave out 1,000 of 3,200 badges that were ordered.
Gender critical activists claimed the initiative was politically motivated and said NHS staff had been pressured to endorse a 'dangerous ideology'.
Trina Brudge, a director at For Women Scotland, told the Daily Telegraph: 'This may sound like a harmless scheme but it is underpinned by a dangerous ideology which harms women's rights.
'It is astonishing that NHS Scotland partners with a group like Stonewall which believes sex doesn't matter and ideology trumps biology.
'Given the pressures on the NHS, asking staff, many of whom may not understand the ethos behind it, to pledge to this ideology is absurd.
'It is no surprise that so many of these political badges are lying in a drawer somewhere.'
Scotland's NHS has been critcised in the past for offering smear tests for 'anyone with a cervix' under inclusive language rules.
Staff were told they must 'call out hate speech' and their badge would be a 'signpost of safety' for LGBT and minority groups.
A Scottish Government spokesman told the Daily Telegraph: 'Our health system is based on the core values of care, compassion, openness, honesty, dignity and respect for everyone, irrespective of their individual identities.
'The NHS Scotland Pride Badge encourages open and constructive conversations on difficult issues pertaining to ethnicity, age, sex and sexuality and showcases our commitment to foster an environment that is open, tolerant and inclusive for all.' | Health Policy |
Extending dog years: New drug could increase lifespan of dogs, company awaits FDA approval
The lifespan of dogs is far shorter than their human counterparts, but now one company is one step closer to finding a way for these furry friends to live longer.
Loyal, a San Francisco based biotech company working to develop drugs to extend a dog's lifespan, said the Food and Drug Administration gave it a "technical section complete." That means the FDA agrees that the companies data shows that the drug is effective.
"We can't sell the drug yet, you can't go ask your vet about it yet," Loyal CEO Celine Halioua told ABC7. "We still have to finish manufacturing and safety, but the 'Does it work?' is kind of historically the most challenging, and most complex, aspect of getting a drug approved."
Drug would prolong lifespan of large dogs
The drug, which was codenamed LOY-001’s is designed to be used in large dog breeds for lifespan extension, Loyal said.
This new development means Loyal has met one requirement for “expanded conditional approval,” a fast-tracked authorization for animal drugs. Loyal hopes to have conditional approval of LOY-001 in 2026, which would allow it to begin marketing the product.
"From our data, the FDA believes LOY-001 is likely to be effective for large dog lifespan extension in the real world. Once we satisfactorily complete safety and manufacturing sections and other requirements, vets will be able to prescribe LOY-001 to extend the lifespan of large dogs while we complete the confirmatory pivotal lifespan extension study in parallel," the company said.
Naughty dog finds forever home:Shelter's hilarious post: 'We want Eddie out of here'
How would the drug work?
LOY-001 would be a routine injection administered by a veterinarian every three to six months. The company is also working on two other drugs: LOY-002 which can be used in aging dogs of all sizes, and LOY-003, a pill form of LOY-001.
Halioua told ABC7 the various forms of the drug are important to allow for convenience and affordability.
"This is not going to be a rich person drug, this is not going to be something that puts your family to bankruptcy," she said, "I don't know the final price yet. We're working on finalizing that but think double digits per month. It's not going to be thousands." | Drug Discoveries |
Mounting evidence shows that more young adults are experiencing heart problems compared to decades past, and that worsening lifestyle habits—namely, poor diet and lack of exercise—are to blame. And some research suggests that COVID infections are adding insult to injury.
Perhaps the most alarming trend is that, despite declines among older adults, the proportion of heart attacks among younger adults is increasing across the globe—which many doctors who spoke to National Geographic consider a public health emergency. (Young adults are loosely defined as those between 20 to 50 years old.)
Recent events have underscored these concerns. In late July, 18-year-old Bronny James, the oldest son of NBA star LeBron James, collapsed after going into cardiac arrest during basketball practice at the University of Southern California. (He has since been discharged after a short hospital stay.)
Cardiac arrest is not the same as a heart attack—but the event, and several others like it, raises questions more broadly about cardiovascular health and young people.
“Young individuals are not immune from cardiac arrest or heart attack, yet many think that this is still a disease of older folks,” sas Ron Blankstein, senior preventive cardiologist at Brigham and Women's Hospital and professor of medicine at Harvard Medical School in Boston. “But the really important thing for young individuals to know is that cardiovascular disease, for the most part, can be prevented if you take the right steps.”
Heart attacks on the rise in younger adults
Cardiac arrest, which Bronny James suffered, occurs when the heart experiences an electrical malfunction and suddenly stops beating. This is different from a heart attack, which happens when blood flow into the heart is partially or completely blocked.
Because cardiac arrest can be caused by several conditions—like cardiomyopathy (thickened heart muscle), heart failure, arrhythmias (irregular heartbeat), and yes, heart attacks—it’s difficult for doctors to study and determine whether it’s becoming more common in young adults.
But research does show that heart attacks, also called myocardial infarctions, are on the rise in younger people. Common symptoms include chest pain or discomfort; pain that radiates into the jaw, neck, back or arms; shortness of breath; and feeling weak or faint.
A study of more than 2,000 young adults admitted for heart attack between 2000 and 2016 in two U.S. hospitals found that 1 in 5 were 40 years old or younger—and that the proportion of this group has been increasing by 2 percent each year for the last decade.
The study, published in 2019 in the American Journal of Medicine, also found that people ages 40 or younger who have had a heart attack are just as likely as older adults to die from another heart attack, stroke, or other reason.
In fact, increases in heart disease among younger adults in 2020 and 2021 are responsible for more than 4 percent of the most recent declines in life expectancy in the U.S., according to an editorial published in March in JAMA Network.
Who is most at risk?
The problem isn’t uniquely American. Research shows that adults in Pakistan and India, for example, are also experiencing heart attacks at younger ages. “Cardiovascular disease doesn't know international boundaries,” Blankstein said, “and neither do the risk factors.”
And though heart attacks typically strike men more often than women, recent studies have suggested that more younger women are experiencing heart attacks compared to younger men—and that their outcomes are worse.
A 2018 investigation published in the journal Circulation found that the overall proportion of heart attack hospitalizations among people ages 35 to 54 increased from 27 percent in 1995-99 to 32 percent in 2010-14. The largest increase occurred in young women (21 percent to 31 percent) compared to young men (30 percent to 33 percent).
The young women in the study were more often Black and had a history of high blood pressure, diabetes, chronic kidney disease, and prior stroke.
Studies have found that clinicians are more likely to dismiss symptoms and underdiagnose certain risk factors in women, and are less likely to prescribe them medications to help manage their risks.
What are the biggest risk factors?
The majority of research shows that more people, particularly those of diverse racial and ethnic backgrounds, are developing risk factors for heart disease at younger ages—and that most of the young, seemingly healthy people who have a heart attack almost always have at least one underlying condition.
The biggest risk factors are high blood pressure, diabetes, high cholesterol, and obesity, all of which can clog and damage the arteries and blood vessels that carry oxygen-rich blood to the heart.
While some of these conditions may be genetic, more often they’re brought on by years of unhealthy habits like poor diet and a sedentary lifestyle that typically begin early in childhood, says Eugene Yang, a preventive cardiologist and chair of the American College of Cardiology Prevention of Cardiovascular Diseases Council.
COVID, on the other hand, appears to have a more immediate impact on cardiovascular health. A 2022 study published in the Journal of Medical Virology found that heart attack deaths increased by 14 percent within the first year of the pandemic. The greatest increase was found among adults aged 25 to 44.
COVID is known to activate inflammatory responses in the body and make blood thicker and stickier, Yang said, which can make infected people more susceptible to blood clots that can clog arteries and lead to heart attack. However, it’s still not clear why younger adults appear to be more vulnerable to COVID’s cardiovascular complications.
Young adults aren’t aware of their risks
Yet, most young adults aren’t concerned. A survey conducted in January by The Ohio State University Wexner Medical Center found that 47 percent of people under age 45 don’t think they’re at risk for heart disease; a third of all adults surveyed said they wouldn’t confidently know whether they were having a heart attack.
Similarly, just half of 3,500 younger adults who had significant risk factors believed they were at risk for heart disease before their heart attack occurred; even fewer reported that their doctors told them they were at risk, especially women.
But it’s not all their fault. The health care system isn’t designed to effectively evaluate and treat younger adults with heart disease, Blankstein said, fueling a bias among clinicians that younger patients are at low risk.
The most widely used “risk calculator” developed by the American Heart Association, for example, only assesses risks for those ages 40-75.
Further, most young adults who had a heart attack would not have been eligible for cholesterol treatment under current guidelines before their heart attack occurred; women face even lower eligibility compared with men, despite similar risk factors.
How to reduce risks of heart attack
Early prevention is key. The longer you live with risk factors, the greater your chances of developing heart disease and experiencing worse outcomes later in life, especially if left untreated.
“Take a good look at your risk factors,” says Mariell Jessup, chief science and medical officer with the AHA, “and then develop a plan about how you can tackle one or more of those.”
The AHA recommends following “Life’s Essential 8”: key measures that, if practiced, can improve and maintain your cardiovascular health. These include a healthy diet, regular physical activity, no tobacco smoking, and sufficient sleep, as well as managing your weight, cholesterol, blood sugar, and blood pressure.
“Young adulthood is a phenomenal opportunity for prevention of cardiovascular disease, which goes hand in hand with overall health,” says John Wilkins, associate professor of medicine in cardiology at the Northwestern University Feinberg School of Medicine. “The better job we can do at getting young adults at these optimal levels, the greater chance they have at a longer health span.” | Epidemics & Outbreaks |
A trans lobby group helped to draft NHS plans for treating children questioning their gender, The Telegraph can disclose.
Susie Green, then chairman of the charity Mermaids, was part of a task group reviewing services at the Tavistock and Portman NHS Foundation trans clinic.
The service specification, which outlines treatment for children, included details on how “hormone blockers will now be considered for any children under 12”. The relationship between Mermaids and senior NHS employees is laid bare for the first time in documents seen by The Telegraph.
The Tavistock claimed that it did not have emails or minutes of meetings with Ms Green but after the information regulator threatened court action, it released more than 300 pages.
They show that Ms Green had a direct line to Dr Polly Carmichael, Tavistock’s director, and demanded to be regarded as a professional so she could refer children for treatment when their GPs refused. Ms Green, who has no known formal medical training, held an advisory role on two of the studies that the clinic was involved in on the long-term effect of gender identity.
The service specification, which is still available on the NHS England website, was due to be replaced in 2020 but was put on hold when the Government ordered the independent Cass Review into the clinic.
The Tavistock said: “Like many NHS services, GIDS [gender identity development service] works with a range of third-sector patient support groups and charities that have different views about how the service can improve.”
Mermaids said its “primary focus is to support the mental and physical wellbeing of trans and non-binary young people throughout the UK”.
Ms Green said it was “not a secret” that she was involved in the service specification”.
An NHS spokesman said: “We have started implementing advice from Dr Cass and we have held a public consultation on a new interim service specification, which will be published in the coming weeks.”
'The Tavistock were really in thrall to these activists'
They are the documents that the NHS Tavistock gender clinic claimed did not exist. More than 300 pages of emails and minutes that lay bare for the first time the extent of Mermaids’ involvement in England’s only clinic for transgender children.
The controversial transgender charity has long been named by some whistleblowers as one of the reasons why the Tavistock lost its way, with claims that activists pressured staff to prescribe potentially life-altering drugs.
Now The Telegraph can reveal how Susie Green, then chairman of Mermaids, had a direct line to the clinic’s director Dr Polly Carmichael and was able to make referrals even when a child’s GP repeatedly refused.
The documents lay bare the depth of her involvement in the service, including helping to redraft the service specification and advising on a number of trials designed to inform the way they treated young patients.
The Tavistock and Portman NHS Trust had originally refused to release the details of the meetings between 2014 and 2018, relying on an exemption under Freedom of Information law which said it would have a “disproportionate or unjustified level of disruption, irritation or distress”.
When the Information Commissioner’s Office (ICO) asked them to justify that refusal, the Trust withdrew it and said that following “an extensive search of emails … the Trust does not hold the requested information”.
The ICO said that “on the balance of probabilities” it did hold the information and threatened to refer them to the High Court unless they complied with the request from a parent. The Tavistock has now released 322 pages of communications between 2014 and 2018.
They include emails between Dr Carmichael, who still works at the Tavistock, and Ms Green, who has left Mermaids and now works for an online GP which prescribes puberty blockers. In one exchange from 2016, Ms Green contacted the head of the service to question the decision of staff to refuse a referral she had made.
Upset not to be seen as a professional
Ms Green, who has no known medical training, said that she was told “that the referral was not validated or risk-assessed by a professional” and that is why it was rejected.
She added: “I can only assume from this statement that I am not seen as a professional? I am now very confused, as my understanding was that your service would accept referrals from Mermaids, but this statement appears to suggest the opposite….
“If you do NOT accept referrals from Mermaids due to the fact that I am not a professional I would like to know the reasoning behind this? Referral by a non-healthcare professional is acceptable from schools, social services etc, and my understanding has been that Mermaids referrals were accepted.
“Your admin person made it clear that immediate action was needed or this referral would be refused, so can I ask for a level of urgency to be applied to dealing with this issue?”
Dr Carmichael replied: “We do accept referrals from third sector groups and I know that you have helpfully sent in referrals in the past. This continues to be the case. Third sector groups often play a vital role in supporting young people and their families and we greatly value their involvement.”
Referrals 'unsupported by their GP'
Ms Green sent referrals for young people who were “unsupported by their GP” and in one case she sent the referral noting that the GP “has consistently refused to refer”.
The documents show that as early as 2014 she was involved in the “redraft of the service specification” for the NHS’s gender identity development service (GIDs) for children. She was one of the 10 people who attended a meeting.
Others include Dr Carmichael, who chaired the session, Rob Senior, the Trust’s medical director, Prof Gary Butler, a University College London Hospital consultant who is now the clinical lead for the children’s gender clinic, and Bernard Reed, the founder of the campaign group the Gender Identity Research and Education Society.
The minutes show they agreed that they would act as a “task and finish work group” and that “the content of the discussions were expected to remain within the group”.
They noted the initial findings of “research into the age for hypothalamic blocker treatment” which “suggest that the blocker could be prescribed from early puberty”.
The Tavistock has not provided minutes relating to any further meetings of the group, despite notes stating that they would meet two to three times and share details of their review. As a result, Ms Green’s contributions remain unclear.
Greater emphasis on medical treatment
A new service specification was published by NHS England in 2016, which placed greater emphasis on medical treatment for children.
The new specification said for the first time “that hormone blockers will now be considered for any children under the age of 12 if they are in established puberty”.
It also updated the “informed consent” section to state that: “Age alone does not determine capacity to give consent. If it is concluded that a client has sufficient autonomy and understanding of what is to be offered, plus other key eligibility and readiness criteria have been met, they can consent to treatment.”
The involvement with the service specification came as Mermaids were putting pressure on the Tavistock to lower the age for cross-sex hormones to 14, as Dr Carmichael revealed in an interview at the time.
The charity was also calling for a reduction of time that teenagers had to spend on puberty blockers before they were prescribed cross-sex hormones.
In one email chain Ms Green was involved in, her fellow campaigner Mr Reed questioned if there “are proposals to speed up” the process. He noted that children had to be on puberty blockers for six months to a year before being given cross-sex hormones, which they had to wait until they were 16 to access.
In the response in November 2016 Sally Hodges, one of the Trust’s directors, said that “the situation is rapidly changing” as the service had received more money and “Polly Carmichael is in touch with Susie to ensure that you have the most accurate and up-to-date information”.
Gender reassignment at 16
Ms Green, who now works for Gender GP, an online service which prescribes cross sex hormones, had taken her own child – who was born male – to the US for puberty blockers before their 16th birthday. On their 16th birthday she took them to Thailand for cross-sex surgery.
In one exchange she sought “clarity” from Dr Carmichael on whether the Tavistock would treat children whose parents had sought hormone blockers or cross-sex hormones privately either because of waiting lists or because the drugs were not prescribed on the NHS to under-16s.
“This would be a huge weight off parents’ minds,” she wrote. “Many want to access blockers privately for their children due to the distress caused by ongoing pubertal changes and the huge wait to be seen and assessed, but are then caught in a position of having to fund blockers indefinitely themselves.”
Dr Carmichael replied that she was “very sorry to hear that there has been confusion” and said that “individual circumstances vary widely and so it would be a case-by-case basis”.
She said if the child was already seeing an endocrinologist through the Tavistock they would be removed from their care if they started getting drugs privately, though could still have therapy. But she added that patients “may choose at a later date to be referred to the endocrine clinic, if for example they started cross-sex hormone treatment outside the service at an earlier age than the service offers”.
Charity boss invited to take part in research
In 2018, Dr Carmichael emailed Ms Green again to invite her to take part in research which was supported by the National Institute for Health Research (NIHR). She wrote: “We are in the process of submitting an application to NIHR to follow younger service users. It would be great if Mermaids would be involved.”
Ms Green replied that she would be “delighted to look at working with you on the NIHR application and delivery”.
The study looking at the development of gender identity in children aged 3-14 started in 2019 and it was hoped that it would “inform health and education providers”.
Stephanie Davies-Arai, founder of Transgender Trend, said: “The Tavistock were really in thrall to these activists. They were ideologically captured.”
Ms Davies-Arai, who campaigns for evidence-based healthcare, said that she had first contacted the Tavistock in 2016 amid concerns about the treatment they were offering and was told that they would welcome her input as they were keen to hear from different voices.
However, when she emailed Dr Carmichael with concerns, she got no response.
Ms Green said that it was “not a secret” that she was involved in the service specification and she applied to be involved “as the CEO of the largest UK (and probably European) charity to support transgender children, young people and their families”.
She said that she was “pleased” that the new specification “removed an arbitrary age range” for hormone blockers and agreed to consider them for children under 12. | Mental Health Treatments |
A new Covid variant is spreading in England and has led to an outbreak at a care home in Norfolk, UK health officials say.
There have been 34 confirmed cases of BA.2.86, with 28 of those at the care home. There have been no deaths.
It is too early to draw conclusions on whether it is more serious than past variants, the UK Health Security Agency (UKHSA) said.
People eligible for a booster jab this autumn are encouraged to come forward.
The government recently announced that the vaccine rollout would be earlier than planned because of the new variant. It will start next week.
The UK Health Security Agency's latest briefing on Covid includes an analysis on BA.2.86, an Omicron spin-off.
It says out of the 34 cases confirmed through sequencing in a lab, five people have needed hospital treatment.
Norfolk County Council has been offering infection advice and support to the care home where there was an outbreak.
Staff and residents were asked to have tests when an unusually high number of people became unwell, health officials say.
Lab analysis found that BA.2.86 was confirmed in the majority of samples from those tests, they confirmed.
This variant has been detected in a number of countries around the world.
Dr Renu Bindra, incident director at UKHSA, said BA.2.86 had a significant number of mutations to the viral genome compared to other Covid variants circulating at the moment.
But she added: "The data so far is too limited to draw firm conclusions about the impact this will have on the transmissibility, severity or immune escape properties of the virus."
Dr Bindra said it was likely to be some time before a confident assessment on that could be made.
"It is clear that there is some degree of widespread community transmission, both in the UK and globally, and we are working to ascertain the full extent of this," she said.
Changing dates criticised
The Department of Health and Social Care has been criticised for changing its mind on the start date of the autumn Covid and flu vaccine programme.
It usually begins in early September, but was pushed back to October to increase protection in December and January when flu and Covid are more likely to cause problems.
The timing has now changed again, to 11 September, because of concerns over the new variant.
Pharmacists said last week that they had been left with very little time to prepare for the rollout of Covid and flu vaccines.
People who are eligible for a Covid-19 vaccine include:
- residents in a care home for older adults
- all adults aged 65 years and over
- anyone aged six months to 64 years in a clinical risk group
- front-line health and social care workers
- anyone aged 12 to 64 years who lives in the same house as people with weakened immune systems | Epidemics & Outbreaks |
The former Tory minister who chaired NHS England helped arrange a meeting for an American private health firm that paid millions of pounds to the investment bank that employed him.
David Prior emailed Matthew Gould, a senior NHS executive, in February 2021 asking him to “have a conversation” with Jason Gorevic, chief executive of Teladoc, a multibillion-pound virtual medicine firm.
In the exchange, Lord Prior described Teladoc as “the biggest US medicine and remote monitoring provider” and told Gould: “They have a footprint in the UK which they are keen to expand. Could you have a conversation?” Gould was the head of NHSX, which developed best practice for data and digital in the health service at the time.
Alongside his role as chair of NHS England, Prior was paid by the investment firm Lazard to provide strategic financial advice to clients in the healthcare sector. One of Lazard’s clients was Teladoc.
The emails, obtained in an investigation by the Observer and OpenDemocracy, raise questions about potential conflicts of interest and transparency. Details of Prior’s contact with Teladoc were initially kept secret by NHS England, which redacted his name in emails.
The month before Prior’s intervention, Teladoc, the largest virtual care company in the United States, bought the UK company Consultant Connect, which offers remote health services in the NHS, including an initiative that provides GPs with access to advice from specialist hospital teams.
The firm’s executives were keen to expand their UK operations and promote the potential of virtual triage. The acquisition gave the US multinational a valuable foothold in the NHS.
The Observer has established that following Prior’s top-level introduction, less senior Teladoc representatives met NHSX officials to share data from their operations and its impact on patient care. The Teladoc subsidiary says it covers 38 million patients in more than 120 hospitals across the country.
There is no suggestion of wrongdoing by Teladoc or Consultant Connect, which said they derived no financial benefit from Prior’s intervention, and no suggestion that Prior had any involvement in arranging contracts. But the revelations have led to questions for Prior about his second job and how the potential conflicts were declared.
A press release about Prior’s role at Lazard in 2018 said his job was to advise clients, “particularly in the healthcare sector”, using his “experience and connectivity” to help them “navigate fundamental changes” in global healthcare delivery.
Teladoc was one of Lazard’s biggest health clients, with records showing it advised on at least three major business deals between 2018 and 2020.
In August 2020, Lazard earned $31.5m advising Teladoc over its $38bn merger with the US company Livongo Health, described as the “largest digital health deal in history”. It went on to buy companies working in the NHS including, in January 2021, Consultant Connect, which claims to help hospitals reduce admissions. Transparency records show Prior disclosed that he was a senior adviser at Lazard in NHS England’s register of interests. But he did not declare that the role was focused on advising Lazard’s healthcare clients or mention that Teladoc was a client of the firm. Entries to the House of Lords register of interests also do not refer to the health focus of the role.
The life peer, who was recently appointed a director of Lazard’s UK company, denied any wrongdoing and said he had no direct involvement with Teladoc at Lazard while NHS chair. He told the Observer he “talked to different companies all the time” but said he was “no more involved in introducing Teladoc to the NHS than I was in introducing anyone else to the NHS” and was “not involved at all” in the Livongo transaction. When asked why he did not disclose that his role at Lazard had a global health focus, or that Teladoc was a Lazard client, he said: “I didn’t have any particular relationship with Teladoc, no more so than I had with many many other companies at that time.”
Prior is understood to have had contact with Teladoc on several other occasions while at the NHS, including appearing on a panel in April 2021 on “the future of healthcare” with its president of international operations, Carlos Nueno, and hosting a “digital therapeutics” summit in July 2021 in which Teladoc and other companies were involved.
In September 2021, he was pictured meeting the founder of another health firm, Proximie, the day after it announced a “partnership” with Teladoc.
NHS England initially redacted his name from the Teladoc emails, which were disclosed under Freedom of Information laws. Sources with knowledge of the exchange confirmed Prior made the introduction. He said he could not recall it.
Further messages about the NHS “digital therapeutics” summit also had Prior’s name redacted, but metadata in the email files show he hosted the event.
The Liberal Democrat health spokesperson, Daisy Cooper, said the revelations raised questions about a “potential conflict of interest at the heart of the health service”, adding: “The relevant authorities must get to the bottom of these worrying allegations.”
Rose Whiffen, research officer at Transparency International UK, said NHS board members should disclose “any connection”with companies operating in the health sector. “Even the appearance of impropriety can prove hugely damaging for public trust,” she said.
Prior, 68, “trained in finance” at Lazard and Lehman Brothers in New York before being elected an MP in 1997. He went on to be chief executive and deputy chair of the Conservative party and later served as a minister of business and health. He was appointed to the Lords in 2015. In 2018, he resigned the Conservative party whip to become NHS chair.
After leaving government, Prior received approval from Acoba, the advisory committee on business appointments, to return to work for Lazard as an adviser. In his letter to the committee he said he would advise on “general strategy” but did not mention the focus on healthcare clients. He also disclosed that Archie Norman, then chair of Lazard, was a “close personal friend” and that he had attended “personal dinners” at Lazard the year before.
Prior has previously faced questions after arranging for collapsed finance firm Greensill Capital to lobby NHS leaders. He was also linked to allegations about a Covid “VIP lane” after introducing a testing company to the Department of Health which later won Covid contracts.
NHS England said it had “strict protocols for registering conflicts of interest” and Prior had no role in awarding contracts while at NHS England. A source suggested the email introducing Teladoc to NHSX had been sent by a junior staff member.
Teladoc said it had not asked for the introduction or “gained any financial advantage from it”. It said it had a “couple” of conversations with Prior in which he “advocated for “increased use of digital technology” in the NHS. It said it had “no current relationship” with Lazard and had not dealt with Prior when working with the firm.
Consultant Connect said its relationship with NHSX predated Prior’s intervention. “We had already worked with NHSX, and the introduction from Lord Prior resulted in a meeting with the same team to share our data and discuss the impact of specialist advice on patient care,” it said.
Lazard said it was “not actively working” with Teladoc and had “no formal role with the firm”. It said Prior’s appointment as senior adviser in April 2018 was “fully disclosed at the time” and that he had “no involvement in any transactions where Lazard advised Teladoc”. “Lazard maintains strict procedures in relation to conflicts of interest,” a spokesperson said. | Health Policy |
Chinese officials say they did not detect any "unusual or novel diseases" in the country, the World Health Organization said Thursday, following an official request by the U.N. health agency for information about a potentially worrying spike in respiratory illnesses and clusters of pneumonia in children.
WHO cited unspecified media reports and a global infectious-disease monitoring service as reporting clusters of undiagnosed pneumonia in children in northern China and formally requested more details from China earlier this week.
Outside scientists said the situation warranted close monitoring, but they were not convinced that the recent spike in respiratory illnesses in China signaled the start of a new global outbreak.
The emergence of new flu strains or other viruses capable of triggering pandemics typically starts with undiagnosed clusters of respiratory illness. Both SARS and COVID-19 were first reported as unusual types of pneumonia.
WHO noted that authorities at China's National Health Commission on November 13 reported an increase in respiratory diseases, which they said was the result of the lifting of COVID-19 lockdown restrictions. Other countries also saw a jump in respiratory diseases such as respiratory syncytial virus, or RSV, when pandemic restrictions ended.
WHO said that about a week later, media reported clusters of undiagnosed pneumonia in children in northern China.
The U.N. agency said it held a teleconference with Chinese health officials on Thursday, during which the data it requested were provided. Those showed an increase in hospital admissions of children due to diseases including bacterial infection, RSV, influenza and common cold viruses since October.
"No changes in the disease presentation were reported by the Chinese health authorities," WHO said. It added that Chinese officials said the spike in patients had not overloaded the country's hospitals.
New disease doubted
Dr. Paul Hunter, a professor of medicine at Britain's University of East Anglia, doubted the wave of infections was sparked by a new disease.
"If it was [a new disease], I would expect to see many more infections in adults," he said in a statement. "The few infections reported in adults suggest existing immunity from a prior exposure."
Francois Balloux of University College London said China was probably experiencing a significant wave of childhood infections since this was the first winter since lockdown restrictions were lifted, which likely reduced children's immunity to common bugs.
WHO said that northern China has reported a jump in influenzalike illnesses since mid-October compared with the previous three years. It is rare for the U.N. health agency to publicly ask for more detailed information from countries, as such requests are typically made internally. WHO said it requested further data from China via an international legal mechanism.
According to internal accounts in China, the outbreaks have swamped some hospitals in northern China, including in Beijing, and health authorities have asked the public to take children with less severe symptoms to clinics and other facilities.
The average number of patients in the internal medicine department at Beijing Children's Hospital topped 7,000 per day, exceeding the hospital's capacity, state-owned China National Radio said in an online article earlier this week.
China's National Health Commission, in a written Q&A posted online by the official Xinhua News Agency, suggested Thursday that children with mild symptoms "first visit primary health care institutions or pediatrics departments of general hospitals" because large hospitals are crowded and have long waiting times.
WHO said that there was too little information at the moment to properly assess the risk of these reported cases of respiratory illness in children. The agency has previously been stymied by a lack of cooperation from countries when new viruses have emerged, particularly in China.
After SARS broke out in southern China in 2002, Beijing officials told doctors to hide patients, with some being driven around in ambulances while WHO scientists were visiting the country. That prompted WHO to threaten to close its office in China.
Nearly two decades later, China stalled on sharing critical details about the coronavirus with the U.N. health agency after the new virus emerged in late 2019. WHO publicly applauded China's commitment to stopping the virus — weeks before it started causing explosive epidemics worldwide.
"While WHO seeks this additional information, we recommend that people in China follow measures to reduce the risk of respiratory illness," the agency said, advising people to get vaccinated, isolate if they are feeling ill, wear masks if necessary and get medical care as needed. | Epidemics & Outbreaks |
The blood thinner Eliquis and popular diabetes treatments including Jardiance are among the first drugs that will be targeted for price negotiations in an effort to cut Medicare costs.
President Joe Biden's administration on Tuesday released a list of 10 drugs for which the federal government will take an unprecedented step: negotiating drug prices directly with the manufacturer.
The move is expected to cut costs for some patients but faces litigation from the drugmakers and heavy criticism from Republican lawmakers. It's also a centerpiece of the Democratic president's reelection pitch as he seeks a second term in office by touting his work to lower costs for Americans at a time when the country has struggled with inflation.
The diabetes treatments Jardiance from Eli Lilly and Co. and Merck's Januvia made the list, along with Amgen's autoimmune disease treatment Enbrel. Other drugs include Entresto from Novartis, which is used to treat heart failure.
"For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear," Biden said in a statement. "That is why we will continue the fight to lower healthcare costs — and we will not stop until we finish the job."
Biden plans to deliver a speech on health care costs from the White House later Tuesday. He'll be joined by Vice President Kamala Harris.
The drugs on the list announced Tuesday accounted for more than $50 billion in Medicare prescription drug costs between June 1, 2022, and May 31, according to the Centers for Medicare and Medicaid Services, or CMS.
Medicare spent about $10 billion in 2020 on Eliquis, according to AARP research. The drug treats blood clots in the legs and lungs and reduces the risk of stroke in people with an irregular heartbeat called atrial fibrillation.
The announcement is a significant step under the Inflation Reduction Act, which Biden signed last year. The law requires the federal government for the first time to start negotiating directly with companies about the prices they charge for some of Medicare's most expensive drugs.
More than 52 million people who either are 65 or older or have certain severe disabilities or illnesses get prescription drug coverage through Medicare's Part D program, according to CMS.
About 9% of Medicare beneficiaries age 65 and older said in 2021 that they did not fill a prescription or skipped a drug dose due to cost, according to research by the Commonwealth Fund, which studies health care issues.
The agency aims to negotiate the lowest maximum fair price for drugs on the list released Tuesday. That could help some patients who have coverage but still face big bills such as high deductible payments when they get a prescription.
Currently, pharmacy benefit managers that run Medicare prescription plans negotiate rebates off a drug's price. Those rebates sometimes help reduce premiums customers pay for coverage. But they may not change what a patient spends at the pharmacy counter.
The new drug price negotiations aim "to basically make drugs more affordable while also still allowing for profits to be made," said Gretchen Jacobson, who researches Medicare issues at Commonwealth.
Drug companies that refuse to be a part of the new negotiation process will be heavily taxed.
The pharmaceutical industry has been gearing up for months to fight these rules. Already, the plan faces several lawsuits, including complaints filed by drugmakers Merck and Bristol-Myers Squibb and a key lobbying group, the Pharmaceutical Research and Manufacturers of America, or PhRMA.
PhRMA said in a federal court complaint filed earlier this year that the act forces drugmakers to agree to a "government-dictated price" under the threat of a heavy tax and gives too much price-setting authority to the U.S. Department of Health and Human Services.
PhRMA representatives also have said pharmacy benefit managers can still restrict access to drugs with negotiated prices by moving the drugs to a tier of their formulary — a list of covered drugs — that would require higher out-of-pocket payments. Pharmacy benefit managers also could require patients to try other drugs first or seek approval before a prescription can be covered.
Republican lawmakers also have blasted the Biden administration for its plan, saying companies might pull back on introducing new drugs that could be subjected to future haggling. They've also questioned whether the government knows enough to suggest prices for drugs.
CMS will start its negotiations on drugs for which it spends the most money. The drugs also must be ones that don't have generic competitors and are approved by the Food and Drug Administration.
CMS plans to meet this fall with drugmakers that have a drug on its list, and government officials say they also plan to hold patient-focused listening sessions. By February 2024, the government will make its first offer on a maximum fair price and then give drugmakers time to respond.
Any negotiated prices won't take hold until 2026. More drugs could be added to the program in the coming years. | Health Policy |
The UK economy is flatlining and has been for the best part of a year. Recovery after the deep slump of 2020 has petered out. Higher inflation, higher interest rates and higher taxes are all exacting a toll.
Technically, the strict definition of a recession has not been met because the economy has yet to contract for two successive quarters. But official estimates showing zero growth in the final three months of 2022 meant it was a mighty close thing. With the full impact of higher borrowing costs yet to be felt, neither the chancellor nor the governor of the Bank of England would bet against a recession at some point this year.
Britain is the one G7 country where activity is still to return to its pre-pandemic levels and on current trends it will be some time before it does. Growth has not exactly been stellar anywhere else in the developed world either but the UK’s performance has been especially poor. By early 2025, the last possible moment when a general election could be held, the economy will probably still be smaller than it was in late 2019.
Some will wonder what the fuss is all about. There is a strong de-growth community in the UK that says the aim of policy should not be ever-higher levels of growth, but a steady-state economy that ceases to put as much pressure on the carrying capacity of the planet.
Well, for the past three years the UK has been through a process of de-growth. The 16-year period of constant and robust expansion from 1992 to 2008 is now a distant memory. To all intents and purposes the economy has arrived at a steady state. But it would be stretching the truth to say that the country is a happier place because of it. The number of adults rating their satisfaction with life as very high is well down on pre-pandemic levels, according to the Office for National Statistics.
That’s hardly surprising. Living standards are going down because wages are failing to keep pace with prices. Consumers who have savings are dipping into them in order to maintain spending habits. Those without savings are being forced to tighten their belts.
There is, though, more to it than that. To be sure, the pandemic has left its mark through supply chain bottlenecks and an increase in the number of business failures, but there has also been long-term scarring both to the economy and to the nation’s social fabric. The workforce is smaller because the number of people classified as long-term sick or who have taken early retirement has increased.
Meanwhile, evidence is mounting of the long-term consequences of quarantining the country during lockdown. There were warnings at the time that keeping people under a form of house arrest would lead to rising loneliness, mental illness, domestic abuse and childhood obesity; a growing school attainment divide between pupils from rich and poor homes; an increase in hospital waiting lists and a rise in undiagnosed cases of cancer. All of which have come to pass. Only last month, for example, a report by the House of Commons Library expressed concern that the estimated rate of absence from school in the current academic year was 7.8% – compared with 4.8% in 2019-20.
The better off households in Britain – as elsewhere – survived the pandemic reasonably well. This part of the population was able to work from home, and actually stashed money away as its spending opportunities were reduced during lockdown. The value of their houses went up, and they were also the main beneficiaries of rising share prices. The super-rich did best of all from the surge in asset prices driven by record-low interest rates and central bank money-printing. Globally, lockdowns resulted in more billionaires and more people living in extreme poverty.
The response to this is that there was no alternative but to take draconian measures, in order to provide a breathing space before the arrival of vaccines. A single narrative in which policy makers had no choice but to impose lockdowns has largely gone unchallenged.
But as Toby Green and Thomas Fazi note in their book, The Covid Consensus, the idea of entire countries being placed in lockdown was something entirely new. They note that in a report on pandemic preparedness produced by the World Health Organization in November 2019 there was no notion of city-wide, let alone country-wide quarantines being conceived of. The word “lockdown” was not mentioned once.
By late February 2020, the WHO had changed its mind, noting that the only measures “currently proven to interrupt or minimise transmission chains in humans” were the ones introduced in China. Politicians in the west duly accepted the advice. Only Sweden, of the developed countries, went its own way.
Perhaps the WHO was right that Covid 19 represented an unprecedented challenge. Yet as time has worn on the harms from lockdowns have been harder to hide. A pair of self-confessed lefties, Green and Fazi express bewilderment that the liberal left has not kicked up more of a fuss. As they note, an aggressive form of authoritarian capitalism resulted in poor people everywhere suffering enormous losses while rich people everywhere became immeasurably richer.
Britain’s flirtation with recession and a new era of austerity, alongside semi-permanent economic stagnation are the consequences of a policy response to the pandemic that was far-reaching in its scope and severity. Given that the price paid for lockdown was colossal and is still rising, a period of deep reflection is needed. The argument that there was no alternative should be closely examined.
The Covid Consensus by Toby Green and Thomas Fazi is published by Hurst | Epidemics & Outbreaks |
It took years to find out what was causing Gigi Robinson debilitating pain every month.
The social media influencer, who was a finalist for the SI Swim Search in 2022, was diagnosed with endometriosis in December.
The condition, in which endometrial tissue grows outside the uterus, impacts an estimated 176 million women between the ages of 15 and 44. An exact cause is not known, and symptoms can include excessive bleeding, severe menstrual cramps that are felt in the abdomen, lower back and pelvic area, as well as fatigue and even infertility.
The only way to diagnose endometriosis with certainty is through laparoscopy, a minor surgery, according to endometriosis.org.
SPORTS ILLUSTRATED SWIM SEARCH FINALIST GIGI ROBINSON ON POSING WITH CHRONIC ILLNESS: 'I'M EMBRACING MYSELF'
"I thought it was my body reacting to my cycle," the model told Fox News Digital. "That’s what doctors had suspected… And I have always had bad back pain – horrible, awful, awful, awful back pain – three weeks out of the month. And over the past six to eight months, I had a lot of pain in ways that I just didn’t even know were possible. I was like, ‘This is so horrendous.’"
The 24-year-old said she met with several different doctors to find out what was wrong. She said only one suspected it was endometriosis and recommended laparoscopic surgery. A wary Robinson postponed the procedure. Despite the possibility of finally having relief, the idea of going under anesthesia was frightening to her.
"I was getting a little bit of medical anxiety," she admitted. "I wanted to be certain if I was doing the surgery that it was with purpose… But we did it, and we found [endometriosis]. It has been very interesting comprehending all that."
"Something I always talk about is… being your own best advocate," Robinson explained. "What would your mom, your spouse, or your best friend say to the doctor if they saw you in that much pain? That’s how you have to speak about yourself… I downplayed my pain a lot of the time… I wondered, ‘doesn’t it hurt all women sometimes?’ I just thought it was normal… But I’m now seeing a glimmer of hope."
Robinson has been healing from the surgical procedure. However, she noted that the experience has left her "feeling anger and frustration."
"It’s like nobody believed me, I was right," she explained. "I kept advocating for myself. I kept pushing and it still took this long. [But] I’m at a place where I can finally, hopefully, heal. I’m starting to feel like doing certain things doesn’t hurt when it used to. And that’s huge… It’s been great. I feel great today. [After the surgery], it took two and a half weeks for me to start to feel like myself again."
In 2022, Robinson was chosen among thousands of submissions to be flown to the Dominican Republic and be photographed by acclaimed SI Swimsuit photographer Yu Tsai. Her photo was featured in the 2022 issue, which included cover girls Kim Kardashian, Maye Musk, Ciara and Yumi Nu.
Robinson described the experience as "one of the greatest joys of my life."
SI SWIM MODEL VICTORIA VESCE RECALLS OVERCOMING ‘NIGHTMARE’ BRAIN TUMOR: ‘I HAD EVERY SYMPTOM IN THE BOOK’
"It truthfully gave so many people – so many women – hope," she said. "It’s changing the way that we’re looking at bodies, and we’re accepting bodies in all industries, especially one that’s so intimate, like swim. It showed me posing there without going on a crazy diet or without doing all the body sculpting… By the way, we only had 10 days to prepare [for it]… I wanted to set an example and show that if you’re dealing with a health issue, mental health issue, a body image issue, you could show up as you are and wear the damn bikini and love it and have a fun time and feel super sexy and hot. And I feel like I succeeded in doing that."
Robinson noted that the experience allowed her to raise awareness on coping with Ehlers-Danlos syndrome. The connective tissue disorder causes chronic pain and makes one prone to bruises and injuries that can be slow to heal. Robinson received her diagnosis when she was 11 years old.
"It has unleashed this wave of acceptance within the chronically ill community to show up as you are and be OK with it," said Robinson about posing for the magazine. "And it’s just been incredible to get some of these messages from people all around the world. It was a moment where I felt like I needed to do this, and I did it… [The issue was] the true manifestation of being there, speaking out, using my voice. And I did it. I’m just really grateful that Sports Illustrated Swimsuit saw that in me."
The first swimsuit issue ran in 1964. It has been a launching pad for models such as Kathy Ireland, Christie Brinkley, Elle Macpherson, Kate Upton and Ashley Graham.
CHRISTIE BRINKLEY, 68, DISPLAYS HER YOUTHFUL LEGS IN TURKS AND CAICOS: 'MAY 2023 BE FULL OF HAPPY DAYS’
Over the years the issue has tried to stay fresh with painted bikinis, plus-sized models, unedited photos, tiny swimsuits, amputee models, older models and the addition of professional athletes and celebrities in relationships.
In 2018, the issue acknowledged the #MeToo movement by featuring the likes of gymnast Aly Raisman and model Sailor Brinkley Cook posing nude with words like "Every voice matters," ″Survivor" and "Abuse is never OK."
Today, Robinson hopes to use her platform in raising awareness of a personal health battle many women can identify with. Olivia Culpo, who previously appeared in SI Swimsuit, has also spoken out about her struggles with endometriosis.
"I think in general we are getting more and more comfortable talking about health issues and normalizing them online," Robinson explained. "And in doing so, I think it gives people with the platform responsibility to share [their experiences] because it makes others feel less alone in their journey. And it could also inspire them to take direct action to get help. It could potentially lead to a diagnosis… We have to trust our intuition, right? My intuition told me to keep pushing no matter what. And so, I did, even if it took this long. Endometriosis can affect your fertility, your relationships. Therefore, I think speaking out about something so personal and so intimate and so serious is important. It will allow others to feel less alone and fight for answers. And this applies to all health issues.",
These days, Robinson is looking forward to a healthier happier future. About two years ago, she decided to stop drinking.
"I was just like, ‘I don’t know if I really need this in my life,’" she recalled. "If I’m already dealing with all these health issues, I don’t want to exacerbate them. I don’t want to put my body in a state of stress. It felt like I was gaining more control over my health, even though I’ve never had an issue with alcohol to start with. [But] it’s not good for your gut health, and it’s not good for your body… Think about how you feel when you’re hungover… Why would I put my body through that if I don’t have to? It was a personal choice. I did for a month and then for three… It felt easy… I would much rather have a mocktail and enjoy everyone’s presence intentionally and honestly, and have lucid conversations… I would say, if you are sober curious, try it out."
"It feels freeing to talk about my experiences," said Robinson. "I hope others will feel encouraged to use their voices, too."
The Associated Press contributed to this report. | Women’s Health |
Emma took to Instagram to reflect on the hardships she has faced since she and the rest of Bruce's family announced his diagnosis of frontotemporal dementia, which can cause communication difficulties, in February at age 67.
"I think its so important for us to break up our thinking which can feel, for me very much, like gloom and doom," the 47-year-old told her followers as she sat in her car post-hike. "I know it looks like I'm out, living my best life. I have to make a conscious effort every single day to live the best life I can."
As for what motivates Emma? Her family, including her and the Die Hard actor's two daughters Mabel, 11, and Evelyn, 9.
"I do that for myself—I do that for our two children and Bruce," she continued, "who would not want me to live any other way. So I don't want it to be misconstrued that I am good because I am not. I am not good."
But that doesn't mean it is a small feat, as Emma noted it "doesn't come easy" to her.
"I am just doing the best that I can always. Your pictures are making me happy," she continued. "I just want you to take a moment out of your day to break it up for a minute to just look for something beautiful."
Getting emotional, Emma concluded her message, "I have to put my best foot forward for myself and the sake of my family. Again, when we are not looking after ourselves we cannot look after anyone that we love. So, it is really important and, like I said, this is a conscious effort."
"This is a care partner PSA," she captioned the heartfelt post Aug. 14. "My message is simple. When we are not looking after ourselves, we are no good to the people we love who we want to show up for and take care of. I don't have this down to a fine science either, but I try. It's an affirmation I use daily, so it's kept in the forefront of my mind. Your pictures, words of support and love for me and my family were felt. Honestly, thank you, it helps."
Back in May, Emma shared how she has found a new purpose in learning and educating about brain health since Bruce's diagnosis. She—along with Bruce's ex-wife Demi Moore and their three daughters: Rumer, 34, Scout, 32, and Tallulah, 29—have leaned on one another, but she has also found a support system in others.
"What I really was yearning for was community, to be talk to people that are on this journey, that understand this journey, because I felt a little isolated for a while," she explained. "So I think being able to use my platform and raise awareness around dementia and be able to have this conversation with caregivers has been really important to me. And I want to take away that stigma, because there is nothing shameful about what is happening." | Disease Research |
The top 25 costliest drugs for Medicare Part D plans earned their lofty rankings largely through exorbitant price hikes—increases that, on average, more than tripled their list prices since they entered the market, according to a new analysis by AARP.
For nearly all the drugs, the price hikes far outstripped the rate of inflation, with increases ranging from 20 percent to 739 percent during the drugs' lifetimes on the market. Only one of the top 25 drugs—Trelegy Ellipta, an inhaler for asthma and chronic lung conditions—had price increases that were below the rate of inflation during its time on the market. Since its initial release in 2017, Trelegy Ellipta's price increased only 20 percent, compared with a general inflation rate of 23 percent.
Overall, the average lifetime price increase for the top 25 drugs was 226 percent. The highest increases were seen in drugs that have been on the market the longest. For example, drugs that were on the market for under 12 years had an average lifetime price increase of 58 percent, while those on the market for 20 or more years had an average lifetime increase of 592 percent.
The drug in the analysis with the largest lifetime price increase was Lantus, a Sanofi-made, long-acting insulin for diabetes. Since its introduction in 2000, Sanofi has hiked the list price 739 percent, the analysis found. The general inflation rate during that time period was 71 percent.
In 2021, Medicare Part D prescription drug plans spent $80.9 billion on these top 25 drugs, which were used by more than 10 million enrollees. AARP noted in its report that Medicare Part D enrollees take an average of four to five medicines each month, and 20 percent of older adults report using cost-coping strategies like skipping doses or not filling prescriptions to save money.
The report lands amid drug cost-cutting measures in the Inflation Reduction Act (IRA). The act requires drug companies to pay rebates to Medicare when they increase the price of drugs faster than the rate of inflation. And, under IRA provisions, Medicare will soon begin negotiating prices of drugs directly with manufacturers. On September 1, the Centers for Medicare & Medicaid Services will announce the first 10 drugs selected for price negotiations. Some of the drugs expected to be announced are among the top 25 costliest drugs analyzed in the AARP report.
Multiple pharmaceutical companies and the trade group PhRMA have sued the federal government over the IRA's price negotiation provision. The suits, filed in four different federal courts, claim the negotiation program is unconstitutional. Drug makers also claim negotiating prices will cut into profits, preventing them from funding research and development into new drugs. The Biden administration has said it will defend the IRA's price negotiation program vigorously.
In a blog post Friday, PhRMA called the AARP's analysis on drug price increases a "flawed report to spin a misleading narrative." The group pointed to insurers and pharmacy benefit managers for their role in increasing costs for seniors. | Health Policy |
People with chronic pain are being given antidepressants with very little scientific proof the medication helps, a major review has found.
In studies, with nearly 30,000 patients, there was "moderate" evidence for only one drug, duloxetine, and just for short-term pain relief.
And there was a "shocking" lack of long-term data, even though the pills are usually prescribed for many months.
But patients are advised to stay on medication if it works for them.
They must not suddenly stop taking tablets without talking it over with a doctor, experts say.
NHS guidelines say:
- Antidepressants can be used for some chronic-pain conditions, including nerve pain and fibromyalgia
- Strong opioid painkillers, which can be addictive, are not recommended, nor are simple painkillers such as paracetamol and ibuprofen
- Exercise programmes and physical activity may help and some people might want to try psychological therapies such as cognitive behaviour therapy (CBT)
Chronic pain, lasting for more than three months, is extremely common - a BBC News survey suggests one out of every four of people in the UK is living with it.
There can be no obvious cause - or it might be linked to other health conditions, such as arthritis.
Experts say brain systems for mood and pain overlap considerably, which is why it has been suggested antidepressants may help. Hundreds of thousands of patients with chronic pain in the UK are thought to be on them.
The Cochrane review, led by scientists from several UK universities, including Southampton and Newcastle, examined 176 trials. But most looked at patients' experience over a couple of months only.
Among the drugs studied - which included Prozac and a cheap antidepressant called amitriptyline - only one, called duloxetine, showed any evidence for pain relief.
None of the trials gathered long-term safety and effectiveness data, which the researchers say is shocking and needs remedying to guide patients and doctors.
Prof Tamar Pincus said: "It's really shocking that we don't have any evidence for long-term use of even duloxetine.
"This is a global public-health concern. Chronic pain is a problem for millions who are prescribed antidepressants without sufficient scientific proof they help, nor an understanding of the long-term impact on health.
"But it does not mean that people should stop taking prescribed medication without consulting their GP."
Clinical lead for National Institute for Health and Care Excellence (NICE) chronic-pain guidelines Dr Cathy Stannard said: "This well conducted review adds to the substantial evidence we now have that shows that the use of medicines to treat long-term pain is disappointing."
But it could be difficult to translate results from clinical trials to real life.
"It's equally important to emphasise the many social and psychological influences on the pain experience," Dr Stannard said.
"Existing services, usually outside healthcare, including support with mobility, debt management, trauma, and social isolation, can be helpful for people living with pain - and identifying what matters most to people and signposting to appropriate local support is a promising way forward."
When coming off antidepressants, the medication should be slowly reduced over weeks to prevent withdrawal symptoms, says the NHS. | Disease Research |
'Bliss' compound may hold out hope for autoimmune skin disease
A marijuana-like compound holds out promise as a new treatment for a severe autoimmune skin disease called skin lupus, according to a study published recently by a multicenter team including researchers at the George Washington University.
If the results of the mouse study can be replicated in human trials, the compound, known as anandamide, might one day be used to treat or prevent the painful and disfiguring skin lesions that are characteristic of cutaneous lupus erythematosus, Adam Friedman, professor and Chair of the Department of Dermatology at the GW School of Medicine & Health Sciences, said.
Anandamide is an endocannabinoid that acts on similar receptors activated by THC and CBD, the best known active ingredients in marijuana. Researchers know that the human body produces its own cannabinoids like anandamide and this endogenous compound is thought to help regulate many bodily systems, including the immune system.
Friedman and his colleagues wondered if they could harness the power of anandamide to treat or even prevent skin lupus. Skin lupus is thought to occur when the body's own immune system mistakenly attacks healthy skin, causing rashes and painful sores. Previous research has suggested that systemic lupus, where the immune system attacks its own tissues and organs, may in part be caused by dysregulation of the human endocannabinoid system.
Adam Friedman's interest in research was sparked long ago by his father, Joel Friedman, who is a professor of microbiology, immunology and medicine at the Albert Einstein College of Medicine in New York. For this effort, Adam and Joel Friedman teamed up, along with other scientists, and looked for a way to effectively deliver anandamide through the skin using nanoparticles that slowly release the experimental treatment.
Once they had proven that this platform technology delivered the payload more effectively, the team turned to mice that had been engineered in the labs at Albert Einstein to develop this skin disease as a means of testing the system.
The team first gave the anandamide encased in nanoparticles to mice that were slated to get disease but had yet to develop symptoms. "These animals are engineered to develop skin lupus over time," Adam Friedman said "We found that we could prevent skin lesions from developing at the expected time point."
The team then looked to see if they could treat mice that had already developed symptoms of the disease. They compared mice treated with anandamide encapsulated in nanoparticles to control mice that also received the compound but without the nanoparticle delivery system. After ten weeks, the researchers found that the nanoparticle based treatment reduced the size and severity of the skin sores in mice, more so than anandamide alone.
"If future studies verify these results, the treatment could prove to be a promising therapy for people coping with skin lupus," Adam Friedman said. Doctors turn to steroids and other drugs to treat this disease but they are not designed to treat the underlying pathology, he said. "There is an unmet need for a more effective treatment," Adam Friedman said.
The study, "Nano-encapsulated anandamide reduces inflammatory cytokines in vitro and lesion severity in a murine model of cutaneous lupus erythematosus," was published in the journal Experimental Dermatology.
In addition to Adam and Joel Friedman, Erika T. McCormick, a medical student at the GW School of Medicine & Health Sciences served as the lead author on the paper. Other authors included Chaim Putterman and a team at the Albert Einstein College of Medicine as well as Andrew Draganski at Zylo Therapeutics, the South Carolina company that is developing the nanoparticle technology.
Adam Friedman, Joel Friedman and Andrew Draganski are co-inventors of the anandamide nanoparticle technology.
More information: Erika T. McCormick et al, Nano‐encapsulated anandamide reduces inflammatory cytokines in vitro and lesion severity in a murine model of cutaneous lupus erythematosus, Experimental Dermatology (2023). DOI: 10.1111/exd.14935
Provided by George Washington University | Disease Research |
WhatsApp messages sent by Nicola Sturgeon relating to the Covid pandemic were manually deleted from her phone, a newspaper has reported.
The Sunday Mail says the former first minister is among 70 Scottish government figures whose pandemic communications were not retained.
It means these messages cannot be given to the UK or Scottish Covid inquiries into how the pandemic was handled.
Ms Sturgeon's spokesperson said she was co-operating with both inquiries.
It was also reported that, according to UK Covid inquiry documents, WhatsApp data from First Minister Humza Yousaf and former deputy first minister John Swinney no longer exists.
It comes after Scottish ministers faced criticism last week for not handing over their messages.
The UK inquiry was told by a lawyer that 70 individuals were asked for their WhatsApp messages, but "very few appear to have been retained".
On Thusday, it was also reported that national clinical director Jason Leitch deleted messages every day during the pandemic.
It emerged there were at least 137 WhatsApp groups being used across the Scottish government and its agencies during Covid.
Aamer Anwar, lead solicitor for Scottish Covid Bereaved families group, told BBC Scotland's The Sunday Show that the Scottish government had not given details of when messages were deleted.
He highlighted that Ms Sturgeon announced in May 2020 that there would be a Scottish Covid inquiry, which was later confirmed in August 2021.
Mr Anwar said: "From May 2020, if there was a position of auto-delete, if there was a situation where government ministers and senior civil servants were deleting their WhatsApps, it should have been ordered to stop.
"We want to know when was the deletion brought in, who ordered it, why was it not ordered to be stopped?
"And did they continue after the event? Because that's deletion of material."
The Scottish government said it was committed to co-operating with the inquiry and providing any requested material that it holds.
Deputy First Minister Shona Robison said: "The Scottish government records management policy makes clear what must be recorded in the official record, given that it isn't practical, cost-effective or necessary for any organisation to retain every exchange.
"While it is not the culture within Scottish government to use WhatsApp for decision-making, our records management policy states clearly that government decisions, however they are made, should be recorded in the official record."
A spokesperson for Ms Sturgeon said she would continue to provide all information requested by the UK and Scottish Covid inquiries.
They said: "She has recently submitted her third written statement to the UK inquiry - running to around 200 pages - and expects to give oral evidence again next year when she will answer all questions put to her." | Epidemics & Outbreaks |
After plummeting during the COVID pandemic in 2020 and 2021, strep throat infections skyrocketed in February 2023, according to a report from Epic Research, a health analytics firm.
The rate of infections of group A strep (caused by the Streptococcus bacteria) was 30% higher than the previous peak seen in February 2017, the report found.
Leading up to the pandemic, between January 2017 and February 2020, cases of strep throat followed a consistent pattern. Usually, the cases would begin to increase in the fall and peak in February — before dipping again in spring and summer, said the reports from Epic, which is based in Verona, Wisconsin.
Starting in March 2020, amid stay-at-home orders early in the pandemic, strep throat infections plummeted.
Preliminary data from the Centers for Disease Control and Prevention (CDC) showed that severe cases of strep infections decreased by around 25% during the pandemic.
Strep cases didn’t start to increase again until September 2022, then skyrocketed in the winter leading into 2023.
Epic’s data is based on the share of clinic and emergency room visits between January 2017 and February 2023 that resulted in positive group A strep cases across the U.S. and Lebanon. (The data come from "Cosmos, a HIPAA-defined Limited Data Set of more than 184 million patients from 199 Epic organizations including 1,147 hospitals and more than 24,900 clinics," said Epic in its report, in part.)
A majority of the cases affected children ages 4 to 13.
"The rates of group A strep infections, including the more dangerous invasive type, are at the highest levels seen in years," confirmed Dr. Shana Johnson, a physical medicine and rehabilitation physician in Scottsdale, Arizona.
"In February, strep cases were 30% higher than the previous peak seen in 2017."
The CDC’s early data also reflect these findings, showing that cases of both invasive and less severe strep are at elevated levels, "similar to or higher than those seen in pre-pandemic years."
Other viruses could have fueled strep cases
Dr. Marc Siegel, a professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, told Fox News Digital that the spike in strep A cases is likely a result of other circulating viruses.
"The recent assault of viruses, including COVID-19, have weakened people’s immune systems," he told Fox News Digital.
"Also, we haven't been on the lookout for it and have missed cases."
When strep leads to invasive infections
In most cases, strep A causes mild illness, with common symptoms including sore throat, pain when swallowing, fever, red and swollen tonsils, swollen lymph nodes and tiny red spots on the roof of the mouth, per the CDC.
Occasionally, group A strep can lead to severe infections (invasive Group A strep, or iGA), which in rare cases can cause sepsis, streptococcal toxic shock syndrome and necrotizing fasciitis (a serious bacterial infection that destroys tissue). These cases require immediate treatment.
In the U.S., there are between 14,000 and 25,000 cases of invasive group A strep cases per year, with 1,500 to 2,300 of them causing death, the CDC reported.
"Unlike respiratory viral illnesses like the common cold and flu, group A strep is best treated with antibiotics," Dr. Johnson told Fox News Digital.
"Antibiotics for strep throat reduce how long you are sick and prevent the infection from getting more severe and spreading to other parts of the body."
Understand the shortage of antibiotics
With the current antibiotic shortage, some cases aren’t receiving timely treatment, Dr. Siegel said.
"When we don't treat it quickly, it has more time to spread," he told Fox News Digital.
In October 2022, the U.S. Food & Drug Administration (FDA) reported a shortage of amoxicillin, which, along with penicillin, is among the most commonly prescribed treatments for strep.
As of April 2023, amoxicillin remains on the drug shortage list.
Tips for preventing strep’s spread
Group A strep bacteria spreads through droplets when an infected person coughs, sneezes or talks, per the CDC’s website.
"The recent assault of viruses, including COVID-19, have weakened people’s immune systems."
"If you touch your mouth, nose, or eyes after touching something that has these droplets on it, you may become ill," the CDC said.
To help reduce the spread, doctors say to wash hands often with soap and water, avoid sharing glasses or utensils with those who are infected, and cover the mouth and nose when coughing or sneezing.
"If you have strep throat, stay home until you no longer have a fever and have taken antibiotics for at least 24 hours," Dr. Johnson advised.
Early testing and treatment is important, especially among young children, Dr. Siegel said.
"Consider using other antibiotics if amoxicillin is in short supply," he added. | Epidemics & Outbreaks |
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