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Unqualified medical students are being urged to provide clinical support in English hospitals when tens of thousands of junior doctors go on strike this month, the Guardian can reveal.
The NHS faces the prospect of unprecedented disruption to services from 13 March when junior doctors strike for 72 hours in an increasingly bitter row over pay, morale and safe staffing levels.
As hospitals gear up for only the second such action in the 74-year-history of the health service, the Guardian understands several NHS organisations have begun asking students if they can help plug staffing gaps.
It comes as senior activists at unions including Unison and the GMB meet to decide whether to call off NHS strike action next week, and accept an offer from the health secretary to enter into pay negotiations.
If the other unions opt to join discussions, strike action by ambulance workers and NHS support staff planned for Monday and Wednesday next week would not go ahead. Steve Barclay has made a significant concession, offering to discuss a one-off payment for this year – previously a sticking point in the long-running dispute.
The revelation provoked immediate condemnation from doctors’ unions, who raised concerns about safety, and said student medics should refuse to undertake tasks that fall outside their competence or capability.
There are also fears that asking students who have not qualified in medicine to assist with sick patients could see them face legal difficulties if they make mistakes.
Final year medical students at Brighton and Sussex medical school (BSMS) are among those asked if they would be available “to support clinical activity” in a local NHS hospital during the upcoming strikes.
A spokesperson for East Sussex healthcare NHS trust said: “Utilising student doctors to provide cover during the upcoming junior doctors strike has never been part of our strike planning.
“We are surprised to hear that a student doctor was put in a position where they thought this would be expected of them; this should not have happened, and we will be looking into the issue.”
Dr Paul Donaldson, general secretary of HCSA, the hospital doctors’ union, said any attempt to deploy students “into such a high-pressure situation” was alarming.
“There is clearly a risk that they may be asked to do things beyond their skill level and without any indemnity to protect them,” he said. “Undoubtedly, proper supervision is going to be difficult with consultants focusing on emergency and acute cases.”
He added: “Dressing this up as a good learning opportunity is plain wrong and reflects a cavalier approach towards patient safety and their duty of care to students.”
Some universities, including King’s College London, University College London and Queen Mary University London, have won praise from doctors’ groups after cancelling student placements due to take place in hospitals on strike days.
The Doctors’ Association UK (DAUK) has called on all universities in England to cancel placements scheduled for strike days over concerns for patient and staff safety.
It said there was a “high” risk of students being asked to “act up” and cover junior doctors’ duties in their absence without the professional security to do so.
“Instructing students to not fill these gaps is unrealistic and does not take into account the power dynamic between students and clinicians,” DAUK wrote in a recent letter to the deans of medical schools.
“Further to this, students lack the professional indemnity to carry out such roles and would be putting themselves at risk doing so. To prevent these issues arising, medical students should not be expected to attend clinical placement during strike action.”
Ray Effah, co-chair of the British Medical Association medical students committee, said medical students should not be asked to fulfil the role of a junior doctor or undertake any tasks “that would sit outside the normal parameters of their placements” to support trusts during strike action.
“It is absolutely crucial that medical students work with relevant supervision and in a way that is safe and within the limits of their competence and capability at all times.
“This includes any periods of pressure experienced by the health service they are learning in, including pressures created by other healthcare workers taking industrial action. The purpose of students on placement is to learn, not service provision.
“If medical students are asked to undertake any tasks that sit outside the agreed learning outcome of their placements in order to manage the fallout of industrial action taking place at their trust, they should refuse to do this and notify the BMA who can advise and support them.”
On Thursday, junior doctors’ leaders met with Barclay in London but said afterwards that nothing new was offered and described the talks as “disappointing”.
Barclay has repeatedly said he values the work of junior doctors, and wants “to continue discussing how we can make the NHS a better place to work for all”.
Union activists representing ambulance workers and support staff will meet on Friday to decide on whether to call off their strikes. The Royal College of Nursing (RCN) suspended industrial action by nurses last week to enter “intensive” talks with Barclay. | Health Policy |
These Bravolebrities always keep it real while discussing the latest weight loss craze.
But when it comes to Ozempic—Type 2 diabetes medication sweeping the nation as a weight loss drug—the stars of the Real Housewives are pretty divided.
Since giving up alcohol and kickstarting a health journey last year, Kyle Richards has repeatedly been on the receiving end of Ozempic-use accusations.
"I am NOT taking Ozempic," The Real Housewives of Beverly Hills star replied to one social media user in January. "Never have."
Unlike Kyle, several Real Housewives of New Jersey castmates have proudly admitted to using the medication at the advice of their doctors. And although Ozempic has become somewhat of a controversial topic as of late, Botched doctors Terry Dubrow and Paul Nassif are behind the weight loss trend when used responsibly.
"People have to stop making people feel bad about being on these drugs," Terry told E! News in July. "Stop Ozempic shaming because it's not nice."
However, he reminded people should be aware that, like any weight loss drug, there are often side effects.
"It's dangerous because people aren't talking about the side effects," Terry explained. "And the problem with Ozempic shaming is that people won't admit to this, so they're not able to teach other people their experience with it."
So which Real Housewives have admitted to using Ozempic? Keep reading to see every star who has spoken out about the weight loss trend.
(E! and Bravo are both part of the NBCUniversal family) | Drug Discoveries |
We'll be bringing you the very latest updates, pictures and video on this breaking news story.The Level 2 Met Office warning for the coming two-day heatwave Brits are set for a two-day heatwave as the Met Office has issued a heat alert for "dangerous" 34C weather. The Met Office has issued a heat health alert, warning large swathes of England to be alert and ready as temperatures are set to rocket so high they could pose a threat. There is "high confidence" that the second half of this week is due to see searing hot temperatures well into the 30s. The Level 2 warning applies to the East Midlands, East of England, Southeast and Southwest. Friday is expected to bring the hottest temperatures and Brits are warned the mercury could rise to the low to mid-30s. However, on the back of scorching sun, the Met Office said there's a chance it could be followed by rain and even thundery showers. In an alert posted on their website, they said: "There is a 60 % probability of Heat-Health Alert criteria being met between 0000 on Friday and 0000 on Sunday in parts of England. There is high confidence for temperatures to rise significantly through the second half of this week, becoming widely warm or very warm across England and likely hot, or perhaps even very hot in central and southern areas for a time. "The highest temperatures are expected on Friday, with daytime maxima likely to reach into the low to mid-30s of Celsius across large parts of central and southern England. "A cold front will move slowly southeastwards across the country overnight Friday into Saturday. This is likely to bring rain or thundery showers, with an eventual return to drier, but fresher conditions." We'll be bringing you the very latest updates, pictures and video on this breaking news story. Please check back regularly for updates on this developing story HERE . Get email updates on the day’s biggest stories straight to your inbox by signing up for our newsletters . Get all the big headlines, pictures, analysis, opinion and video on the stories that matter to you by following The Mirror every time you see our name. Follow The Mirror on Google News - CLICK HERE and click the star Follow The Mirror on Apple News - CLICK HERE available on Apple devices Follow The Mirror on Flipboard - CLICK HERE and click follow You can sign up for Twitter alerts for breaking news here @MirrorBreaking_ and follow us @DailyMirror , for all the latest updates. Keep up-to-date with your must-see news, features, videos and pictures throughout the day by following us on Facebook at facebook.com/dailymirror See all our social accounts you can follow here: mirror.co.uk/social | Epidemics & Outbreaks |
Pulmonary arterial hypertension (PAH) is a form of pulmonary hypertension that causes the small arteries of your lungs to thicken and narrow. This can lead to high blood pressure in your lungs.
While thereâs no cure for PAH, there are many treatment options that can help control your symptoms. Itâs important to work closely with the doctor to ensure your PAH treatment continues to work.
âTreatments range from medication all the way up to transplantation,â says Richard N. Channick, MD, a pulmonologist at UCLA. Your treatment plan might include:
Vasodilators. Blood vessel dilators, called vasodilators, help relax and open your narrowed blood vessels to help blood flow. Your doctor may give you treatment through an intravenous (IV) infusion, under the skin, as a pill, or through inhalation. With inhalation, youâll breathe in the medication through a machine called a nebulizer.
Anticoagulant medications. These drugs can help prevent blood clots. The most common form is warfarin (Coumadin, Jantoven).
Diuretics. These are "water pills" that help get rid of extra fluid in your body.
Digoxin. This medication can help ease your symptoms, strengthen your heart muscle contractions, and slow down your heart rate.
Oxygen treatment. With this therapy, youâll inhale air that has a higher concentration of oxygen than normal air.
Surgery. In some cases, you may need surgery. There are a few different types, including pulmonary endarterectomy, balloon pulmonary angioplasty, atrial septostomy, and transplant.
There are other treatments less commonly used for PAH as well.
âWe have this big list of potential medications that we can choose from. Which medications we choose and how we use them is also a very important topic,â Channick says.
The main goal of treatment is to ease symptoms and slow the progression of your condition. If your PAH seems to be getting worse, you may need to explore new treatment options.
How Can You Tell if Your PAH Treatment Is Effective?
âIt doesn't matter as much how you are at day one; it's really how you're responding to therapies that will determine how you'll do long term,â Channick says. There are a few different ways to measure the success of someoneâs PAH treatment:
Functional class. Doctors may simply ask how youâre feeling with the current form of treatment. Theyâll have you rate your symptoms on a scale, which experts refer to as a functional class.
âThe functional class ranges from one to four. One being the [person] has no limitations to activity, four means they get symptomatic even at rest or with minimal exertion, and two or three being in between,â Channick says. âTheir functional class can help us determine how they're going to do and whether they need additional therapy.â
Exercise capacity. âWe can measure that using what we call the â6-minute walkâ test, or how far a patient can walk up and down a hallway in 6 minutes. It's a pretty strong measure of how a patient is doing,â he says.
Other tests. âThen we have things that we measure more directly, such as blood tests, an echocardiogram to look at how the right ventricle is functioning, or in some cases, even doing a repeat heart catheterization,â says Channick.
No matter which method your care team uses, itâs important to check in with your doctor to let them know how youâre doing. Every 3 to 4 months is ideal. Donât wait until you think your condition has gotten worse. Itâs easier for them to determine your risk level with regular appointments and tests.
âIt's important that you come in regularly, regardless of the presence or absence of symptoms,â says Channick. âWe have many examples of [people] who felt like they were doing pretty well, but maybe they weren't doing as well as they thought.â
Symptoms donât always tell the whole story, but itâs still important to pay attention to how youâre feeling.
âAre you noticing a decrease in you exercise tolerance? For example, things you could do a month ago, youâre now no longer able to do,â Channick says.
Weight changes are another potential warning sign.
âOne of the problems with PAH that isnât responding to treatment is fluid retention. It may not always be apparent. People hide fluid in places they can't even see,â Channick says. âGetting regular weight checks may help us prevent a real problem or even a need for hospitalization.â
Your treatment may also not be working well if you notice other symptoms, like:
- Shortness of breath with normal activities (like going up the stairs)
- Fatigue
- Dizziness
- Fainting
- Swelling in your ankles, belly, or legs
- Chest pain
- Bluish skin or lips
- A racing heartbeat
- An irregular heartbeat
- Trouble breathing even when youâre not doing anything
What Happens if Your PAH Treatment Doesnât Work?
If one treatment doesnât control your symptoms, itâs likely something else will.
âMost [people] start on two different medications. Then, we do risk profiling, and if they're not at a low risk, and they still have limitations, then we'll often add a third drug to the regimen,â Channick says. âSo they may end up on three different treatments for their pulmonary hypertension.â
How you respond helps determine whether youâre a good fit for infusions.
âItâs generally thought that the infusions can help even when the pills or the other medicines aren't working. Ultimately, if none of that is working, then we consider lung transplantation,â Channick says.
But that doesnât happen often.
âThe majority of patients benefit from just the current therapies and don't need an extreme approach,â Channick says. âBefore these medical therapies, the average survival was less than 3 years with this condition. Now, we have long-term survivors. We still can do better, but we've certainly come a long way.â
Show Sources
Photo Credit: Fuse / Getty Images
SOURCES:
Richard N. Channick, MD, David Geffen School of Medicine, University of California, Los Angeles.
American Lung Association: âLearn About Pulmonary Arterial Hypertension.â
Mayo Clinic: âPulmonary Hypertension.â
National Health Service (U.K.): âPulmonary Hypertension.â
Cleveland Clinic: âPulmonary Hypertension (PH).â | Disease Research |
Canada will legalize medically assisted dying for people who are addicted to drugs next spring, in a move some drug users and activists are calling “eugenics.”
The country’s medical assistance in dying (MAID) law, which first came into effect in 2016, will be expanded next March to give access to people whose sole medical condition is mental illness, which can include substance use disorders. Before the changes take place, however, a special parliamentary committee on MAID will regroup to scrutinize the rollout of the new regulations, according to the Toronto Star.
Currently, people are eligible for MAID if they have a “grievous and irremediable medical condition”, such as a serious illness or disability, that has put them in an advanced state of irreversible decline and caused enduring physical or psychological suffering—excluding mental illness. Anyone who receives MAID must also go through two assessments from independent health care providers, among meeting other criteria.
The contentious idea of including people who are addicted to drugs is being discussed this week at a conference for the Canadian Society of Addiction Medicine in Victoria, British Columbia.
“I don't think it's fair, and the government doesn't think it's fair, to exclude people from eligibility because their medical disorder or their suffering is related to a mental illness,” said Dr. David Martell, physician lead for Addictions Medicine at Nova Scotia Health, who is presenting a framework for assessing people with substance use disorders for MAID at the conference. “As a subset of that, it's not fair to exclude people from eligibility purely because their mental disorder might either partly or in full be a substance use disorder. It has to do with treating people equally.”
However, some drug users and harm reduction advocates told VICE News they’re upset the idea of drug users being given access to MAID is even being discussed, as they feel other public health measures, including better access to overdose prevention sites, opioid agonist medications like methadone, a regulated drug supply, housing, and employment are lacking.
“I just think that MAID when it has entered the area around mental health and substance use is really rooted in eugenics. And there are people who are really struggling around substance use and people do not actually get the kind of support and help they need,” said Zoë Dodd, a Toronto-based harm reduction advocate.
Martell, who has been a MAID provider since 2016, said he agrees that health care options for people with substance use disorders are underfunded and that he hopes this conversation will draw more attention to those concerns.
He said he hasn’t heard a desire for assisted death from his patients who have substance use disorders—and it’s not something he’s sure he would raise as an option unless he was involved in end-of-life planning.
“The idea that we might promote or push this on people, that doesn't resonate with me at all,” he said, adding that even if someone with a substance use disorder was approved to receive MAID, he’s not sure he could be the one to help them end their life.
Martell was part of a Nova Scotia working group that included doctors, psychiatrists, ethicists, and policy analysts. He said some of the criteria they discussed included: requiring an assessor who had expertise in treating substance use disorders if that was the motivation for the MAID request and assessing what type of treatment the person had received and for how long.
“In addition to having a mental disorder that has been there for a very long time and that is significantly impairing their function, treatments have to have been tried and those treatments have to be treatments that are expected, usual, and evidence-based,” Martell said. But there’s no one size fits all answer to what that could mean, he added.
“One of the problems that we had, I think looking at it with that lens, had to do with the fact that we don't really have a whole lot of guidelines when it comes to addiction treatment,” Martell said. “There's still a lot of debate about it, but of the ones that do exist, we need to know that those have been tried.”
Opioid agonist therapy, which involves giving people medications like methadone or buprenorphine to help control their cravings, is considered the gold standard for treating opioid addiction.
But Dodd said that those medications aren’t easily accessible to everyone who needs them in Canada.
“I know people have to travel several hours to get access to what they need in the more rural places,” she said.
Martell said assessors will also need to be able to distinguish whether someone is suicidal or has a “reasoned wish to die.” The former might be linked to a more acute crisis or be a feature of a longstanding psychiatric condition, while the latter applies to someone who is “thinking in a calm and measured way about wanting (their) suffering to end, being able to reason through it,” Martell said. But he noted a person can exhibit signs of both, making it an even trickier ethical ground to navigate, and that it would be “fairly impossible” to make the distinction if the person being assessed was intoxicated.
As Canada prepares to legalize MAID for people with mental disorders, each province will have to develop its own protocol for how to assess people.
Dr. Simon Colgan, lead physician for the Community Allied Mobile Palliative Partnership which provides palliative care to homeless people, said MAID requests “must be understood within the context of a person's lived experience and this takes time and relationship.”
He said any MAID protocols for people with substance use disorders should be made with the input of people with lived experiences.
Karen Ward, a drug user activist in Vancouver, said she considers the expansion of MAID to include people with substance use disorders a “statement in federal law that some people aren't really human.”
“The government has made death accessible while a better life remains impossible,” she said. “Homes for all, guaranteed dignified incomes, access to healthcare, education and employment: these aren't radical demands.”
While there have been fears around a massive influx of people wanting MAID assessments once the new regulations kick in, Martell said if triaged properly he expects the number of people to qualify to be relatively low. | Health Policy |
By Cassie Larkin, as told to Stephanie Watson
Treating our son, Kyan, for atopic dermatitis (eczema) has been a long haul. He was about 6 weeks old when we first noticed that he was breaking out in rashes. That was in May or June of 2013. We just figured he was sensitive to the heat.
Kyan was a pretty fussy baby. We tried switching him to different formulas, but his skin wasnât getting any better. Between the fussiness and the rashes, we had him tested. Thatâs when he was diagnosed with eczema.
I had eczema as a baby, but I grew out of it pretty quickly. By age 2 or 3, my skin had cleared. That wasnât the case for Kyan.
By age 2, his skin was just getting worse. The eczema was everywhere. We tried every cream, every lotion, every ointment. We put him in cotton pajamas and gloves. We rubbed oil onto his head to soothe his itchy scalp.
The pediatrician who was handling his care kept telling us, âThis is normal. We have a lot of kids with eczema. Just try these lotions.â But the lotions werenât touching the eczema and it wasnât going away. It was constant.
It Takes a Little Piece of You
As a parent, your job is to take care of your children and try to make them feel better when theyâre sick. When you canât make them feel better, it takes a little piece of you.
Watching Kyan suffer took a big piece of me. His skin was open and cracked. He had to be hospitalized for staph infections. We bathed him in diluted bleach, which burned his skin so much that he would scream and cry, but it was the only way to stop the infections.
Our daily eczema routine was 2½ hours long. At bedtime, we would bathe Kyan, then apply ointment all over his body to keep the inflammation down, and then put lotion on to seal in that moisture. Finally, we'd dress him in wet pajamas to soothe his skin enough so that he could sleep. Our morning routine was almost as long.
We tried a variety of medications, including the immune-suppressing drug methotrexate, which basically crashed Kyan's damaged immune system to try to rebuild it. Every other week we had to get blood draws to see if the drug was damaging his kidneys and liver. We basically had to keep him in a bubble to prevent him from getting an infection.
Relentless
Eczema was affecting every part of Kyanâs life. His hands were so inflamed and cracked that he couldn't hold a pencil or bend his fingers to write in school. And he was so itchy and uncomfortable that he couldn't pay attention in class. His teachers thought he might have autism or ADHD because he couldn't focus, but he couldn't focus because he was so uncomfortable.
Kyan suffered not only physically, but also emotionally. The kids teased him. They didn't understand why he wore gloves to school. They didn't get why his face was so blotchy. His teachers noticed the dead skin cells on his head and the way he'd scratch at his scalp and they kept flagging him for lice, which made the teasing even worse. Many times he would come home from school crying.
The eczema was relentless. It wasn't stopping and it wasn't getting better. I knew I had to be an advocate for my child. What we had tried so far wasn't working.
We were referred to pediatric dermatologist Sheilagh Maguiness, MD, at M Health Fairview in Minneapolis. I just broke down in Dr. Maguiness's office. I said, "I can't do this anymore."
New Hope
When dupilumab (Dupixent) first came on the market, I remember Dr. Maguiness saying, "We need to get Kyan on this drug."
The trouble is, dupilumab is expensive -- about $3,000 an injection. We battled for 2 years with our insurance company, which wouldn't cover the cost because the drug wasn't approved yet for Kyan's age group. Then in 2020, finally dupilumab was approved and we were able to get our insurance company to pay for it.
The medication has been huge for Kyan. We saw results within 3 weeks. There were no more open sores. We stopped needing to do the bleach baths and steroid creams. Within a few months, his skin was clear.
Today, we just give Kyan one shot every 2 weeks. And we apply lotion once a day, at night.
We hadn't realized just how much atopic dermatitis had consumed our lives because it was our normal. Finding relief for Kyan has been huge. It's been shocking how much freedom we have and how much better he feels.
Kyan has progressed so much, both emotionally and educationally, that it's almost unreal. Now he's in second grade. He's excelling in school. He's creating new friendships. He doesn't have to wear gloves or avoid touching certain things. He's like everybody else now. And he has a confidence he didn't have before.
Seeing how much Kyan has blossomed and flourished as a student and as a person has been awe-inspiring. I was finally able to take the pain away. I was finally able to make him OK. That's all you want for your child, to make them feel better.
Our hope is that Kyan will outgrow the allergies and atopic dermatitis at some point in his life. The chances of that aren't the greatest, but we're keeping our fingers crossed. For now, we just want to give other families some hope and help them see there is a light at the end of the tunnel and they aren't alone in the journey to get there.Â
Show Sources
Photo Credit:Â Halfpoint / Getty Images
Cassie Larkin, Royalton, MN. | Drug Discoveries |
The question of why the government diverged from the suggestions of its scientific advisers on key pandemic policies has long been a source of debate. Why did Boris Johnson proudly boast of shaking hands “with everybody” at a hospital with known coronavirus patients on the same day in early March 2020 when the Scientific Advisory Group for Emergencies (Sage) warned against doing so? Why did the government fail to take action in the autumn of 2020, when cases were rising and Sage recommended a circuit-breaker lockdown? Why were primary schoolchildren sent back to mix in the classroom for just a single day in January 2021? Could it be that ministers simply didn’t understand the science? The recent leak of 100,000 WhatsApp messages has shed some light on the issue.
One conversation emerging from the leak, between Johnson, his chief political adviser, Dominic Cummings, and his scientific advisers, presents a particularly egregious example of scientific illiteracy.
After reading a Financial Times article, Johnson mistakes a case fatality ratio (CFR, the number of people who die of Covid-19 divided by the number of people who test positive) of 0.04, or equivalently 4%, for one of 0.04%, or 0.0004 – a hundred times smaller. His subsequent calculations leave him baffled as to why the UK has already experienced more deaths than his incorrect figure would suggest – even if everyone in the country were to be infected. The chief scientific adviser, Patrick Vallance, patiently explains the difference “It seems that the FT figure is 0.04 (ie 4% not 0.04%)”, to which Johnson replies: “Eh? So what is 0.04 if it is not a percentage?”
While it is clear that Johnson is conversing informally with his advisers in private, the case fatality ratio he plugs into his calculation is the wrong number to use to work out the expected number of deaths. Instead we need the infection fatality ratio – the number of people who die divided by the number of infections. Since the true number of infection is usually far larger than the number of people who test positive (especially at the beginning of the pandemic when testing was scarcer), the CFR tends to overestimate the IFR. At first glance the difference is subtle, and failure to spot it might be forgivable in someone naive to these sorts of discussions, but this was August 2020. That the prime minister was still making these sorts of mistakes is indicative of his lack of engagement with the relevant science.
In another of the WhatsApp exchanges, Johnson posts a Spectator article suggesting that herd immunity might provide the way out of the pandemic for the UK. England’s chief medical officer, Chris Whitty, quickly refutes this piece, explaining that it’s not clear that infection provides the long-lasting immunity that would be required for herd immunity.
Johnson persists by suggesting that those over 65 could be offered a choice between shielding or living with the risk of being infected with Covid-19. To back up his assertion he claims, “If you are over 65 your risk of dying from Covid is probably as big as your risk of falling down stairs. And we don’t stop older people from using stairs.”
His made-up statistic is illustrative of Johnson’s complete misunderstanding of the level of risk posed by Covid-19 to elderly people. The five-year average death rate for people aged over 65 falling down the stairs is just under 550 a year. More than 60,000 people aged over 65 died of Covid-19 in 2020 in England and Wales alone, despite the interventions that were taken.
Again, Whitty has to step in to explain the fundamental impossibility of keeping older, more vulnerable individuals completely isolated from infectious individuals: “Most of those who die in that situation will not have chosen to take the risk.” Despite his scientific advisers’ reminders that attempting to achieve herd immunity had not been a successful strategy during the first wave of the pandemic and would have probably led to the overwhelming of the NHS, the idea seems to have lodged in Johnson’s head.
In September 2020, Sage suggested a two-week “circuit breaker” lockdown to save lives and potentially prevent economically damaging longer restrictions later on. Instead, Johnson invited three fringe scientists to speak at Downing Street – one of whom was a proponent of the widely debunked Great Barrington Declaration, which advocated Johnson’s pet policy of shielding vulnerable people to achieve herd immunity. As a result, the proposed mitigations were tabled for more than a month. Despite the introduction of a tier system, cases rose until a lockdown was inevitably introduced in England in early November.
We saw the first hard evidence of Johnson’s scientific frailties in WhatsApp messages from around this time leaked by Dominic Cummings. In the messages, Johnson notes (perhaps as his idea of a joke) that the average age of death with Covid-19 is above life expectancy and concludes: “So get Covid and live longer.” But life expectancy increases as you age. The typically quoted mean figures of 79 for men and 83 for women are life expectancies “from birth”. Once you make it to 80, you expect to live another nine or 10 years. People who died from Covid-19 lost about a decade of life on average. Perhaps most alarming is that Johnson bafflingly suggests a causal relationship between dying of Covid-19 and living longer. How could that possibly work?
The previously private scientific blunderings of our former PM demonstrate similar ineptitude to those very public missteps of his US counterpart, Donald Trump, who suggested that injecting patients with disinfectants might help treat coronavirus. But it could have been a very different story.
Germany, for example, went into the pandemic with a detailed national pandemic plan. Its politicians understood, from the beginning, the importance of ramping up testing capacity and of containing cases of the disease. You only need look Angela Merkel – a scientifically literate leader who was able not just to understand but to explain the intricacies of relevant scientific principles to her people – to see how different it could have been.
Kit Yates is director of the Centre for Mathematical Biology at the University of Bath and author of The Maths of Life and Death | Epidemics & Outbreaks |
Patients with Lou Gehrig's disease are angry about the possibility that the first new promising treatment in five years could be kept from them despite clinical evidence pointing to its benefits. The treatment from Amylyx Pharmaceuticals, AMX0035, consists of two medications that are already widely used for other reasons but together could prolong ALS patients’ lives and slow the decline in their abilities to function. But the Food and Drug Administration’s panel of outside advisers voted narrowly in March to turn down Amylyx’s application for approval, citing concerns with the way researchers interpreted the data and the need for more robust clinical evidence from an additional, larger trial. While the agency’s regulators are not obligated to abide by the committee’s vote, it often portends which way regulators are leaning. Patients and advocates were disheartened at the outcome of the Peripheral and Central Nervous System Drugs Advisory Committee vote, which was 6-4 in the negative. “For us and for most people with ALS, it's hard to provide a rationale for not approving the drug,” said Dr. Neil Thakur, chief mission officer at the ALS Association. “There were criticisms of that study, and I don't think you could find anything like a perfect study anywhere. Yes, we would like more data. But the question is, what do we do for people now?” Patients and advocates have launched an impassioned campaign for the treatment’s approval. The ALS Association, whose proceeds from the ice bucket challenge helped finance Amylyx’s research, led a group of 38 clinicians in a written plea last month for the FDA to approve the medication swiftly. In September, the organization launched a petition pressuring the FDA and Amylyx to work together to expedite the approval process. The petition was signed by about 43,000 people from across the ALS community, including patients, caretakers, people who have lost loved ones to ALS, and researchers searching for treatments and a cure. The Amylyx trial was made up of 137 people who had the degenerative nervous system disorder, a sample size that the FDA deemed too small. But advocacy groups such as the ALS Association argue that because ALS affects about five people per 100,000, the sample size is actually acceptable relative to other studies like the one from Amylyx. Most studies into other health conditions, such as heart disease, which affects many more people than ALS does, would include more people in their sample. The study used a common clinical metric for gauging people's ability to walk, talk, feed, and dress themselves, known as the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale. Each function is scored from 4 (normal ability) to 0 (no ability) with a maximum total score of 48 and a minimum total score of 0. People in the study who received the treatment were found to have lost fewer points over the six-month time period. They were also able to survive about 6 1/2 months longer than those who took a placebo. The FDA was set to make a decision on June 29, but that date was pushed back three months to give the agency more time to review additional analyses of data from Amylyx’s clinical studies. The delay means not only that patients will have to wait until the fall to find out if they have another treatment option. Many patients alive now will not survive until then. ALS is relentlessly progressive, gradually eroding all voluntary muscle abilities, strength, and the capacity to speak, eat, move, and breathe over a span of three to five years. “Our overarching feeling is in ALS we have to move fast,” said Justin Klee, Amylyx's co-founder and co-CEO. “While it's an encouraging time, FDA is engaged, an additional three months can literally mean life and death for people with ALS. So it means we just have to constantly make sure we're moving fast.” The drug combination was deemed safe in the trial, and given the dearth of medications for ALS, patients and patient advocates say the benefits of the medication far outweigh the risks of taking it. “There really is a trade-off between approving a drug that may not have a benefit versus the downside of waiting to confirm that a drug actually does have a benefit,” Thakur said. “Everyone we’ve spoken to with ALS and almost all of the ALS clinicians we've spoken to said the same thing — that [they] would rather take the drug with a risk of no benefit than wait a few years to find out that there was a benefit that we didn't get.” | Drug Discoveries |
Schizophrenia is a severe neuropsychiatric disease that remains poorly understood and treated. Schizophrenia onset is typically in adolescence or early adulthood, but its underlying causes are thought to involve neurodevelopmental abnormalities. Because human prenatal and postnatal brain tissue is exceedingly difficult to procure and therefore study, researchers have had limited opportunities to identify early disease mechanisms, especially during the critical prenatal period. Now, a pair of studies that appear in Biological Psychiatry, published by Elsevier, use new technology to study schizophrenia in models of early human brain development.
The first study used a unique approach involving three-dimensional brain organoids, which are known to recapitulate fetal brain development. The researchers, led by first author Ibrahim A. Akkouh, PhD, and senior author Srdjan Djurovic, PhD, both at Oslo University Hospital, collected skin cells from 14 patients with schizophrenia and 14 healthy controls and generated induced pluripotent stem cells (iPSCs), which they then manipulated to develop into brain-like cortical spheroids.
The organoids grown from patients and controls differed in their expression of thousands of genes -- in line with the finding that the genetic influences on schizophrenia are many and very small. However, among the genes, those associated with neuronal axons stood out as a group.
Dr. Akkouh explained, "We identified persistent axonal dysregulation as an early contribution to disease risk."
Importantly, the researchers assessed organoid maturation at several time points, which enabled them to establish the persistent nature of the disturbances throughout development.
Dr. Akkouh added, "Our findings provide novel and hitherto inaccessible insights into the molecular basis of schizophrenia during early brain development."
In the second study, researchers led by Roy H. Perlis, PhD, at Harvard Medical School, focused on a particular genetic risk locus. The schizophrenia risk locus 15q11.2, a particular chromosomal region containing four genes, has a penetrance of over 10%, translating to a doubling of risk for schizophrenia among people carrying an unusual copy number of this genetic region. One gene in the locus, CYFIP1, has been associated with synaptic function in neurons and confers increased risk for neurodevelopmental disorders including schizophrenia and autism.
CYFIP1 is highly expressed in microglia, the brain's own immune cells, but its function there is unknown. Microglia are known to carry out synaptic pruning, in which they "eat" excess synaptic structures, a process critical to healthy brain development.
Dr. Perlis and colleagues collected blood cells from healthy volunteers and isolated iPSCs, which they then manipulated to differentiate into microglia-like cells. The researchers then used CRISPR technology to remove functional CYFIP1 from the cells.
Dr. Perlis said of the work, "Our findings suggest that changes in the behavior and function of microglia due to aberrant CYFIP1 function, such as through coding or copy number variants, could affect microglial processes such as synaptic pruning, homeostatic surveillance, and neuronal maintenance, which are critical for proper brain development and function. This could contribute to CYFIP1-related neurodevelopmental and psychiatric disorders resulting in part from microglia dysfunction. Among the specific disorders linked to variation in CYFIP1 are both autism and schizophrenia."
John Krystal, MD, Editor of Biological Psychiatry, commented, "The biology of schizophrenia is very complex and yet two themes represented by these two studies seem to be very important: the increased rate of elimination of glutamatergic synapses during development, and disturbances in the signaling properties of these glutamate synapses. These two disturbances could perturb circuit function in ways that are critical to development of symptoms and cognitive impairments associated with schizophrenia."
Dr. Perlis added, "More broadly, our findings highlight the importance of looking beyond neurons to understand risk genes. While finding risk loci may be the first step in understanding the role of genes in brain diseases, it's only a first step; figuring out the relevant cell type, and what those genes are doing, is absolutely critical in moving from association to -- we hope -- actual treatments."
Journal Reference:
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New research published in the journal Neurology suggests that brushing your teeth boosts the brain — helping to reduce the risk of dementia.
People with good dental hygiene had more neurons in the hippocampus, the study found; the hippocampus plays a role in memory.
Gum disease and tooth loss were linked with less gray matter and declining mental health.
These findings have clinical implications as regular visits to the dentist may help prevent Alzheimer's, scientists pointed out.
Said lead author Dr. Satoshi Yamaguchi, of Tohoku University in Japan, "Tooth loss and gum disease, which is inflammation of the tissue around the teeth that can cause shrinkage of the gums and loosening of the teeth, are very common," SWNS, the British news service, reported of the findings.
"So evaluating a potential link with dementia is incredibly important," he also said.
"Our study found these conditions may play a role in the health of the brain area that controls thinking and memory — giving people another reason to take better care of their teeth."
Chewing boosts blood and oxygen flow to the head — keeping the brain healthy.
Tooth loss may also lead to unhealthy eating.
For those with mild gum disease, fewer teeth was associated with a faster rate of brain shrinkage in the left hippocampus.
Gum disease is caused by inflammation of tooth-supporting tissues. It affects about one in seven adults.
The study involved 172 Japanese participants whose average age was 67; they did not have memory problems at the outset.
For those with mild gum disease, fewer teeth was associated with a faster rate of brain shrinkage in the left hippocampus — key for remembering words and language.
The same phenomenon was identified in those with severe gum disease and more teeth.
Said Dr. Yamaguchi, "These results highlight the importance of preserving the health of the teeth and not just retaining the teeth. The findings suggest retaining teeth with severe gum disease is associated with brain wasting."
He also said, "Controlling the progression of gum disease through regular dental visits is crucial, and teeth with severe gum disease may need to be extracted and replaced with appropriate prosthetic devices."
In mild and severe gum disease, one less or one more tooth was equivalent to nearly one year and 1.3 years of brain aging, respectively, the study noted.
Participants underwent dental exams and memory tests.
They also had brain scans to measure the volume of the hippocampus at the beginning of the study — and again four years later, as SWNS reported of the results.
For each participant, researchers counted the number of teeth and checked for gum disease by looking at periodontal probing depth, a measurement of the gum tissue.
Healthy readings are from one to three millimeters.
Mild gum disease involves probing depths of three or four mms in several areas, and severe gum disease five or six mms as well as more bone loss.
It can cause teeth to become loose and eventually fall out.
More study needed
Dr. Yamaguchi said future studies are needed with larger groups of people.
Last year an international study of more than a million people found those with poor dental hygiene were 21% more likely to develop Alzheimer’s.
Previous studies linked gum disease to diabetes and cardiovascular illnesses. It can even lead to chronic systemic inflammation.
The new study does not show causation between gum disease or tooth loss and Alzheimer's disease; it only shows an association.
Currently over 55 million people have dementia worldwide, according to the World Health Organization, with over 60% living in low-and middle-income countries. Every year, there are nearly 10 million new cases.
Dementia results from a variety of diseases and injuries that affect the brain, the WHO also notes on its website.
Alzheimer disease is the most common form of dementia and may contribute to 60–70% of cases.
Dementia is right now the seventh leading cause of death and one of the major causes of disability and dependency among older people globally, the WHO says. | Mental Health Treatments |
The number of steps you should walk every day to start seeing benefits to your health is lower than previously thought, according to the largest analysis to investigate this.
The study, published in the European Journal of Preventive Cardiology [1] today (Wednesday), found that walking at least 3967 steps a day started to reduce the risk of dying from any cause, and 2337 steps a day reduced the risk of dying from diseases of the heart and blood vessels (cardiovascular disease).
However, the new analysis of 226,889 people from 17 different studies around the world has shown that the more you walk, the greater the health benefits. The risk of dying from any cause or from cardiovascular disease decreases significantly with every 500 to 1000 extra steps you walk. An increase of 1000 steps a day was associated with a 15% reduction in the risk of dying from any cause, and an increase of 500 steps a day was associated with a 7% reduction in dying from cardiovascular disease.
The researchers, led by Maciej Banach, Professor of Cardiology at the Medical University of Lodz, Poland, and Adjunct Professor at the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, found that even if people walked as many as 20,000 steps a day, the health benefits continued to increase. They have not found an upper limit yet.
“Our study confirms that the more you walk, the better,” says Prof. Banach. “We found that this applied to both men and women, irrespective of age, and irrespective of whether you live in a temperate, sub-tropical or sub-polar region of the world, or a region with a mixture of climates. In addition, our analysis indicates that as little as 4,000 steps a day are needed to significantly reduce deaths from any cause, and even fewer to reduce deaths from cardiovascular disease.”
There is strong evidence that a sedentary lifestyle may contribute to an increase in cardiovascular disease and a shorter life. Studies have shown that insufficient physical activity affects more than a quarter of the world’s population. More women than men (32% versus 23%), and people in higher income countries compared to low-income countries (37% versus 16%) do not undertake a sufficient amount of physical activity. According to World Health Organization data, insufficient physical activity is the fourth most frequent cause of death in the world, with 3.2 million deaths a year related to physical inactivity. The COVID-19 pandemic also resulted in a reduction in physical activity, and activity levels have not recovered two years on from it.
Dr Ibadete Bytyçi from the University Clinical Centre of Kosovo, Pristina, Kosovo, senior author of the paper, says: “Until now, it’s not been clear what is the optimal number of steps, both in terms of the cut-off points over which we can start to see health benefits, and the upper limit, if any, and the role this plays in people’s health. However, I should emphasise that there were limited data available on step counts up to 20,000 a day, and so these results need to be confirmed in larger groups of people.”
This meta-analysis is the first not only to assess the effect of walking up to 20,000 steps a day, but also to look at whether there are any differences depending on age, sex or where in the world people live.
The studies analysed by the researchers followed up participants for a median (average) of seven years. The mean (average) age was 64, and 49% of participants were female.
In people aged 60 years or older, the size of the reduction in risk of death was smaller than that seen in people aged younger than 60 years. In the older adults, there was a 42% reduction in risk seen in those who walked between 6,000 and 10,000 steps a day, while there was a 49% reduction in risk in younger adults who walked between 7,000 and 13,000 steps a day.
Prof. Banach says: “In a world where we have more and more advanced drugs to target specific conditions such as cardiovascular disease, I believe we should always emphasise that lifestyle changes, including diet and exercise, which was a main hero of our analysis, might be at least as, or even more effective in reducing cardiovascular risk and prolonging lives. We still need good studies to investigate whether these benefits may exist for intensive types of exertion, such as marathon running and iron man challenges, and in different populations of different ages, and with different associated health problems. However, it seems that, as with pharmacological treatments, we should always think about personalising lifestyle changes.”
Strengths of the meta-analysis include its size and that it was not restricted to looking at studies limited to a maximum of 16,000 steps a day. Limitations include that it was an observational study and so cannot prove that increased step counts cause the reduction in the risk of death, only that it is associated with it. The impact of step counts was not tested on people with different diseases; all the participants were generally healthy when they entered the studies analysed. The researchers were not able to account for differences in race and socioeconomic status, and the methods for counting steps were not identical in all the studies included in this meta-analysis.
(ends)
[1] “The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis”, by Maciej Banach et al. European Journal of Preventive Cardiology. doi:10.1093/eurjpc/zwad229
Journal
European Journal of Preventive Cardiology
Method of Research
Observational study
Subject of Research
People
Article Title
The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis
Article Publication Date
9-Aug-2023
COI Statement
M.B.: speakers bureau: Amgen, Daiichi Sankyo, Kogen, KRKA, Polpharma, Novartis, Novo-Nordisk, Sanofi-Aventis, Teva, Viatris, Zentiva; consultant to Amgen, Daiichi Sankyo, Esperion, Freia Pharmaceuticals, NewAmsterdam, Novartis, Novo-Nordisk, Polfarmex, Sanofi-Aventis; Grants from Amgen, Daiichi Sankyo, Sanofi, Valeant, and Viatris, CMDO at Longevity Group; CMO at Nomi Biotech Corporation; P.E.P. owns four shares in AstraZeneca PLC and has received honoraria and/or travel reimbursement for events sponsored by AKCEA, Amgen, AMRYT, Link Medical, Mylan, Napp, Sanofi. S.S.M. has received research support from Apple, Google, and iHealth, all companies that sell devices that measure step counts. All other authors report no competing interests. | Stress and Wellness |
Surgeons have performed the first womb transplant in the UK, it has been announced. The 34-year-old recipient received her sister’s uterus in an operation in February at Churchill hospital in Oxford that took nine hours and 20 minutes.
We look at some other major transplant breakthroughs over the years – and consider what the future may hold.
Heart and lungs
The first successful human heart transplant took place in Cape Town in South Africa in 1967. It was performed by the surgeon Christiaan Barnard on the patient Louis Washkansky, who died of pneumonia 18 days later.
In the UK, the first successful heart transplant took place in 1979 at the Royal Papworth hospital in Cambridge. The operation was performed by Sir Terence English on 52-year-old Keith Castle. Castle, who at the time of the operation was seriously ill, went on to live another five years.
Transplant surgery went from strength to strength and in 1983 the first combined heart and lung transplant was performed by Sir Magdi Yacoub at Harefield hospital. The Swedish journalist Lars Ljungberg underwent the transplant, receiving the organs of a woman from the south of England who had died the previous day.
Ljungberg survived for 13 days after the operation. The hospital said the heart and lungs he had been given had worked well and had not been rejected, but that he had died as a result of his pre-operation condition.
Face
In 2005, Isabelle Dinoire had the world’s first partial face transplant after her dog mauled her face while she was passed out having overdosed on sleeping pills. The surgery was performed by Prof Bernard Devauchelle at a hospital in France using using tissue from a brain-dead woman in a 15-hour operation at Amiens Picardie hospital.
For months before the transplant, Dinoire had said that she had “the face of a monster”. She had no mouth and her teeth and gums were exposed, skull-like, in a “reminder of death”. Most of her nose was missing. But she said she had no hatred for her dog Tanya, who she felt had been trying to save her.
Since Dinoire’s partial face transplant, more than 40 people worldwide have had similar surgery.
Hands
The first hand transplant took place in September 1998 in Lyon, France. A team of surgeons led by Jean-Michel Dubernard transplanted the right arm of a brain-dead donor on to Clint Hallam.
Although the 13-hour surgery was successful, Hallam was unable to psychologically cope with the new hand and stopped taking medication to prevent his body rejecting it. In 2001 the hand was amputated. Since then, more than 150 hand or upper limb transplants have been performed across the world.
The NHS performed the world’s first double hand transplant on Steven Gallagher after he was left unable to use his hands due to the condition scleroderma. Gallagher spent about four weeks in Leeds general infirmary after the operation in December 2021.
Sternum
In 2021 the first sternum transplant in the UK took place at the John Radcliffe hospital in Oxford. The procedure replaced the cancerous sternum of 34-year-old Nathalie Brett, who was diagnosed with stage four breast cancer when she was 24, with a healthy one from a deceased donor.
According to NHS Blood and Transplant, it is believed to be the first time surgery like this had been done in the UK, being a version of an operation that was carried out in Italy.
Possible future innovations
In 2019 Bruce Matthew, a former clinical lead for neurosurgery at Hull University teaching hospitals NHS trust, said the world’s first human head transplant could be achieved by 2030.
In an interview with the Telegraph, Matthew said: “It will take a number of advancements and incremental steps but it will probably happen in the next 10 years.”
Researchers are also looking into the possibility of synthetic organ transplants, using organs produced with 3D bioprinting. In 2011, a synthetic windpipe made from nanocomposite materials was transplanted into a patient whose own windpipe was damaged by cancer.
In 2021, surgeons in New York announced they had successfully transplanted a kidney grown in a genetically altered pig into a brain-dead human patient and found that the organ worked normally. The surgery was seen as a breakthrough in the field of cross-species organ transplants that could eventually help save lives. | Medical Innovations |
BERLIN, Aug 16 (Reuters) - Germany's cabinet passed a contentious bill on Wednesday to legalize recreational marijuana use and cultivation, one of the most liberal cannabis laws in Europe that could potentially provide further momentum for a similar worldwide trend.
The legislation, which still has to pass parliament, would allow adults to possess up to 25 grams (0.88 oz) of the drug, grow a maximum of three plants, or acquire weed as associates of non-profit cannabis clubs.
The centre-left government of Chancellor Olaf Scholz hopes the law will curb the black market, protect consumers against contaminated marijuana and reduce drug-related crime.
A key pillar of the plan, which removes the taboo around cannabis use, is also a campaign to raise awareness about the risks, which should ultimately curb consumption, said Health Minister Karl Lauterbach, of Scholz's Social Democrats (SPD).
Such a campaign would not gain the same level of attention if it were introduced without a change in the law, he said.
"With the current procedures we could not seriously protect children and young people, the topic has been made a taboo," Lauterbach told a news conference in Berlin to present the law.
"We have rising, problematic consumption, we couldn't simply allow this to go on," he said. "So this is an important turning point in our drug policy."
The number of adults in Germany aged between 18 and 25 years old that consumed cannabis at least once nearly doubled in 2021 from the previous decade to 25%, according to the health ministry.
Young adults are considered more vulnerable to the health risks of cannabis. The new legislation will limit the amount of cannabis young adults can buy to 30 grams a month, compared to 50 grams for older adults.
CRITICISM FROM BOTH SIDES
Opposition to the legislation is fierce, with conservative policymakers in particular warning that it will encourage marijuana use and that the new legislation will create even more work for authorities.
"This law will be linked to a complete loss of control," Armin Schuster, conservative interior minister for the state of Saxony, told media group RND.
A U.N. narcotics watchdog said in March moves by governments to legalize the recreational use of marijuana have led to increased consumption and cannabis-related health problems.
Lauterbach said Germany had learned from other countries' mistakes, however.
Scholz's government had already watered down original plans to allow the widespread sale of cannabis in licensed shops after consultations with Brussels.
Instead, it said would launch a pilot project for a small number of licensed shops in some regions to test the effects of a commercial supply chain of recreational cannabis over five years. For that, it will need to present separate legislation in a second phase.
Similar such projects already exist or are planned in the Netherlands and Switzerland.
Many countries in Europe have already legalised cannabis for limited medicinal purposes, including Germany since 2017. Others have decriminalized its general use.
Malta became the first European country to allow limited cultivation and possession of cannabis for personal use in late 2021. Germany would become the first major European country to do so.
The legislation presented on Wednesday includes strict rules for growing weed - cannabis clubs of up to 500 associates must have burglar-proof doors and windows, with greenhouses fenced off. Associates will not be allowed to smoke weed at the clubs or in the vicinity of schools, nurseries, playgrounds or sports grounds.
Germany's hemp association said the rules were "unrealistic" and the black market could only truly be fought with the introduction of cannabis sales in shops.
The parliamentary drug policy spokesperson of junior coalition partner the Free Democrats, Kristine Luetke, accused Lauterbach of continuing a "prohibition policy" and creating a "bureaucratic monster".
Reporting by Sarah Marsh and Andreas Rinke; Editing by Angus MacSwan and Bernadette Baum
Our Standards: The Thomson Reuters Trust Principles. | Health Policy |
NHS ambulance trusts in England are struggling with high staff turnover as key workers leave the crisis-hit service for less stressful or better paid work, according to figures obtained by the Observer.
Data sourced under the Freedom of Information Act reveals the backdrop to recent ambulance strikes, with sickness rates above pre-pandemic levels and low levels of staff retention. Ambulance services in southern England are particularly struggling. Staff turnover rates at South Central ambulance service (SCAS) are soaring at 20% – meaning one in five staff members leave over the course of a year.
The turnover rate for advanced paramedics is 20%, rising to more than 40% for dispatchers, 55% for assistant dispatchers, and 80% for emergency call-takers and NHS 111 healthcare advisers. Sickness absence rates are also higher thanbefore the pandemic.
South Western ambulance service (SWAS) has among the longest emergency response times in England. Hospital handover delays mean a third of 999 calls to the trust are repeat calls from patients or carers asking when an ambulance will come.
During 2022, monthly sickness absence rates at SWAS regularly rose above 10% in certain staff roles – and were often well over 20% among staff on the clinical support desk. Staff turnover over 12 months was up to 30% for clinical support desk staff and above 50% among emergency medical dispatchers – both of them pressurised roles.
High turnover makes it harder to increase staff levels, diluting the effect of recruitment drives. A spokesperson for SWAS said the trust was seeing improved retention rates among Emergency Operations Centres (EOC) staff, who receive 999 calls: “This focus and effort is particularly important within our EOC because of the continued and extensive pressure that has been placed on the service since the beginning of the pandemic, which has inevitably impacted on our sickness and turnover rates.”
Ambulance workers have gone on strike over pay in recent months, with members of the GMB trade union among those currently voting on a pay offer. Rachel Harrison, GMB national secretary, said: “Ambulance workers do an incredibly important job, but it is no surprise that the stress they face has increased since the pandemic.
“Even at the best of times this is a physically and mentally demanding job. And after 13 years of Conservative mismanagement, the NHS is at breaking point. Workforce numbers haven’t kept pace with sharply rising demand. Fewer staff are having to cover more – all as delays and backlogs in the system make their jobs harder.
“The absences caused by staff shortages and overwork are already contributing to potential delays in attending incidents. It’s time paramedics and other ambulance staff workers got the support they deserve.”
The effect of high staff turnover is visible in the South East Coast ambulance service. Trust board papers suggest that high turnover is part of why it is failing to employ enough staff in 999 frontline positions. It also contributes to the poor performance of its NHS 111 service. The 12-month turnover rate in EOC roles reached 40% in December. A spokesperson said the service was committed to increasing recruitment and retention levels.
A Department of Health and Social Care spokesperson said: “We know that if we are to build a stronger NHS it is vital to have the workforce to support it – and their health and wellbeing is of paramount importance.
“The NHS is providing mental health support for staff, including targeted psychological support and treatment and a national service for those with more complex mental health needs.
“To ease the pressures on healthcare staff, the NHS will soon publish a long-term workforce plan to support and grow the workforce.” | Health Policy |
We have only furtively shot videos and eyewitness testimony.
Iranian authorities allow very few journalists into their country so we cannot investigate or verify. But what is going on in Iran's schools is deeply sinister and worrying.
In one school after another since November students have been victims of what appear to be gas attacks. What kind of gas and the way it is disseminated is impossible to say. Students report the smell of eggs and citrus fruit before becoming overpowered. Some pass out, others are dizzy and nauseous, and many need to go to hospital.
Sky has been handed an interview with one schoolgirl in the Kurdish region of northwest Iran. She described the terrifying moment her classmates realised their school had been targeted.
"The gas attack started from the upper floor and more than half of the 9th graders fell sick and then gradually it spread to the lower floors and they did not let us leave until school time was over, the gas was still there but they did not let us go home."
Making matters worse it seems school authorities and the government have tried to cover up the attacks after they have been carried out.
"A few of us told the principal that our friends are sick and they are in a bad state. But they said you are just acting and lying and nothing has happened to you. Then our own friends called the emergency services and three ambulances arrived and they said it is true what the pupils say."
Sky was passed the interview by a human rights group operating in Iran. It also provided an interview with a mother of a nine-year-old caught in another alleged attack also in the northwest of the country.
"The children and teachers were struggling to get out of the class our eyes were burning, we felt that our faces were burning, the children were all panicking and screaming and pouring into the corridors then the principal called the ambulance and several students and two of the teachers were taken to hospital."
And again how authorities tried to hush it up.
Read more:
Iran's Ayatollah Khamenei says culprits in suspected schoolgirl poisonings should be executed
Iran: Protests break out over suspected poisoning of schoolgirls
"The security forces arrived at the school and ordered the personnel and the teachers not to talk about the attack and should say the smell of the gas and the poisoning of the students was because of a burst in the central heating pipes if someone asked."
The country's supreme leader Ayatollah Khamenei has condemned the attacks as unforgivable. But that will leave many unconvinced.
Iran is one of the most tightly controlled countries in the world. Multifarious security agencies maintain a firm grip on society. It is hard to believe that a nationwide campaign of gas attacks on schools has happened without the knowledge of at least some in the government.
Some have claimed the attacks are the work of religious extremists. Militants were blamed for similar attacks in neighbouring Afghanistan. But it seems inconceivable for that to happen on such a large scale below the radar of regime surveillance in a country like Iran.
We can only speculate. Factions in the government may be exacting revenge on schoolgirls who have taken a prominent role in the unrest that has rocked the country for months now.
The government may be trying to shut down schools that have been much of the focus of much of the discontent. Or it may be trying to heighten a sense of terror hoping that too will crush the spirit of discontent.
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Iran was already gripped by fear in the wake of months of repression and unrest. Thousands have reportedly been arrested, tortured and disappeared. Their government has lost all credibility in the eyes of millions but has used brute force to maintain its trip on power.
Iranians must now cope with what appears to be a concerted effort to poison their children. | Epidemics & Outbreaks |
The care minister, Helen Whately, has declined to back Matt Hancock’s claim that the government threw a “protective ring around care homes” at the start of the pandemic.
Whately worked under the former health secretary in the first 18 months of Covid, but she avoided endorsing her former boss’s assertion, which will be tested at the public inquiry which starts in earnest this week.
Asked whether Hancock was right in May 2020 when he told parliament “we absolutely did throw a protective ring around social care”, Whately told the Guardian she wanted to “use my own words which is that I look back on doing everything I felt that we could to help care homes and social care more broadly at an incredibly difficult time”.
In the first wave of the pandemic there were almost 27,000 “excess deaths” in care homes in England and Wales compared with the 2015–19 average. The virus penetrated care homes so widely and spread so fast that 13 homes in England saw two dozen or more Covid deaths each in just 11 weeks at the start of the pandemic, official figures have revealed.
Evidence sessions examining the UK’s preparedness for the pandemic start this week and Hancock, who resigned from the government in June 2021 after breaking lockdown rules, is due to give evidence this month.
Lawyers for trade unions are expected to highlight the chronic underfunding of social care and its fragmented provision in an opening statement to the inquiry this week. Government policy at the start of the pandemic of not requiring the isolation of untested hospital patients discharged into care homes has already been ruled illegal in the high court, where judges described it as “irrational”.
“I look back on it, how hard it was at that time when we were trying to get PPE out to social care,” Whately said. “We had so few tests available.”
She added: “I know looking back on it, it was very hard in the early days … We were really doing all that we possibly could. Still, it was really hard because people who were living in care homes were particularly vulnerable to Covid, as we know.”
Labour’s Liz Kendall, the shadow care minister, seized on the comments as an admission by the Conservatives of “what the country could see: their ‘protective ring’ was an insult to the staff, families and care home residents who were not only vulnerable but voiceless”.
She said: “For the 43,000 families mourning the loss of a care home resident, nothing will bring their loved one back. But they will be looking to the inquiry for answers and lessons to be learned.”
Leaked WhatsApp messages have already revealed Whately warned Hancock against restricting visits to care homes in October 2020 saying it would be “inhumane” and some elderly people were “just giving up”. Earlier, on 8 April 2020 she urged Hancock: “We should be testing all care home residents and staff who have had Covid contact, irrespective of symptoms.”
However, care homes were not able to start testing residents or staff without symptoms until the end of April. She also complained to Hancock that PPE supplies were “all over the place” and that discharging hospital patients into care homes was “my biggest concern”.
The chancellor, Jeremy Hunt, who preceded Hancock as health secretary, has also been called as a witness in the module starting this week on pandemic preparedness, alongside David Cameron and George Osborne, who are set to be asked about the impact of their austerity policies from 2010 onwards on the nation’s readiness.
The module on care homes is not due to start hearing from witnesses until spring 2025.
Broader government handling of social care, which looks after over a million people in England, has been widely criticised.
It is estimated that an extra 480,000 care workers are needed in England by 2035 and there are already 165,000 vacancies. In 2020 when Hunt was out of government under Boris Johnson and chaired the Commons health and social care select committee, he said the annual social care budget must rise by £7bn by the end of 2024. The Health Foundation charity estimates the funding gap will be £9.3bn by next year but last autumn the government raised spending by equivalent to £3.75bn a year.
Whately told the Guardian there had been “big, big workforce challenges” over “many years”.
“The thing that I hear from the frontline is we need to be able to pay the care workforce better,” she said. “And for that, we need better funding to come through from local authorities for the care rates.”
Asked if the latest £7.5bn increase in central government funding over two years was the right amount, she said: “I want to see social care really well funded, but I’m not making the decisions for how all of government is funded. I will argue the corner for my sector.”
Today in England about 10,000 people live in the worst inadequate care homes, where problems are often caused by lack of staff. Asked if she accepted staff shortages were causing pain and suffering, she said: “You’ll understand if I choose my own words, but I know … for some providers, staffing is one of their big challenges. Really good care homes have staff there for a long time but others are finding it really difficult. I think we’ll see quality of care improve if we can help providers retain staff.”
She said increasing recruitment of care staff from overseas by adding them to the shortage occupations visa list was helping in the short term, but it was not a long-term answer.
“I want everyone to be in a good, if not outstanding, care home,” she said. “That is why I think the workforce reforms and the funding for social care are really, really important. But I don’t think anybody sitting in my position could come in and fix it in 24 hours. This is a long-term problem.” | Health Policy |
If anyone asked if I get enough exercise, my answer would be unequivocal: Yes, I make a point of carving out time to sweat, get my heart pumping and move around.
I probably would not mention that I prefer to drive the half mile to pick up my coffee instead of taking a 15-minute walk. Or that using the drive thru sounds infinitely more appealing than actually getting out of my car. Or that you'd rarely spot me choosing to trudge up the stairs at the end of the day.
None of these shortcuts on their own feel like that a big deal. After all, I worked out today, right? But added up these are slowly sapping a sometimes overlooked source of metabolic health.
It's a concept that goes by the name non-exercise activity thermogenesis, or NEAT, for short.
This is essentially all the calories that a person burns through their daily activity excluding purposeful physical exercise. Think of the low-effort movements that you string together over the course of your day – things like household chores, strolling through the grocery aisle, climbing the stairs, bobbing your leg up and down at your desk, or cooking dinner.
"The fact there's so many things in part explains why it's so difficult to study, because how on earth do you measure everything?" says Dr. James Levine, an endocrinologist who pioneered research on NEAT while at the Mayo Clinic and now heads the nonprofit Foundation Ipsen.
But researchers have made progress understanding how NEAT works – and how we can tap into its benefits. They've learned that even small behaviors changes can amplify or diminish how much NEAT you get, and this can shape your health in powerful ways.
They've also found that people of the same size can have dramatically different levels of NEAT, based on factors like their job and where they live, as well as their biological drive to get up and move around.
What's clear is that many of us who live screen-based lives have the capacity to inject more NEAT into our daily rhythms, not necessarily through seismic changes in our lifestyle, but small-scale ones that mostly just require a shift in mindset.
Here's what to know about how NEAT works and how to get more of it.
NEAT fills in the slack in your energy expenditure
Much of our daily energy expenditure is relatively fixed. More than half of those calories goes toward supporting basic bodily functions, what's known as our basal metabolic rate.
"That's for the most part not modifiable," explains Seth Creasy, an exercise physiologist at the University of Colorado Anschutz Medical Campus. "There are some things that can maybe change your basal metabolic rate, but not drastically."
Laura Gao for NPR
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Daily errands like grocery shopping can increase your NEAT.
Laura Gao for NPR
Digesting and metabolizing food takes up another sliver of our daily energy, roughly about 10%, and likewise cannot be changed significantly.
"That leaves the remaining 30% to 40% for all your activity," says Colleen Novak, a neuroscientist whose lab studies NEAT at Kent State University.
That's where NEAT comes in – moving around as you go about your day can chip away at that remaining slice of the energy pie.
And even among those who do exercise regularly, NEAT usually plays a bigger role in calorie burning than working out.
It's not that NEAT should be considered a substitute for more structured bouts of intense physical exercise, which has its own well-established health benefits. But revving up NEAT can be more accessible for some people, especially those who don't exercise as much, if at all.
"Sometimes it's hard to carve out 30 to 60 minutes of your day to do an exercise routine," says Creasy. "These little behaviors can accumulate and end up comprising a lot of energy expenditure."
Common daily activities can increase your NEAT by surprising amounts
Long before the advent of the Apple Watch, Levine began picking apart the energetic costs of daily activities, performing tightly controlled experiments involving body sensors and other technology to understand the implications for metabolic health.
He explains that sitting up as you would at the computer only burns about 5% to 7% more calories than if you were lying down at rest. Fidgeting excessively while seated can bring that up a few percentage points.
"If I then start to move around, let's say ironing or folding up clothes, I can move that to 15%," he says. "But it all changes the moment I start to walk."
Just strolling about one and a half to two miles an hour — the speed people tend to go while shopping — can double your metabolic rate.
All of this starts to give a sense of how seemingly trivial movements, like walking to the corner store, or mowing the lawn, can add up to make a big difference over the course of the day. Even chewing gum can go a surprisingly long way (about 20 calories an hour above your resting metabolic rate, according to Levine's calculations.)
Laura Gao for NPR
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Cooking can burn an estimated 50-100 calories per hour. A nice perk to also getting a tasty meal to enjoy!
Laura Gao for NPR
He offers the all-too-familiar example of coming home from work, sitting down and watching TV for the rest of the night. If that's your entire evening, your NEAT could end up at just 30 calories. Taking up household projects that force you to move around when you get home could alternatively bring up your NEAT by 700 calories or more in the same time frame.
It's a simple idea at its core: Inject mobility — ideally whatever gets you walking around — into what would otherwise default into sitting time.
An internal Apple Watch: Biology may affect our drive toward NEAT
Evidence suggests that some people have a better ability to sense when they take in extra calories and this may set in motion an unconscious drive to move more.
In the 1990s, Levine and his colleagues carried out a now widely cited study examining what happened to 16 lean people who were fed an extra 1,000 calories a day for two months. The found weight gain varied considerably and that levels of NEAT directly predicted how well someone was able to avoid putting on fat.
"People who have the capacity to burn off extra calories and remain thin are people who can switch on their NEAT," Levine says.
Laura Gao for NPR
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Play actively with kids to increase their (and your) NEAT. Sitting playing on a screen barely raises your metabolism over resting rate.
Laura Gao for NPR
Play actively with kids to increase their (and your) NEAT. Sitting playing on a screen barely raises your metabolism over resting rate.
Laura Gao for NPR
The idea that NEAT is naturally dialed up or down in response to how much energy you are taking in hasn't always been replicated in subsequent research, says Cathy Kotz, an integrative biologist and physiologist who studies obesity at the University of Minnesota.
"It's just been a little bit hard to study that compensatory action," she notes, "I would say the jury is still out."
However, evidence from the lab supports the idea that our biology plays a role in NEAT. Kotz is researching a compound in the brain, called orexin, that appears to have a key role in regulating NEAT.
She was studying how it influenced feeding behavior in animals when she noticed that it also was having another effect.
"Through a lot of experiments, we discovered that when we either give the animals more orexin, or we stimulate their orexin neurons in the brain, it causes them to move more," she says.
This may help explain why certain animals in the same setting with the same food, end up gaining weight, while others don't.
In the context of NEAT, Kotz describes the role of orexin as "similar to what our Apple Watch is trying to do – every now and again reminding us, 'hey, you should stand up, you should move around.'"
"Orexin seems to do this naturally," she says.
These kinds of experiments haven't yet been done yet in humans, but the hope, Kotz says, is that a medication could leverage orexin so that it's easier for people to be active. However, that doesn't mean people who have lower orexin "signaling or tone" are destined to be sedentary.
"I think it can be overcome just by being conscious and aware of the fact that you do need to move more," she says.
Novak says increasing NEAT is an "untapped resource" for managing weight, but that it's not effective on its own — that is, absent changes in diet.
Keeping your NEAT levels up has long-term health benefits
It's not all about weight. Being sedentary is associated with a range of health problems independent of obesity, from cardiovascular disease to joint problems to mental health issues.
Keeping yourself moving is all the more important as we age, says Todd Manini, an epidemiologist who researches physical activity and aging at the University of Florida.
In one study, Manini tracked how much energy about 300 older adults expended from physical activity, including exercise, over about two weeks.
This snapshot of their daily energy expenditure helped predict the risk of being alive or dead about seven to 10 years later. For every 287 calories a person burned per day, there was about a 30% lower chance of dying.
"We immediately thought that the people in this higher group would be the all-stars of exercising," says Manini, "But that wasn't the case at all."
It turned out those who were less likely to die didn't exercise more than others, it seemed to be the NEAT in their lives. "They were more likely to have stairs where they live and were more likely to volunteer," he says.
"Those things we don't equate to exercise, but it is movement," he says.
Skip the shortcuts and increase your NEAT
The solutions for maximizing NEAT aren't necessarily sexy (although that, too, can burn quite a few calories), but many of them are relatively easy to take up. They often involve choosing to make slightly more effort, rather than choosing convenience.
Laura Gao for NPR
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You can break up all the sitting that computer work requires by taking calls while standing, which burns 50 to 100 calories per hour. Or pace around the office while you talk, which burns even more.
Laura Gao for NPR
Unfortunately, our natural impulses to move can be in direct conflict with the environment around us. Many people sit at screens to do their work, their personal errands like banking and shopping, and for their leisure time.
For those with office jobs, work exerts an especially powerful influence over our NEAT. "If your brain is sharing signals to move and you have a job that ties you to the chair, it's unnatural and you don't move," says Levine.
NEAT varies greatly across societies and occupations. Research shows there can be as much as a 2,000-calorie difference between people of the same body size, depending on how physically active their occupation is.
"People who are living in agricultural communities are literally moving three times more than even lean or overweight people in North America, just in the environments in which they live," he says.
Novak likes to use the example of her own grandparents when describing the two ends of the NEAT spectrum.
"One lived on a farm and was constantly out doing things, digging out weeds. You just couldn't have them sit down," she says. "The other grandparent just preferred to chill and talk to us."
Estimates show that someone who has to sit down for work might burn 700 calories per day through NEAT; a job that involves standing all day would be twice that.
Since jobs take up so much time, it's a smart place to try to increase NEAT.
Try standing desks, walking during meetings, or if you work from home, try breaking up the work day with household chores.
Levine's personal NEAT trick: Instead of hunting for the closest parking spot, he finds one farther away and walks 20 minutes.
"Then I walk back at the end of the day and take my car and go home," he says. "That's a 40 minute walk, 100 calories for free!"
Outside of work, mundane tasks like vacuuming, doing the laundry or gardening can burn a few hundred calories in an hour. Playing a video game can go from about 50 calories an hour to more than 100 if you move around. Taking the stairs can more than triple the amount of energy you'd use when riding the elevator. Even watching TV can be transformed if you walk around during commercials.
"I was surprised that making your bed actually expends more calories than other activities that you might think of, like taking a slow walk," says Manini.
Worth noting: Manini says the calorie estimates in popular wearable devices can measure walking pretty well, but they aren't all that accurate at gauging other lifestyle activities.
Ultimately, the key is to root out the shortcuts that hamper our natural impulses to move.
"The power of NEAT is that it's available to absolutely everybody," Levine says. "We can all do it and we can all do a little bit more."
This story was edited for broadcast by Jane Greenhalgh and for web by Carmel Wroth. Illustrations by Laura Gao. Art production by Pierre Kattar. | Aerobics & Cardio |
About one million people in England are on more than one waiting list for treatment, it has been revealed for the first time, as the NHS backlog hits a new record high.
There were 7.77 million waits for non-emergency care at the end of September - up from 7.75 million in August.
But analysis by NHS England has found that includes many people who are waiting for more than one treatment.
Most are on two or three waiting lists, but some will be on up to five.
Many will be elderly people waiting for a variety of non-emergency treatments, including everything from knee and hip replacements to those who may need drug therapies or physio.
The fresh insight has been provided after NHS England drilled down into the figures by using patients' unique NHS numbers.
It showed the backlog of 7.77 million waits involved an estimated 6.5 million patients - around 1 million of whom were waiting for more than one treatment.
The waiting list is now nearly 3.5 million higher than it was before the pandemic.
'Deep frustration'
It has continued rising this year despite the prime minister's pledge to cut down waiting lists.
However, progress has been made on tackling the longest waits of more than 18 months.
Rishi Sunak has blamed strikes for the lack of progress.
The continued industrial action is estimated to have cost the NHS £1bn in this financial year in paying premium rates to staff to cover shifts, and in planning and preparing for walkouts.
The ones by doctors have proved to be the most disruptive - and still remain unresolved, although talks are under way between the government and the British Medical Association.
The NHS had asked for extra funding to cover the cost of strikes.
But this week it emerged its plea had been rejected, with the Treasury only agreeing to an extra £100m.
Instead, the NHS has been told it will have to use £200m of winter money and raid other budgets, including those originally earmarked for IT and maintenance, to tackle the backlog.
In return, the target for the amount of treatments the NHS is expected to have carried out has been relaxed - a further sign that the government accepts its push to tackle the backlog will take longer than first hoped.
Saffron Cordery, of NHS Providers, which represents hospitals, said there was a "deep sense of frustration" about the lack of extra funding.
"This will undoubtedly have knock-on consequences for the health service and patient care." | Health Policy |
Go on a run, hike through nature and meditate, and you’re basically guaranteed a happier life. At least, that’s what scores of listicles might lead you to believe. But a new review of hundreds of studies on happiness questions just how strong the evidence is for some of these happiness hacks.
The finding comes in the wake of the “replication crisis” in psychology, where the results of dozens of key psychological studies haven’t been able to be repeated (SN: 8/27/15). In response, scientists have reassessed reams of old studies and doubled down on the best practices for ensuring that new studies will hold up under scrutiny (SN: 8/27/18).
To find studies of happiness that applied these best practices, psychologists Dunigan Folk and Elizabeth Dunn of the University of British Columbia in Vancouver combed through hundreds of papers. The team focused on research that studied a large sample of people, which helps tease out real effects, and studies that were pre-registered, meaning that researchers outlined how they were going to conduct a study before starting it. That way, they can’t tweak it midway; it’s the scientific equivalent of calling your shot in pool.
Although studies of happiness were plentiful, studies that met these high standards were relatively scarce. And the evidence they offered, especially for exercise, meditation and time in nature, was weaker than one might expect, the researchers report July 20 in Nature Human Behaviour.
Science News spoke with Dunn to discuss happiness, how we can get better at studying it and what science says works — and doesn’t — to build a happier life. This interview has been edited for length and clarity.
SN: Why study happiness?
Dunn: Science has given us our most essential human advances. It’s because of science that we got to the moon, that we have substantially increased longevity, that we have COVID vaccines. The scientific method is what solves our greatest challenges, and so I want to apply that method toward understanding happiness.
I think of happiness as being kind of the ultimate outcome measure. You know, whatever else we might be interested in, what ultimately matters is: “Are people leading happy lives?”
For me, understanding happiness is one of the fundamental mysteries and challenges of human existence.
SN: What gave you the idea to look into these past studies of happiness?
Dunn: This research actually started with a question from a journalist who asked, ‘’These things we hear about in the media as being really important for happiness, like meditation and nature, how rigorous is the research behind those kinds of claims?”
I realized I didn’t know. We were inspired to go look at the scientific literature, really comb through it to understand how good the evidence is underlying commonly recommended strategies. We didn’t go in with an agenda, but rather just an open curiosity.
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SN: So where did you start?
Dunn: First, we wanted to identify what strategies were most recommended to the public. So we googled phrases like “how to be happy” and identified media stories providing recommendations. Then we said, OK, these five strategies [practicing gratitude, meditating and being mindful, spending time in nature, being social and exercising] are really commonly recommended to the public as ways to be happier.
And then we combed through the literature and found every experiment that we could testing the effectiveness of these strategies for happiness. We wanted to look for studies that hold up to modern standards of what constitutes good evidence. We found over 500 studies examining these strategies, but fewer than 60 of them actually met contemporary standards for rigor.
SN: What did you find?
Dunn: The key takeaway here is that some of the strategies that have been widely recommended to the public as ways of improving happiness are not actually supported by very rigorous evidence.
What’s shocking to me is when we reviewed the literature on meditation, exercise and nature, of the hundreds of studies that we looked at, 95 percent of them didn’t include enough people that we would trust these studies by contemporary standards.
[Take exercise. Dunn and Folk found no study that both had a sufficiently large sample size and was pre-registered. They did find a dozen studies that included enough people to have meaningful conclusions. Five of those studies “found evidence that people feel happier after a single bout of exercise, but only in comparison with rather boring activities, such as sitting in silence or watching a documentary on bookbinding,” the researchers write in the paper. Similarly, the researchers found only four experiments that supported the happiness benefit of spending time in nature and had large enough sample sizes, though none were pre-registered either.]
Importantly, we’re certainly not saying that this is all snake oil. There are good reasons why these strategies should work. It’s just that there isn’t all that much rigorous evidence to show that they actually do work.
If something works for you, great. I’m not saying you should stop. It’s important to emphasize that if you’re, for example, dealing with an anxiety disorder and your therapist is recommending meditation, you know, we’re not saying ignore this advice. All we’re saying is that, for the average person trying to get a little bit happier, the evidence is maybe not there yet.
This is really a call to action to say, hey, we as researchers and as a society need to better understand these topics because they have been so widely embraced by the public and so widely disseminated by the media. We built our castles in the sky; you really need to get some foundations under them.
Assessing happiness studies
Of the hundreds of studies that experimentally tested common recommendations for happiness, only a handful met the gold standard for rigor (larger samples and pre-registered, in blue). Some have one or the other, and the majority didn’t have large sample sizes and weren’t pre-registered.
Common happiness hacks aren’t rigorously tested
SN: Even if there’s limited evidence, what’s the harm in, say, going for a walk in nature?
Dunn: Most of these behaviors, like going for a nature walk or meditating, require time and effort. And as somebody who has a child and job, I can tell you time and effort are not in super strong supply.
Particularly for people who are working multiple jobs and have a lot of family responsibilities, finding even 20 minutes on a typical Tuesday where they can do something purely for themselves that they think will make them happy [can be hard]. How they use that 20 minutes really matters.
And they should be getting the best scientific guidance you can possibly give them about how to make the most of that scarce resource of time and of energy.
There’s also a potential danger that people could [needlessly] feel like they failed. If they are like, “Well, nature and meditation make everybody happier, and they don’t work for me. I guess there’s nothing that’s gonna make me happier.”
It’s important that we not overstate the strength of the evidence behind these things.
SN: Did any strategies seem to work in making people happier?
Dunn: Gratitude comes out looking pretty good, and also chatting with strangers and acting more extroverted. I would always like for the evidence to be even stronger, but those are the strategies I would probably feel the best about recommending from our current review.
[There is “consistent evidence that people in diverse cultural contexts benefit from making gratitude lists,” Dunn and Folk write in the review paper. The researchers also found two studies that had large enough sample sizes and were pre-registered that found talking to strangers boosts mood. Another study that included enough people but wasn’t pre-registered had a similar finding.]
We have another paper in process where we looked at the best studies on happiness, meeting the modern gold standard. From that, there’s also pretty good evidence that spending money on others promotes happiness. And there’s good evidence that giving money to poor people makes them happier.
It’s not that [psychologists] know nothing about happiness. We do. It’s just that some of the strategies that have been so widely touted and disseminated are not actually among the sort of best and brightest to emerge from our field.
SN: Do you have personal practices that help you be happier?
Dunn: [My past research has shown a link between] generosity and happiness. One thing that I’ve done with a group of friends was privately sponsor a family of Syrian refugees. Without really intending it this way, it was the perfect application of all of my research, and was probably the most rewarding experience I’ve ever had.
I also work out every day. It does put me in a really good mood. But this research has given me perhaps some humility in recognizing that that was the case for me. It’s not like other people would experience necessarily the same benefit as I do from that experience. | Stress and Wellness |
Washington— A federal appeals court upheld the Food and Drug Administration's 23-year-old approval of the widely used abortion pill, but said a series of actions the agency took in recent years to make it easier to obtain went too far.
A three-judge panel from the U.S. Court of Appeals for the 5th Circuit issued a divided ruling Wednesday regarding an order from a federal district court in Texas. The panel agreed with the lower court that the agency's moves since 2016 to relax the rules for mifepristone's use should be reversed, but the panel declined to suspend the underlying approval of the medication.
The ruling will not affect availability of the drug, since the Supreme Courtof the lower court's order as the appeals process plays out.
"This means that, until final judgment, Mifeprex will remain available to the public under the conditions for use that existed in 2016," the court said, referencing the name of the drug manufactured by the company Danco Laboratories.
The 5th Circuit panel also said the FDA's 2019 approval of a generic version of mifepristone, made by the company GenBioPro, should be left in place and "will also be available under the same conditions as Mifeprix."
The panel of Judges Jennifer Walker Elrod, James Ho and Cory Wilson noted its decision is subject to the earlier ruling from the Supreme Court. Ho said in a separate opinion that while he agrees with the majority that the 2016 and 2021 changes to mifepristone's rules must be set aside, he believes the FDA's initial approval in 2000 violates the agency's own rules and must also be invalidated.
Under the tighter rules, the drug can be taken up to seven weeks into a pregnancy, rather than 10 weeks, and must be dispensed in-person instead of by mail.
for more features. | Health Policy |
Like many Australians, Wayne Grimley grew up spending a lot of time in the sun. His family had lax views about sunburn and sun safety.
Key points:
- A Gold Coast ophthalmologist says about half of her surgeries are to remove skin cancer from eyelids
- An estimated 2 in 3 Australians will be diagnosed with some form of skin cancer in the lifetime
- Cancer Council Queensland says Queensland has the highest skin cancer rates in the world
"[I was] in the water from dawn to dusk," he said of his childhood on the Gold Coast.
"The grandparents said, 'Summer's coming on, you get a nice little burn to start the season.'"
Decades later, Mr Grimley still spends time outdoors, but his attitude towards sun safety has changed after finding a basal cell carcinoma (BCC) skin cancer near his eye.
"I had a little BCC that started close to my tear duct," he said.
It took ophthalmologist and oculoplastic surgeon Sharon Morris five-and-a-half hours to remove the skin cancer from Mr Grimley's face.
"We were touch and go... at one stage we were very close to losing the eye," Dr Morris said.
What lay on the surface of Mr Grimley's face was not representative of the depth of the cancer, she said.
"What was laying deeper was inside the nasal cavity and inside the orbit sitting against one of the muscles of the eyes," she said.
"Then it was involving at least a half of the upper and lower eyelid,
"So we've lost all of that tissue to clear the window [to] try to save the eye [and] keep the eye moving."
Mr Grimley's upper and lower eyelids needed to be reconstructed by using skin from his forehead.
He is now "tumour free" and "able to function", Dr Morris says, "I'm so thrilled for him".
Treating eyelid skin cancers
Of all skin cancers, 5–10 per cent are found in the eyelid region, Dr Morris says.
"Almost 50 per cent of our theatre lists are now taken up with eyelid cancer cases," she said.
Treating skin cancers near the eyes can be more complex than treating cancers on other parts of the skin, Dr Morris says.
"It's the fact the eyelid is a very important structure for protecting against the eye. It's the first form of defence for the eye itself," she said.
"It's a bit like a joint: It needs to function and move and therefore each part of the eyelid needs to be reconstructed when there's a larger cancer involved."
Dr Morris and the ophthalmology team at Gold Coast University Hospital (GCUH) are pushing for more people to be sun safe.
"There's a huge burden on the population and on the health resources," she said.
"While we can help people at that stage, we want people to protect themselves more so that we can prevent it from being an issue,"
Preventing skin damage
Elliott Moussa is an ophthalmology registrar at GCUH and a volunteer surf lifesaver at a Gold Coast beach where he sees the potential sun damage being caused.
"We know that varying degrees of sun exposure can predispose people to developing skin cancers, particularly on the eyelid, which may or may not be covered with sunscreen," Dr Moussa said.
"Hats are great and sunglasses are great but when we're in the water, we don't wear them so sun exposure does increase."
Surgery to remove skin cancers has become routine at the hospital, he says: "We're cutting them out day in, day out".
Dr Moussa says people need to remember that skin cancer can affect people of any age and doesn't solely develop in older people.
"We spend a lot of our time on weekends, mornings and afternoons outside of work at the beach It's where we want to be," he said.
"But we just need to be sun smart — sun safe."
The doctors are asking people to remember to slip, slop, slap, seek and slide and are urging parents to help set up good behaviours in their children.
"What you do as a child really reflects on what you do now — so schools making sure they look after children when they go to swim carnivals and not letting them burn [and] parents taking a lot of precautions around children and their friends' children," Dr Morris said.
World's skin cancer capital
Joanne Aitken from Cancer Council Queensland says skin cancer is the most common cancer to be diagnosed in Australia.Sunscreen use across Australia
"Queensland has way and above the highest rate of melanoma and skin cancer in total in the world," she said.
"Australia has very high rates, but the other states don't have rates as high as Queensland and we do lead the world in skin cancer rate tables.
"We estimate that about 2 in 3 people in Australia will be diagnosed with some form of skin cancer during their life."
Professor Aitken says there is no exact record for the number of non-melanoma skin cancers, which aren't as serious as melanomas.
"Non-melanoma skin cancers are far more common," she said.
"They don't tend to cause as much death as melanoma, but because of the sheer number of them that are diagnosed, they are actually the biggest cost.
"So it's a really big cost to the health system. Not only to the health system but to the population of Australia." | Disease Research |
Almost half of Scottish patients registered with an NHS dentist have not attended in the past two years, figures show. The data was obtained by the Lib Dems in a freedom of information request to Public Health Scotland.
Some 5,208,625 NHS registrations are held by Scottish dentists, with SNP ministers boasting that this represents 95 per cent of the country. But the Lib Dems say this claim is a "distortion" of the true picture.
The figure includes 10.2 per cent (530,538 registrations) who have not had their teeth checked in 10 years. Some 46.9 per cent had not participated within two years, with 23.7 per cent not participating within five years.
Scottish Liberal Democrat leader Alex Cole-Hamilton said a new recovery plan is needed for NHS dentistry. He said: "For years, SNP ministers and parliamentarians have been serving up the great dentistry distortion.
"These new figures show that simply being registered with a dentist is not a measurement of accessibility. In reality, a quarter of people registered - well over a million people - haven't seen a dentist in the last five years.
"One in 10 registered with a dentist haven't had a check-up or any treatment for more than a decade.
"It's ridiculous that the First Minister's spin even relies upon patients who haven't been to a dentist since before the Bush administration or the Sydney Olympics. That is not a mark of success."
A Scottish Government spokeswoman said: "It is factually the case that more than 95% of the population is registered with an NHS dentist - and it is also hugely encouraging.
"It should also be noted that the two-year period referred to includes the time when dentists were working under restrictions and appointments were limited."
She added that the figures showed "a significant recovery in NHS dental service provision from April last year, with over 3.8 million courses of treatment completed in 2022/23, an increase of more than 40 per cent compared with 2021/22" when restrictions were still in force.
The spokeswoman said: "In February 2022 we replaced the basic examination with an enhanced examination, so comparisons between pre and post-pandemic statistics must be treated with caution.
"This was a deliberate choice, listening to the voices of dentists that they required more time with patients and consider the quality of dental care as much as the volume."
READ NEXT: | Health Policy |
The UK is gripped by a "sickness explosion" costing the economy £15 billion a year, experts have warned.
Britons have "among the worst population health in Europe" due to high levels of obesity, excessive drinking and large health inequalities, according to a new report.
Poor health in the population, a rising number of elderly people and "ballooning demand" for care are leading to a "health emergency", the study found.
As a result there is a high level of "premature often avoidable ill health" which is damaging the economy and the NHS.
The new report, titled A Covenant for Health, states that millions are becoming prematurely ill which is forcing many to drop out of work.
It has been estimated that this cost the economy £15 billion in 2022 to 2023 due to higher welfare costs and lower tax revenues.
The authors wrote: "It is urgent to act - the UK has among the worst population health in Europe, the highest levels of obesity, the worst excess drinking levels, very large health inequalities, and very many people become ill much earlier than they should.
"Our high level of premature, often avoidable ill health, damages lives, our society, localities and our economy. Without resolute action it will get worse."
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The new report, by former Labour minister Lord Filkin, former health minister Lord Bethall, public health experts and academics from the King's Fund think tank, calls for an "emergency programme for better health".
Lord Filkin, chairman of the Covenant for Health Commission, said: "We have a population health emergency - poor population health, more older people, ballooning demand, and costs on the NHS are leading to a sickness explosion. There will be 16 million people living with obesity by 2030 and 500,000 will die from smoking and poor air quality over the next five years.
"We need to keep well to be happy, to contribute and to sustain our economy and our NHS. Yet government, business, society, ourselves, we have all done far too little to prevent ill health.
Former health minister Lord Bethell added: "Our leaders should recognise the public do support measures to tackle smoking, obesity, heart disease and other chronic illnesses and address junk food, and dirty air, to support healthy communities and to engage people in their own health."
A Department of Health and Social Care spokesperson said: "Our ambition is for people to live longer, independent lives in good health, and we are committed to improving healthy life expectancy by five years by 2035 and reducing the gap between areas where it is highest and lowest by 2030.
"We have introduced calorie labelling, restricted the placement of less healthy food in shops, provided the largest ever single increase in drug and alcohol treatment and recovery funding in England, and will help a million smokers across England quit by giving them a free vaping starter kit.
"Our Major Conditions Strategy will set out our plan to tackle the six major conditions most prevalent, from prevention to treatment, and will consider a range of factors including work, education and transport which are all critical to good physical and mental health." | Epidemics & Outbreaks |
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Endemic leprosy in Florida, the threat of tens of thousands of measles cases in London and syphilis increasing by 50 percent or more in Ireland and Portugal.
This is not an excerpt from a Victorian novel but a sobering snapshot of the Western world in 2023.
Falling childhood vaccination rates, changes in behaviors and eating habits — and, of course, climate change — contributed to a perfect storm where dangerous diseases, thought to be relegated to a bygone era, returned to countries that had previously practically eliminated them.
Added to this, bacteria are becoming increasingly resistant to our antibiotics, meaning one of the most transformational medicines of the past 100 years is now under threat.
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While wealthy nations were able to eliminate many of the epidemics of previous centuries through concerted vaccination campaigns, smart public health messaging and the rollout of effective modern medicines, the 21st century has seen a reversal of fortunes. With the COVID-19 pandemic and the "era of global boiling" thrown in the mix, health systems have been on the back foot when it comes to tackling some of the oldest illnesses.
Here are five diseases that have made a comeback:
Measles
Measles is one of the most contagious human diseases and used to arrive in epidemics every two to three years, causing more than 2 million deaths. But that all changed when the so-called father of modern vaccines, John Franklin Enders, developed a vaccine. The first jab was licensed for use in 1963 and widespread vaccination followed. But because the disease is so infectious, immunity in communities needs to be really high — at 95 percent — to stop the disease spreading.
Nowadays, those figures aren’t being reached, and the result has been outbreaks across Europe. In recent years, the U.K., Greece, the Czech Republic and Albania have lost their measles free status. Just two months into 2023 there were already 900 cases of measles in the European region — exceeding the total number from 2022.
The Netherlands has warned that a reduction in coverage in the country means that measles is more likely to resurface. In London, the Health Security Agency said in July that the capital is poised for tens of thousands of cases due to lower levels of vaccination over several years, which was compounded by the pandemic.
The data from London paints “a harrowing picture,” said Andrew Pollard, director of the Oxford Vaccine Group. “We must not underestimate the seriousness of this message,” he said at the time.
Syphilis
Syphilis, also known as venereal disease (VD) or the pox, is a sexually transmitted bacterial disease that can be treated with penicillin if caught early. If not, it progresses in stages, with the first being a painless sore, the second a rash with other symptoms such as a fever or fatigue, and the third a latent stage where the bacteria stays in the body but doesn't cause problems. The final stage can happen decades after the first infection and can damage organs and lead to death.
In the late 18th Century, it is estimated over one in five Londonders had syphilis by their mid-30s. Now, the country’s Health Security Agency is seeing massive spikes again, with the number of cases in 2022 — 8,692 — being the largest annual number since 1948.
And it’s not just the U.K.
The most recent annual epidemiological survey from the European Centre for Disease Prevention and Control shows that cases across the EU and EEA are on an upward trajectory. The highest rate in 2019 was in Malta followed by Ireland.
Casual sexual encounters are easier than ever, with ubiquitous dating apps and the rise of chemsex. But it’s not just riskier behaviours that have driven the increase. Cuts to sexual health services — for example £1 billion slashed in England — are also thought to be to blame for the rise.
Gout
The disease of kings is back and this time, it’s not only royalty feasting on red meat and alcohol that is afflicted.
Gout is a painful type of arthritis where small crystals form around the joints — often the big toe. Cases are increasing around the world, with the U.S. and Canada having the highest increases in prevalence estimates of gout between 1990 and 2017.
Risk factors for gout include being male, obese, having health problems such as high blood pressure and diabetes and eating foods high in fructose. It also increases in line with alcohol consumption.
With rates of obesity in the European region showing no sign of slowing down, it seems the disease of kings might not be going away anytime soon.
Leprosy
The severe skin disease caused by a bacteria that leads to nerve damage and loss of sensation in the skin, eyes and nose is something few people living in Western countries would have ever seen. Until now.
A new case report indicates that leprosy may have become endemic to Florida in the U.S. The number of reported cases have more than doubled in the last decade in the southeastern states of the U.S. While unhealthy lifestyles have been blamed for the increase, researchers have also pointed to poor management of the condition.
Historically, the policy was to send people with the disease to remote quarantine islands, known as leper colonies. Now, it can be cured with months of multi-drug therapy and catching it early can avoid disability.
Malaria
Malaria wasn’t always a disease that only occured in tropical regions in Africa, Asia and Latin America. Cases were seen in the marshy areas of Paris and along London’s River Thames, with Italy’s Sardinia seeing 300 deaths per 100,000 inhabitants in the late 1800s. But Europe managed to eradicate malaria through a huge postwar program of insecticide spraying, swamp draining and drug therapy.
While malaria has yet to fully return to the region — barring a few locally transmitted cases — the rise of other mosquito-borne diseases such as dengue and West Nile virus should be seen as a flashing warning sign. Across the Atlantic, in June the U.S. Centers for Disease Control and Prevention issued an alert about several locally acquired cases of malaria.
As for Europe’s fate, the head of the Global Fund to Fight AIDS, TB and malaria Peter Sands said that with extreme weather events increasing in the region, Europe “may well see malaria coming back.” | Epidemics & Outbreaks |
The World Health Organization said Friday that COVID-19 no longer qualifies as a global emergency, marking a symbolic end to the devastating coronavirus pandemic that triggered once-unthinkable lockdowns, upended economies and killed at least 7 million people worldwide.
WHO first declared COVID-19 to be an emergency more than three years ago. The U.N. health agency's officials said that even though the emergency phase was over, the pandemic hasn't come to an end, noting recent spikes in cases in Southeast Asia and the Middle East.
WHO says that thousands of people are dying from the virus every week, and millions of others report that they are still suffering from debilitating, long-term effects from the disease.
"It’s with great hope that I declare COVID-19 over as a global health emergency," WHO Director-General Tedros Adhanom Ghebreyesus said.
"That does not mean COVID-19 is over as a global health threat," he said, adding he wouldn't hesitate to reconvene experts to reassess the situation should COVID-19 "put our world in peril."
Tedros said the pandemic had been on a downward trend for more than a year, acknowledging that most countries have already returned to life before COVID-19.
He bemoaned the damage that COVID-19 had done to the global community, saying the pandemic had shattered businesses, exacerbated political divisions, led to the spread of misinformation and plunged millions into poverty. Tedros also noted that there were likely at least 20 million COVID-19 deaths, far more than the officially reported 7 million.
"COVID has changed our world and it has changed us," he said, warning that the risk of new variants still remained.
Dr. Michael Ryan, WHO's emergencies chief, said it was incumbent on heads of states and other leaders to decide on how future health threats should be faced, given the numerous problems that crippled the world's response to COVID-19. Countries are negotiating a pandemic treaty that some hope may spell out how future disease threats will be faced — but it's unlikely any such treaty would be legally binding.
When the U.N. health agency first declared the coronavirus to be an international crisis on Jan. 30, 2020, it hadn't yet been named COVID-19 and there were no major outbreaks beyond China.
More than three years later, the virus has caused an estimated 764 million cases globally and about 5 billion people have received at least one dose of vaccine.
In the U.S., the public health emergency declaration made regarding COVID-19 is set to expire on May 11, when wide-ranging measures to support the pandemic response, including vaccine mandates, will end. Many other countries, including Germany, France and Britain, dropped many of their provisions against the pandemic last year.
When Tedros declared COVID-19 to be an emergency in 2020, he said his greatest fear was the virus’ potential to spread in countries with weak health systems.
In fact, some of the countries that suffered the worst COVID-19 death tolls were previously judged to be the best-prepared for a pandemic, including the U.S. and Britain. According to WHO data, the number of deaths reported in Africa account for just 3% of the global total.
WHO doesn't "declare" pandemics, but first used the term to describe the outbreak in March 2020, when the virus had spread to every continent except Antarctica, long after many other scientists had said a pandemic was already underway.
WHO is the only agency mandated to coordinate the world’s response to acute health threats, but the organization faltered repeatedly as the coronavirus unfolded.
In January 2020, WHO publicly applauded China for its supposed speedy and transparent response, even though recordings of private meetings obtained by The Associated Press showed top officials were frustrated at the country’s lack of cooperation.
WHO also recommended against mask-wearing for the public for months, a mistake many health officials say cost lives.
Numerous scientists also slammed WHO’s reluctance to acknowledge that COVID-19 was frequently spread in the air and by people without symptoms, criticizing the agency’s lack of strong guidance to prevent such exposure.
Tedros was a vociferous critic of rich countries who hoarded the limited supplies of COVID-19 vaccines, warning that the world was on the brink of a "catastrophic moral failure" by failing to share shots with poor countries.
Most recently, WHO has been struggling to investigate the origins of the coronavirus, a challenging scientific endeavour that has also become politically fraught.
After a weeks-long visit to China, WHO released a report in 2021 concluding that COVID-19 most likely jumped into humans from animals, dismissing the possibility that it originated in a lab as "extremely unlikely."
But the U.N. agency backtracked the following year, saying "key pieces of data" were still missing and that it was premature to rule out that COVID-19 might have ties to a lab.
Tedros lamented that the catastrophic toll of COVID-19 could have been avoided.
"We have the tools and the technologies to prepare for pandemics better, to detect them earlier, to respond to them faster," Tedros said, without citing missteps by WHO specifically.
"A lack of (global) solidarity meant that those tools were not used as effectively as they could have been," he said. "Lives were lost that should not have been. We must promise ourselves and our children and grandchildren that we will never make those mistakes again." | Epidemics & Outbreaks |
Are 3D mammograms better than standard 2D imaging for catching advanced cancers?
A clinical trial is recruiting thousands of volunteers — including a large number of Black women who face disparities in breast cancer death rates — to try to find out.
People like Carole Stovall, a psychologist in Washington, D.C., have signed up for the study to help answer the question.
“We all need a mammogram anyway, so why not do it with a study that allows the scientists to understand more and move closer to finding better treatments and ways of maybe even preventing it?” Stovall said.
The underrepresentation of women and minorities in research is a long-simmering issue affecting health problems including Alzheimer’s disease, stroke and COVID-19. Trials without diversity lead to gaps in understanding of how new treatments work for all people.
“Until we get more Black women into clinical trials, we can’t change the science. And we need better science for Black bodies,” said Ricki Fairley, a breast cancer survivor and advocate who is working on the issue.
Black women are 40% more likely to die from breast cancer than white women and tend to be diagnosed younger. But it’s not clear whether 3D mammography is better for them, said Dr. Worta McCaskill-Stevens of the National Cancer Institute.
“Are there populations for whom this might be important to have early diagnosis?" asked McCaskill-Stevens. "Or is it harmful,” causing too many false alarms or unneeded follow-up tests and treatments?
McCaskill-Stevens, who is Black, leads NCI’s efforts to boost access to cancer research in minority and rural communities. She has joined the study herself.
The newer 3D technique has been around for a decade, but there’s never been conclusive evidence that it's better than 2D at detecting advanced cancers. The screening technique combines multiple pictures of the breast taken from different angles to create a 3D-like image. Both 3D and 2D mammograms compress the breast and use low doses of radiation.
Prior studies suggest that 3D finds more cancers than 2D, but catching more cancers doesn’t necessarily mean more lives saved. Some cancers missed by standard screening may not progress or need treatment. Previous studies did not randomly assign patients to a screening method, the gold standard for research.
The notion “that if it’s new, it’s shiny, then it’s better,” isn’t necessarily true, McCaskill-Stevens said. “Until we have the evidence to support that, then we need well-designed randomized trials.”
The trial has enrolled nearly 93,000 women so far with a goal of 128,000. The NCI-funded study is now running in Canada, South Korea, Peru, Argentina, Italy and 32 U.S. states. A site in Thailand will soon begin enrolling patients.
“We added more international sites to enhance the trial’s diversity, particularly for Hispanic and Asian women,” said Dr. Etta Pisano, who leads the study.
Overall, 42% of participants are Hispanic. As recruiting continues, enrolling Black women and other women of color will “absolutely” continue as a priority, Pisano said.
Participants are randomly assigned to either 2D or 3D mammograms and are followed for several years. The number of advanced cancers detected by the two methods will be compared.
At the U.S. study sites, 21% of study participants are Black women — that's higher than a typical cancer treatment study, in which 9% of participants are Black, McCaskill-Stevens said.
The University of North Carolina has signed up more Black women than any other study site. Nearly a quarter of the nearly 3,000 women enrolled at UNC’s two locations are Black.
“Women in North Carolina want to take part in something that’s bigger than them,” said Dr. Cherie Kuzmiak, who leads the UNC arm of the study. “They want this active role in helping determine the future of health care for women.”
In Washington, D.C., word of mouth has led to successful recruiting.
A chance encounter at her hair salon persuaded Stovall to join the research. While waiting for a hair appointment, she met Georgetown University cancer researcher Lucile Adams-Campbell. The two, both Black, started chatting.
“She explained how important it was to get women of color into the program,” said Stovall, who jumped at the chance to catch up on her mammograms after the COVID-19 pandemic delayed screening for her and thousands of others.
For Stovall, there was a personal reason to join the research. Her sister recently completed treatment for triple negative breast cancer, an aggressive type that affects Black women at higher rates than white women.
Women ages 45 to 74 without a personal history of breast cancer are eligible for the study, which launched in 2017. Many women also are providing blood and cheek swab samples for a database that will be mined for insights.
“It’s a dream that people had since the beginning of screening that we wouldn’t fit everybody into the same box,” Pisano said. The study's findings could “reduce disparities if we’re successful, assuming people have access to care.”
Stovall, 72, had a brief scare when her mammogram, the traditional 2D type, showed something suspicious. A biopsy ruled out cancer.
“I was extremely relieved,” Stovall said. “Everybody I know has heard from me about the need for them to go get a mammogram.”
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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 |
Matt Hancock told aides he wanted to “frighten the pants off everyone” to ensure compliance with Covid-19 restrictions, according to the latest batch of leaked messages which reveal discussions over when to “deploy” details of a new strain.
The WhatsApp exchanges suggest the then health secretary and others discussed how to use an announcement about the Kent variant of the virus to scare the public into changing their behaviour.
The messages, published in the Sunday Telegraph, show that cabinet secretary Simon Case suggested in January 2021 that the “fear” factor would be “vital” in stopping the spread of the virus.
In December 2020, the exchanges appear to show concern that London mayor Sadiq Khan could follow the example of Andy Burnham, the mayor of Greater Manchester, who had clashed with the government over the decision to impose stringent lockdown restrictions on the region.
Hancock’s adviser said: “Rather than doing too much forward signalling, we can roll pitch with the new strain.”
“We frighten the pants of everyone with the new strain,” the then health secretary responded.
“But the complication with that Brexit is taking the top line,” he said, in an apparent reference to media coverage of the UK’s EU exit.
“Yep that’s what will get proper behaviour change,” the adviser said.
“When do we deploy the new variant,” Hancock said.
The conversation, on 13 December 2020, came amid concerns about the rapid spread of the virus in southeast England.
Hancock announced that a new Covid-19 variant had been identified in the UK on 14 December.
Five days later it was announced that London and southeast England were to enter a new tier 4 alert level when then prime minister Boris Johnson also cancelled a promised Christmas “bubbles” policy allowing families to meet.
The entirety of England entered the third national lockdown on 6 January 2021.
Messages from 10 January show Hancock and the cabinet secretary discussing ways to ensure compliance.
Case wrote: “More mask-wearing might be the only thing to consider.
“Effectively free and has a very visible impact? Wear masks in all settings outside home and in more workplaces?
“Am not sure that got us much further, did it? Basically, we need to get compliance up.”
Hancock tells Case, after a brief discussion on angling, that he “honestly wouldn’t move on any small things unless we move on a lot”.
Case responded: “I think that is exactly right. Small stuff looks ridiculous. Ramping up messaging – the fear/guilt factor vital.
“I suspect London Nightingale [hospital] coming into use will feel like a big public moment.
“Especially as I guess it will be full within a couple of days (based on current data).”
Journalist Isabel Oakeshott was originally given the material by Hancock while they were collaborating on his memoir.
He has condemned the leak as a “massive betrayal” designed to support an “anti-lockdown agenda”.
In a statement this week, Hancock said all the materials for his book have been made available to the official Covid-19 inquiry.
Oakeshott has said the disclosures are in the public interest. | Epidemics & Outbreaks |
Mike Peters, frontman for Welsh post-punk band the Alarm and the voice of triumphant anthems like “The Stand,” “68 Guns,” and “Strength,” has always been a “glass-is-half-full kind of guy.” That’s why when he was first diagnosed with lymph cancer in 1995, with doctors telling him he had “only a half-chance” of survival, he rejected treatment and went on tour anyway. He somehow went into spontaneous remission and made a miraculous recovery, but a decade later, he was diagnosed with chronic lymphocytic leukemia. That time, he underwent treatment, but that still didn’t stop him from going back on the road.
It seemed nothing could stop Peters — or his wife and Alarm bandmate Jules, a fellow cancer survivor — until September 2022. That’s when Mike found himself back at North Wales Cancer Centre, this time for “a few months,” and he began to wonder if his luck had finally run out. “I could see it in [my doctors’] eyes that they were thinking the worst,” Peters tells Yahoo Entertainment. “I thought, ‘This is it. … I'm probably not coming back, and I'm probably not getting out of here.’”
Thankfully, Peters bucked the odds yet again, and the result is the Alarm’s passionate new album Forwards, written almost entirely during Peters’s scary hospital ordeal.
The first real sign that Peters’s leukemia had returned last year occurred during the Alarm’s 40th anniversary tour, when he developed “a cough that never stopped.” Recalls Peters, “I was very tired on the tour and I was sleeping a lot during the day, and we were playing pretty intense shows. A lot of the time I woke up with severe night sweats, which is always a big giveaway that something terrible is happening. And of course, it was.”
However, Peters says he missed the early signs of his cancer relapse as “probably a result of the pandemic, really, because I wasn't allowed to see my doctors; it was all telephone consultations and going off the stats of blood counts, so the big picture was being overlooked — not anybody's fault, just that's how it was for a lot of people in lockdown. And when I finally got to go into hospital, it became apparent that there were a lot of things out of control.”
Returning home from the tour in rough shape, Peters underwent an X-ray that revealed he had “very aggressive pneumonia, quite far advanced, in both my lungs.” But it wasn’t until he got a CT scan that doctors learned of “all the underlying causes that were going on besides pneumonia. When I got through to the end of the new first pneumonia cycle, I thought, ‘It's not getting better. The cough isn't going away.’ I kept phoning the doctors and they'd say, ‘Oh, give it time. You need to rest more. We know you — you'll be working when you should be resting!’ But it got out of hand, and I realized I couldn't even walk out the door. Jules took me for a walk one day and I got a hundred yards and had to turn back. I couldn't even cross a sports field to see my son play. And so Jules got me in the hospital the next day, and then they did the CT scans and the full range of testing. And it became clear that I was in a desperate situation. What looked like at first another case of pneumonia was actually blood that had filled my lungs. It was much more severe than a case of pneumonia. I was in a bad place. Luckily, they were able to get me straight onto the wards. I had a drain put into my back, which wasn't a nice procedure, to get inside my lungs and drain off all the blood. And that was it: I knew I was going to be in the hospital for a long time.”
Once Peters was admitted to the cancer center, doctors feared his “disease was mutating into something far more aggressive, another form of leukemia called Richter’s Syndrome.” Luckily, that turned out not to be the case, but doctors didn’t want to give Peters “false hope” as he faced what appeared to be his most difficult cancer fight yet. “I was in such a bad place. I was dependent on drugs that were killing me, really — the drugs that kept me alive started to kill me. And my glands were out here and I looked like the Elephant Man.”
Peters was only allowed one visitor a day, for one hour per day, and that visitor — his wife of 35 years, Jules — began filming Peters’s harrowing experience, “kind of documenting it for her own sanity, really.” Jules even asked Mike on camera if this was “the end of the road,” to which he answered with his typical optimism, “No, it's the beginning of a new road.” But he admits now, “It could have been [the end]; we couldn't pretend otherwise. We had to face up to the fact that it was very real.” Mike’s long cancer journey had already been the subject of several documentaries — including Mike Peters on the Road to Recovery, Mike and Jules: While We Still Have Time (which also chronicled Jules’s 2016 breast cancer battle), and The Man in the Camo Jacket — but the short film Jules made from her 2022 footage is especially “a hard watch,” says Mike. He’s still not sure if it will be screened outside of the Gathering, the Alarm’s annual weekend concert event for superfans. Says Peters of the film, “It’s quite an emotional rollercoaster, because you do see the extent of how far I'd fallen before I recovered.”
However, Forwards is a much more upbeat document of the Alarm singer’s “long road to recovery.” Bored in isolation in the cancer ward, Peters “asked the nurses, ‘Do you think I could have my guitar brought in?’” And the rest was history. But the famous workaholic insists that the album “started accidentally, really. I'd asked for my guitar just purely to keep my fingers active and to keep myself amused. … You had to really dig deep to survive, and by playing a bit of music, I was creating my own soundtrack of hope to keep me going.” At first Peters thought he “could just strum quietly and it's not going to disturb [other patients’ recoveries]… but the nice thing was the nursing staff and the other patients were shouting out, ‘Hey, can you play a bit louder? Don't turn it down because of us!’” Eventually he was playing along to “all the noises of the hospital, and the heart-rate monitor going ‘beep-beep’ and the alarms going off became like a little rhythm track.” And he started “secretly using [the patients and hospital staff] as a bit of an acid test to see if [my new songs] were any good or not,” Peters chuckles. “Because you never know when you've written a song if it's any good until you play it for someone else.”
Peters says he “didn't want the album to be about where I've been; I wanted it to be about where I was going,” so the LP’s title came to him after he signed an open letter announcing his latest grim diagnosis. Peters had tried to keep his condition on the down-low, but after a hospital visitor spilled the beans on an Alarm fan site, Peters knew, “I had to go online and write a letter to the fans, just to reassure them. I was trying to be positive, but also not ducking out what was really going on. I wasn't sure, but I knew I had to say to people, ‘Look, I'm confident I'll get out of this — but, who knows?’ And then, I signed off with the word ‘forwards,’ and I had never signed off a letter with that word before. When I did, I thought, ‘There's an album title. There's a reason why I'm here,’ in a strange sort way. … I thought, ‘I've gotta make a record about this. Someone's telling me something here.’ … And so, it became real. I was glad I had the guitar there, because it was quite therapeutic.”
One of the key Forwards tracks keeping with the title’s theme is the single “Next,” although Peters confesses now, “When I wrote that song, I was not quite sure what was next. I was like, ‘Is this it? Is this gonna be it? Am I preparing myself for the next world, or for the next chapter of my life story?’ It was on a tightwire, which way it was going to fall. Luckily for me it, it fell to the right way and I was able to carry on living.” Eventually Peters was able to leave the North Wales Cancer Centre — “I was determined to walk out as in the best shape possible; I didn't want to go home with assistance, with a walking stick or a wheelchair” — only to boldly return, still on his own two feet, to shoot the rogue-style “Next” music video.
“Yeah, we shot it in the hospital,” Peters chuckles. “I said to Andy, our tour manager, ‘Come on, let's go back and sneak in!’ And we did, literally. … Andy's filming me on the camera and we walked through the corridors. We went to one end of the hospital and back, and that was it. It was shot in 20 minutes. And it's got that energy — you know, if you're strong enough, then no one wants to walk out of hospital slowly. Everyone wants to run and get home to their loved ones. As much as the hospital can be an amazing place and the staff are brilliant at keeping your spirits up, nobody wants to spend the night there voluntarily. Everyone wants to get home. And when you do get home, it's joyous. I wanted to convey that feeling.”
Peters admits that he has “lost count” of how many times his doctors have scolded him for continuing to work at such a rapid pace (since his first cancer diagnosis in 1995, he has released 15 Alarm studio albums and more than a dozen solo albums and EPs), but he laughs off their warnings. “When I say, ‘Oh, by the way, I'm playing in New York next week,’ [my doctor] goes, ‘You are crazy, Mr. Peters! You should be at home! With the drugs you are on now, that are keeping you alive, you shouldn't be running around like you're doing! But, no one's going to stop you doing that.’ But you know, I'm maintaining my blood count; it's the best it's ever been for probably 35 years. So, something's going right. I'm feeling really great. And so, I want to make the most of everything, because you could get ridden over by a bus tomorrow — never mind cancer! I might as well get out there and do what I gotta do.
“Whenever I'm in trouble and I have to go and play a show and I sing these songs, it reminds me that I'm lucky to be alive,” Peters concludes. “I'm grateful to be here, and I've got a lot to live for.”
Read more from Yahoo Entertainment: | Disease Research |
Australia will ban imports of disposable vapes from January, in an effort to curb nicotine addiction in children.
New laws to stop single-use vapes from being made, advertised, and supplied in the country will also be introduced.
It comes amid a broader push to phase out recreational vaping completely.
Vaping has been marketed as a way to quit smoking, but Australia's health minister says it has created a "new generation of nicotine dependency".
Vapes, or e-cigarettes, are lithium battery-powered devices that have cartridges filled with liquids containing nicotine, artificial flavourings, and a range of other chemicals.
It has been illegal for any Australian to purchase or import e-cigarettes or nicotine vapes without a doctor's prescription since 2021, but despite those restrictions rates of addiction have continued to skyrocket.
A study from the University of Sydney earlier this year found that over a quarter of teenagers aged 14-17 had vaped, while research from Australia's Cancer Council charity found that nine out of 10 teenagers in the same age group found it easy to access nicotine vapes.
"All Australian governments are committed to working together to stop the disturbing growth in vaping among our young people," said Mark Butler, the federal health minister who is leading the ban.
In May, the Australian government signalled its intention to phase out the use of single-use vapes, but until now it had provided no concrete timeline.
Mr Butler says that the import ban on disposable vapes will start on 1 January, and that by March refillable non-therapeutic vapes will also be banned from entering the country.
Importers and manufacturers supplying therapeutic vapes will also have to comply with tighter government regulation concerning the flavours, nicotine levels, and packaging of their products.
Experts have warned that not enough is known yet about the long-term impacts of vaping.
Research from Johns Hopkins University has linked the practice to chronic lung disease and asthma.
And in Australia, scientists who have studied the liquids used in vapes have warned that they contain "a suite of chemicals" known to impact lung health.
Australia's announcement comes just days after New Zealand's government scrapped its world-leading smoking ban to pay for tax cuts. | Epidemics & Outbreaks |
Diabetes-turned-weight loss drug Mounjaro helped patients shed pounds nearly twice as fast as its ultra-popular counterpart Ozempic, according to a study released Monday.
The extensive study of more than 18,000 overweight or obese people found that those taking once-weekly injections of Eli Lilly’s Mounjaro were able to melt off 15.2% of their weight — compared to 7.9% for those on Novo Nordisk’s Ozempic.
There was also a stark contrast in results at the three-month and six-month marks, according to the study by Truveta Research
At the three-month mark, patients taking Mounjaro lost 5.9% of their weight, compared with 3.6% for those on Ozempic, the study showed
At six months, people taking Mounjaro shed 10.1% of their weight, while patients on Ozempic lost 5.9%
Eli Lilly’s Mounjaro patients “were significantly more likely to achieve 5%, 10% and 15% weight loss and experience larger reductions to weight at three, six and 12 months,” than those who took Ozempic, the report concluded.
Over the entire time period analyzed — between May 2022 and September 2023 — researchers found that patients taking Mounjaro were three times more likely to lose 15% of their weight than those on Ozempic.
Mounjaro patients were also 2.6 times more likely to achieve 10% weight loss and 1.8 times more likely to lose 5% of their weight, according to Truveta, which was earlier reported on by CNBC.
The Post has sought comment from Truveta Research, and representatives for Mounjaro and Ozempic.
Roughly half of the patients in the study had Type 2 diabetes, which is what Mounjaro and Ozempic were both originally produced to treat. While Ozempic has yet to nab FDA approval for weight loss, the federal agency green-lit a new version of Mounjaro earlier this month to be sold for weight loss.
Truveta found that the patients with Type 2 diabetes lost more weight than their counterparts without the chronic condition.
The real-world study attributed increased weight loss to the active medications sold under the brand name Mounjaro — tirzepatide, an appetite-suppressing drug, and glucose-dependent insulinotropic polypeptide.
Tirzepatide functions similarly to the medication found in Ozempic, semaglutide, as they both mimic the actions of the GLP-1 hormone, which the pancreas releases after eating that makes people feel full.
“Tirzepatide appears to provide greater weight loss than semaglutide in this population,” whose participants were, on average, aged 52 and roughly 240 pounds.
However, Mounjaro also contains glucose-dependent insulinotropic polypeptide, or GIP, a hormone found in the gut that helps regulate bodyweight by stimulating satiety.
A similar conclusion was drawn at the European Association for the Study of Diabetes in early October, where researchers conducted a meta-analysis of 22 randomized controlled trials that pitted Mounjaro against Ozempic, according to Healthline — and found that Mounjaro came out on top.
Eli Lilly is now testing its “superior” weight-loss injection against Wegovy, also made my Novo Nordisk, which contains a higher dose of semaglutide, in an ongoing clinical trial. Results are set to be released next year, according to CNBC. | Drug Discoveries |
By David Tom Cooke, MD, as told to Susan Bernstein
The term is "inoperable lung cancer." It means that the risk of surgery to remove the lung cancer exceeds the benefits of the surgery for a patient. However, it is hard to tell if someone is âinoperable.â
Age is one factor that can slightly increase your risk, but itâs not necessarily prohibitive. Iâve operated on 90-year-olds. Other health problems you have can be a factor, such as impaired lung function. If we remove a lung tumor in a person who already has minimal lung function due to severe COPD or emphysema, that can make surgery risky, for example. There is a growing population of people who fit that description. To be determined that your lung cancer is "inoperable," you really need to be seen by a thoracic surgeon.
The gold standard for treatment of early-stage, inoperable lung cancer is something we call SBRT, or stereotactic body radiation therapy. Itâs high-dose, focused radiation. SBRT is used to try to destroy the tumor. Itâs very targeted, and we use special imaging to be very precise with this treatment, typically CT scans. Itâs different from traditional, high-dose radiation therapy to shrink or kill tumors. SBRT has potential to cure lung cancer, but itâs not known if it has the same cure rate for patients as surgery. We usually perform one or two SBRT treatments, and then you have routine follow-up for 5 years.
There are some newer experiments going on in this area. Itâs thought that radiation can cause the release of antigens, small proteins that activate your immune system. There are studies to see if the combination of SBRT with immunotherapy drugs called checkpoint inhibitors can increase the likelihood of killing and eliminating lung tumors. Checkpoint inhibitors activate oneâs own immune system -- to remove the âcheckpointsâ that slow down the immune system -- to fight cancer.
Researchers are studying not only the effects of this combination therapy, but how long patients would have to take these drugs. Right now, there have been phase I studies to look at the safety of this SBRT/checkpoint inhibitor combination, as well as clinical trials underway to look at the results of the combination therapy.
Another treatment used in early stages is the use of [local scopes to treat the tumor], such as navigational bronchoscopy. For this treatment, we take a camera attached to the end of a catheter and insert it into the patientâs trachea, or windpipe. Then, either using high-tech guidance tools or combined with a CT scan, we aim the catheter toward the tumor. This is also being done with robotic technology combined with a CT scan to guide the catheter to the tumor, followed by microwaves to kill the tumor, or to locally inject chemotherapy directly into the tumor. There are animal studies being done now to test this type of technique.
There have been recent advances in surgery, so people whose lung cancer was once considered inoperable may become operable. One key factor here is robotic surgery. We can make smaller incisions for less stress on the body. Robotic surgery also allows us to take less lung tissue out to remove your tumor.
There are other new technologies on the horizon for lung cancer treatment. One may be a combination of robotic surgical technology with 3D imaging and heads-up displays in the operating room to carefully guide the surgery. I always use this comparison: If your child is going to the prom, do you want them going in a 1992 Ford Taurus or a 2022 Toyota Camry with all the latest safety innovations, such as blind spot assist, airbags on all sides, and a backup camera? We can use these technologies to greatly increase safety during surgery.
There is another point that is important for the big picture of lung cancer treatment. According to the American Lung Associationâs 2021 "State of Lung Cancer" report, over 20% of patients diagnosed with lung cancer did not receive any treatment whatsoever. In addition, Black patients with lung cancer are 23% less likely to receive surgical treatment and 9% less likely to receive any treatment compared with white patients.
Before you have any treatment for lung cancer, it is best to discuss it with a team of doctors, including a thoracic surgeon, because we have so many different options to fight your disease.
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Photo Credit:Â yodiyim / Getty Images
SOURCE:
David Tom Cooke, MD, professor and chief, Division of General Thoracic Surgery; director, General Thoracic Surgery Robotics Program, UC Davis Health. | Medical Innovations |
A former transgender kid who detransitioned after having a double mastectomy told Fox News Digital that she was worried about living with the painful side effects of the "gender-affirming" medical interventions for the rest of her life.
"At this point, I'm far from whole. I'm far from healed. I'm still processing and dealing with what I went through," Chloe Cole, 18, told Fox News Digital in an interview.
"I've lost all my trust in my health care provider and possibly even health care," she said.
Cole, who calls herself "the canary in the coal mine," has become one of the most prominent voices speaking out against what is known as "gender-affirming care" for kids. She joined Do No Harm – an organization fighting to restore the ideals of the Hippocratic oath in the medical field – as part of its campaign to "protect[t]minors from gender ideology."
Cole's motivations, she explained, derived directly from her heart and concern for others; she is trying to prevent a future generation from treading on her path.
"It's not loving to lie to a child. It is not loving to disrupt a child's natural, healthy development, or to encourage them to do so," she said.
Cole was put puberty blockers and testosterone at 13; she underwent a double mastectomy at 15.
"I wasn't really allowed any time to just be and to just be observed alone without intervention. I mean, it was only about half a year between being diagnosed with gender dysphoria and actually being medicated. So the process for me was very expedited and there weren't really any pushback from any medical professionals," she told Fox News.
Cole began to question her identity at the age of 12. Her parents were advised by medical professionals that she would commit suicide if she wasn't "affirmed" with medical intervention.
"My distraught parents wanted me alive, so they listened to my doctors," Cole previously said at a hearing.
Then, at 16, Cole detransitioned. Two years later she continues to experience painful side effects from the medical interventions.
For example, Cole reported that the double mastectomy procedure causes fluid to leak.
"They use skin grafts as part of it. Two years after the surgery, I thought the healing was going fairly well – save for the grafts being slightly dry on the surface. But they started to leak fluid, and I've had to start wearing bandages over them again," Cole said.
"I don't know what it is. I don't know if it's an infection, [or] if it's some other complication from the surgery. But I've gotten no help from it, and I'm not sure whether it'll even go away or if I'll have to live like this for the rest of my life."
TRANS TEACHER WITH GIANT PROSTHETIC BREASTS/NIPPLES FORCES CANADIAN SCHOOL BOARD TO DEMAND DRESS CODE CHANGES
Cole added that she doesn't know if she will be able to carry a child to term.
"Because of the testosterone, I have permanent changes to my bone structure that cannot be reversed. And I have issues with my urinary tract, but I'm not sure whether I'll be able to conceive a child or be able to safely carry to term or to birth. And because of the mastectomy, I'll never be able to breastfeed," she said. "Transitioning… affects every area of your life… [including] your ability to conceive children in the first place, and a lot of people don't know whether they want to have children until they're in their thirties or forties or even beyond that."
Other side effects Cole experiences includes joint pain which she attributed to the puberty blockers.
"While I went on puberty blockers… I would hear cracks in my neck and my back," Cole said. "But to this day, I still experience joint pains, mainly in my arms, my hands, my knees, and mostly in my back and my neck."
Puberty blockers are considered to be "temporary," according to St. Louis Children's Hospital. Blockers, however, the hospital added the drugs can cause lower bone density, delayed growth plate closure, less development of genital tissue and other possible long-term side effects that are not yet known.
Female cross-sex hormones – estrogen – can cause blood clots, gallstones and a heightened risk of diabetes and heart disease, according to the hospital. Testosterone can cause a higher risk of heart attack, heart disease and stroke.
Cole is currently being represented by the Dhillon Law Group and will be seeking damages from her former medical providers "based on the evidence of malice," according to a notice of intent to sue.
"I have been emotionally and physically damaged and stunted by so-called medical professionals in my most important developmental period. I was butchered by an institution that we trust more than anything else in our live," Cole said at the time.
Cole said she will be working with Do No Harm to affect change through legislation. For example, Cole told Fox News that she supported Utah banning gender-affirming surgery and other treatments for minors diagnosed with gender dysphoria.
"I plan to work with Do No Harm to organize events and to work on legislature against the mutilation of children, and for a better standard of care for patients with gender dysphoria," she said.
MINNESOTA TEACHER GIVES STUDENTS SURVEY ABOUT PRONOUNS, ASKS WHETHER TO CONCEAL GENDER CHANGES FROM PARENTS
"I'm afraid that my generation, and the generations following mine, are going to be led to led astray down the same path that I was on," Cole said.
In August, Cole testified on California's State Senate Judiciary Committee against a bill that would make the state a "sanctuary" for gender surgeries.
"Who here really believes that, as a 15-year-old, I should have had my healthy breasts removed or that it should’ve been an option?" she said. "How many more children’s bodies will be destroyed before you actually listen? What is the sweet spot? 100? 200? 1000?"
"SB107 will open the flood gates for confused children like me to get the gender interventions that many regret. I am the canary in the coal mine."
The bill was passed and took effect on January 1.
The chairman of Do No Harm, Dr. Stanley Goldfarb, said, "The movement to promote ‘gender-affirming care’ is profoundly dangerous and driven by ideology rather than scientific evidence."
"At their core, medical professionals who support [medical interventions for minors]… are violating the Hippocratic oath directive to ‘do no harm’ by ignoring key consequences of this type of ‘care,’ including the fact that underlying mental health concerns are usually not addressed," he added.
Though her advocacy, Cole hopes to protect a future generation from being "lead astray" into making a life-changing decision they may regret later in life.
"I'm afraid that my generation and the generation, the generations following mine, are going to be led to led astray down the same path that I was on. It is not loving to lie to a child. It is not loving to disrupt a child's healthy natural development. Or to encourage them to do so," she said. "I stayed quiet about it for a little for a little while…. But I at the same time, I was also speaking to other people who… regretted their transactions and people who… we're harmed medicall."
Cole continued, "And seeing how these people were suffering, how a lot of them had all the same struggles that I did – and some… even worse off – I realized that this is this experience is a lot more common than previously thought. And not everybody in the situation feels that they're able to speak up. And that's a large part of what motivates me to speak out."
"I think the things that keep me the most motivated to do what I'm doing would be the love of my friends and family and my friends who are detransitioning as well. Just seeing what they're going through… and [what] thousands of children and young people are going through reminds me what I'm fighting for," she said.
Fox News' Tyler O'Neil, Bradford Betz, Maria Lencki and Ashley Carnahan contributed to this report. | Medical Innovations |
Georgia mom Deshai Fudd thought she had an idea of what to expect when she started having contractions one day in late November last year.
Fudd already had two children, but to her great surprise, she and her husband Loston Fudd welcomed their third child not at the hospital where they expected to be, but in the car, in traffic on the way there.
"I gave birth to my baby girl in the car on the way to the hospital," Fudd wrote in a Jan. 16 TikTok post. "We got stuck in traffic and had to flag down police for an escort. We made it to the hospital and she was in mint condition! Thank God! We even got discharged the very next day!"
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"She met her big sister and brother who love her very much," the video post continued. "This was very scary but we are blessed to have another healthy, beautiful addition to the family! 🥰 We can't wait for her to grow up and hear her crazy birth story 🤣."
Fudd recalled to "Good Morning America" that earlier that day, she had told her husband, a security guard, to go to work as usual and that she'd call him if she needed him.
"Every other baby, I was in labor for a very long time. With my son, I was in labor for three days, and the hospital is pretty far, so I was like, I don't want to go up to the hospital and just get sent right back and we'd be driving back and forth all day," the 23-year-old mom explained.
As luck would have it, Loston Fudd got off work early and by the time he made it home, Deshai Fudd said she had been having contractions for about five hours and told him to get ready to leave for the hospital.
"We got in the car and the GPS said [it would be] about 30, 40-minute drive because there was traffic," Deshai Fudd recalled. "And about 10 minutes into the drive, my water broke and she just came right out."
Ready or not, little Dariya Fudd made her big entrance on Nov. 29, when her mom was 38 weeks along.
Deshai Fudd said initially, her husband panicked and she herself wasn't sure how to respond.
"He's like, 'Oh my gosh, what do I do? Is she OK? What's going on?'" she recounted.
"There was a moment of shock but I was just like, 'Let's just get to a hospital because I don't know what to do right now.'"
The couple found themselves in "standstill traffic" and it took them another 15-20 minutes to reach Emory University Hospital Midtown near downtown Atlanta.
"After we calmed down a little -- because it was a pretty long ride after the fact -- I started to text my family and let them know what happened before we even made it to the hospital," Deshai Fudd said. "And my sister in the group chat, she was like, 'Can we get a picture or video or something?'"
That's when Deshai Fudd recorded the clip she ended up sharing in her viral TikTok post, which has since been viewed over 11 million times in two weeks.
Thankfully, the Fudds managed to reach the hospital safely and Deshai Fudd said a traffic officer helped them flag nurses who came out to meet the Fudds at their car.
"They just came out and cut the umbilical cord right there in the car and wrapped her up in some blankets," Fudd said. "They put me in a wheelchair and took us up. And they did all their normal checks when a baby comes and everything was good."
"She passed everything with flying colors," she added.
A little over 24 hours later, mom and baby girl were on their way home again -- and two months later, Deshai Fudd said Dariya is starting to get to know her older siblings, Demiah and Lamell, and transition to tummy time.
"[The older kids] like to look at her, maybe play with her hands or something and then hold her every now and then," she said.
As for why she wanted to share Dariya's dramatic entrance on social media, Deshai Fudd said she simply felt compelled to.
"I feel like maybe God just put it on me to share it because I was feeling pretty down about the situation and all the comments and love and views and everything I've been getting, I could've never imagined that that would've happened," she said. "It just makes me feel so much better about the situation." | Women’s Health |
The synthetic drug trade in Asia is roaring to “extreme levels,” with crime groups establishing new trafficking routes to evade enforcement crackdowns and methamphetamine prices hitting fresh lows, according to a new report released Friday.
The research by the United Nations Office on Drugs and Crime (UNODC) found that meth seizures in East and Southeast Asia, which spiked to record highs during the pandemic as cartels switched to bigger and riskier bulk shipments, returned to pre-Covid numbers last year.
But other key indicators such as arrests, street availability, purity as well as low wholesale and street prices “indicate the supply has remained very high or unchanged,” the report said.
And as pandemic border closures and travel restrictions began lifting, international criminal organizations began reconnecting, with “late 2022 and early 2023 patterns starting to look similar to 2019,” said Jeremy Douglas, UNODC Regional Representative for Southeast Asia and the Pacific.
There are other signs of the drug trade bouncing back. Japan’s customs officials saw a rise in air passengers smuggling methamphetamine in the second half of 2022, after the country reopened its borders. West African trafficking networks in East and Southeast Asia, which “all but disappeared” during the pandemic, have now resumed their activities, the report said.
“The most powerful regional trafficking networks are able to operate with a high degree of certainty they can and will not be stopped, and they are able to dictate the terms and conditions of the market as a result,” the report warned.
Some countries have stepped up their anti-trafficking efforts in recent years. More stringent law enforcement in China’s southwestern Yunnan province, and along the Thai border with Myanmar, has seen a significant drop in meth seizures in China and a slight decrease in Thailand.
But in turn, traffickers have adapted to “try to circumvent what governments do,” Douglas said.
Andaman trafficking
Asia’s drugs cartels generate billions through the global narcotics trade while generating a fraction of the attention of their counterparts in Latin and Central America, in part because they keep a much lower profile and are less prone to bouts of internecine warfare.
For years, the majority of regional meth production has taken place in the jungles of the Golden Triangle, a remote area where the borders of Thailand, Laos and Myanmar meet that has long been one of the world’s key narcotic hubs.
The closely-watched area still sees large volumes of drugs pass through – but crime groups are increasingly turning to western maritime routes, rerouting supply through central Myanmar to the Andaman Sea “where it seems few were looking,” said Douglas.
From Myanmar, meth and other synthetic drugs then travel out to the world, with shipments previously found as far away as Japan, New Zealand and Australia. South Asia, too, is being pulled further into this market, with meth transported in “high volumes” from Myanmar to Bangladesh and northeast India, the report found.
Despite the government crackdowns and increased seizures, wholesale and street prices for meth fell to record lows across the region in 2022 – a sign that that ample drug supplies were still getting through uninterrupted, according to the report. It also pointed to the high number of drug-related arrests and admissions at drug treatment facilities as further evidence of robust trade.
Other UNODC findings in recent years have painted a picture of a booming drug industry in Asia in spite of the pandemic, with some drug cartels taking advantage of distracted governments scrambling to contain the virus and enforce public health measures.
Organized crime groups have also capitalized on political instability such as the 2021 military coup in Myanmar and ongoing conflict in the country, which has made the country’s already lawless border regions an even more ideal production and smuggling hub.
Surge in ketamine
Besides meth, the production and trafficking of ketamine is also rising rapidly in the region, with authorities seizing 27.4 tons of the powerful dissociative anesthetic often used as a party drug.
That figure is 167% higher than the previous year, according to the UNODC report. Nearly every country and territory in the region reported an increase in seizures, except Japan and Hong Kong.
“The ketamine situation in the region in many ways mirrors the supply-driven approach used to expand the methamphetamine market in the mid-2010s,” said Inshik Sim, UNODC regional coordinator on synthetic drugs, in a news release.
“That being said, information on ketamine use is limited, and it is unclear how widespread it is – research is badly needed.”
Cambodia, long a transportation hub, has also begun to emerge as a key drug manufacturing location, with authorities discovering a series of secret industrial-scale ketamine labs, storage facilities and processing warehouses in the country.
The chemicals and equipment found in these labs point to a sprawling international network, originating or transiting from at least 12 different countries and provinces, the report said. For instance, there were chemicals found produced in France with Vietnamese writing on the packaging; other substances came from Poland, India, Indonesia and South Korea.
The sheer amount of chemicals found also point to a boom in ketamine production; Cambodian authorities seized 518 tons of chemicals in 2022, compared to just 5 tons in 2020, alarming international and regional leaders. | Drug Discoveries |
The Environmental Protection Agency on Thursday proposed a stricter rule on lead in drinking water that would require that all lead service lines in the country be replaced within 10 years, and would lower the current lead action level in drinking water from 15 parts per billion to 10 parts per billion.
More than 9.2 million American households have water connections that include lead piping, according to the White House. Lead moves from the pipes into the water when the plumbing experiences corrosion, which is most severe when the water is acidic or has low mineral content. There is no safe level of lead, which is a toxic metal with wide-ranging health effects, including neurotoxic effects. In children, lead exposure can damage the brain and nervous system, slow development, lower IQ, and cause learning, behavioral, speech, and hearing problems. In adults, it can increase the risk of high blood pressure, cardiovascular problems, and kidney damage.
The EPA estimates that the rule will generate between $9.8 billion to $34.8 billion in economic benefits each year based on health improvement, including higher IQs in children, healthier newborns, lower cardiovascular risks in adults, and a reduction in care for attention-deficit/hyperactivity disorder.
But, ripping out and replacing lead pipes will not come cheap. The EPA estimates that it will cost $20 billion to $30 billion to replace the pipes over 10 years. Currently, there is $15 billion available to find and replace lead pipes from the 2021 infrastructure law. The White House notes that there is also an additional $11.7 billion in general-purpose funding through the Drinking Water State Revolving Fund, which can also be used for lead pipe replacement.
In addition to lowering the lead action level and removing remaining lead pipes, the new rule will also help identify lead piping, spur improvements for lead testing, and require more public outreach when lead levels are found to exceed the action level, including offering communities more filters that remove lead.
The rule is part of a larger effort by the Biden administration to reduce lead exposure in children and advance environmental justice. Lead exposure disproportionately affects low-income communities and communities of color.
"Lead in drinking water is a generational public health issue, and EPA's proposal will accelerate progress towards President Biden’s goal of replacing every lead pipe across America once and for all," EPA Administrator Michael Regan said in a statement. "With collaboration and the focused actions proposed today, EPA is delivering on our charge to protect all Americans, especially communities of color, that are disproportionately harmed by lead in drinking water systems."
The EPA is accepting comments on the proposed rule for 60 days and could finalize it sometime next year. | Global Health |
Europe's drugs regulator has told BBC News it is conducting a review of some weight-loss jabs after being alerted to a possible link to thoughts of suicide and self-harm among users.
Member state Iceland notified the European Medicines Agency after seeing three cases.
The safety assessment will look at Wegovy, Saxenda and similar drugs, such as Ozempic, that help curb appetite.
Product leaflets already list suicidal thoughts as a possible side effect.
Suicidal behaviour is not currently listed for these prescription drugs.
The EMA's Pharmacovigilance Risk Assessment Committee (PRAC), which is conducting the review, will consider whether other treatments in same broader category of medicines, glucagon-like peptide-1 (GLP-1) receptor agonists, also need assessing.
But initially, it will assess only the risks of using weight-loss medication that contains either semaglutide or liraglutide.
An EMA official said: "The review is being carried out in the context of a signal procedure raised by the Icelandic Medicines Agency, following three case reports.
"A signal is information on a new or known adverse event that is potentially caused by a medicine and that warrants further investigation.
"The case reports included two cases of suicidal thoughts - one following the use of Saxenda and one after Ozempic.
"One additional case reported thoughts of self-injury with Saxenda.
"The EMA will communicate further when more information becomes available."
Global shortages
Social media posts about people, often celebrities, shedding large amounts of weight has led to big demand for these types of treatment.
Saxenda and Wegovy are approved and licensed for weight loss. Wegovy is not yet available in the UK - but the prime minister has said GPs in England may soon start offering it to some patients, as well as specialist weight-management clinics.
Ozempic is for people with diabetes to help control blood sugar as well as weight but contains a lower dose of the same medicine, semaglutide, as Wegovy. And with some people without diabetes buying the pre-filled pens to lose weight, there have been continuing global shortages.
All medicines have potential side effects. For weight-loss drugs, which should be used alongside a healthy diet and exercise, more common ones include:
- nausea
- vomiting
- headaches
- diarrhoea
- constipation
- stomach ache
- tiredness
Depression or thoughts of suicide is listed in the product-information leaflet, which advises users: "You should pay attention to any mental changes, especially sudden changes in your mood, behaviours, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you."
Prescribers are also advised to monitor for this.
Manufacturer Novo Nordisk is working with the EMA and says patient safety is a top priority. A representative said: "GLP-1 receptor agonists have been used to treat type-2 diabetes for more than 15 years and for treatment of obesity for eight years, including Novo Nordisk products such as semaglutide and liraglutide that have been in the UK market since 2018 and 2009 respectively.
"The safety data collected from large clinical-trial programmes and post-marketing surveillance have not demonstrated a causal association between semaglutide or liraglutide and suicidal and self-harming thoughts.
"Novo Nordisk is continuously performing surveillance of the data from ongoing clinical trials and real-world use of its products and collaborates closely with the authorities to ensure patient safety and adequate information to healthcare professionals.
"EMA continuously monitors for safety signals and so does Novo Nordisk.
"Novo Nordisk remains committed to ensuring patient safety."
The UK's drug regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), said it was monitoring the situation.
Dr Alison Cave, MHRA Chief Safety Officer, said: "As part of our close monitoring, any emerging evidence is routinely considered alongside other sources of information, including suspected adverse drug reactions. We will communicate any new advice to healthcare professionals and patients if appropriate.
"If you are experiencing suicidal thoughts or thoughts of self-harm, please seek immediate medical assistance.
"We ask everyone to report any suspected side effects using our Yellow Card scheme website."
If you have been affected by any of these issues, visit BBC Action Line, where you can find support. | Drug Discoveries |
A decision to allow a neurologist to voluntarily remove himself from the medical register has been quashed.
Dr Michael Watt was at the centre of Northern Ireland's biggest ever recall of patients over concerns about his clinical practice.
The Medical Practitioners Tribunal Service (MPTS) allowed him to voluntarily remove himself in 2021.
It meant he would not face a public hearing about any fitness to practise issues.
However, two former patients of Dr Watt challenged the decision in a judicial review at the High Court in Belfast.
Mr Justice McAlinden said the issue at the heart of the case, brought by Danielle O'Neill and Michael McHugh, was whether the MPTS had the jurisdiction to deal with the application in the matter that it did.
"I am utterly convinced that the initial hearing and I use that word carefully... the original hearing that was heard in this case was heard without jurisdiction as an application for voluntary erasure had not been made at that stage," the court heard.
"It certainly didn't have jurisdiction to do so at the second, reconvened hearing because there had been no legitimate first hearing, the hearing hadn't commenced.
"If it hadn't commenced, the hearing had not begun then the hearing has no jurisdiction to deal with that."
'Monumental for victims'
Ms O'Neill said the decision marked a "monumental day for patients" and was delighted by the judge's decision.
"Today there is some form of relief, but this is only the first step that this isn't the end this is only the beginning," she told BBC's Evening Extra programme.
"We're going to be scarred with the trauma of this for the rest of our lives."
Former patients of Dr Watt have been left with zero confidence in the medical profession and the regulator, Ms O'Neill added.
Solicitor Claire McKeegan described the ruling as a "huge day" for Dr Watt's former patients.
"These people deserve answers, truth and all the accountability that any court can bring and I'm just delighted for them today."
Ms McKeegan said by being voluntary struck off the register, Dr Watt avoided the public scrutiny of "catastrophic failings".
"We like to think that after the judgement of the court today, the MPTS will think twice in allowing Michael Watt to get out of this again."
A solicitor for Michael McHugh said the ruling was a "revelation with regards to the need for those who are responsible for safeguarding the medical profession to be entirely scrupulous when applying the rigor of the law".
Striking down the voluntary erasure order made by the tribunal, Mr McAlinden said Dr Watt will have to make a fresh application.
"That application will have to be considered and determined by the GMC (General Medical Council) in strict accordance by the statutory framework that they are bound to comply with."
Largest recall of its kind
An inquiry into Dr Watt's clinical practice at the Royal Victoria Hospital found the Belfast Trust failed to intervene quickly enough.
The Independent Neurology Inquiry concluded that the combined effect of the failures ensured that patterns in the consultant's work were missed for a decade.
More than 5,000 former patients of neurologist Dr Michael Watt were invited to have their cases examined for possible misdiagnoses.
Among the conditions being treated were stroke, Parkinson's disease and multiple sclerosis (MS).
It concluded the combined effect of the failures ensured patterns in the former consultant's work were missed for a decade.
It also found failures were not confined to the Belfast Trust and communications between different organisations and management levels were inadequate. | Health Policy |
The evolution of higher cognitive functions in humans has so far mostly been linked to the expansion of the neocortex. Researchers are increasingly realising, however, that the "little brain" or cerebellum also expanded during evolution and probably contributes to the capacities unique to humans. A Heidelberg research team has now generated comprehensive genetic maps of the development of cells in the cerebella of human, mouse and opossum. Comparisons of these maps reveal both ancestral and species-specific cellular and molecular characteristics of cerebellum development.
"Although the cerebellum, a structure at the back of the skull, contains about 80 percent of all neurons in the whole human brain, this was long considered a brain region with a rather simple cellular architecture," explains Prof. Kaessmann. In recent times, however, evidence suggesting a pronounced heterogeneity within this structure has been growing, says the molecular biologist. The Heidelberg researchers have now systematically classified all cell types in the developing cerebellum of human, mouse and opossum. To do so they first collected molecular profiles from almost 400,000 individual cells using single-cell sequencing technologies. They also employed procedures enabling spatial mapping of the cell types.
On the basis of these data the scientists noted that in the human cerebellum the proportion of Purkinje cells -- large, complex neurons with key functions in the cerebellum -- is almost double that of mouse and opossum in the early stages of fetal development. This increase is primarily driven by specific subtypes of Purkinje cells that are generated first during development and likely communicate with neocortical areas involved in cognitive functions in the mature brain. "It stands to reason that the expansion of these specific types of Purkinje cells during human evolution supports higher cognitive functions in humans," explains Dr Mari Sepp, a postdoctoral researcher in Prof. Kaessmann's research group "Functional evolution of mammalian genomes."
Using bioinformatic approaches, the researchers also compared the gene expression programmes in cerebellum cells of human, mouse and opossum. These programmes are defined by the fine-tuned activities of a myriad of genes that determine the types into which cells differentiate in the course of development. Genes with cell-type-specific activity profiles were identified that have been conserved across species for at least about 160 million years of evolution. According to Henrik Kaessmann, this suggests that they are important for fundamental mechanisms that determine cell type identities in the mammalian cerebellum. At the same time, the scientists identified over 1,000 genes with activity profiles differing between human, mouse and opossum. "At the level of cell types, it happens fairly frequently that genes obtain new activity profiles. This means that ancestral genes, present in all mammals, become active in new cell types during evolution, potentially changing the properties of these cells," says Dr Kevin Leiss, who -- at the time of the studies -- was a doctoral student in Prof. Kaessmann's research group.
Among the genes showing activity profiles that differ between human and mouse -- the most frequently used model organism in biomedical research -- several are associated with neurodevelopmental disorders or childhood brain tumours, Prof. Pfister explains. He is a director at the Hopp Children's Cancer Center Heidelberg, heads a research division at the German Cancer Research Center and is a consultant paediatric oncologist at Heidelberg University Hospital. The results of the study could, as Prof. Pfister suggests, provide valuable guidance in the search for suitable model systems -- beyond the mouse model -- to further explore such diseases.
The research results were published in the journal Nature. Also participating in the studies -- apart from the Heidelberg scientists -- were researchers from Berlin as well as China, France, Hungary, and the United Kingdom. The European Research Council financed the research. The data are available in a public database.
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When we think of the effects of age on baby-making, we tend to focus on women. That withering supply of eggs. Those chromosomal problems. Infertility. But men are affected by age too. There is now a substantial – and growing – body of evidence that suggests delaying fatherhood may carry its own consequences. These are seldom talked about – how often, for example, are men told to “pay more attention” to their biological clocks?
Nor, generally, are fertility services discouraged for older men wanting to be fathers in the way some countries do for older women who want to be mothers. In England and Wales, for example, the National Institute for Clinical Excellence recommends that the NHS does not offer IVF to women over 42, but no mention is made of paternal age in its guidance. Nor is there an agreed definition of “old” when it comes to fathers.
Yet we know that some time about the age of 40, men’s sperm start to get slower. Conception gets harder. And children born to older fathers face higher rates of conditions such as autism, schizophrenia and leukaemia.
In many countries, men are becoming fathers at older ages. In America, for example, in 1980 about 43 in 1,000 babies were born to men aged between 35-49; by 2015 this had jumped to about 69 in 1,000 babies.
Age affects the sperm itself. A large systematic review published in 2015, looking at 90 separate studies involving 93,839 subjects, found that a man’s age negatively affected measures of sperm quality – the way sperm looked, how well they moved, and how many were damaged.
The physical attributes of the sperm can be important when it comes to conceiving a child. Research suggests conception rates for older men are lower than for younger men. In a study of 2,112 UK couples, men over 45 were nearly five times more likely to take more than a year to conceive compared with men aged under 25, and this held true even when the female partner was young.
In vitro fertilisation (IVF) outcomes for older men also appear worse. A paper this year in the Journal of Assisted Reproduction and Genetics examined findings from 11 studies and 10,527 egg donation cycles – egg donors tend to be young – and found that increasing male age was associated with a slight decrease in live birthrate.
Conceptions from older men are also more likely to end in miscarriage or stillbirth. And those babies born to older fathers are more likely than those conceived by younger men to be born preterm (between 32 and 37 weeks of pregnancy) or very preterm (between 28 and 32 weeks of pregnancy).
“People assume that if there is a sperm that swims and can penetrate an egg, everything is fine,” says Bernard Robaire, a professor at McGill University in Montreal who specialises in the ageing of the male reproductive system, “but that’s not the case.” And it’s not just the general public that hasn’t twigged. Robaire says that last year he gave a presentation on the topic to physicians specialising in obstetrics and gynaecology. Many were unaware of the link between male age and poor reproductive outcomes.
In a review paper published last year in Frontiers of Endocrinology, Robaire and his McGill colleague Peter Chan also underscored numerous epidemiological studies that have linked older fatherhood to health problems in their children.
Older fathers are more likely, for instance, to have children with birth defects such as cleft lip or a hole in the diaphragm, and the odds increase with each year of paternal age. Some cancers also become more common. A birth registry study of nearly 2 million children in Denmark found that a certain kind of childhood leukaemia increases in likelihood by 13% for every five years older the father is. The risk of brain cancer and breast cancer are also elevated in people born to older fathers.
There are also neurological effects. Children with fathers who are more than 40 at their birth are almost six times more likely to have autism than those whose fathers are less than 30, according to one study. Babies born to fathers aged over 50 face an up to fivefold increased risk of schizophrenia. Obsessive compulsive disorder, ADHD, bipolar disorder – all are more likely, research indicates, if the father is older.
But how can this be, you may ask, with more and more older fathers in the news? Didn’t Mick Jagger have a child at 73, Robert De Niro at 79 and Al Pacino at 83? Aren’t sperm made fresh every 74 days or so? Don’t male humans just never run out of the stuff? Yes, yes, and yes.
Much is made of the fact that a woman is born with all the eggs she will ever have; that by her mid-30s they start to spoil, and before you know it, she has run out. At about the age of 50 or so, a woman faces a full shutdown of her reproductive capability. Not so for males, who are able to reproduce pretty much until the end of their lives. But research now shows that the longer the sperm factory operates, the more likely it is that glitches will be introduced during the manufacturing process.
The raw material for sperm are spermatogonial stem cells in the testes. As part of the sperm production process, these immature cells continuously replenish themselves through cell division. Only about half of the new cells will set off on the journey to become new sperm, while the other half will remain to maintain the spermatogonial stem cell pool.
But replication involves copying the entire genome, which is about 3bn letters long. Though rare, sometimes a copying error is made. And if that happens, the sperm that will later arise from that spermatogonial stem cell will forever carry that mutation.
The older a man is, the more times his spermatogonial stem cells will have been replicated. It has been estimated that the sperm produced by a 25-year-old will have undergone 350 replications, whereas the sperm of a 45-year-old will have had 750. Each replication creates more opportunity for a mistake. Which means the children of older men are likely to have more genetic mutations than those born to younger ones.
We are all born with new mutations – about 60 on average. But people born to older fathers have more. In fact, researchers who have sequenced whole genomes or whole exomes (specific parts of genomes) of mother-father-child trios have found that the number of new mutations in children increases steadily with paternal age – about one to two additional mutations for every year older the father is at the time of the child’s birth.
And since we can deduce which chromosome comes from which parent, we know that about 80% of these “de novo” mutations come from the father, whether younger or older.
The good news is that most of the acquired mutations are harmless. “The vast majority of these mutations will have no effect, because they will occur in a part of the genome that is not coding,” says Anne Goriely, professor of human genetics at the University of Oxford. But some will have effects, she says, and although they are rare, they are important contributors to genetic disease. They affect about one in every 300 live births, she noted in a review paper with her colleague, Katherine Wood, in Fertility and Sterility last year.
Goriely’s own interest is in a small subset of these disorders, known as “paternal age effect disorders”, long associated with older fathers. They include conditions such as achondroplasia, which causes dwarfism, and Apert syndrome, which leads to a misshapen skull and fused fingers and toes. Unlike many conditions caused by de novo mutations, however, these paternal age effect disorders do not show just a linear increase with age, but rise sharply in prevalence as the father’s age goes up – occurring much more frequently than you would expect by chance.
But de novo mutations alone may not explain the higher frequency of complex conditions such as autism and schizophrenia that we see in people born to older fathers.
Could modification of epigenetic marks play a role? “What’s passed on to a child is not simply the sequence of [DNA] bases,” says Robaire, who is studying epigenetic alterations in sperm from older men, “but a bunch of other messages that are included to allow some genes to be turned on or not to be turned off.” These messages, or epigenetic marks, control the expression of genes. The very act of living, says Robaire, exposes a man to stresses, toxins, chemicals and experiences that will modify the epigenetic marks on his spermatogonial stem cells. Those modified marks will be copied to any sperm produced from them.
In 2020, Robaire and his colleagues published a paper in Clinical Epigenetics showing that there are age-dependent alterations in the epigenetic marks found on DNA in human sperm. He says you can look at the patterns of epigenetic marks and “predict a man’s age within two years”.
The researchers had expected to find that the epigenetic changes were related to sperm development, but they weren’t. Intriguingly, the places that showed the most epigenetic age-related change were sites associated with neurodevelopment. “Why those sites are selectively affected, I have no idea,” says Robaire.
Men produce a huge number of sperm – about 2,000 with every heartbeat, he says. That’s several million a day. “It’s an amazing machine to be able to produce that many cells.”
But problems pile up as a man gets older. Stem cells acquire more mutations. Epigenetic marks get modified. Experiences in the man’s life, including environmental exposures, cause oxidative stress and damage. These things, and more, may act in concert to cause the effects researchers are seeing in children born to older fathers.
What’s clear is that paternal age matters – and that more men are becoming older fathers. As Robaire and Chan write, a number of factors including delayed marriages, second marriages, assisted reproduction, treatments such as Viagra for erectile dysfunction, and celebrity men modelling older fatherhood “have provided elements for a perfect storm”. | Men's Health |
I battled eating disorders in secret for nine years - I was too scared to get help from the NHS because the wait times are so long
- Emma Dransfield, 29, first struggled with disordered eating when she was 18
- Over the course of nine years, she battled anorexia and bulimia in silence
- She couldn't afford private treatment and was intimidated by long NHS waitlists
- Read More: Young woman's horrific battle with an eating disorder that left her bedridden, 'tubed' and suicidal for years - and how she found the strength to finally beat it
A woman who battled eating disorders in private for nine years has revealed how she was too scared to get help from the NHS because of long wait times.
Emma Dransfield, 29, from Leeds, first started struggling with disordered eating in 2012 when she started university.
The graphic designer gained three stone in less than a year following a series of binge-eating episodes.
As she desperately tried to regain control, Emma sadly then developed bulimia and would make herself sick several times a day.
Although she battled disordered eating and obsessive exercise for the best part of a decade, Emma says she brushed off concern from friends and family and once opened up to an 'unsupportive' ex-boyfriend.
Emma Dransfield pictured during the height of her eating disorder. Over the course of her nine year battle with anorexia and bulimia, Emma would binge and purge or limit herself to 400 calories a day
She explained: 'When I was 18, I started gaining weight and felt like I couldn't stop eating.
'This then turned into bulimia because, to me, it felt like the only solution to stop binge eating and gaining weight.
'The worst times during my eating disorder were early on. I was binging and purging up to nine times a day. I had low self-esteem and depression.'
Before she would eat anything, Emma had to weigh it first - and would only consume it if it was less than the recommended serving suggestion.
She continued: 'I remember when I was at uni I wrote down meal plans and I would put chewing gum as a snack.
'I found it hard to accept myself and see my worth. I was abusing my body through exercise, trying to shrink it as much as I could because I thought if I lose a couple of more pounds I would be happy, but I never was.'
Although friends and family expressed concern about her weight, Emma admits she was too ashamed to open up about the extent of her disordered eating.
Describing how she found her eating disorder 'embarrassing', she added: 'My partner who I was with at the time found it frustrating when I wouldn't want to eat at certain places or eat certain things.
'It put a lot on the relationship as when I found the courage to open up to him about my eating disorder as he wasn't supportive.'
Emma pictured running a marathon in 2018 as a way to keep her weight down. Around this time, Emma also said she would weigh everything she ate
Emma Dransfield plummeted to eight stone while battling her eating disorders from 2012 to 2021
Pictured: Emma shortly after she started battling disordered eating when she was 18 years old in 2012
WHAT IS ANOREXIA?
Anorexia is an eating disorder and a mental health condition.
People diagnosed with it try to keep their weight as low as possible by eating little or excessive exercise.
Men and women can develop the illness, however it typically starts in the mid-teens.
Those with anorexia can have a distorted image of their bodies, thinking they're fat when in fact they are severely underweight.
Causes of the condition are unknown, but those with it have either low self-esteem, have a family history of eating disorders or feel pressured from society or place of work.
Long term health complications can include muscle and bone problems, loss of sex drive, kidney or bowel problems or having a weakened immune system.
Treatment for anorexia can include cognitive behavioural therapy.
At her worst, Emma would eat as little as 400 calories a day - causing her weight to plummet to just eight stone.
As a result, she suffered from amenorrhea - the absence of menstrual bleeding - and severe stomach ulcers.
But despite these alarming side effects, Emma still felt as though she couldn't confide in a doctor.
She said: 'I didn't seek any help as it was too expensive and the waiting list on the NHS was too long.'
Although wait times differ from area-to-area, the NHS revealed last year that it is now treating a record number of young people for eating disorders.
There were 207 under-19s in England waiting for 'urgent' care for conditions such as bulimia and anorexia by the end of June. It is the highest number since NHS records began in 2016 and more than triple the amount at the same time in 2021.
On top of this, Emma then developed orthorexia, an eating disorder that is characterised by the obsession with only eating foods that are considered 'healthy', and became obsessed with exercise.
She ran a marathon in 2018 as a way to keep her weight down, and was doing as many as 30,000 steps everyday in 2020.
However in 2021, Emma started to regain control over her life when she moved into her first home of her own.
In the past two years, she has gained three stone and is feeling more comfortable in her own skin after discovering her 'new love' of strength-building exercises.
Emma (pictured) last year feels like she 'has her life back' after breaking free of her disordered eating
Emma Dransfield now boast 12,000 Instagram followers and shares her day-to-day life in recovery
Discussing her recovery, Emma said: 'My advice to someone going through the same thing would be that recovery isn't linear. Some days you will feel like you've gone back to your old ways and you're never going to recover but you will.'
Record numbers of children and young people are waiting for treatment for eating disorders. There were 207 under-19s in England waiting for 'urgent' care for conditions including bulimia and anorexia by the end of June - the highest number since records began in 2016 and more than triple the amount at the same time last year (shown)
Emma explained: 'It's been one of the hardest things I've done but also the best thing.
'I did everything alone which I think was harder than seeking professional help.
'I've read books on binge eating and bulimia and also turned to social media recovery accounts and therapists for tips and support.
'Social media can have a bad reputation but the community on there for eating disorder recovery is so motivating.'
Emma has since learned to enjoy food again after breaking free of her eating disorder. She now eats between 2500 and 3000 calories per day, and has found a "new love" for strength-building exercises
Emma also developed orthorexia, an eating disorder that is characterised by the obsession with only eating foods that are considered "healthy", and became obsessed with exercise
Emma now feels happier than ever after years of struggling to 'see her worth' beyond her weight
As well as regaining her menstrual cycle, Emma has gone from a UK six size to between a 10 to 12.
Describing how she has 'got her life back', Emma continued: 'Having an eating disorder strips you of so much,' Emma said.
'I had social anxiety. I didn't like going out for meals or events. I turned down so many fun things because I feared not being able to exercise or what food there would be.
'I now have the freedom to say yes to events and meet friends without having to think about it. I can go out for food and order what I truly want without the fear of calories.
Emma says she had to teach herself to eat without feeling any guilt. Pictured: Emma recently enjoying a meal with a friend
Left: At her worst, Emma would obsessively walk 30,000 steps a day to maintain her size six frame. Right: Emma says she now sees exercise as a way to grow rather than shrink
Left: Emma pictured on holiday while still in the grips of her eating disorder. Right: Emma pictured enjoying a meal out with friends
'Once you find that freedom from your eating disorder, the feeling is unmatched.'
What's more, Emma has also shared her recovery on her Instagram account - which now boasts over 12,000 followers.
She added: 'My advice to someone going through the same thing would be that recovery isn't linear.
'Some days you will feel like you've gone back to your old ways and you're never going to recover but you will.
Emma said: 'I now have the freedom to say yes to events and meet friends without having to think about it. I can go out for food and order what I truly want without the fear of calories.'
Emma pictured at a festival last month. She added: 'I want to keep sharing my journey on Instagram because I know how many others it helps.'
'I spent so many days feeling like I was making no progress and my eating disorder was still ruling my life but these bad days only bring you back stronger than before.
'I want to keep sharing my journey on Instagram because I know how many others it helps.
'I'll also continue training and improving my performance in the gym because it's something I love doing and I gain so much from it, not just physically but mentally as well. I train to see what my body can do and not because I wanted to shrink it.'
If you’re worried about your own or someone else’s health, you can contact Beat, the UK’s eating disorder charity, on 0808 801 0677 or beateatingdisorders.org.uk | Mental Health Treatments |
- DeSantis wouldn't decriminalize pot as president, he said when asked about it by a South Carolina voter.
- The Florida governor said last year that he didn't like the "putrid" smell.
- But DeSantis did help advance access to medical marijuana in Florida.
Republican Gov. Ron DeSantis said legalizing cannabis would not be on his agenda if he's elected to the White House in 2024.
DeSantis, who did advance rules for medical cannabis use in Florida, said he wouldn't pursue legalization nationally, expressing concerns about more young people accessing weed.
The definitive statement from the 2024 candidate for president came after a voter, speaking on behalf of injured veterans, asked DeSantis to "please decriminalize marijuana in 2025" during a campaign event in Augusta, South Carolina, on Thursday.
"I don't think we would do that," DeSantis responded. "But what I have done in Florida is we have a medical program through our Constitution that the voters did. Veterans in those situations in Florida are actually allowed access — it's very controversial because obviously there are some people that abuse it and are usuing it recreationally."
DeSantis argued that cannabis has become more powerful than it used to be, though many proponents of decriminalization say the drug should also be better regulated and labeled once it's legal, in a similar way as alcohol, so that people understand how much they're consuming.
As part of his response, the governor touted a schools initiative led by his wife, Florida first lady Casey DeSantis, that educates children about the consequences of drug use. US policy should be geared toward keeping children "clear of drugs," he said, and asserted that legalization would make the drug more accessible to young people.
Increased legalization of marijuana isn't associated with a rise in youth use, a 2021 study in the Journal of the American Medical Association showed.
But part of DeSantis' response to the cannabis question focused on the US opioid epidemic, in which he pointed out that sometimes people think they're using one drug — even illicit cannabis — only to learn, often too late, that it's been laced with deadly fentanyl.
"We have too many people using drugs in this country right now," DeSantis said. "I think it hurts our workforce readiness, I think it hurts people's ability to prosper in life."
Unlike cannabis policy, the opioid crisis was spurred along legally by doctors' overly aggressive prescribing practices. The medical community heavily marketed pain medications and pushed regulators to approve widespread use. Companies eventually conceded — after lying about it for years — that the drug was addictive and being misused.
Patients abruptly lost access to painkiller medications and many turned to similar, illicit drugs such as heroin. Most-recent available data show 68,630 people died opioids in 2020.
DeSantis has a mixed record on pot
Marijuana is illegal under federal law and is listed as a "Schedule 1" drug like heroin and meth, meaning justice agencies view it as having "no currently accepted medical use and a high potential for abuse." The Biden administration is reviewing the scheduling by the end of this year.
President Joe Biden has previously expressed skepticism about all-out legalization but in October 2022 he pardoned all prior federal offenses of simple marijuana possession.
Florida voters passed a constitutional amendment in 2016 that legalized cannabis use for medical reasons; the amendment had the support of more than 70% of voters.
Soon after becoming governor in 2019, DeSantis succesfully convinced the legislature to lift a state ban on the smokable form of the drug — a move meant to help the ballot initiative go into effect, and one that stunned the political class.
As a US Congressman, DeSantis voted in favor of spending bill amendments to protect state cannabis programs from federal interference. But the governor, who is also a Navy vet, voted against legislation that would allow doctors to recommend cannabis to patients.
In Florida, proponents are working to bring a ballot measure before Florida voters in 2024 that would legalize cannabis for recreational reasons for people ages 21 and over. The initiative has secured enough signatures to be considered, though it faces other hurdles.
Before it can be on the ballot, it must first go before the state Supreme Court for review. It could also face a challenge from Republican Florida Attorney General Ashley Moody, a DeSantis ally.
Asked about cannabis support in 2022, DeSantis expressed some hesitancy on the issue and derided the "putrid" smell of the drug.
"I think a lot of those other areas that have done it you know have ended up regretting it," DeSantis said in 2022, according to Politico. "I could not believe the pungent odor that you would see in some of these places and I don't want to see that here. I want people to be able to breathe freely."
At the time, former Agriculture Commissioner Nikki Fried — a leading proponent of legalization in Florida who now chairs the state's Democratic Party — was running for the Democratic nomination for governor, though it ultimately went to former Charlie Crist, a former congressman.
On Capitol Hill, the issue of cannabis legalization has become more bipartisan, particularly as a growing number of states have made it available medically and recreationally. Gallup polling finds 68% of voters, including half of Republicans, say marijuana use should be legal.
Senate Majority Leader Chuck Schumer met with Republicans this year to see what types of legalization measures might pass, including changes that would allow more banks to lend to cannabis businesses Marijuana Moment reported. | Drug Discoveries |
By Carolyn Newberry, MD, as told to Alexandra Benisek
In the WebMD webinar "Eating for a Healthy Weight," Carolyn Newberry, MD, of Weill Cornell Medicine of Cornell University and NewYork-Presbyterian Hospital/Weill Cornell Medical Center, answered viewer questions about how to create a healthy diet for weight management.
What do you think about margarine, low-fat butter-like spreads, and real butter? Which is best?
A lot of this depends on your personal health history. For somebody who doesn't have a history of heart disease or coronary artery disease, it’s OK or even possibly better to eat butter that’s less processed, even if it’s higher in fat. You just want to watch your portions. Eating a little bit of fresh, farm-made butter on a piece of whole-grain toast is completely fine.
Some products may seem healthier if they have a “low fat” or “low sugar” label. But when you really dive into the food labels, these have a lot of additives, artificial sweeteners, or other ingredients that aren’t in the natural food product. These things could lead to other health issues. There’s also data that shows that more artificial sweeteners and other artificial ingredients can cause digestive health problems.
Overall, for the average person who doesn't have specific health problems, it’s better to have more natural and less-processed food with fewer ingredients.
What about the number of eggs in a healthy diet for people with high cholesterol, and for people who don't have any cholesterol issues?
In general, if you don't have very high cholesterol or some other reason you need to limit cholesterol in your diet, then I think eggs actually are a really good source of protein.
You want to eat both the egg white and the yolk because it's a little more of a complete food, with protein, too. If you eat a bowl of egg whites, it's very hard to feel satisfied afterward. But with the yolk in it, even though it has more calories, you may eat a smaller portion of food, and you're going to get more nutrients.
Some more recent research says maybe it's not dietary cholesterol that’s raising our cholesterol levels. Maybe it's more of the saturated fat, like whole milk products, red meat, or processed meats. Those are probably more likely to cause rises in cholesterol, coronary artery disease, and heart disease than dietary cholesterol from an egg.
What's the best way to balance between cardiac and diabetic diets?
It’s common to have both because they go hand-in-hand. These diets don’t have to be entirely different.
With diabetes, you have to watch your simple sugar intake. These are the sugars that are broken down really quickly and raise your blood sugar quickly. But carbohydrates are still an important part of the diet. So it’s important to eat carbohydrates that have a higher amount of fiber in them instead of sugar or added sugar. And a lower-processed sugar, higher-fiber diet also helps lower your heart disease risk.
With heart disease, you’ll also want to watch your saturated fat intake. Somebody with diabetes is at a higher risk of heart disease. So they also should also watch their saturated fat intake.
The diet that’s best for cardiovascular health is the Mediterranean-style diet . It has more fruits, vegetables, and whole grains. This diet is high in fiber, and a lot of its protein comes from plants, nuts, or legumes. There’s also some seafood in there for omega-3s.
Do you think organic foods are best?
They tend to be a lot more expensive, so I don't know if the organic option is always better than the non-organic option. But it’s good to stick to less-processed foods that have fewer ingredients.
It's not realistic for most people to buy all organic. You can also buy a bag of frozen fruits or vegetables. They are frozen at the time that they are fresh, so they still have a lot, if not all, of their nutrient content. That’s just a much cheaper way to consume food.
Can a healthy diet include alcohol? If so, what are the best guidelines?
It depends on your medical history. If you have certain health conditions, alcohol should be avoided. But a modest amount of alcohol in your diet is usually fine for most people.
The Mediterranean diet does contain a small amount of red wine. If you’re choosing alcoholic beverages, a glass of wine might be a better option than a mixed cocktail. Those often have a lot of added sugar.
It’s not that you can never have a cocktail. But you need to find the right balance for making good decisions. Make sure you don’t have a sugary cocktail every day. But on a Saturday night, if you're celebrating with your friends, it’s OK to have a cocktail. Then for the rest of the week, make sure to limit alcohol or choose a better option.
Is too much fruit a problem when trying to lose weight? What about lowering your A1c?
Fresh or frozen fruit – as long as it's not in a syrup or in the form of a dessert – has a lot of good vitamins, minerals, and fiber. Plus, it tastes good.
When you eat fruit, you shouldn't worry. Fruit isn’t added sugar, it’s natural sugar. What could be an issue is processed fruits like fruit juice. People may think it’s healthy, but if you think about the number of oranges you need to squeeze for a glass of orange juice, it's a lot. When you use a juicer, you take out all the fiber from the fruit and you’re left with only the natural sugars. Then you drink those natural sugars at a really high level. You can still have fruit juice from time to time, but it’s not as good for you as a whole fruit.
I advise people to make a smoothie instead. This way, you grind up the whole fruit and still have all the fiber to make it more filling, And it's much more nutritious that way.
If your diabetes is very poorly controlled, your hemoglobin A1c is really high, or your blood sugars are really high, you may have to cut back on certain fruits that have higher natural sugars like watermelon or berries. But most people do totally fine with fruit.
Is it healthy to drink your calories?
Most liquid calories are not going to have a lot of health benefits. There are a lot of products on the market now that have a lot of added sugar or artificial sweeteners. In a perfect world, everyone would drink water to hydrate. But coffee is fine in reasonable amounts. Sometimes having fruit juice – like a glass of fresh orange juice with your breakfast – is totally fine. But just understand that most liquid calories are not really doing a lot for your health, even though it’s safe to drink them. Just think of it as a dessert.
Are any foods safe and healthy to eat all you want?
In general, it's best to keep your diet balanced and realistic. It’s unlikely that somebody will sit down and just eat kale all day. It's a great source of fiber, but you're not getting a lot of protein, you're not getting fat, and all these things are also important parts of the diet.
This is also why I'm hesitant to suggest fad diets, very low fat diets, or really low carbohydrate diets. They’re very restrictive. Some people with certain health problems may need to go that route. But the vast majority of people should look for diets with balanced macronutrients.
So there's no food that you can just eat all day, every day, as much as you want. That's not the way we should think about food.
Should multivitamins or other supplements be taken when dieting for weight loss?
Usually, if you’re cutting your calories, a once-a-day multivitamin can be a good idea, but it may not be necessary. Hopefully, you're getting the nutrition you need as part of your diet.
Some groups of people may benefit from other supplements . For example, people who are postmenopausal may need calcium and vitamin D supplements. A lack of iron is also common, especially if you’re on a plant-based diet. So you may need an iron supplement. But there are a lot of good plant sources of iron as well like spinach, green beans, or legumes. Just make sure you eat enough to get the right amount of iron.
If you’re vegan, you need a B12 supplement because B12 is only in animal products.
What are some examples of natural appetite suppressants?
Honestly, there isn't a lot of information that supports anything to naturally slow down or suppress your appetite. No supplement is FDA regulated, so you never really know what you're getting.
It’s not that supplements don’t work; most just haven’t been researched enough.
I can’t suggest a supplement that’s been shown to lower appetite. But you can do things to feel more full: eat balanced meals; have snacks that have carbs, fat, and protein to feel full all day; eat a lot of fiber; and drink a glass of water before every meal.
I would definitely urge people to talk to their doctors when they start any supplements, since none of them are regulated.
You mentioned social support groups for helping with weight loss success. What's the best way to find those groups?
There are many national programs like Weight Watchers or Jenny Craig. These may help with accountability, help regulate what you eat, and also give you a support system.
There are also medically supervised weight-management programs if you qualify for them. Usually you need to have a certain amount of extra weight to lose to be in a program like that. A BMI greater than 30 usually can make you eligible for things like medications and procedures to use with diet and exercise changes.
I definitely urge people to get professional help because obesity is a chronic disease and can be treated just like any other long-term disease.
What are the pros and cons of intermittent fasting?
Many people do well with small meals eaten often during the day. Intermittent fasting is a different approach, where you eat during a very short time window, and then you fast, or don’t eat. There are certainly health benefits for some people. You may find it easier, or it might help you eat fewer calories during the day if you need a lower-calorie diet.
Some studies show that it could help people who are insulin resistant, have elevated blood sugar level problems, or have other metabolic syndrome history. I think it totally depends on you. The best diet plan is the one you can follow.
What are some examples of micronutrients and macronutrients?
Macronutrients are proteins, fats, and carbohydrates. Those are the basic things that foods are made out of. Then micronutrients are all your vitamins and minerals. There are a number of trace metals as well, like copper, selenium, zinc, and iron.
How much water should someone drink each day? Is sparkling water as hydrating as still water? Is tap water as good as bottled?
Hydration is really important. Eight glasses of water a day is roughly a good number.
Yes, sparkling water is just as hydrating. It's water, it just has bubbles in it. But what you have to watch for with sparkling water is the extra bloat. If you're somebody who's sensitive to that, adding a lot of gas bubbles to your digestive system can be uncomfortable. If it doesn't cause symptoms, you’re fine to drink it. But just be aware that a lot of sparkling waters do add sweeteners or flavorings, which can add calories or sugars.
For tap water, it depends on where you live. Some tap water also has fluoride, which can be very good for your teeth. There are some places where the water isn’t safe to drink or isn’t as processed. But you would probably know if you’re in an area like that.
Watch a replay of the WebMD webinar "Eating for a Healthy Weight."
Watch other free WebMD webinars by leading experts on a variety of health topics. | Nutrition Research |
Trish Webster started taking Ozempic—the trade name of an injectable medication called semaglutide developed to treat type 2 diabetes—after struggling to lose weight through traditional means, her husband Roy Webster told 60 Minutes Australia. The 56-year-old, who did not have diabetes, saw a TV ad for Ozempic and obtained a prescription from her doctor in 2022 after learning that significant weight loss was one of the drug's side effects.
"Her daughter was getting married, and she just kept mentioning that dress that she wanted to wear," Roy recalled. "So, she went into drastic measures."
Trish was on Ozempic before switching to Saxenda, a liraglutide injectable that helps with chronic weight management, according to Roy.
He said Trish lost 35 pounds in five months, but also experienced severe nausea, vomiting and diarrhea. As Roy explained, "It was one big nightmare from there."
The situation took a turn on Jan. 16, when Roy noticed "brown stuff" coming out of Trish's mouth.
"I realized she wasn't breathing," he remembered, "and I started doing CPR."
Unfortunately, his efforts were to no avail and Trish died that night. Per 60 Minutes Australia, her cause of death was listed as acute gastrointestinal illness on her death certificate.
Roy now believes the injectables his wife was taking contributed to her sudden passing.
"I couldn't save her," he tearfully told the outlet. "If I knew that could happen, she wouldn't have been taking it. I would have make sure she wasn't going to take it."
Ozempic has been approved as a type 2 diabetes treatment by Australia's Department of Health and Aged Care, though the agency notes on its website that the drug is now commonly being prescribed "off-label" by medical practitioners as a form of weight loss.
"It is a regular occurrence in the Australian healthcare system, particularly for uncommon diseases and conditions or underrepresented patient groups," the department said. "The TGA does not have the power to regulate the clinical decisions of health professionals and is unable to prevent doctors from using their clinical judgement to prescribe Ozempic for other health conditions."
E! News has reached out to Novo Nordisk, the maker of Ozempic and Saxenda, for comment but hasn't heard back. However, a spokesperson for the manufacturer told People that patient safety is "a top priority."
"We take all reports about adverse events from use of our medicines very seriously. However, we do not comment on individual patient cases," their statement read. "Ozempic (semaglutide) is a prescription medicine that should be taken under the care of a licensed healthcare provider."
The rep said the drug is FDA-approved to treat type 2 diabetes to improve blood sugar and reduce the risk of cardiovascular events, adding, "Ozempic is not indicated for chronic weight management."
Their statement continued, "The safety and efficacy profile of Ozempic has been evaluated in clinical studies involving more than patients. The most commonly reported side effects were gastrointestinal, including nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation. The known risks associated with use of Ozempic are reflected in the FDA-approved product labeling. We stand behind the safety and efficacy of Ozempic when used as indicated."
To see what Hollywood is saying about Ozempic, keep reading. | Drug Discoveries |
Samuel Hanke is a pediatric cardiologist in Cincinnati, but when you ask him for his title, he follows it by saying: "Most importantly, I'm Charlie's dad."
Hanke remembers the night 13 years ago when Charlie, then 3 weeks old, was fussier than usual, so he picked him up to soothe him back to sleep. With Charlie still in his arms, he sat on the couch, turned on the TV, and nodded off.
"We were kind of chest to chest, the way you see in pictures a lot," Hanke said. But he didn't realize Charlie's airways were blocked. Too young to turn his head, too squished to let out a cry, Charlie died silently. The next morning, Hanke woke up to his worst nightmare. Years of medical school weren't enough to prevent Hanke from losing Charlie to accidental suffocation.
Sudden infant death syndrome, a well-known term that describes unexplained but natural infant deaths resulting from an unknown medical abnormality or vulnerability, is the leading cause of unexpected deaths among infants in the U.S. It has long been among new parents' greatest fears.
Centers for Disease Control and Prevention. Accidental suffocations and strangulations aren't necessarily happening more often, some experts say; rather, fatality review teams have become better at identifying causes of death.have declined since the 1990s, but a different cause of infant death — accidental suffocation or strangulation — has also been a persistent problem. That national rate for the past decade has hovered between 20 and 25 infant deaths per 100,000 live births, accounting for around a fifth of all unexpected infant deaths, according to the
And the trend remains steady despite decades of public information campaigns imploring parents to take steps to keep their babies.
In the mid-1990s, the National Institute of Child Health and Human Development launched its "Back to Sleep" campaign, to teach parents to lay infants on their backs to sleep. "There were tremendous results after 'Back to Sleep,'" said Alison Jacobson, executive director of First Candle, a Connecticut-based nonprofit focused on safe sleep education. Unexpected infant deaths dipped about 40% from 1990 levels, which was before that campaign launched, according to the CDC. "But then it plateaued," Jacobson said.
The NICHD eventually broadened this message with other ways to limit risks beyond a baby's sleep position with the "Safe to Sleep" initiative.
Some clear warnings from it: Infants shouldn't sleep with blankets, stuffed toys, or bumpers that "can potentially lead to suffocation or strangulation," said Samantha St. John, program coordinator for Cook Children's Health Care System in Fort Worth, Texas. They also should sleep in cribs or bassinets — not on beds with siblings or in parents' arms.
But these public health messages — contradicted by photos or videos circulating in movies and social media — don't always find traction. Professional photos of infants, for example, too commonly show them peacefully snoozing surrounded by plush animals and blankets. St. John added that parents sometimes have preconceived ideas of how infants' sleeping spaces should be decorated. "When you think of cribs and nurseries and things like that, you imagine the pictures in the magazines," St. John said. "And those are beautiful pictures, but it doesn't keep your baby safe."
St. John said many parents know that babies should be on their backs to sleep, but warnings about strangulation by blankets or suffocation by sharing a bed with them sometimes fall through the cracks.
For instance, new parents, especially single parents, are more likely to accidentally fall asleep with their infants because of exhaustion, said Emily Miller, a neonatologist at Cincinnati Children's Hospital.
The idea that sleeping with one's baby is dangerous can also be counterintuitive to a new parent's instinct. "We feel like being close to them, being able to see them, being able to touch them and feel that they're breathing is the best way we can protect them and keep them safe," said Miller, who is also an assistant professor at the University of Cincinnati's Department of Pediatrics.
Organizations across the country are working to help parents better understand the true risks. Hanke and his wife, for instance, channeled their grief into Charlie's Kids, a nonprofit focused on safe sleep practices for infants. The Hankes also wrote a book, "Sleep Baby, Safe and Snug," which has sold about 5 million copies. The proceeds are used to continue their educational efforts.
Ohio, where Charlie's Kids is based, in 2020 saw 146 sudden unexpected infant deaths, a classification that includes SIDS, accidental suffocation and strangulation, and other instances in which the cause is undetermined. That's about a death for every 1,000 live births, according to the state's health department. Thirty-six percent of those deaths were attributed to accidental suffocation or strangulation. Nationally, the rate of these unexplained deaths has declined since the 1990s, but, according to the CDC, significant racial and ethnic differences continue.
The particular risks for an infant's accidental suffocation in many respects are situational — and often involve people at the lower end of the income scale who tend to live in close quarters. People who live in a small apartment or motel often share sleeping space, said St. John.
Tarrant County has one of Texas' highest rates of infant deaths — three to four each month — attributed to accidental suffocation.
So, organizations like the Alliance for Children in Tarrant County, which serves Fort Worth and parts of Dallas, have been providing free bassinets and cribs to those in need.
County representatives spoke during the state's Child Fatality Review Team meeting in May and focused on the prevalence of infant deaths linked to accidental suffocation. For the past decade, data shows, the county has averaged 1.05 sudden unexpected infant deaths per 1,000 births, which is higher than both the state and national averages of 0.85 and 0.93, respectively. During a 15-month period starting in 2022, Cook Children's Medical Center recorded that 30 infants born at the hospital died after they left because of unsafe sleeping environments.
Sometimes parents' decisions are based on fears that stem from their environments. "Parents will say 'I'm bringing my baby into bed because I'm afraid of gunshots coming through the window, and this is how I keep my baby safe' or 'I'm afraid rats are going to crawl into the crib,'" said First Candle's Jacobson.
She understands these fears but stresses the broader context of safe sleep.
The key to educating parents is to begin when they are still expecting because they receive "a load of information" in the first 24 or 48 hours after a baby is delivered, said Sanjuanita Garza-Cox, a neonatal-perinatal specialist at Methodist Children's Hospital in San Antonio. Garza-Cox is also a member of the Bexar County Child Fatality Review Team.
And once a child is born, the messaging should continue. In Connecticut, for instance, First Candle hosts monthly conversations in neighborhoods that bring together new parents with doulas, lactation consultants, and other caregivers to discuss safe sleep and breastfeeding.
And both Tarrant and Bexar counties are placing ads on buses and at bus stops to reach at-risk parents and other caregivers such as children, relatives, and friends. Parents are very busy, Garza-Cox said. "And sometimes, multiple children and young kids are the ones watching the baby."
KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
for more features. | Epidemics & Outbreaks |
Patients have been sharing their negative and positive experiences of the health service with Sky News during a day of special programmes about the NHS crisis, including a live phone-in and an audience debate.We have been looking at whether the service can survive as it currently endures its most difficult winter on record.
You can see how your health service is performing using the tool below. It comes as new data shows that GP waiting times fell in December for the second consecutive month, with the share of people managing to secure an urgent appointment on the same day rising from 69% to 74%.And separate figures found ambulance handover delays outside hospitals in England have dropped to their lowest level this winter, though one in five patients are still waiting at least half an hour to be transferred to A&E teams.
NHS latest: Rock star unexpectedly joins our NHS phone-in and offers to pay for life-saving scans Please use Chrome browser for a more accessible video player NHS Crisis: 'He got very frail' Sarah's mother ended up staying for an extended time in hospital and 'dying for no reason' More on Nhs Sir Rod Stewart calls in to Sky News to donate for medical scans after hearing NHS crisis stories and says 'change the bloody government' NHS figures: Ambulance delays slowly improving after record waits over Christmas NHS crisis: 'Over my dead body' - Proposals to make some patients pay for care spark backlash Sarah Templeton said her mother had been admitted for treatment for a punctured lung, six fractured ribs and a damaged spleen following a fall.Her mother was in there for four weeks before Ms Templeton was told her loved one could be moved to a discharge and assessment centre. But she was not released and she ended up getting a chest infection, flu and pneumonia, and then "we sat holding her hand while she died on 30 December". Image: Sarah Templeton Ms Templeton said: "She didn't need to die. She was perfectly well for three weeks. She was bored. She wanted to come out of that hospital."She said she could not fault the "amazing" medics but added that two doctors on separate occasions told her: "I'm really sorry Sarah, but this is what happens when you come into hospital now."If you come in and you're elderly, or you've got a lower immune system, you will get a chest infection, you will get the flu, you will get pneumonia, and you will die. I said to them: 'Why didn't you tell us that because would have broken her out of here'."We would not have left her there. We thought she was in the best place for seven weeks. She died gasping for breath. There was nowhere to take her."Ms Templeton said the hospital would not let her take her home as she had to be under the responsibility of the local authority. "But the local authority didn't look after her. She ended up staying and dying for no reason."The chief nurse of Buckinghamshire Healthcare NHS Trust said: "We would like to extend our sincere condolences to the family and friends of Jennifer Storey and would be happy to meet with the family to discuss any concerns they have about her care."Our trust works closely with local social care organisations to help patients return to their own home or care home as soon as it is safe and appropriate for them to do so, this includes helping to train care home staff in managing patients who have complex needs."Janet had a 37-hour wait in A&E - 'I was bleeding all over my nightdress'A former practice manager in primary care, Janet said she had two spinal surgeries within 14 days last year and had only just been discharged after the second procedure when she suffered complications and was taken back into hospital in an ambulance.She said that after about six hours she had a "lot of tests" and had a cannula (small tube) inserted in her arm, before being moved to another part of A&E which was "overflowing with patients".Janet, from Lancashire, added that she felt "so sorry" for the nurses and the doctors. "Honestly, it was dreadful. There weren't enough staff," she said.She went on to say that during the night in hospital she felt like she needed to use the toilet but realised her catheter bag was "full and overflowing"."I got urine on my nightdress, on the sheets. Also I tried to take my dressing gown off because it was wet with urine and I pulled a cannula out of my arm."I was bleeding all over my nightdress. I was shouting desperately for a nurse to come and help me and got to the stage where I got myself up and sat on the edge of the trolley and started to cry."Read more:Sir Rod Stewart calls in to Sky News to donate for medical scansProposals to make some patients pay for care spark backlash Please use Chrome browser for a more accessible video player 'Very difficult December' for ambulance service Amy was moved to a different hospital during labourAmy, from Essex, says she had originally planned to go to a midwifery-led unit but during her pregnancy it shut down due to staffing issues.She ended up having to go to her nearest hospital, which is an hour away, but due to her not going there for appointments she was sent to a day assessment unit rather than the maternity ward to give birth to her daughter."I actually ended up nearly having her in the corridor because there wasn't anywhere for me to go," she said.Describing her maternity care, she added: "After I had her, I was due to be stitched up but I was actually left for about three hours after having her due to a shift change."But the lady who did end up coming in to do my stitches apologised profusely. It was no fault of her own. She was honest, which I appreciated. She just said, 'I'm really sorry'." Please use Chrome browser for a more accessible video player NHS is 'failing every day', says paramedic Anastasia left on waiting list for three years - 'I feel like I'm losing the will to live'Anastasia, from Leeds, has been waiting for an appointment for three years.She has cerebral palsy and is now suffering with a urology issue."I feel like I'm losing the will to live. I have a urological condition and I just want it fixed. I'm not receiving any social care, I'm not receiving any support."Unfortunately, I come from a care background from no fault of my own because my mother put me in an institution when I was two weeks old - the support isn't there."She explained that she was once called up for an appointment to have the procedure, but they did not realise she had cerebral palsy."It all often depends on who you speak to, and I don't feel listened to," she added."I don't know what to do, and what worries me is that the situation for me and others could get worse." Please use Chrome browser for a more accessible video player The crises facing ambulances Ezra 'can't praise NHS staff enough'Cancer patient Ezra, from Lincoln, said he "can't praise enough" those who looked after him and the fast turnaround between when he was first diagnosed and then had surgery.Ezra said he had a PSA blood test which can help detect prostate cancer.He had a raised level and was asked to come into his GP surgery the day after the result came in, and had an examination.Ezra said he was then put on to a two-week cancer care wait and within a fortnight he had an MRI scan at his local hospital. He also had a biopsy and a bone scan, and a urologist talked him through the whole procedure for his cancer.He asked if the surgery could be after Christmas and he went into his local hospital early this month.Recalling his time there, Ezra said: "One night about 3am, a nurse came up to me. I think it was a 10-bed ward and all the men were sleeping. Very quietly with a little light on, so not to disturb me, she did my blood pressure, my oxygen levels. These people, they're not heroes, they're professionals. And I really can't praise them enough." Please use Chrome browser for a more accessible video player NHS crisis: 27 hours for a bed Shirley says NHS staff 'saved my life so many times'Shirley from Devon has been hospital for the last 10 days in the midst of nurses going on strikes.She said she "supports the staff 100%" and added they were "not getting what they deserve".Speaking about the treatment she has received from NHS workers over the years, she said: "They saved my life so many times these last 10 years."Last month, I was in with heart problems and they saved my life there. It was serious. I can't fault them."She said she even asked her local MP to do a shift with staff in hospitals "so he could see how they work".Carole says 'all the nurses were fabulous' after her 90-year-old father was picked up by ambulance and treated within five and half hoursCarole, from Sheffield, said her dad fell on the ice last Friday and broke his leg.She says the ambulance was called at around 9.45am and by 2.30pm that afternoon she had already received a call to say her father was comfortable and being treated for his pain."All of his treatment has been absolutely brilliant, it has all gone really swimmingly and the nurses have been fabulous."In the olden days, five and half hours might have seemed like a long time, but let's be straight and let's give some credit where it is due for people still managing to do a fabulous job.""They must get very demoralised when they hear negative stories the whole time," she said. | Health Policy |
Medical milestone: Monkey lives for 758 days with pig kidneyCould humans be next?Mrigakshi Dixit| Oct 12, 2023 03:56 AM ESTCreated: Oct 12, 2023 03:56 AM ESTscienceA monkeyEnes Evren/iStock Get a daily digest of the latest news in tech, science, and technology, delivered right to your mailbox. Subscribe now.By subscribing, you agree to our Terms of Use and Policies You may unsubscribe at any time.Xenotransplantation is one possible approach to tackle the severe shortage of human organs.It entails transplanting organs or tissues from one species, generally pigs, into another, such as humans.However, before xenotransplantation can be considered a feasible alternative for human patients, scientists have been performing considerable research and studies on animal models to examine the procedure's safety and efficacy. A significant breakthrough in the field of xenotransplantation has been achieved through a recent study. This study demonstrated the more prolonged survival of animal recipients who got genetically engineered pig kidneys, with one monkey living for over two years (758 days). See Also Related 'History making' dual-organ transplant saves 31-year-old woman Genetically modified pig hearts transplanted into two more patients In a first, rat organs successfully transplanted after 100-day storage This “extraordinary milestone” was achieved by a team of researchers from the Harvard Medical School and the US biotech company eGenesis. The latter’s goal is to develop human-compatible organs to treat organ failure.“This is a major step forward for the field of transplantation. One of the biggest hurdles has been the long-term survival of the genetically engineered organ in the NHP recipient [non-human-primate], said Tatsuo Kawai, M.D., Ph.D., Professor of Surgery at Harvard Medical School, in the company’s press statement.Genetically modified pig kidney Scientists have been researching the viability of animal-to-human organ transplants for decades. The primary goal is to guarantee that animal organs operate efficiently and safely when transplanted into human patients, all while avoiding immune system rejection.However, it has been proven to be incredibly daunting for many years. But, the advent of the remarkable gene-editing tool CRISPR-Cas9 has brought some promising solutions.This technology allows for the deliberate modifications of a chosen animal's genome, permitting the elimination of harmful genes, including removing viruses genes inherent in the animals. The technique also enables the addition of some pivotal genes to make the organ compatible with the recipient's body.The ultimate goal is to trick the recipient's immune system into recognizing the foreign organ as one of its own, allowing it to operate properly once inside the body.Pigs are frequently employed in xenotransplantation studies because their organs are anatomically comparable to humans in terms of organ size and physiological metabolism.Human and other primates' immune systems are known to naturally respond to three specific molecules present on the surfaces of pig cells. This raises the likelihood of unaltered pig organs being rejected right away.To address this issue, the researchers used genome-editing techniques to disable these specific genes in this study. The company seeks FDA nod For this trial, a total of 69 genes were edited — marking the most extensive gene editing conducted in animals for xenotransplantation. Some of these changes involved the inclusion of at least seven human transgenes that serve to maintain the transplanted organ healthy and avoid unwanted blood clotting.69 distinct genetic modifications were performed on Yucatan miniature pigs, and the recipients were crab-eating macaques.The experiment results showed that kidneys incorporated with seven human genes allowed monkeys to live for at least 176 days.In the case of kidneys modified with seven human genes and coupled with immune system suppression therapy, one of the recipient monkeys has lived for over two years or roughly 758 days. The monkey is still being watched over.This new development brings researchers one step closer to potential human applications. Following this study, the company actively seeks approval from the US Food and Drug Administration to begin a human clinical study.“This dataset will support the advancement of the company’s lead candidate for kidney transplant, EGEN-2784, toward clinical development. These results represent the largest and most comprehensive preclinical dataset published in the field to date. Recipient survival in the preclinical setting has historically been measured in weeks or months,” noted the release. Reportedly, to date, two individuals have undergone pig heart transplants. Unfortunately, David Bennett, the first recipient, died two months following the procedure in 2022. The second person, 58-year-old Lawrence Faucette, underwent a pig heart transplant in September and is recovering.The company also aims to assess the effectiveness and safety of other genetically modified organs, such as the heart and liver, for xenotransplant. Because of the shortage of organ donors, research in this field is critical. In the United States alone, over 100,000 individuals need an organ transplant, and tragically, approximately 17 of them lose their lives each day while waiting for a suitable donor.The results were reported in the journal Nature. Study abstract:Recent human decedent model studies1,2 and compassionate xenograft use3 have explored the promise of porcine organs for human transplantation. To proceed to human studies, a clinically ready porcine donor must be engineered and its xenograft successfully tested in nonhuman primates. Here we describe the design, creation and long-term life-supporting function of kidney grafts from a genetically engineered porcine donor transplanted into a cynomolgus monkey model. The porcine donor was engineered to carry 69 genomic edits, eliminating glycan antigens, overexpressing human transgenes and inactivating porcine endogenous retroviruses. In vitro functional analyses showed that the edited kidney endothelial cells modulated inflammation to an extent that was indistinguishable from that of human endothelial cells, suggesting that these edited cells acquired a high level of human immune compatibility. When transplanted into cynomolgus monkeys, the kidneys with three glycan antigen knockouts alone experienced poor graft survival, whereas those with glycan antigen knockouts and human transgene expression demonstrated significantly longer survival time, suggesting the benefit of human transgene expression in vivo. These results show that preclinical studies of renal xenotransplantation could be successfully conducted in nonhuman primates and bring us closer to clinical trials of genetically engineered porcine renal grafts. HomeScienceAdd Interesting Engineering to your Google News feed.Add Interesting Engineering to your Google News feed.SHOW COMMENT (1) For You International E-Waste Day to focus on 'invisible e-waste'Astrophysicists predict a hidden planet in the Kuiper BeltFossilized feces reveals diverse diet of Caribbean culturesSpace Solar's ambitious target of a space solar farm by 2035India's first indigenous carrier INS Vikrant is advanced and powerfulPlant-based meat sales are plummeting. Here’s why.Improved ICEs or all-in on EVs: which is better for the future?Bionic hand solves user's pains in more than one wayGiorgio Rosa, the engineer who built his own islandAre smart phones destroying our mental health? Job Board | Medical Innovations |
Image source, Lucy BakerImage caption, Lucy Baker was 42 when she became pregnant with her third childWhen she announced she was pregnant aged 42, Lucy Baker says she experienced negativity from several quarters - including a midwife. She is now calling on society to rethink how it views pregnancy. BBC News went along to speak with her."She asked me for my date of birth," says Lucy, recalling the moment she met her community midwife shortly after finding out she was pregnant with her third child. "I said January 1976 and she gasped. That reaction from her stuck in my mind."Furthermore, Lucy claims the midwife then scribbled the words "older mum", in capital letters, on her maternity notes."You can't forget that kind of stuff," she says. "It was so obvious that she was shocked at my age. It hurts."Image caption, Lucy Baker talks about negativity she faced when she became pregnant at 42Though her family and closest friends soon warmed to the idea she was expecting another baby, she says it was not long before others less close to her made their views known, fuelling anxiety.Lucy says: "I have to say, some of the people we knew who were probably not my closest friends but still people I would class as friends, school mums for example, I had quite a lot of negativity from when I shared I was pregnant."There were all sorts of comments that I had already probably actually thought of myself but when faced with them from other people stung. It was painful hearing people were judging my pregnancy."According to Lucy, one mother, on the playground at their children's school, told her, "you'll be 47 when your baby starts school". Another asked her if she "was sure you want to go back down the nappy route?" A mum also pointed out she would "be the oldest mum on the school gates".Lucy says she laughed off the comments at first but privately, and with time to reflect, dwelt on them. "I thought, 'what are you doing?'" she says. "I am going to be an old mum. Is that a good thing or a bad thing? So I started questioning my choices."Lucy, a confidence coach, lives with husband Dan and their three children, now aged three, 10 and 12, in Woodhall Spa, Lincolnshire. But she says she quickly discovered other women across the country - and further afield - who were experiencing similar negativity.She says many women take exception to what she believes are, at best, careless terms to describe pregnancy."The term 'geriatric pregnancy' needs to go," she says. "If you think of the term 'geriatric', one thing comes into your mind - a very elderly person who probably needs a lot of support. But I do not think the term fits motherhood at all."Lucy says she was never called geriatric during her pregnancy. Instead, as well as "older mum", she also had "advanced maternal age" recorded on her medical notes. However, she says as many as half of those mothers who joined a Facebook group she set up to shine a light on the issue had it written on their notes."It's not helpful," she says.She would later begin a blog called Geriatric Mum - a tongue-in-cheek reference to the unflattering label given to some women over 35.Image source, Lucy BakerImage caption, Lucy's three children, aged three, 10 and 12Despite the judgy comments, Lucy says she "loved every minute" of her final pregnancy. She describes having felt "in tune" with her body throughout.She explained, like many first-time mums, she was bordering "obsessional", consuming "every book going" when she first became pregnant at 34.Lucy adds: "My second pregnancy, when I was 37, I felt I had already done it once and I was a little bit more calm about it."'There to support'Sally Ashton-May, director for midwifery policy and practice at the Royal College of Midwives, was clear, when approached by the BBC, that maternity professionals were there to support, not judge.She said: "Women are increasingly having babies later in life. This may be personal choice or for economic reasons, or because their journey to conceive hasn't been straightforward for example. Regardless, midwives, maternity support workers, doctors and their colleagues are there to support them, not to make judgments."The most important thing is that women receive the care they need, personalised to them, throughout and after pregnancy. This is why it is so crucial that midwives have the time and resources to spend the time needed for all women, so they get the safest and best possible care."Follow BBC East Yorkshire and Lincolnshire on Facebook, Twitter, and Instagram. Send your story ideas to [email protected] Internet LinksThe BBC is not responsible for the content of external sites. | Women’s Health |
When Howard Chang, 50, first learned about biologic treatments for psoriasis almost 20 years ago, he was eager to give them a try. Now theyâre a mainstay in his overall treatment plan.
Chang was first diagnosed with psoriasis around age 8. He tried lots of different treatments, including tar, phototherapy, topical creams and ointments, steroids, and oral medications.
âI definitely was always looking for the next new treatment, given that it was so hard for me to find anything that was effective,â Chang says.
He hoped biologics would provide much needed relief.
What Are Biologics?
Biologic drugs -- often called biologics or biologic medications -- work by changing parts of your immune system. You usually give yourself a shot. But some are given through an IV at your doctorâs office. The FDA approved the first two biologics for psoriasis in 2003. Now there are several options.
Theyâre generally prescribed for people with moderate to severe psoriasis, based on the amount of skin affected. But doctors also consider how psoriasis impacts a personâs life when deciding, says Malini Fowler, MD, a board-certified dermatologist in San Antonio, TX.
âThere is no cookie-cutter candidate,â Fowler says. âEven if someone has mild disease, they are still probably a candidate for biologics, depending on how it affects their life.â
These drugs might also do more than just clear up your skin. They could help protect your heart, joints, and other body parts from inflammation.
âWhen we talk about using biologics, itâs a systemic medication treating (people) from the inside out, decreasing psoriasis on the skin, and hopefully helping with inflammation on the inside, too,â Fowler says.
What Are the Pros and Cons of Biologics?
Chang read up on how the drugs work, possible side effects and the risks when first considering biologics.
âPutting something in your body via an injection is something you have to think about, especially how itâs affecting your immune system,â Chang says.
Next, he spoke to his dermatologist.
âItâs key to have a dermatologist who understands the medications and also collaborates and connects with me as a (person),â Chang says. âWe work on a plan together.â
While biologics can ease psoriasis symptoms, there are potential dangers, like with any drug. Some of them can up your odds for inflammatory bowel disease and cancer.
âYou need to check if you have underlying cholesterol or hypertension problems,â Fowler says. âEvery biologic medicine is slightly different; most of them have a different mechanism of action with different safety profiles.â
Itâs important to tell your doctor about any other conditions you may have, so they can make sure the biologic wonât interfere with them or any medications you take.
Which Biologic Is Most Effective for Psoriasis?
Chang has tried six biologic drugs since 2003. One helped for about 8 years, but he had to switch up the rest because he couldnât tolerate the side effects of some drugs, they stopped working after a certain period of time, or they just didnât work at all.
While Chang says he knows many people who have achieved healthier skin with biologics, treatment hasnât been as successful for him.
âIâve never really been clear,â he says. âItâs not a cure. There are still triggers that can cause a flare.â
Finding a biologic that works for you can be emotionally draining.
âItâs a roller coaster ride. You keep hoping itâs going to work, and you wait for it to kick in. And then if it doesnât work for you, it can be a big letdown,â Chang says. âEspecially since [psoriasis] has such a big impact on my life. Sometimes, I feel like I canât fully function because I have all of this physical discomfort when Iâm running, working, teaching, meeting with people. I just want to be comfortable.â
Fowler likes to give a biologic 3 months to run its course.
âNot every medicine is going to work for every (person), but itâs also important to stick with the medications and give them a chance to see if they help,â she says. âI tell (them), âIf this doesnât work, weâll go on to the next one. We will find the right medicine for you, but it may be a bit of trial and errorâ.â
Can I Take Biologics With Other Treatments?
Chang continues to use other psoriasis treatments, including topical creams and phototherapy.
âI feel better about things overall [with biologics], that I donât have to do everything perfectly,â he says. âIt feels a little better to know I have a medication that is working in the background.â
And he knows that managing stress, exercising, and eating healthy are critical to keeping flare-ups at bay. They do the same for metabolic syndrome, a group of conditions linked to stroke, type 2 diabetes, and heart disease. People with psoriasis have a higher risk of metabolic syndrome.
In addition to regular appointments with a dermatologist while on biologics, Fowler suggests keeping your primary care doctor in the loop, getting blood work done every year, and seeing a rheumatologist every 6 months.
âI also routinely ask patients about joint pain, because about 30% [of people with psoriasis] will develop psoriatic arthritis,â she says.
Whatâs Most Challenging About Taking Biologics?
One of the hurdles is learning how to inject the medications yourself.
âI think Iâve self-injected myself over a thousand times,â Chang says.
Luckily, the number of injections is significantly lower with newer biologic medications. Chang says he used to have to inject himself two times a week, but some injections can now be weeks or months apart, depending on the medication.
Chang came up with a routine to follow when giving himself an injection, from washing his hands and setting out all the materials, to ensuring he has something to watch in the background.
âIt calms me to have a routine,â Chang says. â[Injecting yourself is] something you never completely get used to, but you get more skilled at.â
Another hurdle can be getting approval from your insurance company to cover different biologics.
Chang is hopeful that the biologic treatments for psoriasis and other options will continue to improve.
âItâs just a time to be really optimistic as someone living with psoriasis,â he says. âWith all the research, medications, and advocacy, we have options and more coming.â
Show Sources
SOURCES:
Howard Chang, ordained minister and advocate with National Psoriasis Foundation, Woodland, CA.
Malini Fowler, MD, board-certified dermatologist, San Antonio, TX. Â
International Journal of Rheumatic Disease: âSystematic review and meta-analysis on prevalence of metabolic syndrome in psoriatic arthritis, rheumatoid arthritis and psoriasis.â
Mayo Clinic: âPsoriasis,â âMetabolic syndrome.â
Dermatological Therapy (Dermatol Ther): âThe Patientâs Guide to Psoriasis Treatment. Part 3: Biologic Injectables.â
Journal of Managed Care & Specialty Pharmacy: âAdvancements in the treatment of psoriasis: role of biologic agents.â
National Psoriasis Foundation: âAbout Psoriasis.â | Drug Discoveries |
Immunotherapy research shows potential to extend healthy lifespan of humans
A Brock-led international research team has discovered an immunotherapy method that could potentially add years to healthy aging. The research, published in the journal EMBO Molecular Medicine, introduces an innovative method to address health issues arising from poor lifestyle choices, which can cause damage to biomolecules and contribute to the development of diseases later in life.
Professor of Health Sciences Newman Sze and his team developed an approach that involves directing the immune system to clear out accumulated proteins damaged by inactive lifestyles, unhealthy diets, various stresses and genetic factors, root causes of aging and age-related diseases.
"Age-related chronic diseases are a major health care burden," says Sze, the Canada Research Chair in Mechanisms of Health and Disease. "We therefore developed a first-of-its-kind monoclonal antibody drug that harnesses the immune system to target and remove these abnormal proteins, providing an effective treatment for age-related health problems."
As time passes, environmental stresses and physiological conditions cause biomolecular damage in tissues. One of these changes, called isoDGR, triggers chronic inflammation in the body and leads to tissue degeneration.
Uncontrolled chronic inflammation, in turn, can lead to conditions such as cardiovascular disease, cancer, type 2 diabetes, arthritis and Alzheimer's disease.
While the accumulation of isoDGR has been identified as a "molecular clock" of aging, the new research paper says the potential benefits of targeting these structures with specific immunotherapies remain largely unknown.
Sze and his team created monoclonal antibodies called isoDGR-mAb. These lab-engineered proteins are designed to boost the immune system's ability to attack unhealthy cells or abnormal molecules. Such immunotherapies are already being used to treat various cancers, autoimmune disorders and infectious diseases.
Using animal models, the team found that these lab-engineered molecules stimulated the immune system to clear out the proteins in tissues that had been damaged by isoDGR. Treatment with isoDGR-mAb not only doubled lifespan but also preserved behavior and coordination functions and reduced pro-inflammatory cytokine levels in the circulation and body tissues.
Sze says the team's findings could lead to the development of immunotherapy-based interventions to extend the healthy lifespan of humans.
"The existing treatments for age-related diseases primarily address symptoms," says Sze. "Our pioneering mAb, uniquely focused on targeting the root causes of chronic diseases, is anticipated to substantially extend human health span."
As Canada Research Chair, Sze studies diseases that occur as people age, specifically diseases related to the brain and the blood vessels becoming damaged. His lab has developed new research methods that investigate how body tissues deteriorate over time and created new drugs to guide the immune system to eliminate abnormal biomolecules.
This latest paper, "Immunotherapy targeting isoDGR-protein damage extends lifespan in a mouse model of protein deamidation," involved researchers from Brock as well as universities in Singapore, China, New Zealand and the United Kingdom.
More information: Pazhanichamy Kalailingam et al, Immunotherapy targeting isoDGR‐protein damage extends lifespan in a mouse model of protein deamidation, EMBO Molecular Medicine (2023). DOI: 10.15252/emmm.202318526 | Medical Innovations |
‘Forever chemicals’ are everywhere; experts worry public awareness is low
A new study finding “forever chemicals” in nearly half of U.S. drinking water adds to a growing body of research on the toxic substances’ pervasiveness in American life.
Yet many Americans remain oblivious to the very existence of a cancer-linked group of compounds known as PFAS — or per- and polyfluoroalkyl substances.
This comes on top of other evidence that the chemicals are widespread, including research finding them in the blood of about 97 percent of Americans, as well as significant portions of U.S. waterways.
Toxicologist Jamie DeWitt told The Hill that she is hardly shocked by the findings, which she described as a “verification” from a government agency “that PFAS are present in multiple drinking water supplies as well as in finished drinking water.”
“Where scientists look for PFAS, they find them,” said DeWitt, a professor of pharmacology and toxicology at East Carolina University. “If they can find them in polar bears and in the bottom of the ocean, then we shouldn’t be surprised that we find them across drinking water supplies.”
DeWitt expressed dismay as to what she feels is an ongoing lack of public awareness about the very existence, let alone pervasiveness, of forever chemicals, even as an accumulating body of evidence piles up about their dangers.
She recalled speaking to an undergraduate student from Fayetteville, N.C. — home to a major PFAS manufacturer, Chemours — who had never heard of PFAS despite wanting to become a toxicologist.
“Maybe we’re not reaching the right audiences who really need to hear about PFAS, but I think that’s not uncommon with many different types of environmental pollutants, unfortunately,” she said.
Also problematic in the current political environment is the “mistrust of science right now,” according to DeWitt. “That’s another hurdle to overcome in terms of public health protection from contaminants,” she added.
Linda Birnbaum, former director of the National Institute of Environmental Health and the National Toxicology Program, echoed DeWitt’s sentiments with regards to the public’s insufficient knowledge of a growing PFAS problem.
“I wish the public understood and were concerned, but lots of people are still unaware,” Birnbaum said.
Exposure to PFAS — which are present in certain firefighting foams, Teflon pans, waterproof apparel and cosmetics — has been linked to illnesses such as kidney and testicular cancer, thyroid disease and high cholesterol.
While there are thousands of types of PFAS, the Geological Services study only looked for 32 types. Seventeen kinds of PFAS were observed at least once, while PFBS, PFHxS and PFOA were observed most often — in about 15 percent of the samples, according to the study.
Scott Bartell, a professor of environmental and occupational health at the University of California, Irvine, said that people who have the chemicals in their water should be concerned about elevated risks of cancer and other illnesses.
“We have good evidence that, for example, exposure to PFOA, which is one of the chemicals that was detected in many of the water supplies in the study, that it almost certainly causes kidney cancer,” he said.
Carmen Messerlian, an assistant professor of environmental reproductive, perinatal and pediatric epidemiology at Harvard, said that it’s not one specific chemical that is the problem, it’s the PFAS family.
“We know that the class of chemicals is carcinogenic, immunotoxic, reprotoxic, endocrine-disrupting,” she said.
Messerlian added that the fact that the study only looks at 32 chemicals rather than the thousands that are out there means it is very likely an undercount.
“If we’re only looking at PFOA and PFOS, for example, those are just two … types of PFAS. There’s thousands of them,” she said. “You can’t find something that you’re not looking for.”
Similarly, while the study’s authors — who sampled 716 spots nationwide — found that urban areas are more at risk than rural ones when it comes to PFAS, they also warned of “a notable paucity of data available for private-wells across the U.S.,” where information is often “limited or not available.”
“It highlights an area of our population that really aren’t going to receive the same types of protections that people like me receive,” said DeWitt.
“I get my water from a utility that serves a big population,” she added.
Utilities, DeWitt explained, will be required to adhere to the guidelines of the Safe Water Drinking Act as soon as the Environmental Protection Agency regulates maximum contaminant levels for the two most notorious PFAS variations, PFOA and PFOS.
But private well owners “aren’t going to be subject to the same set of rules,” according to DeWitt.
“So if you’re a well owner in a rural area, or if you get your water from a well in a rural area, you’re on your own,” DeWitt said, identifying what she described as “a huge gap.”
Many people who rely on private wells are also located in rural or underserved areas — and therefore already face numerous challenges, DeWitt explained.
“And yet again, they’re kind of left out in the cold,” she said.
The USGS findings were based on the 716 samples collected around the country and then extrapolated through a model.
The chemicals were found in about 70 percent of areas that are either urban or have a known history of PFAS contamination, compared to just 8 percent of rural areas. Areas with the greatest concentrations were in the Great Plains, the Great Lakes, the Eastern Seaboard and Central and Southern California.
“Some of the concentrations are probably due to population densities and where there are activities where PFAS are either manufactured or used,” DeWitt said.
It is also logical to find higher levels of PFAS near airports, municipal firehouses, military bases or places where the compounds are entering a wastewater stream, according to DeWitt.
“So I’m not surprised that it kind of tracks with where there are greater populations,” she added.
As far as public health ramifications are concerned, DeWitt was hesitant to draw a definitive conclusion as to whether the entire country is at risk based on the study’s conclusions.
But at the same time, she stressed that the world’s leading cause of chronic disease-related premature deaths is environmental pollution, citing findings from a 2017 Lancet study.
“If pollutants are the world’s leading cause of chronic disease, and PFAS are part of the mix of pollutants to which we are exposed, a logical conclusion would be that PFAS are contributing to chronic diseases,” DeWitt said.
“So in terms of public health, they’re undoubtedly part of the problem that leads to chronic diseases that we all will likely experience or that our loved ones will experience within our lifetime,” she added.
Erin Bell, a professor of epidemiology and environmental health sciences at the State University of New York at Albany, pointed to guidelines from the National Academies of Science, Engineering and Medicine, which recommend that doctors screen patients for different illnesses depending on the level of PFAS in their blood.
She also noted that PFAS is even being observed in the blood of newborn babies, referencing a study she conducted on infants born in New York state between 2008 and 2010.
“We detected measurable amounts in 99 percent of those infants,” she said.
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. | Global Health |
The International Day for the Elimination of Violence against Women is observed every year on November 25. Launched by feminist activists in 1981, the day draws attention to the various forms of violence that women face.
In Iran, little is said officially about this day. When Iranian media takes up the topic of "violence against women," the focus is usually placed on violence against women in Western countries, where people supposedly live without the protection of religion.
They refer to statistics that ostensibly indicate a much higher level of violence against women than in Iran.
However, statistics on violence against women in Iran are difficult to find and are often incomplete. Many forms of violence against women in Iran are not even recorded, for example, the forms of violence experienced daily by women at the hands of the Iranian state.
Iran's power apparatus the biggest danger facing women
"The greatest danger for women in Iran comes from the state," Iranian legal and religious scholar Sedigheh Vasmaghi told DW.
The 62-year-old lawyer from Tehran is one of the most prominent critics of the Islamic Republic. For many years, she was the only woman to teach at the Faculty of Theology at Tehran University. Her critical attiude is a thorn in the side of those in power in Tehran.
Vasmaghi particularly criticizes regulations that are based on a strict interpretation of Sharia law. "These laws legitimize the use of violence against women and thus give it a legal basis," she said.
The lawyer cites an example of this in a new draft law on compulsory headscarves, along with all other strict measures regarding a dress code for women, "which are enforced with naked violence on a large scale in public."
Vasmaghi, who lived in Germany between 2011 and 2017, and worked as a visiting professor at the University of Göttingen, wrote an open letter to the Supreme Leader of the Islamic Republic, Ali Khamenei, in April 2023.
In the letter, she questions the hijab from a theological perspective. According to her, the Islamic Republic's hijab laws have no basis in the Quran.
Punishing women who break these rules, Vasmaghi warned, has social, political and psychological consequences. Such punishments have violated the dignity of women and exacerbated social polarization.
At the end of September, Iran's Parliament passed a controversial dress code reform for women, which stipulates drastic penalties for violations, especially of the headscarf requirement.
Repeated violations could even result in prison sentences of up to 15 years. In addition, the publication of photos of women without headscarves on the internet is punishable, for example, by being barred from leaving the country. The judiciary has threatened to close shopping malls, restaurants and museums if violations are found.
Iranian women who disobey dress code live in fear
For many women who are tired of conforming and constantly wearing the headscarf, this means they live their daily lives in constant fear of being attacked or even beaten to death.
Since the tragic death of 22-year-old Jina Mahsa Amini in police custody in September 2022, and the subsequent nationwide protests, many women have nevertheless refused to wear the headscarf in public.
Hossein Jalali, a member of the parliamentary culture committee, has said the headscarf represents the "flag of the Islamic Republic" for women. This symbolizes the state's discrimination against women, which is also reflected in laws and jurisdiction, inheritance law, contract law, freedom of travel and much more.
"In Iran, violence against women is a continuum," Iranian sociologist Azadeh Kian told DW. Kian lives in Paris and is director of the Center for Gender and Feminist Studies at the University of Paris.
Kian has studied the women's movement in Iran for a long time. "State violence in public is continued in domestic violence," said Kian. "If a woman in Germany or France is a victim of violence at home, she turns to the police. In Iran, the police use violence against women," she added.
In confidential conversations with DW, Iranian women who have appeared in public without their headscarves spoke about the stress they are exposed to.
A 50-year-old woman from the capital Tehran described her experience when she was caught on camera without a headscarf.
"I dropped my headscarf in my car. The surveillance cameras caught me, and my car was confiscated. But the worst thing was how rudely the vice squad spoke to me and allowed themselves to shout at me," referring to the Guidance Patrol or "morality police" which enforces Sharia-Islamic law in Iran.
Other women spoke of similar experiences, emphasizing that the "morality police" often turn up unexpectedly and try to intimidate women with violence and brutality.
Small changes in Iran towards women's rights
"This violence will not intimidate women," says Iranian legal and religious scholar Vasmaghi.
"As a member of this society, I am observing a profound change. Belief in the hijab and the headscarf is dwindling even among many religious people, both women and men. I see more and more religious women who no longer wear the headscarf in their own circles and are supported by their husbands," she added.
Sociologist Kian also sees signs of change in Iranian society. "When women experience violence on the street, sometimes men now step in front of them and protect them."
She finds it remarkable that these changes can be seen not only happening in the traditionally more liberal capital Tehran, but also throughout the country.
There are now also restaurant and store owners who would rather close their businesses than implement the ban on serving unveiled women.
"These men and women are part of a resistance that is creating women's rights not in the law, but in the public sphere."
This article has been translated from German | Women’s Health |
GENEVA - Chinese health authorities have not detected any unusual or novel pathogens and provided the requested data on an increase in respiratory illnesses and reported clusters of pneumonia in children, the World Health Organisation (WHO) said on Nov 23.
The WHO had asked China for more information on Nov 22 after groups including the Program for Monitoring Emerging Diseases (ProMED) reported clusters of undiagnosed pneumonia in children in north China.
As per the rule, China responded to the WHO within 24 hours. The WHO had sought epidemiologic and clinical information as well as laboratory results through the International Health Regulations mechanism.
The data suggests the increase is linked to the lifting of Covid-19 restrictions along with the circulation of known pathogens like mycoplasma pneumoniae, a common bacterial infection that typically affects younger children and which has circulated since May.
Influenza, respiratory syncytial virus (RSV) and adenovirus have been in circulation since October.
The agency does not advise against travel and trade as they have been monitoring the situation with authorities.
No unusual pathogens have been detected in the capital of Beijing and the north-eastern province of Liaoning.
Chinese authorities from the National Health Commission held a press conference on Nov 13 to report an increase in incidence of respiratory disease.
Both China and the WHO have faced questions about the transparency of reporting on the earliest Covid-19 cases that emerged in the central Chinese city of Wuhan in late 2019.
The UN health agency had also asked China for further information about trends in the circulation of known pathogens and the burden on healthcare systems. The WHO said it was in contact with clinicians and scientists through its existing technical partnerships and networks in China.
WHO China said it was “routine” to request information on increases in respiratory illnesses and reported clusters of pneumonia in children from member states, such as China.
The global agency decided to issue a statement on China to share available information, as it received a number of queries about it from media, WHO China said in an emailed statement.
The ProMED alert was based on a report by FTV News in Taiwan that came out on Nov 21.
Undiagnosed pneumonia was not mentioned at last week’s press conference, according to a transcript, but one speaker said everyone felt like there had been an increase in respiratory illnesses this year compared with three years ago.
The speaker said that global monitoring for mycoplasma pneumoniae had been at a low over the past three years and outbreaks were cyclical, occurring every three to seven years.
‘Seasonal surge’
The rise in respiratory illnesses comes as China braces for its first full winter season since it had lifted strict Covid-19 restrictions in December. Many other countries saw similar increases in respiratory diseases after easing pandemic measures.
“It is just a relatively large seasonal surge, perhaps partly due to chance and partly because there’s a bit of ‘immunity debt’ from the lesser winter surges in the last three years,” said Mr Ben Cowling, an epidemiologist at Hong Kong University.
China’s National Health Commission did not immediately respond to a request for comment.
On Nov 23, it published an interview with the state media agency Xinhua in which it advised parents what to do and mentioned that big hospitals were receiving a large number of patients and waiting times were long. It did not comment on the WHO notice.
Since mid-October, the WHO said northern China had reported an increase in influenza-like illness compared with the same period in the previous three years.
It said China had systems in place to capture information on trends in illness incidence and to report that data to platforms such as the Global Influenza Surveillance and Response System.
In recent days, media in cities such as Xian in the northwest have posted videos of hospitals crowded with parents and children awaiting checks.
Some social media users have posted photos of children doing homework while receiving intravenous drips in hospital.
The WHO said that while it was seeking additional information, it recommended that people in China follow measures to reduce the risk of respiratory illness.
Measures included vaccination, keeping distance from sick people, staying at home when ill, getting tested and medical care as needed, wearing masks as appropriate, ensuring good ventilation, and regular hand-washing, it said. REUTERS | Epidemics & Outbreaks |
Covid vaccine rules are changing, but those most at risk will be offered another jab this autumn.
All adults aged 65 years and over will be offered the vaccine automatically, following advice from UK immunisation experts.
In 2022, boosters were offered to all people over 50.
Who can have an autumn Covid booster?
At the moment you can still only get the Covid vaccine via the NHS.
The government has confirmed which groups will be entitled to an autumn booster:
- Residents in care homes for older adults
- All adults aged 65 years and over
- People aged six months to 64 years in a clinical risk group
- Frontline health and social care workers
- People aged 12 to 64 who are household contacts of people with weakened immune systems
- People aged 16 to 64 who are carers and staff working in care homes for older adults
In autumn 2022, all over-50s were offered an extra dose, but the government's advisers on vaccines recommended that only over-65s should automatically be included this year.
How do I book my Covid booster?
The NHS will contact those who are eligible.
People in England will be able to book their jabs through the NHS website, the NHS app or from 18 September by calling 119.
The government hopes that as many people as possible will be vaccinated by 31 October.
The roll-out has been brought forward in England, because of a new Covid variant, BA.2.86, which was first detected in the UK on 18 August.
Scotland, Wales and Northern Ireland have also brought forward their booster rollouts.
As before, anyone also eligible for a free flu jab may receive it at the same time.
You can check if you qualify for an NHS flu vaccineon the NHS website.
Which vaccine will people get?
Approval has recently been granted in the UK for a new Pfizer jab that targets the Omicron subvariant XBB 1.5.
Four different vaccines are in use across the UK: Pfizer-BioNTech, Moderna, Sanofi/GSK and Novavax.
All of them help to improve protection compared with earlier versions of the vaccines and give longer-term protection against getting seriously ill from Covid-19.
Most people can have any of them, but those who are pregnant, under 18 or over 75, will be offered a particular jab.
If you are not in one of those categories, you cannot choose which vaccine you get.
People are advised to take whichever they are offered, as all protect against severe illness or death.
How long after having Covid can I have a jab?
You should wait at least four weeks after a positive test, even if you had no symptoms.
You should not have a jab if you have a severe illness or high fever.
The vaccines do not infect people with Covid and cannot cause positive test results.
How many people have been vaccinated against Covid?
Across the UK, by May 2023, nearly 176 million Covid vaccines had been given.
About 88% of people in the UK over the age of 12 (58 million) are thought to have had both a first and second dose of a vaccine, with 93% receiving a single jab.
A small number of people aged five to 11 (fewer than one million as of September 2022) had received a first and second dose of a coronavirus jab.
These numbers are based on the Office for National Statistics mid-year population estimates for 2021, and vaccine data from up to 7 May in Scotland and 5 May for the other UK nations.
How are the rules changing about who can get the Covid vaccine?
At the moment, primary vaccine doses are only available to children aged between six months and four years, who are at increased risk from Covid.
From autumn 2023, the Joint Committee on Vaccination and Immunisation has said only one jab will be needed to provide primary protection. Only people in the categories that are entitled to the autumn 2023 booster will be eligible for primary vaccination.
People with weakened immune systems may be entitled to additional doses.
What are the side effects of the Covid vaccine?
They are part of the body's normal immune response to vaccination, and tend to resolve within a day or two.
It has also been listed as a rare possible side effect of the Novavax vaccine, after a very small number of cases were reported during clinical trials.
There have also been extremely rare, but occasionally fatal, cases of people developing blood clots after taking the AstraZeneca vaccine.
A very small number of people have experienced a severe allergic reaction after the Pfizer vaccine.
Patients with serious allergies should talk to their healthcare professional before being vaccinated.
What misinformation is there about Covid vaccines?
False and misleading claims about Covid vaccines have circulated online since they were first introduced. Most wrongly argue the jabs are not safe.
A number of social media accounts with lots of followers regularly misrepresent real stats and studies to do this.
Former Conservative MP Andrew Bridgen was expelled from the party after comparing the side effects of Covid vaccines to the Holocaust and breaching lobbying rules.
However, for most people, the evidence shows that the benefits of vaccination significantly outweigh the risks.
In fact, you are more likely to develop serious conditions including myocarditis from having Covid than from getting the vaccine.
Studies confirm young people do not have an increased risk of other heart problems after taking the vaccine.
Others strands of disinformation wrongly suggest that negative things that have happened to people after they were vaccinated were caused by the injection.
Died Suddenly, a film from far-right US radio DJ Stew Peters, which promotes anti-vaccine conspiracy theories, has been found to drive harassment of bereaved families in the US, the UK and Ireland. | Vaccine Development |
Emma Clarke and David Rice have three kids and had the rest of their lives to look forward to when the mum began suffering abnormal bleeding, despite repeated reassurances it was not major, she was diagnosed with cancerEmma Clarke and partner David Rice were left reeling after the shock diagnosisA mum who was told she was “too young” for her bleeding to be “anything else” was shocked to later be given just a year left to live. Emma Clarke was reassured by doctors and her GP that the abnormal bleeding she had experienced was just as a result of her contraception becoming “misaligned” and it “lacerating” her womb. The 31-year-old was assured that she was “too young for it to be anything else”. However, the bleeding and pain intensified but doctors repeated reassured her it was due to her IUD. Eventually Emma was seen by a specialist who told her “I've never seen a womb look that way which wasn't a case of cervical cancer." The mum was tragically diagnosed with stage three cervical cancer and given just one year to live. Her partner David Rice told the Liverpool Echo: "It started a year ago. She started having certain symptoms and she was bleeding a lot from her vagina. "She kept going to the doctor about it and they told her it was her contraception. They started saying it was misaligned . "When she went to visit her local GP they said the contraception had become stuck and lacerated her womb. “We were told she was too young for it to be anything else each time she went. "After ringing up for a couple of weeks she got an emergency appointment with a specialist. The specialist said 'I've never seen a womb look that way which wasn't a case of cervical cancer'. "She was diagnosed as stage three cervical cancer." The mum-of-three was given just one year to live after her tragic diagnosis (
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David Rice and Emma Clarke) Emma, David and their three young kids (
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David Rice and Emma Clarke) Emma, who lives with her partner in Cloughton, Scarborough, underwent radiotherapy and chemotherapy, but was forced to stop the chemo because it was damaging her kidney. Doctors also tragically found radiotherapy wasn’t helping either, and further tests revealed that the cancer had worsened and spread to her lungs. David added: "I woke up to her crying. It wasn't unusual as some times the pain did that to her. But then she told me that it was now stage 4. "They gave us approximately 12 months. We've got three young kids, they're 12, 10 and five. "Who wants to say goodbye to the person they wanted to spend their life with. "I tried to be optimistic, thinking there might be other trials or something like that which could work. But as time goes on I see Emma's condition and I'm less sure. "Emma also wants to encourage woman to get checked, because as we've seen if they don't or if they don't trust themselves it can lead to something devastating." Despite the "terrible" diagnosis David wants to marry Emma, something the pair have previously pushed back due to financial reasons. The childhood sweethearts first met when David was 16 and Emma was 15 and now plan to get married in a "princess" style wedding. David said: "I've never been able to give her the big wedding she deserved. "We always knew it was bad because everytime we spoke to anyone about it they never gave us any sense there could be good news, they just said they were sorry. "They just kept saying she was too young and apologised." Anyone who wishes to contribute to the couple's wedding can find their fundraiser here. Read More Read More Read More Read More Read More | Disease Research |
Research shows bone density is maintained by proteins that are also involved in hair color
Bone is maintained via a delicate balance between formation and resorption, and its imbalance leads to bone related diseases like osteoporosis, rheumatism and periodontitis.
Researchers led by Osaka University have revealed that proteins named Rab32 and Rab38 play pivotal roles in bone resorption in osteoclasts. These proteins are also crucial for pigmentation of hair and skin.
The researchers have published two articles, "Characterization of Rab32- and Rab38-positive lysosome-related organelles in osteoclasts and macrophages" in the Journal of Biological Chemistry and "Rab32 and Rab38 maintain bone homeostasis by regulating intracellular traffic in osteoclasts" in Cell Structure and Function.
Bone is resorbed by specialized cells called osteoclasts, and several substances, such as acids (H+) and degrading enzymes (TRAP, CatK), are secreted out to the pits where osteoclasts attach to bones and resorption occurs. Rab is a group of small proteins that regulate the logistics between cell organelles.
Over 50 Rab proteins are known in mammalian cells, and they are thought to be specifically involved in the traffic between each specific organelle. "Which Rabs are involved had been scarcely understood," says lead author of the first paper, Kazuya Noda. "To better understand the molecular mechanisms of osteoclast function, we first screened Rab proteins especially induced during osteoclast formation in mouse."
Rab38 was found to be elevated during differentiation into osteoclast. Importantly, Rab38 closely resembles partner Rab32, and both of them are known to be important for determination of hair color, by regulating the logistics to the melanosome, an organelle specialized for color pigmentation in skin and hair forming cells.
In the second paper, lead author Kanako Tokuda used a double knock out mouse model with both Rab32 and Rab38 deleted. As expected, the double knock out mouse showed beige-like hair color and red eyes, while a wild type mouse has black hair and eyes. Interestingly, the double knock out mouse shows increased bone density, and as aging progresses, the spine becomes more bent, especially in male mice.
Significantly, bone related diseases like osteoporosis, rheumatism and periodontitis are associated with hyper activation of bone resorption by osteoclast. "Therefore, understanding the underlying mechanism of bone resorption facilitated by Rab32 and Rab38 will provide us useful information regarding potential treatment target for these diseases," says senior author of the two papers, Takeshi Noda.
More information: Kazuya Noda et al, Characterization of Rab32- and Rab38-positive lysosome-related organelles in osteoclasts and macrophages, Journal of Biological Chemistry (2023). DOI: 10.1016/j.jbc.2023.105191
Kanako Tokuda et al, Rab32 and Rab38 maintain bone homeostasis by regulating intracellular traffic in osteoclasts, Cell Structure and Function (2023). DOI: 10.1247/csf.23061
Journal information: Journal of Biological Chemistry
Provided by Osaka University | Disease Research |
An anonymous reader quotes a report from KOMO News: A groundbreaking medical procedure for those with kidney stones will soon be offered at the University of Washington after more than two decades of research. It will also give astronauts the go ahead they need from NASA to travel to Mars. It's a groundbreaking procedure to get rid of painful stones while you're awake, no anesthesia needed. "This has the potential to be game changing," said Dr. Kennedy Hall with UW Medicine. Still being run through clinical trials at UW Medicine, the procedure called burst wave lithotripsy uses an ultrasound wand and soundwaves to break apart the kidney stone. Ultrasonic propulsion is then used to move the stone fragments out, potentially giving patients relief in 10 minutes or less.
This technology is also making it possible for astronauts to travel to Mars, since astronauts are at a greater risk for developing kidney stones during space travel. It's so important to NASA, the space agency has been funding the research for the last 10 years. "They could potentially use this technology while there, to help break a stone or push it to where they could help stay on their mission and not have to come back to land," said Harper. The research has been published in the Journal of Urology.
This technology is also making it possible for astronauts to travel to Mars, since astronauts are at a greater risk for developing kidney stones during space travel. It's so important to NASA, the space agency has been funding the research for the last 10 years. "They could potentially use this technology while there, to help break a stone or push it to where they could help stay on their mission and not have to come back to land," said Harper. The research has been published in the Journal of Urology. | Medical Innovations |
For the Greek philosopher Celsus, wine was the answer to endless ailments, from fatigue and fever to coughs and constipation. But despite its convenient healing powers, the grape, he conceded to his faithful readers, could bring about the odd headache.
Now, researchers believe they have hit on the reason why wine – red wine, in particular – causes such swift and undeserved headaches. When the liver breaks down a particular ingredient, it produces a substance that has the same effects as a drug used to make alcoholics feel dreadful if they drink.
“We think we are finally on the right track toward explaining this millennia-old mystery,” said Morris Levin, the director of the Headache Center at the University of California, San Francisco. “The next step is to test it scientifically on people who develop these headaches.”
Red wine headaches are a different beast from the hangover variety that set up shop the morning after the night before. Rather than coming on after a lengthy session, they can strike 30 minutes after drinking only one or two small glasses.
Since Celsus’s time, researchers have eyed all manner of red wine compounds in their search for the culprit. Tannins, sulphites, phenolic flavonoids and biogenic amines have all come under suspicion. So far, none has been nailed as a clear trigger.
Writing in Scientific Reports, the US researchers said they homed in on phenolic flavonoids, compounds that derive from grape seeds and skin and which contribute to red wine’s colour, taste and mouthfeel. Levels of flavonoids can be 10 times higher in red wines than whites, making them prime candidates for causing immediate headaches.
When people drink wine, the alcohol is metabolised to acetate in two steps. The first converts alcohol in the form of ethanol to acetaldehyde. The second turns acetaldehyde to acetate. Specific enzymes in the liver orchestrate each of these processes.
The researchers, including Prof Andrew Waterhouse, an expert in viticulture at the University of California, Davis, ran lab tests on more than a dozen compounds in red wine. One stood out. A flavanol called quercetin, found almost exclusively in red wine, is processed in the body into various substances. One of these, quercetin glucuronide, turned out to be particularly effective at blocking the enzyme that converts acetaldehyde into acetate.
This could be key to solving the mystery. With the crucial enzyme suppressed, toxic acetaldehyde builds up in the bloodstream, the scientists believe. At high levels, this causes headaches, nausea, facial flushing and sweating. In fact, a drug called disulfiram blocks the same enzyme and is used to treat alcoholics by producing the same miserable symptoms if they drink.
According to the researchers, when susceptible people drink red wine with even modest amounts of quercetin, they can develop a headache, especially if they are prone to migraines. Why some are more affected that others is unclear: their enzymes may be easier to block, or they may simply be more susceptible to toxic acetaldehyde.
The team now hopes to test the theory with a clinical trial on the headache-inducing effects of red wines with different quercetin levels. The results could help people avoid red wine headaches in future. Grapes make quercetin in response to sunlight, so grapes grown in exposed clusters, such as Napa Valley cabernets, can have five times more quercetin than other reds. Skin contact during fermentation, fining processes and ageing also affect quercetin levels.
“It will be potentially very helpful for people who drink red wine to be able to choose wines less likely to cause headaches,” Levin said. “Also, winemakers may use our findings to reduce quercetin in their wines.” | Disease Research |
Pancreatic cancer is deadly, and its toll is growing. Scientists find that scar tissue around the tumor suggests how long a patient will live after diagnosis.
November 22, 2023 - By Krista Conger
Scar tissue that forms around a growing pancreatic tumor called a pancreatic ductal adenocarcinoma harbors valuable clues as to how long people with these cancers are likely to live, according to a new study led by researchers at Stanford Medicine.
The architecture and organization of cells in the scar tissue can be used to categorize patients into two groups. Members of one group lived a median of nearly two years longer than members of the other group — a substantial difference for a cancer with a five-year survival rate after surgery of only 20% to 25%.
In fact, the researchers found that the patterns of a patient’s scar tissue are among the most predictive prognostic elements for this type of cancer — second only to the stage of the tumor at diagnosis.
The finding suggests that cells in the scar tissue, as well as its overall structure, interact with the cancer cells to either egg on or tamp down their growth. Drugs that intercept pro-growth messages, or mimic cellular conversations that discourage growth, may lead to new avenues of therapy.
“Our study puts new therapeutic approaches on the table,” said professor of surgery Michael Longaker, MD. “Should we be treating not just the tumor but also the scar tissue? I would say yes. Both obviously play a role in patient outcome.”
Longaker, the Deane P. and Louise Mitchell Professor in the School of Medicine, is the senior author of the study, which was published in the Nov. 21 issue of Cell Reports Medicine. Post-doctoral scholar Jason Guo, PhD, and former graduate student Shamik Mascharak, MD, PhD, are the lead authors of the research.
Deaths increasing
Deaths from pancreatic ductal adenocarcinoma, the most common type of pancreatic cancer, are rising, and it is projected to be the second leading cause of cancer deaths in the next 10 years. Because the disease metastasizes, or invades other parts of the body, early and quickly, it often recurs within two years of initial treatment.
Pancreatic ductal adenocarcinoma sparks a particularly strong response by cells called fibroblasts found in the connective tissue surrounding the pancreas. The fibroblasts secrete collagen and other components of what’s known as the extracellular matrix to bind the tumor in a web of cancer-associated scar tissue called desmoplasia. Earlier research has hinted that this scar tissue affects patient prognosis, but the analyses were confined primarily to simple quantitative measurements.
“Previous studies have focused on the cancer cells themselves, or how much fibrosis, or scarring, surrounds the tumor,” Guo said. “But our findings reveal that maybe the critical information comes not from the quantity or mass of the scar tissue, but from its internal components and organization.”
Guo and his colleagues studied hundreds of samples of pancreatic ductal adenocarcinoma tissue collected during surgery to remove the cancerous portion of the pancreas — a standard treatment for the condition. They used a computer algorithm to identify and analyze nearly 300 distinct attributes of the desmoplasia, including the length, width, alignment and density of their fibers, and another technique called CODEX to assess the prevalence and location of immune and other types of cells in the desmoplasia.
The results effectively allowed the researchers to zoom in to get a cell’s-eye view of who’s rubbing shoulders with whom (and how tightly they are pressed together) versus others exchanging friendly waves across a crowded room. They were particularly interested in investigating the interactions between immune cells called B and T cells and specialized cancer-associated fibroblasts that promote inflammation.
Survival patterns
The researchers then used a machine-learning approach to combine the data about multiple cellular interactions and fiber architecture with clinical information about each patient to uncover specific patterns associated with overall survival in the months and years after the initial diagnosis. They found that the presence of a specific type of T cell called a cytotoxic T cell was strongly associated with longer overall survival, while an abundance of tumor cells that modulate the immune system, as well as activated B cells, were associated with poorer survival.
“Pro-inflammatory fibroblasts also popped up in our analyses, which we were happy to see,” Guo said. “Knocking out these fibroblasts or inhibiting their activity is a potential target for new therapies. We also saw close relationships between B cells and these fibroblasts, which is interesting. What are they talking about? We’d love to follow up and see what cellular signals are being exchanged.”
They also found that thinner fibers predicted better survival than the beefy, densely packed fibers found in samples from patients who died soon after diagnosis.
When all the data were incorporated, the computers were able to categorize patients with pancreatic ductal carcinoma into two main groups. Patients in one group lived a median of 655 days longer than the other.
Longaker, Guo and their colleagues hope that new information about the contributions of the desmoplasia to pancreatic cancer growth will not just open doors for new therapies but that it will also be used to guide clinical decisions.
“In the future, I envision that a patient gets a biopsy before treatment has started, and doctors will look not just at the cancer but also at the patterns and types of cells in the desmoplasia,” Longaker said. “This could also help doctors decide which patients are likely to need more aggressive therapy early in the course of their disease, and who could be spared invasive or harsh chemotherapy or radiation. I hope we can develop a chemotherapeutic approach that doesn’t just focus on the cancer but that also impacts fibroblasts and their role in promoting tumor growth.”
Researchers from the University of Virginia School of Medicine contributed to the work.
The study was funded by the National Institutes of Health (grant R01-GM136659) the Hagey Laboratory for Pediatric Regenerative Medicine, the Taylor Family Cancer Research Fund, the Rantz Family Research Fund, the Gunn/Olivier Fund, and Judy and Warren Kaplan.
About Stanford Medicine
Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu. | Disease Research |
An anonymous reader quotes a report from CNN: Adults ages 19 to 64 in the United States should be screened for anxiety disorders, according to a new recommendation from the US Preventive Services Task Force released Tuesday. The final recommendation, published in the medical journal JAMA, marks the first time the USPSTF has made a final recommendation on screening for anxiety disorders in adults, including those who are pregnant and postpartum. The task force found "insufficient evidence" to screen for anxiety in older adults. The USPSTF, a group of independent medical experts whose recommendations help guide doctors' decisions and influence insurance plans, also continues to recommend that all adults be screened for major depressive disorder, including those who are pregnant or postpartum and older adults. The recommendation is consistent with the task force's 2016 recommendation on depression screenings.
While rates of clinical depression had been rising steadily in the United States, they jumped significantly during the Covid-19 pandemic. In general, about 1 in 6 adults will have depression at some time in their life, according to the US Centers for Disease Control and Prevention. And although depression and anxiety are different conditions, they commonly can happen together -- and such screening recommendations can help clinicians identify which patients may need treatment for both conditions or one versus the other. "Anxiety disorders are common, and they can really impact people's quality of life, and what the task force found is that screening for anxiety disorders in the general adult population can lead to identifying these conditions early and then, if those people who are identified get linked up with appropriate care, they will benefit," said Dr. Michael Silverstein, vice chair of the USPSTF and director of the Hassenfeld Child Health Innovation Institute at Brown University. "So it really is extremely good news for the delivery of preventive services for the American public," he said. "We also found that in the older adult population, which is defined as age 65 and older, that the task force really needs more evidence to weigh the risks and benefits of screening for anxiety disorders. And for that older adult population, we're calling for urgent new research."
USPSTF researchers noted in their anxiety screening recommendation statement that most people with anxiety disorders don't receive treatment within the first year of symptoms, if ever -- showing a need for more robust screening. "Only 11% of US adults with an anxiety disorder started treatment within the first year of onset; the median time to treatment initiation was 23 years," the researchers wrote. "A US study of 965 primary care patients found that only 41% of patients with an anxiety disorder were receiving treatment for their disorder." Once the new screening recommendations are practiced in the real world, the results may reveal that anxiety disorders are much more prevalent than previously thought, said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the recommendation statements. "Anxiety has been way under the radar for a long time, and so I think it's good that they are recommending for the broad population to be screened. When we start screening for anxiety, we're going to find a lot more of it than we thought we had," he said.
"I think it's an opportunity for us to get our hands around this crisis before we have a mental health emergency," Benjamin added. "So we definitely have to do more. We know as a nation, we have under-invested in mental health. We have not put as much money into mental health. We have not been treating mental health at the same level as physical health. And we know that people who need mental health services are really struggling to find providers to care for them."
While rates of clinical depression had been rising steadily in the United States, they jumped significantly during the Covid-19 pandemic. In general, about 1 in 6 adults will have depression at some time in their life, according to the US Centers for Disease Control and Prevention. And although depression and anxiety are different conditions, they commonly can happen together -- and such screening recommendations can help clinicians identify which patients may need treatment for both conditions or one versus the other. "Anxiety disorders are common, and they can really impact people's quality of life, and what the task force found is that screening for anxiety disorders in the general adult population can lead to identifying these conditions early and then, if those people who are identified get linked up with appropriate care, they will benefit," said Dr. Michael Silverstein, vice chair of the USPSTF and director of the Hassenfeld Child Health Innovation Institute at Brown University. "So it really is extremely good news for the delivery of preventive services for the American public," he said. "We also found that in the older adult population, which is defined as age 65 and older, that the task force really needs more evidence to weigh the risks and benefits of screening for anxiety disorders. And for that older adult population, we're calling for urgent new research."
USPSTF researchers noted in their anxiety screening recommendation statement that most people with anxiety disorders don't receive treatment within the first year of symptoms, if ever -- showing a need for more robust screening. "Only 11% of US adults with an anxiety disorder started treatment within the first year of onset; the median time to treatment initiation was 23 years," the researchers wrote. "A US study of 965 primary care patients found that only 41% of patients with an anxiety disorder were receiving treatment for their disorder." Once the new screening recommendations are practiced in the real world, the results may reveal that anxiety disorders are much more prevalent than previously thought, said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the recommendation statements. "Anxiety has been way under the radar for a long time, and so I think it's good that they are recommending for the broad population to be screened. When we start screening for anxiety, we're going to find a lot more of it than we thought we had," he said.
"I think it's an opportunity for us to get our hands around this crisis before we have a mental health emergency," Benjamin added. "So we definitely have to do more. We know as a nation, we have under-invested in mental health. We have not put as much money into mental health. We have not been treating mental health at the same level as physical health. And we know that people who need mental health services are really struggling to find providers to care for them." | Mental Health Treatments |
A bacterial outbreak at Virginia Mason Franciscan Health in Seattle, Washington, has infected a total of 31 patients, according to a press release on the hospital’s website.
Four of the 31 patients have died, it's been reported, but public health officials at Public Health - Seattle & King County have not yet confirmed that the infections were a factor in their deaths.
The bacteria has been identified as Klebsiella pneumoniae. The hospital first announced the outbreak in October 2022 and has posted multiple updates, most recently on April 25.
"Beginning in October 2022, Virginia Mason Medical Center detected an increase in cases of Klebsiella pneumoniae bacteria at our downtown campus," said Sydney Bersante, interim president of the Virginia Mason Medical Center, in a statement on the hospital’s website.
"We immediately implemented increased safety measures, notified patients who had tested positive for the bacteria and promptly provided treatment where necessary," he continued.
"While the risk of transmission is extremely low for patients, we continue to take proactive steps to avoid additional transmission."
The hospital is working with public health officials to pinpoint the source of the outbreak, Bersante said.
"These types of outbreaks are complex, and despite thorough investigation, we may never know the source," said Dr. Eric Chow, chief of communicable disease epidemiology and immunization public health at Public Health - Seattle & King County, in a public statement.
What is Klebsiella pneumoniae?
Klebsiella pneumonia is a rare cause of infection that is very uncommon in patients with normal immune systems who have not been in the hospital for extended periods of time, Dr. Ken Perry, an emergency physician in Charleston, South Carolina, told Fox News Digital.
"It is a common cause of infections in patients who have spent any time on ventilators."
Symptoms of Klebsiella pneumonia are very similar to other common bacterial pneumonias, including fever, chest pain and difficulty breathing, the doctor said.
"The infection will show up in an X-ray of the chest, and will grow worse the longer the patient remains on the ventilator," said Perry, who is an executive board member of the State Chapter of the College of Emergency Physicians.
The Klebsiella bacteria can cause infections of wounds and surgical sites, as well as pneumonia, bloodstream infections or meningitis, according to the Centers for Disease Control and Prevention (CDC).
Those with weakened immunity are most at risk
"Most of the patients who get K. pneumonia infections have other underlying medical problems that limit their immune systems as well," Perry also said.
"Although still rare in the general population, it is a common cause of infections in patients who have spent any time on ventilators."
The infection most often affects sick patients in health care settings who are on ventilators, catheters or extended antibiotic treatments, the CDC stated.
Healthy people are generally not at risk.
The bacteria is not airborne, the CDC stated.
The infection can also happen in other at-risk patients who are not hospitalized.
"For these patients, they will have similar symptoms such as chest pain, cough, fever and the textbook answer of ‘currant jelly sputum,’" said Perry.
"This is a characterization of phlegm that is thick and bloody from the necrosis, or damage, to the lung tissue from the bacteria."
Antibiotic-resistant bacteria can be hard to treat
One of the most dangerous aspects of the infection is that some forms of the bacteria are resistant to some antibiotics, which makes it difficult to treat, the doctor warned.
This can make it a "life-changing if not fatal infection" for some patients, he said — particularly those who do not have robust immune systems.
"For any hospital that has an increase in this bacteria, the first thing that is necessary is to ensure the eradication of the bacteria from their environment," Dr. Perry said.
"This means that it will be necessary to deep-clean devices such as air vents, where the bacteria may be able to survive even normal adequate decontamination." | Epidemics & Outbreaks |
NHS funding will have to return to levels not seen since before the Tories came to power if it is to fill staffing shortfalls.
The Institute for Fiscal Studies (IFS) has conducted analysis on the cost of NHS England’s “historic” workforce plan. Boosting staffing to the required levels would require a return to annual Government funding rises of 3.6%. This was the same as the average rise awarded to the NHS since 1949 however the last decade has seen this drop to 2.4%.
The long-awaited workforce plan published earlier this year would see the workforce grow from 1.4 million to 2.3 million over 15 years to cater for a growing and ageing population. The Government has backed the plan in theory but not committed detailed funding plans.
Max Warner, research economist at IFS and an author of the paper, said: "We estimate that the plan might imply average real-terms funding growth of around 3.6% per year for the NHS in England. That is by no means outlandish by historical standards, but would nonetheless require difficult fiscal decisions in the current climate of sluggish growth.”
The first ever modelling of how many medics the NHS would need to properly care for the population suggests almost half of public sector workers would work for the NHS. It would employ one in 11 workers overall. It comes as the UK as a whole has some of the fewest medics per head of population compared to other developed nations.
Danny Mortimer, deputy chief executive of the NHS Confederation, said: “We know that the workforce plan will require long term funding if it’s to be rolled out successfully, and health leaders will agree that NHS funding should revert to the long run average growth rate to be in line with the ever-growing demand the NHS faces. We have an ageing and growing population, with increasingly complex needs.”
The Government has so far only committed to providing funding to expand training places in first five years of the 15-year strategy. The £2.4 billion allocated covers the expansion of training and education places, but not the cost of employing any more staff.
A Department for Health and Social Care spokeswoman said: “The NHS Long Term Workforce Plan is both a plan for investment and a plan for reform. As well as doubling medical school places and almost doubling the number of adult nurses and midwives in training, it sets out how we will deliver long-term productivity improvements in the NHS workforce.
“We will train new types of staff to free up doctors’ and nurses’ time so they can spend more time caring for patients, remove regulatory barriers facing healthcare professionals, and train doctors to work in more flexible ways. We are backing the plan with over £2.4 billion over the next five years. Decisions about spending review periods beyond this will be announced in the usual way, but this demonstrates our commitment to delivering the whole plan.” | Health Policy |
Test tubes labelled "Monkeypox virus positive and negative" are seen in this illustration taken May 23, 2022. REUTERS/Dado Ruvic/Illustration/File PhotoRegister 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.Danish 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 |
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EUGENE, Ore. (AP) — Psilocybin tea, wind chimes and a tie-dye mattress await those coming to an office suite in Eugene to trip on magic mushrooms. For roughly six hours, adults over 21 can experience what many users describe as vivid geometric shapes, a loss of identity and a oneness with the universe.
Epic Healing Eugene — Oregon’s first licensed psilocybin service center — opened in June, marking the state’s unprecedented step in offering the mind-bending drug to the public. The center now has a waitlist of more than 3,000 names, including people with depression, PTSD or end-of-life dread.
READ MORE: Colorado voters approve initiative to decriminalize psychedelic mushrooms
No prescription or referral is needed, but proponents hope Oregon’s legalization will spark a revolution in mental health care.
Colorado voters last year passed a measure allowing regulated use of magic mushrooms starting in 2024, and California’s Legislature this month approved a measure that would allow possession and use of certain plant- and mushroom-based psychedelics, including psilocybin and mescaline, with plans for health officials to develop guidelines for therapeutic use.
The Oregon Psilocybin Services Section, charged with regulating the state’s industry, has received “hundreds of thousands of inquiries from all over the world,” Angela Allbee, the agency’s manager, said in an interview.
“So far, what we’re hearing is that clients have had positive experiences,” she said.
While psilocybin remains illegal in most of the United States, the Food and Drug Administration in 2018 designated it a “breakthrough therapy.” This summer, the FDA published draft guidance for researchers designing clinical trials for psychedelic drugs.
Researchers believe psilocybin changes the way the brain organizes itself, helping a user adopt new attitudes and overcome mental health issues.
The Oregon Psychiatric Physicians Association, however, opposed Oregon’s 2020 ballot measure legalizing psilocybin, saying it “is unsafe and makes misleading promises to those Oregonians who are struggling with mental illness.”
Allbee noted that psychedelic mushrooms have been a part of tribal spiritual and healing practices for thousands of years. Her agency is focused on safety, she said.
First, customers must have a preparation session with a licensed facilitator who stays with clients as they experience the drug. The facilitator can deny access to those who have active psychosis, thoughts of harming anyone, or who have taken lithium, which is used to treat mania, in the past month.
The clients can’t buy mushrooms to go, and they must stay at the service center until the drug wears off.
Besides approving psilocybin, Oregon voters in 2020 decriminalized possession of hard drugs, cementing the state’s reputation as a leader in drug-law reform. Oregon was the first state to decriminalize marijuana possession and one of the first to legalize its recreational use.
But these days, the regulated marijuana industry is struggling with massive oversupply. And drug decriminalization has not greatly expanded addiction treatment or reduced overdoses as hoped. A new poll indicates most voters would repeal it.
It’s too early to assess Oregon’s mushroom legalization.
READ MORE: Oregon looks to crack down on illegal pot growers by holding landowners responsible
Oregon Psilocybin Services spent two years establishing regulations and began accepting license applications in January. There are now 10 licensed service centers, four growers, two testing labs and dozens of facilitators.
While Epic Healing Eugene has a long waitlist thanks in part to early media attention, other service centers say business is picking up as awareness spreads.
Omnia Group Ashland, which opened this month in southern Oregon, has a prospective client list of 150, said co-founder Brian Lindley. Jeanette Small, the owner of Lucid Cradle in Bend, said she intends to see only one client per week to give close attention to each and is already booked through December.
The law allows local jurisdictions to ban psilocybin operations, and several rural counties have done so.
There are complaints the cost is too high, but those in the industry expect prices to fall as more businesses are established. A client can wind up paying over $2,000, which helps cover service center expenses, a facilitator and lab-tested psilocybin. Annual licenses for service centers and growers cost $10,000, with a half-price discount for veterans.
Allbee said her agency requires every licensee to work toward social equity goals, with some already providing sliding-scale price models. She expects Oregon’s psilocybin program, currently receiving millions in taxpayer dollars, to be fully supported by licensing fees by mid-2025. She promised to then boost efforts to lower prices.
Cathy Jonas, Epic Healing Eugene’s owner, said she doesn’t expect her service center to start making money for a while. Providing legal access to psychedelic mushrooms is a calling, she said: “The plant medicines have communicated to me that I’m supposed to be doing this thing.”
State regulations allow doses of up to 50 milligrams, but when Jonas tested a 35-milligram sample of pure psilocybin — typically equal to about 6 grams of dried mushrooms — she found it so powerful that she decided it would be the most her facility would offer.
One of Jonas’ first clients took 35 milligrams and described seeing a “kind of infinite-dimension fractal that just kept turning and twisting.”
“It was kind of mesmerizing to watch, but it got so intense,” said the client, who didn’t want to be identified to protect his privacy. “I started to have this experience of dying and being reborn. And then I would kind of see large portions of my life going by in a very rapid way.”
He said the session “was not particularly pleasant,” but that it beneficially transformed how he views painful memories and provided a sought-after mystical experience.
READ MORE: Oregon leads the way in decriminalizing hard drugs
Licensed grower Gared Hansen has come full circle from the 16 years he spent as a police officer in San Francisco. He once busted a psilocybin dealer in Golden Gate Park.
Today, he runs Uptown Fungus, a one-person psilocybin-growing operation in a nondescript building set among towering cedar trees near Springfield, Oregon. He tends mushroom varieties with names like Golden Teacher, Blue Meanies and Pink Buffalo. A 25-milligram dose costs $125.
Hansen said he sometimes meditates with the mushrooms, hoping to imbue them with healing energy.
Little, brown psychedelic mushrooms can be found growing in fields or in the woods, but they can closely resemble poisonous varieties. Hansen and others caution against obtaining psilocybin cheaper on the black market or tripping alone. Service centers provide measured — and often strong — doses in a controlled environment.
“Sometimes part of the healing could be a negative experience someone has to go through, to kind of flush negative emotions out or reexperience some trauma in a healthier way,” Hansen said. “I’d hate to have someone that’s never tried it before take it home, have a bad trip and hurt themselves.”
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WASHINGTON -- With the growing popularity of disposable e-cigarettes, communities across the U.S. are confronting a new vaping problem: how to safely get rid of millions of small, battery-powered devices that are considered hazardous waste.
For years, the debate surrounding vaping largely centered on its risks for high school and middle school students enticed by flavors like gummy bear, lemonade and watermelon.
But the recent shift toward e-cigarettes that can’t be refilled has created a new environmental dilemma. The devices, which contain nicotine, lithium and other metals, cannot be reused or recycled. Under federal environmental law, they also aren’t supposed to go in the trash.
U.S. teens and adults are buying roughly 12 million disposable vapes per month. With little federal guidance, local officials are finding their own ways to dispose of e-cigarettes collected from schools, colleges, vape shops and other sites.
“We are in a really weird regulatory place where there is no legal place to put these and yet we know, every year, tens of millions of disposables are thrown in the trash,” said Yogi Hale Hendlin, a health and environmental researcher at the University of California, San Francisco.
In late August, sanitation workers in Monroe County, New York, packed more than 5,500 brightly colored e-cigarettes into 55-gallon steel drums for transport. Their destination? A giant, industrial waste incinerator in northern Arkansas, where they would be melted down.
Sending 350 pounds of vapes across the country to be burned into ash may not sound environmentally friendly. But local officials say it’s the only way to keep the nicotine-filled devices out of sewers, waterways and landfills, where their lithium batteries can catch fire.
“These are very insidious devices,” said Michael Garland, who directs the county’s environmental services. “They’re a fire risk and they’re certainly an environmental contaminant if not managed properly.”
Elsewhere, the disposal process has become both costly and complicated. In New York City, for example, officials are seizing hundreds of thousands of banned vapes from local stores and spending about 85 cents each for disposal.
HAZARDOUS WASTE
Vaping critics say the industry has skirted responsibility for the environmental impact of its products, while federal regulators have failed to force changes that could make vaping components easier to recycle or less wasteful.
Among the possible changes: standards requiring that e-cigarettes be reusable or forcing manufacturers to fund collection and recycling programs. New York, California and several other states have so-called extended product responsibility laws for computers and other electronics. But those laws don't cover vaping products and there are no comparable federal requirements for any industry.
Environmental Protection Agency rules for hazardous waste don’t apply to households, meaning it's legal for someone to throw e-cigarettes in the garbage at home. But most businesses, schools and government facilities are subject to EPA standards in how they handle harmful chemicals like nicotine, which the EPA considers an “acute hazardous waste," because it can be poisonous at high levels.
In the U.S., the push to manage disposable e-cigarettes has chiefly come from schools, which can face stricter regulation if they generate more than a few pounds of hazardous waste per month. Monroe County schools pay $60 to dispose of each one-gallon container of vapes. More than two thirds of the e-cigarettes collected by the county come from schools.
“Our schools were very relieved because they had confiscated so much of this material,” Garland said. “If you think of all the high schools across the country, they are in a very difficult place right now.”
Lithium in e-cigarette batteries is the same highly sought metal used to power electric vehicles and cellphones. But the quantities used in vaping devices are too small to warrant salvage. And nearly all disposable e-cigarette batteries are soldered into the device, making it impractical to separate them for recycling.
Disposable e-cigarettes currently account for about 53% of the multi-billion U.S. vaping market, according to U.S. government figures, more than doubling since 2020.
Their rise is a study in unintended consequences.
In early 2020, the Food and Drug Administration banned nearly all flavors from reusable e-cigarettes like Juul, the cartridge-based device blamed for sparking a nationwide surge in underage vaping. But the policy didn't apply to disposables, opening the door to thousands of new varieties of fruit and candy-flavored vapes, almost all manufactured in China.
In recent months the FDA has begun trying to block imports of several leading disposable brands, including Elf Bar and Esco Bar. Regulators consider them all illegal, but they have been unable to stop their entry to the U.S. and the devices are now ubiquitous in convenience stores, gas stations and other shops.
FDA’s tobacco chief, Brian King, said in a statement that his agency “will continue to carefully consider the potential environmental impacts” of vaping products.
THE COST OF CONFISCATING DISPOSABLE E-CIGARETTES
In 2020, New York City outlawed the vast majority of e-cigarette types, banning flavors that can appeal to youngsters.
City employees conduct thousands of inspections annually, and last year issued more than 2,400 citations to corner stores and bodegas selling illegal flavored products. Adding to the challenge are THC vapes sold at hundreds of unlicensed marijuana shops, a separate but related problem that has mushroomed since New York's legalization of recreational pot.
Since last November, officials have seized more than 449,000 vape units, according to city figures. New York City is spending about $1,400 to destroy each container of 1,200 confiscated vapes, but many more remain in city storage lockers.
“I don’t think anyone ever considered the volume of these in our community,” said New York Sheriff Anthony Miranda, who leads a task force on the issue. “There’s a tremendous amount of resources going into this effort.”
A recent lawsuit against four large vaping distributors aims to recoup some of the city's costs.
For now, New Yorkers who vape can bring their used e-cigarettes to city-sponsored waste-collection events.
Ultimately those vapes meet a familiar fate: They are shipped to Gum Springs, Arkansas, to be incinerated by Veolia, an international waste management firm. The company has incinerated more than 1.6 million pounds of vaping waste in recent years, mostly unsold inventory or discontinued products.
Veolia executives say burning e-cigarettes' lithium batteries can damage their incinerators.
“Ideally we don’t want to incinerate them because it has to be done very, very slowly. But if have to, we will,” said Bob Cappadona, who leads the company’s environmental services division.
Veolia also handles e-cigarettes from Boulder County, Colorado, one of the only U.S. jurisdictions that actively tries to recycle e-cigarette batteries and components.
Historically, Boulder has had one of the highest teen vaping rates in the country, peaking at nearly 33% in 2017.
“It was like someone flicked the switch. Suddenly e-cigarettes were everywhere,” said Daniel Ryan, principal of Centaurus High School.
Beginning in 2019, county officials began distributing bins to schools for confiscated or discarded e-cigarettes. Last year, they collected 3,500.
County staffers sort the devices by type, separating those with removable batteries for recycling. Disposables are packed and shipped to Veolia's incinerator. Shelly Fuller, who directs the program, says managing vape waste has gotten more costly and labor intensive with the shift to disposables.
“I kind of miss the days when we had Juuls and I could take each battery out and recycle them very easily,” Fuller said. “No one has time to dismantle a thousand Esco Bars.”
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AP video journalist Joseph Frederick contributed to this story from New York
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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. | Global Health |
The US Food and Drug Administration has approved the medication zuranolone for the treatment of major depressive disorder and severe postpartum depression – making it the first FDA-approved oral pill in the United States specifically for postpartum depression, a serious mental illness that can develop in about 1 in 7 new mothers after childbirth.
On Friday, the FDA announced that the treatment, to be sold under the brand named Zurzuvae, has been approved as a once-daily pill taken over the course of 14 days.
“Postpartum depression is a serious and potentially life-threatening condition in which women experience sadness, guilt, worthlessness—even, in severe cases, thoughts of harming themselves or their child. And, because postpartum depression can disrupt the maternal-infant bond, it can also have consequences for the child’s physical and emotional development,” Dr. Tiffany R. Farchione, director of the Division of Psychiatry in the FDA’s Center for Drug Evaluation and Research said. “Having access to an oral medication will be a beneficial option for many of these women coping with extreme, and sometimes life-threatening, feelings.”
The FDA added a boxed warning to the drug’s labeling, noting it can impact a person’s ability to drive and perform other potentially hazardous activities. Patients also may not be able to assess their degree of impairment. To reduce the risk of harm, the agency says patients should not drive or operate heavy machinery for at least 12 hours after taking the drug.
The FDA said the most common side effects include drowsiness, dizziness, diarrhea, fatigue, nasopharyngitis (the common cold), and urinary tract infection. The agency also said use of the drug may cause suicidal thoughts and behavior. It may also cause fetal harm. The agency said women should use effective contraception while taking, and for one week after taking the medication.
It’s estimated that each year in the United States, more than 400,000 babies are born to mothers who are depressed. Without any treatment, postpartum depression can last for months or even years, according to the National Institute of Mental Health.
Treatment options for postpartum depression have included counseling or therapy with a mental health professional and antidepressant medications, but until Zulresso and zuranolone, no antidepressant medication had been specifically FDA-approved to treat postpartum depression. Also, antidepressant medications generally don’t provide an immediate relief of symptoms and may take several weeks to help.
Becoming the nation’s second postpartum depression drug
In February, drugmakers Biogen and Sage Therapeutics, Inc. – the two companies behind zuranolone – announced that the FDA had accepted their application for the approval of zuranolone and their application was granted priority review.
“We see potential for zuranolone, if approved, to be a meaningful new option that can help address the serious unmet need faced by the diverse populations struggling with” major depressive disorder and postpartum depression, Dr. Priya Singhal, executive vice president and head of development at Biogen, said in a news release at the time.
In 2019, Zulresso became the first postpartum depression drug to receive FDA approval.
That treatment is administered as a single 60-hour IV drip of the drug brexanolone and was found to have mild side effects, such as headache, dizziness or excessive sleepiness, but also sudden loss of consciousness. Some women may face barriers accessing this type of treatment, as it requires 60 hours of time and must be used within a health care setting. Whereas, with zuranolone, it is a pill you can take at home.
Both brexanolone and zuranolone are versions of a naturally occurring substance in the body called allopregnanolone, a neuroactive steroid that is a metabolite of the hormone progesterone. Levels of allopregnanolone can rise dramatically during pregnancy and then abruptly drop after childbirth, potentially contributing to postpartum depression.
So restoring allopregnanolone with medications structurally similar to it, like brexanolone or zuranolone, can help provide some relief to people with postpartum depression. Both drugs work in a similar way; they are just administered differently.
“After years of dedicated research and collaboration with other scientists around the country, women living with postpartum and perinatal depression have a new, at-home, easy-to-use treatment option that has the potential to alleviate their symptoms,” Dr. Kristina Deligiannidis, a professor at the Institute of Behavioral Science at the Feinstein Institutes for Medical Research in New York, who has been the principal investigator on national multi-site clinical trials that led to zuranolone’s approval, said in a news release.
Postpartum depression “is often underdiagnosed and undertreated. With the FDA’s decision today, we may be able to reverse this and help many more women in need,” Deligiannidis said.
A previous Phase 3 clinical study of zuranolone, published in 2021 in the journal JAMA Psychiatry, found that among 151 women with severe postpartum depression, the patients taking daily zuranolone at 30 milligrams for two weeks experienced greater reductions in their depressive symptoms compared with those taking a placebo. Those reductions in symptoms were seen within three days and lasted through 45 days, according to the study, which was conducted in 2017 and 2018 at 27 sites.
A more recent Phase 3 study, published last week in the American Journal of Psychiatry, found that a 50-milligram dose of zuranolone was well tolerated and effective. The study found that among 196 women with postpartum depression, the patients taking daily zuranolone at 50 milligrams for 14 days demonstrated “significant improvements in depressive symptoms” compared with those taking a placebo.
The day after the women completed the 14-day treatment course, the researchers found that 57% reported a 50% or higher improvement in their depressive symptoms, compared with 38% of those on a placebo. As the researchers continued to follow the women through 45 days, 61.9% of participants who received zuranolone, compared with 54.1% of those taking a placebo, saw such high improvements in their symptoms.
The FDA approval of zuranolone marks “a very important step forward” for the field of maternal mental health, Dr. Samantha Meltzer-Brody, director of the Center for Women’s Mood Disorders at the University of North Carolina at Chapel Hill, said in an email. She was one of the investigators on the zuranolone clinical trials.
“It will be an important tool in treating postpartum depression. Rapidly acting antidepressant therapies are needed and this would be the first oral drug formulation of a rapidly acting antidepressant. That is a very big deal for moving the bar forward to improve treatment options for women with postpartum depression,” Meltzer-Brody said in the email.
“I believe that many women will be very eager for a rapidly acting antidepressant,” she said, adding that if a mother can have relief from postpartum depression within three days, which was found for some participants in the zuranolone clinical trials, “that is extremely important as the postpartum period is such a vulnerable time.”
Some mental health experts raise concerns
Approval of this medication is an important milestone in postpartum depression treatment, specifically as it has a new biological target and is fast-acting, said Catherine Monk, professor and chief of the division of women’s mental health in Obstetrics & Gynecology at Columbia University Vagelos College of Physicians and Surgeons.
Yet she added that there are certain concerns among some maternal mental health experts when it comes to zuranolone – the medication was originally tested primarily on women with severe postpartum depression, not mild or moderate depression, and patients should still consider psychotherapy as an intervention for depression.
“There’s a concern that this medication will just get used for everybody. Whereas for people with mild to moderate depression, the gold standard of care is to start with psychotherapy and other behavioral and lifestyle changes,” Monk said, adding that the pill should not be a first response for patients with mild to moderate postpartum depression.
“It needs to be clear that it originally was established as having efficacy mainly with people who had severe depression,” she said. “Also, there are significant health disparities in the rates of postpartum depression, much higher rates for those living in poverty and minoritized populations.”
While such disparities are a social-political problem, Monk said, “we must address the social determinants of health in the causal pathway to postpartum depression and not let the excitement of a new medication overshadow these issues.”
Judite Blanc, assistant professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine, had similar sentiments.
Zuranolone “could be particularly beneficial for women who face barriers to accessing long-term treatments, such as low-income women or those with limited healthcare access. However, from a scientific, social, and ethical standpoint, this clinical trial is not the panacea to tackle the maternal health crisis in the U.S. and globally,” Blanc wrote in an email last month.
“Medications shouldn’t be the first or only line of treatment for mental health conditions, particularly among women, children, and historically oppressed populations,” she said.
And as the effect of zuranolone reported in the trial was followed only for 45 days among postpartum women who don’t breastfeed, Blanc added that “we need further studies to assess the long-term impact of Zuranolone, including among breastfeeding mothers, as well as the patient-child interaction.”
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Postpartum depression symptoms may include crying spells, difficulty bonding with your baby, inability to sleep, or feelings of hopelessness. With severe postpartum depression, women are unable to function with daily routines and often have recurring thoughts of suicide, self-harm or harming the baby, which are very serious symptoms that require immediate evaluation and attention.
“Someone with a really severe depression, often there is suicidal ideation, and very concerning, a plan,” Monk said. But she added that, for any new mother, “if you feel like you could use some support and help, it doesn’t matter if you have what we call a subclinical depression, please reach out and you should get help – and it may be that you don’t need as much help as someone else with a very serious depression, but let’s get you the support and help you need — especially to prevent the situation from worsening.” | Mental Health Treatments |
William and Kate listened to heart-breaking accounts from child survivors as they joined mourners at Westminster Abbey as Britain remembers the 72 victims of Grenfell Tower who died five years ago today.The Duke and Duchess of Cambridge stood with survivors of the fire along with bereaved relatives at a memorial service also attended by MPs including Theresa May, who was prime minister at the time of the tragedy.With Prince William looking on, Kate laid a wreath with white flowers at the base of Grenfell Tower to mark the five-year anniversary of the deadly fire. Afterwards, both bowed their hoods and paused for a moment of reflection.It was also revealed the Duke and Duchess had held a private meeting earlier on Tuesday between the royal couple and those directly affected by the disaster.The royal couple have long supported survivors and the families who died in the fire on June 14, 2017, which was accelerated by deadly combustible cladding and where many of those who died had been told to stay in their flats. 72 people died in the tragedy - but more are feared to have perished but were never identified.Attendees marked the memorial with a 72-second silence in memory of the 72 victims of the fire, which took place exactly five years ago, was observed by attendees including William and Kate, and followed by applause. Mourners donned green scarves and clothing to match the green hearts which adorn the wall below the 220ft tower, and which have become a powerful symbol representing the memory of those lost in the tragedy.Green balloons were later released in memory of the 18 children who perished in the deadly blaze.Eight-year-old Ayeesha, who survived the fire, also recited a poem she wrote called Never Forget, which was met with raucous applause from both Prince William and Kate.She said: 'We will stay strong, we will rise up as a community, we will fight for justice together, we will always remember our friends and our neighbours, we will always remember our home.'We can't change the past but we can change the future. Never forget.'The little girl smiled as she ended the poem and the Duke and Duchess of Cambridge could be seen smiling as they joined in applause.And today with tears streaming down the faces of mourners, dressed in green and clutching photographs of their loved ones, the fifth anniversary was marked. Prince William shakes the hand of two young attendees at the Grenfell Tower memorial service in LondonWith Prince William looking on, Kate laid a wreath with white flowers at the base of Grenfell Tower to mark the five-year anniversary of the deadly fire. Both bowed their hoods and paused for a brief moment of reflection Prince William and the Duchess of Cambridge speak with survivors and bereaved children during a memorial service to mark the fifth anniversary of the Grenfell Tower fire Hundreds of mourners attended Tuesday's service of remembrance - marking five years since the Grenfell Tower tragedy A young schoolgirl is pictured laying flowers at the site of the Grenfell Tower memorial in north Kensington on TuesdayThe Duchess of Cambridge arrives during their unannounced visit to the memorial service at the base of Grenfell Tower earlier today The Duke and Duchess of Cambridge stood shoulder-to-shoulder with survivors of the fire along with bereaved relatives at Tuesday's memorial service William and Kate have long supported survivors and families who died in the tragedy, which took 72 lives when a fire took hold in the tower block on June 14, 2017Eight-year-old Ayeesha, who survived the fire, recited a poem she wrote called Never Forget which was met with raucous applause from both Prince William and Kate Hundreds gathered at the base of Grenfell Tower in north Kensington, London as they watched the memorial service get underway Rapper Stormzy watched on as a wreath laying ceremony was displayed on big screens at the base of Grenfell Tower Hamid Ali Jafari staples to a tribute wall at Grenfell Tower a photo of his father, Ali Yawar Jafari, who died in the Grenfell Tower fire on June 14, 2022 in London, England People read the written tributes left to victims of the deadly Grenfell Tower fire on Tuesday, June 14 Prince William and Kate Middleton look sombre as they attend a memorial service marking the fifth anniversary of the Grenfell Tower tragedy William and Kate sit among the congregation during the unannounced visit to today's wreath laying service at the base of Grenfell Tower After each group of names was read out, the congregation said in unison 'Forever in our hearts' - the phrase emblazoned across the top of the covered-up tower in north Kensington. Pictured: The Duchess of Cambridge today The Duke of Cambridge is pictured addressing fellow attendees at the Grenfell Tower memorial on Tuesday as he and the Duchess of Cambridge made a surprise visit Prince William speaks at the memorial service at the base of Grenfell Tower. Mourners were dressed in green and clutching photographs of loved ones William and Kate were present as the congregation took part in the special service to commemorate those lost in the tragedy Grenfell survivors and bereaved relatives are releasing 18 green balloons from the base of the west London tower to represent each child who died there five years ago. Pictured: Prince William speaks with fellow attendees on Tuesday afternoon The Duke and Duchess of Cambridge chatted with attendees before taking their seats in the front row for a multi-faith service at the base of the north Kensington high-rise on Tuesday It is one of several events at which Grenfell survivors, the bereaved and the community will gather on Tuesday, five years on from the deadliest domestic blaze since the Second World War The Duke of Cambridge is pictured arriving at the memorial service on Tuesday afternoon The 72 victims who lost their lives in the deadly Grenfell Tower blaze Mohammad al-Haj Ali, 23 Sakina, 65, and Fatema Afrasehabi, 59 Fathia Ahmed, 71, Abufars Ibrahim, 39, and daughter Isra Ibrahim, 35 Raymond Bernard, 63 Kamru Miah, 79, Rabeya Begum, 64, Mohammed Hamid, 27, Mohammed Hanif, 26 and Husna Begum, 22 Maria del Pilar Burton, 72 Ali Yawar Jafari, 81Amna Mahmud Idris, 27 Victoria King, 71, and Alexandra Atala, 40 Tony Disson, 65 Rania Ibrahim, and her young children Fethia and Hania Vincent Chiejina, 60 Joseph Daniels, 69 Mariem, 27, and Eslah Elgwahry, 64Hesham Rahman, 57 Gary Maunders, 57 Hashim Kedir, 44, Nura Jemal, 35, Firdows Hashim, 12, Yahya Hashim, 13, and Yaqub Hashim, sixGloria Trevisan, 26, and Marco Gottardi, 27Khadija Saye, 24Mary Mendy, 54Hamid Kani, 60 Deborah Lamprell, 45 Abdulaziz El-Wahabi, 52, Faouzia, 41, Yasin, 20, daughter Nur Huda, 16, and son Mehdi, eight Ligaya Moore, 78 Dennis Murphy, 56 Mohamed Neda, 57 Mohamednur Tuccu, 44, his wife Amaya Tuccu-Ahmedin and Amal Ahmedin, threeOmar Belkadi, 32, Farah Hamdan, 31, and daughters Malak, seven, and six-month-old LeenaBerkti, 29, and Biruk Haftom, 12Khadija Khalloufi, 52 Steve Power, 63 Jessica Urbano Ramirez, 12 Zainab Deen, 32, and her son Jeremiah, 2 Logan Gomes Abdeslam Sebbar, 67 Sheila Smith, 84 Marjorie, 68, and Ernie Vital, 50Isaac Paulos, 5 Nadia, Bassem, Sirria, Mierna, Fatima and Zeinab Choucair Tuesday marked the latest public show of support from the Cambridges.William, along with his grandmother, the Queen, visited the site in west London in the days following the fire in June 2017.And the Duke was joined by his wife when they met with survivors as part of the launch of the National Emergencies Trust in 2019.It comes as local residents praised the appearance of the Duke and Duchess of Cambridge as 'huge' for the community and showed they 'shared that feeling' of mourning on the fifth anniversary.Mother-of-five Muna Hussain said her children went to the same school as five of those who died in the fire and her household was evacuated in the days following.When asked about William and Kate's appearance at the service, Ms Hussain, 50 said: 'I was happy.'I was glad to see at least they know how we are feeling as a community and they shared that feeling.'It makes me very happy. It's massive, it's huge for us. It makes you feel better.'Today's congregation, organised by campaigners with Grenfell United, stood as the Westminster Abbey special service choir sang Psalm 102:1: 'Hear my prayer, O Lord, and let my crying come unto thee.'Mrs May, London Mayor Sadiq Khan, Housing Secretary Michael Gove, former building safety and fire minister Stephen Greenhalgh, and shadow housing secretary Lisa Nandy sat to the side of the pulpit. Journalist Jon Snow sat in the front row and also spoke to the congregation.The names of the 72 men, women and children who lost their lives in the worst fire in a generation were also read out.Floral displays -including a 72 constructed of white flowers - and written tributes were left beside the Grenfell 'tribute wall'.Opening the service, the very Reverend Dr David Hoyle, Dean of Westminster, said the loss and anguish 'are still vivid and sharp' as the congregation gathered 'in sorrow and in pain'.He said: 'Here we renew our commitment to remember those we have lost.'We gather as those who look for justice and a renewed commitment to securing safety in our homes, safety in times of fire.'Grateful for the support of the communities and individuals that have sustained the bereaved and the survivors over the last five years, we meet in faith and hope looking to a better, safer, surer future.'It came as politicians paid tribute on social media, with Prime Minister Boris Johnson tweeting: 'Today marks five years since the Grenfell Tower fire took the lives of 72 people.'My thoughts are with the survivors, those who lost loved ones and the wider community.'Labour leader Sir Keir Starmer posted: 'Five years on from the Grenfell tower fire we remember the 72 people killed.'The Grenfell community are courageous in their pursuit of justice and change.'We stand with them. To honour the memories of those lost we must prevent such a tragedy happening again.Mr Khan tweeted: 'Along with all Londoners I stand with the Grenfell community, today on the fifth anniversary of that terrible tragedy, and always.'Together, we will get the answers, justice and change that we need to protect communities in London and across the rest of our country.'Multi-faith leaders said the names of the victims of the tragedy, during a service at Westminster Abbey to remember those who perished in the tower block fire on June 14 2017.After each group of names was read out, the congregation said in unison 'Forever in our hearts' - the phrase emblazoned across the top of the covered-up tower in north Kensington.Hundreds of people connected to Grenfell Tower have heard a reading from the Quran at a multi-faith service being held at the base of the building.Christian prayers were also being read by Reverend Gerard Skinner from the Roman Catholic Parish of Notting Hill. Following the readings, the local Soul Sanctuary Choir began a rendition of Amazing Grace.Several hundred mourners later held a silent walk through North Kensington for the 72 victims of the devastating fire.Survivors and bereaved relatives holding a banner reading 'United for Grenfell' led the walk while other members of the community are held huge home-made green hearts aloft. Theresa May and Levelling Up Secretary Michael Gove lower their heads in prayer during the service in Westminster Abbey today Theresa May and community volunteer Claire Walker speak before the Grenfell fire memorial service at Westminster Abbey todayA green ribbon is tied to railings below the empty shell of the building, where loved ones continue to commemorate those lost in the fire Grenfell Tower went up in flames five years ago today in the early hours of June 14, 2017, and became the worst fire in a generation Campaigners have continued to question why nobody has ever been prosecuted in relation to the blaze, which took place five years ago todayIt is one of several events at which Grenfell survivors, the bereaved and the community that gathered on Tuesday, five years on from the deadliest domestic blaze since the Second World War.At 2pm a 72-second silence was observed at Westfield shopping centre, after which the names of the 72 victims was read out over the public address system.Later in the afternoon, cording around the tower in north Kensington was removed so survivors, the bereaved and community groups could gather at its base for a multifaith service and lay flowers and wreaths.Natasha Elcock, chairwoman of campaign group Grenfell United, said: 'This week will be a difficult week for everyone affected by the Grenfell Tower fire.'For many of us the events five years ago are still so raw in our minds and our losses remain heavy in our hearts.'In the evening, firefighters from across the country will form a guard of honour as members of the community take part in a silent walk starting from the base of the tower.Pete Wolfenden, a firefighter who responded to the blaze, said: 'It's been five years since the Grenfell Tower fire and the thoughts and wishes go out from all London firefighters and fire control staff personnel to the survivors and friends and family of those who lost their lives in this appalling incident, the worst domestic blaze in living memory.'We also remember the brave and courageous members of all the emergency services who attended on the night and subsequent days, some of whom still suffer ill-health and bear the mental scars of attending that traumatic incident.' The loss of 72 lives inside Grenfell Tower made it the worst fire in a British residential building since the Second World War The Dean of Westminster David Hoyle addresses the congregation on the fifth anniversary of the Grenfell tragedy at Westminster Abbey People arrive for a Grenfell fire memorial service at Westminster Abbey earlier today, where tributes were paid to those who lost their lives in the tragedy Some in the crowd held flowers in memory of loved ones, with this person hold a white rose in Westminster Abbey during the service Sir Martin Moore-Bick (centre), who led the public inquiry into the cause of the fire at Grenfell Tower, attended the ceremony today A community choir dressed in green and black performs at the Grenfell Tower fire memorial service at Westminster Abbey today A tree is decorated in green and with placards near to the remains of Grenfell Tower today, where the memory of the tragedy still looms large Flowers and tributes to those who lost their lives in the tragedy have been placed at a wall in the area, with the remains of the tower in the backgroundMatt Wrack, general secretary of the Fire Brigades Union, said: 'Firefighters and the Grenfell community have a bond that was forged in tragedy, and the Fire Brigades Union stands in solidarity with all bereaved, survivors and residents.'Today, on the fifth anniversary of the fire, it is a time for reflection, and to remember all those who lost their lives, and the loved ones they left behind. Their legacy lives on in the fight for justice.'The community have faced constant denials from those responsible for Grenfell being covered in cladding as flammable as petrol.'They have faced a wait for criminal charges that continues to this day. They inspire us all with their relentless fight for justice and we continue to stand in solidarity with them every step of the way.'London Fire Commissioner Andy Roe said he has found the strength and dignity of the Grenfell community 'humbling and inspiring'.He added: 'I give my commitment that we will continue to listen and make changes to our service and work to drive improvements in the built environment to ensure such a tragedy can never happen again.'A spokeswoman for campaign group Justice 4 Grenfell said: 'Today we stand with the Grenfell bereaved, survivors and community. Forever in our hearts.'The Grenfell Tower fire has become a symbol of the social inequality and injustice that exists in our country.'Seventy-two people lost their lives, many people lost their homes, possessions, families and loved ones.'The first duty of any government is to protect the lives of its citizens. From the right to life and including the duty to provide adequate housing, these duties are enshrined in law and are where the Government has and continues to fail.'It comes as other members of The Firm were out in force at Royal Ascot, with Prince Charles and Camilla leading the royal family today while the Queen missed the event amid her ongoing mobility issues.Her Majesty was a regular at the Berkshire racecourse before the pandemic and has been at every Royal Meeting since acceding to the throne in 1952, apart from when it was held behind closed doors in 2020.However the 96-year-old monarch will likely be watching from home just seven miles away at Windsor Castle this afternoon, especially when her horse King's Lynn started racing in the King's Stand Stakes at 3.40pm.Instead, the Prince of Wales, 73, and Duchess of Cornwall, 74, were in attendance alongside a host of other royals - including Princess Anne, 71, and her two children Peter Philips, 44, and Zara Tindall, 41, Countess Sophie Wessex, 57, and Princess Beatrice, 33, who was joined by her husband Edoardo Mapelli-Mozzi, 38.Just over a week after the Platinum Jubilee celebrations ended, members of the royal family appeared in high spirits, with many taking part in the carriage procession, before greeting one-another in the warm summer sunshine at the racecourse.Zara could be seen affectionately greeting her uncle Charles, as well as Princess Michael of Kent, while Princess Beatrice was also beaming with joy at the event.Meanwhile the Duchess of Cambridge's parents Carole and Michael Middleton also made a surprise appearance at the event today. Prince Charles, 73, and Camilla, 74, led the royal family today at Royal Ascot as they came out in force for the first day of the races - while the Queen, 96 missed the event amid her ongoing mobility issuesThe Prince of Wales and Duchess of Cornwall were in attendance alongside Princess Beatrice (left with her husband Edoardo Mapelli Mozzi) and Zara Tindall (right) Meanwhile the Queen's only daughter Princess Anne was also in attendance at the event, opting for a cream coat dress with a brown fascinator Prince Charles and Camilla, Duchess of Cornwall shared a laugh with William Buick's trainer Charlie Appleby during the event Meanwhile Sophie Wessex was elegant in an over-the-top raspberry hat today as she joined other members of the royal family at the event Scoring a winner! The Duchess of Cambridge's mother was seen jumping for joy during the races at Ascot The best view in the racecourse! The royal couple could be seen peering through their binoculars as they watched the King's Stand Stakes | Epidemics & Outbreaks |
Presidential hopeful Gov. Ron DeSantis frequently pitches his response to the COVID-19 pandemic in Florida as a top reason why Republican primary voters should choose him over Donald Trump and other candidates. DeSantis fought off local mask mandates, questioned the safety of vaccines, and reopened schools, businesses and beaches before much of the country, policies he claims saved Florida’s economy while focusing prevention efforts on the elderly and vulnerable.
Or so the story goes. A national study on “excess mortality” published in the journal Science this week pours cold water on DeSantis’s claims and reveals that the number of COVID-related deaths outside of major metropolitan areas were likely much higher than initially reported. Like other rural and lower-income areas across the United States, and the Deep South in particular, counties in central Florida and the panhandle suffered tragically high death tolls during the second year of the pandemic despite a massive, nationwide effort to make COVID testing and vaccines widely available.
As of March 10 of this year, about 86,850 Floridians have died from COVID according to official tallies, with Florida ranking third in the nation for total COVID deaths behind the behemoth states of Texas and California. In the end, Florida’s response to COVID was not as effective as DeSantis and others may advertise, according to Andrew C. Stokes, a demographer and sociologist at Boston University who coauthored the study with scientists and public health experts.
“Ron DeSantis has been able to sell Florida as a success story, but that does not bear out once you dig into the county level data,” Stokes said in an interview. “Much of central and rural Florida experienced exceptionally high mortality rates in the second year, when vaccines were available and other measures were in place, like increased access to [COVID] treatments.”
By comparing the total number of recorded deaths from April 2020 to February 2022 to the number of deaths scientists would normally expect to see over the same time period, the researchers measured “excess mortality” or “excess deaths” at the state and county level across the nation. Stokes said this method provides more accurate snapshots of the pandemic’s impact than official death counts from rural areas where COVID data reporting is spotty and fewer sick people die inside health care facilities.
In many rural areas, coroners are elected officials who may not have deep medical expertise or the resources to accurately investigate the cause of death. Stokes said some coroners may also be swayed by their own partisan biases about COVID and the pandemic. Indeed, both Trump and DeSantis systematically downplayed the pandemic, dismissing data experts and misleading the public while attacking Democrats to appease far right pundits and the GOP base.
Excess deaths not assigned to COVID-19 may also reflect deaths indirectly related to the pandemic, including deaths associated with hospital avoidance due to fear of the virus or the brutal increase in fatal drug overdoses. At the same time, what COVID mitigation measures were in place likely reduced the number of deaths caused by other common diseases such as the flu.
“We suspect that most of the excess deaths that we are seeing above the official COVID tallies are COVID deaths, the vast majority of them,” Stokes said. “Many of the areas that were most deeply affected by the pandemic in the second year were also areas with the poorest surveillance data, so studies using the official death tallies tend to miss the full extent of the pandemic in the second year.”
The study found nearly 1.2 million excess deaths across the U.S. during the first two years of the pandemic, while the Centers for Disease Control and Prevention reports about 1.1 million COVID deaths as of July 1, 2023. Nearly half of the excess deaths — the lives of an estimated 544,194 people — were recorded during the second year of the pandemic, when billions of dollars in aid from Congress was flowing through the states to provide widespread access to COVID tests and vaccines. According to the study, excess mortality in Florida followed broader national trends:
Overall, excess mortality decreased in large metropolitan counties but increased in nonmetropolitan counties. Despite the initial concentration of mortality in large metropolitan Northeastern counties, nonmetropolitan Southern counties had the highest cumulative relative excess mortality by July 2021. These results highlight the need for investments in rural health as the pandemic’s rural impact grows.
“In western Europe, their second pandemic year was much better,” Stokes said. “They generally rebounded, while we continued to see sustained excess mortality in the second year despite widespread vaccine access.”
In the U.S., the pandemic has laid bare the deep inequities in health care quality and access faced by lower-income people and people of color, who disproportionately work the “essential” jobs on the pandemic’s front lines. Stokes said one of the most alarming findings was a tragic increase in excess mortality across the rural South during the 2021 Delta wave. In many of these areas, funding for well-functioning public health systems was cut out of state budgets years ago if it existed in the first place, and conservative politicians (including in Florida) have refused to expand Medicaid to provide health coverage for more lower-income patients.
“Rural Southern communities, including Black communities, were heavily affected due to failures in state policies and a failure to support rural health infrastructure — especially the failure to get ‘shots in arms’ in these areas,” Stokes said. “There also is a misconception that rural America [equals] white people. Black communities sustained excess COVID mortality in later stages of the pandemic, and that reflects lack of access.”
White people in rural Florida and across the South were also hit hard as conservative politicians exploited public backlash to pandemic restrictions and vaccines that the Trump administration spent $18 billion to roll out quickly and provide free of charge.
“The story of the second year of the pandemic is a story of white mortality rates increasing without a marked decline in Black and Hispanic mortality rates,” Stokes said. “The [racial] disparities declined in the second year, but not because rates improved noticeably for Black and Hispanic populations. It was more that white death rates got worse due to partisanship and misinformation.”
Counties in the rural Southwest and Four Corners area also saw dire increases in excess deaths during the pandemic’s second year, even as excess mortality declined in other regions and more populous areas of Southwestern states. Stokes said this reflects a dearth of quality health care facilities in rural areas and especially on Native American reservations, where people tend to live remotely and public health is chronically underfunded.
“Some counties, like Navajo County in Arizona, are disproportionately reservation and Native American populations,” Stokes said. “We unfortunately see remarkably high excess mortality there even after a period of widespread vaccination, due to a combination of social and structural factors.”
The COVID virus first swept cities in the Northeast in 2020, but by July 21, 2021, rates of excess mortality in the nonmetro West and South had eclipsed the urban Northeast. Cumulative rates of excess mortality remained higher in the nonmetropolitan South than in any other region through the end of February 2022, including in Florida, where excess deaths spiked in rural counties relative to the cities and suburbs.
Stokes compared Florida’s excess mortality data — and by extension, DeSantis’s much-touted pandemic policies — to that of Massachusetts and other New England states, where pandemic restrictions were in place longer, vaccination rates are higher and health care is generally easier to access for lower-income people.
“One way to really highlight that policy failure in Florida is to compare Florida during the Delta wave to any state in the mid-Atlantic or New England during the Delta wave,” Stokes said. “Massachusetts saw almost no excess mortality increase during Delta, while Florida saw a surge in deaths, especially in rural areas where excess deaths skyrocketed relative to the rest of the state.”
The DeSantis presidential campaign did not respond to a request for comment by the time this story was published. | Epidemics & Outbreaks |
Recreational cannabis has been legalized in more than 20 states and Washington, D.C., and there is now a bipartisan effort on Capitol Hill to change a law that limits federal hiring by automatically disqualifying candidates who admit to having used cannabis.
The proposed bill introduced by Rep. Jamie Raskin, D-Md., has already received bipartisan support, with Raskin and Rep. Nancy Mace, R-S.C., sponsoring the Cannabis Users Restoration of Eligibility Act. The bill comes as a growing number of states enact laws to legalize recreational marijuana, on top of the several states that have had legal pot use for years.
But despite state laws allowing cannabis use, thousands of people who consumed the plant have still been barred from gaining employment as federal workers, even if it was consumed legally.
"Every year, qualified and dedicated individuals seeking to serve our country are unable to secure federal jobs and security clearances because the federal government has not caught up with the widely established legal use of medical and recreational cannabis," Raskin said in a statement. "I am proud to partner with my friend Representative Mace to introduce the bipartisan CURE Act that will eliminate the draconian, failed and obsolete marijuana policies that prevent talented individuals from becoming honorable public servants in their own government."
The CURE Act would make it so that a person's past or current marijuana use cannot be used to deny security clearance or be the basis to be found unsuitable for federal employment. The legislation would also allow someone who has previously been denied a security clearance or a federal job opportunity over marijuana use over the past 15 years the chance to have that denial reviewed.
According to the bill, all federal agencies would be required to create a process within one year of enactment to review each past decision to deny security clearances or job opportunities over cannabis use from as far back as January 1, 2008. These agencies would need to maintain a website, so people could request a review of a decision and the agencies must also reconsider the applicant's security clearance or employment application within 90 days if they find that the individual was denied solely because of marijuana use.
"Look we’ve got 2.8 million federal employees in America. In my state, more than 100,00 people and people have been disqualified from federal [employment] because they honestly admit on a security clearance that they have once used marijuana," Raskin said in front of Congress, according to Fox 5 DC.
The bill would treat legalized marijuana like alcohol, meaning federal workers could still face serious consequences for getting high during work.
Last year, President Biden announced a blanket pardon for people convicted at the federal level of simple possession of marijuana. Roughly 6,500 people convicted in federal court of simple marijuana possession were affected by this mass pardon, although none of them were in prison at the time and nobody is currently in federal prisons solely for simple possession of marijuana.
The president had also announced that his administration would review the Schedule I narcotic classification of marijuana under the Controlled Substances Act. | Health Policy |
An eight-year-old girl has become the first person in the UK to have a transplant - and not need to take immunosuppressant drugs for the rest of her life.
Aditi Shankar, who has a rare genetic condition, has received both a new kidney and bone marrow from her mother, Divya.
Because she had a stem cell transplant, via the bone marrow, she was able to come off immunosuppressants a month after receiving the new organ.
Following pioneering work by doctors at London's Great Ormond Street Hospital (GOSH), her body has accepted the new kidney as its own.
Immunosuppressants are an important part of most transplant patients' lives, because they stop the body from rejecting a donated organ.
But while they provide a vital function, they work by dampening down the body's immune system.
Anyone taking them is therefore at higher risk of infection, among other complications.
Aditi was referred to GOSH when she was five and doctors discovered she had a condition called Schimke's immuno-osseous dysplasia, which impacts the immune system and kidneys.
In the UK, it affects about one child in every three million.
Aditi's underlying immune condition initially meant she would "not be able to receive a kidney transplant", said Professor Stephen Marks, children's kidney specialist at GOSH.
But working with international colleagues, the renal, immunology and stem cell transplant teams at GOSH came up with a treatment plan.
Prof Marks added: "Her immune deficiency had to be corrected by having mum's bone marrow first, and because Aditi was able to accept her mum's bone marrow, that therefore meant her body could then see her mum's kidney as being part of her.
"A month after the transplant, we were able to take her off all of her immunosuppression, which means she doesn't get the side effects of the drugs."
Only last year, Scrabble-loving Aditi was spending a lot of time in hospital receiving dialysis - a procedure that removes waste products and excess fluid from the blood when the kidneys have stopped working properly.
Now, she is able to swim, sing, dance, and play on her trampoline.
Mum Divya said: "I was so happy to give her blood cells and a kidney. I just feel so proud."
Aditi said: "My mum gave me my new blood cells. I got the kidney transplant when I went to special sleep and closed my eyes.
"Now I have got the line out, I can go swimming." | Medical Innovations |
BBC journalist Jeremy Bowen has urged people to get tested for bowel cancer following the death of his colleague and friend George Alagiah, who died on Monday.
Speaking to Sky News, the BBC correspondent, who revealed his own bowel cancer diagnosis in 2019, implored those who received NHS test kits to use them.
The 63-year-old said: "For God's sake use it. You're an idiot if you chuck it away. It could save your own life."
Alagiah, 67, was diagnosed in 2014 with stage four bowel cancer, which had spread to his liver and lymph nodes and had to undergo two rounds of chemotherapy and several operations, including the removal of most of his liver.
Bowen described how Alagiah would "rationalise his symptoms", for example when losing weight he said he would attribute that to exercising or eating more vegetables.
However, the former Middle East editor, who is also a patron for Bowel Cancer UK, urged people to open up about the disease if signs are spotted.
"It involves poo and backsides. We tend not to mention [these things] in polite conversation but actually if anything goes wrong in your toilet activities in a period of over more than a few weeks you need to talk to someone," said Bowen, who is nearly five years into remission.
He said he was able to tackle his bowel cancer early despite not having classic symptoms like blood in his poo or weight loss.
He decided to go to his GP and get tested after feeling pain while working in Iraq and India - a few weeks later he was found to have microscopic amounts of blood in his stool.
Read more:
Jeremy Hunt reveals he caught cancer early after discovering mole which 'grew and grew'
George Alagiah: BBC newsreader remembered for his 'kindness, empathy and wonderful humanity'
"Four years earlier I had a virtual colonoscopy, a big scan of my gut and had nothing wrong then," Bowen said.
In four years the journalist went "from nothing wrong" to having a stage three tumour in his bowel and lymph nodes.
He described the cancer as "really quite advanced" and had to have surgery and eight rounds of chemotherapy.
"I was really quite ill. Luckily I had done that test. If I hadn't... I might not be here," he said.
Sky News reported 30% of people who get NHS kits to test for the cancer ignore them, which Bowen strongly advised against.
He said: "Don't do it. It could be your life at stake."
Bowel cancer check rates soared after the death of Dame Deborah James last year from the disease, who also encouraged the public to get screened.
Her daughter Eloise has since launched an anniversary clothing line for her late mother's Bowelbabe Fund.
On Alagiah, who was also a vehement advocate of cancer screening, Bowen said his friend had the "right mental attitude" after he knew his cancer had spread.
Bowen said Alagiah "beat the odds" of his stage four cancer but knew it was "going in one direction [which is why] he was so evangelical to get tested if you had any dodgy symptoms".
Speaking about the newsreader, Bowen added: "I met him on his first day at the BBC and showed him around. He was clearly a very nice guy and it emerged he was a very good reporter as well. What followed was a very, very distinguished career." | Disease Research |
Today might be the perfect time to celebrate love.
But Valentine's Day can be painful for anyone experiencing heartbreak.
And the intense hurt caused by splitting up with your partner may not just be an emotional one.
For experts say a break-up can cause temporary physical problems too, such as hair or weight loss.
Here, MailOnline reveals all the possible physical effects of a broken heart.
Having your heart broken is a metaphor for the overwhelming sadness felt when a relationship ends.
But that very grief can actually cause cardiac issues.
Broken heart syndrome, medically called takotsubo cardiomyopathy, occurs when the heart suddenly becomes weakened or 'stunned', according to the NHS.
The symptoms mimic some of those of a heart attack, with sufferers experiencing sudden, intense chest pain, shortness of breath and abnormal heart rhythms.
It causes your heart's main blood-pumping chamber (the left ventricle) to change shape and get larger, according to the British Heart Foundation.
This weakens the heart muscle and means it doesn't pump blood as well as it should.
Navin Khosla, a pharmacist at online NHS prescription service Now Patient, said that broken heart syndrome occurs after an extremely stressful event, such as the death of a love one.
But he added that 'in a small minority of cases, it can be linked to a severe break-up'.
The condition affects around 2 per cent of people who present to hospital with a suspected heart attack.
Middle-aged and older woman are more than 10 times more likely to have takotsubo cardiomyopathy than younger women or men of any age, according to a study by researchers from the Smidt Heart Institute.
They studied 135,463 documented cases of broken heart syndrome, and also found that prevalence of the condition is rising.
There is no specific test for broken heart syndrome and it is often diagnosed once other causes of symptoms have been ruled out.
According to Cardiomyopathy UK, the condition is usually temporary, with people recovering within a few weeks once they have received treatment - which involves medication to help the pumping ability of the heart recover.
This can include medications such as ACE inhibitors - which cause the relaxation of blood vessels and decrease in blood volume.
A certain type of hair loss — called telogen effluvium — can occur during periods of extreme stress.
Dr Greg Vida, a senior surgeon at the Harley Street Hair Clinic, said changes in your mood can trigger hormone imbalances that disrupt the hair follicle growth cycle.
This cycle has four stages — anagen, catagen, telogen and exogen.
The anagen phase is when hairs are actively growing and the catagen phase is when they have stopped growing and are cut off from the blood supply.
During the telogen phase, hairs remain in a 'resting' state. They fall out of the follicles during exogen.
Dr Vida claims emotional stress can move hair follicles prematurely into the telogen (resting) stage.
'This means the hairs lie dormant for around 90 days, preventing them from growing,' he said.
'The hairs then move into a shedding phase, causing hair thinning and loss on the scalp.'
Dr Vida added: 'If the emotional trauma is not addressed and the heartbreak isn't healed by this stage, the cycle starts again — the hair follicles will rest and then shed, and not grow.'
According to a study by researchers in India, the shedding is typically seen three to four months after a 'triggering event', such as a partner asking for a divorce unexpectedly.
And Dr Vida says once you're 'emotionally healed' the hair will begin to regrow, however this can take seven to eight months as the follicles moved into the resting phase will need to shed first.
Rebound sex is often hailed as a way to get over an ex.
However for some, a relationship ending can cause an extreme libido surge.
Experts have suggested that the grief of separating from a partner can manifest itself in many ways.
There are five stages of grief — denial, anger, bargaining, depression and acceptance, according to psychologist Dr Laura Louis, CEO of Atlanta Couples Therapy.
She says for some people the grief can show up as anger, sadness or emotional distress, acting as a libido killer.
But according to clinical sex counsellor Eric Garrison, author of Mastering Multiple Position Sex, sometimes grief can trigger an increased interest in sex.
He said if your libido skyrockets, this could mean the sex in your relationship was really good or really bad.
'If there was an absence of sexual intimacy or sexual pleasure in the relationship, the horniness can stem from the fact that you're now free to start having the kind of sex you wanted to be having all along,' Mr Garrison added.
'If the sex was great, the horniness just symbolizes the fact that your body is still craving that.'
But a libido spike may not be about the sex itself, as Mr Garrison claims for many the desire is more about how a lost relationship is a lost access to touch, so you will 'seek it out elsewhere'.
While the cause of rosacea is unknown, it has been reported that heartbreak can cause extreme flare-ups of the skin condition.
According to the NHS, rosacea is a long-term skin condition mainly affecting the face, which results in redness across your nose, cheeks, forehead and chin, as well as burning or stinging.
It can also cause dry skin, swelling, yellow-orange patches, sore eyelids and thickened skin.
The National Rosacea Society says emotional stress can be a trigger for a flare-up of symptoms.
According to a survey of 700 rosacea patients by the charity, emotional stress, such as a relationship ending, is the most common flare-up trigger.
Rachael Miles, a mother-of-two from Glasgow, claims her rosacea was triggered by the shock of finding out her partner of three years had been cheating on her.
The 41-year-old, who claims to have had great skin before the break-up, said her face 'erupted into a furious red, lumpy mess', which she was then told was rosacea.
Treatments for rosacea include prescription creams and gels, antibiotics and intense pulse light treatment (IPL). IPL may not be available on the NHS.
It's jokingly dubbed 'the heartbreak diet'. But there's a scientific explanation behind the weight loss effect.
The human body produces adrenaline in response to the onset of grief, according to experts.
This triggers the fight or flight response - where appetite is temporarily suppressed.
This is due to the body slowing digestion to ensure energy is directed to where it is most needed.
Dr Cwanza Pinckney, an emergency care physician in Texas, said: 'Your body is being flooded with adrenaline which essentially overstimulates your cortisol levels.
'But in a great many people the flooding of adrenaline will suppress the appetite and cause weight loss by metabolic stimulation and appetite suppression.'
A 2014 study by slimming product firm Forza Supplements found women lose an average of 5lbs in the first month after being dumped.
It also found that if they stay single for a year after the break-up of a long-term relationship they are likely to end up at least a stone lighter. | Disease Research |
The Conservatives have accepted a £350,000 donation from a company which sells vaping products with names like Watermelon Bubblegum and Cotton Candy Ice, despite the Government pledging to crack down on vapes aimed at children.
Rishi Sunak’s party received the money from Supreme 8 Ltd in May, latest records published by the Electoral Commission reveal.
Supreme 8 is owned by Sandeep Singh Chadha, the chief executive of parent company Supreme PLC, a Manchester-based vaping, lighting and battery distributor and manufacturer.
Among the vaping products it distributes for wholesale and trade are Elf Bar, a Chinese-owned firm which has been criticised for marketing vapes to younger age groups.
Supreme currently sells lines of Elf Bar brands including disposable vapes named Blue Razz Cherry, Watermelon Bubblegum and Cotton Candy Ice.
Elf Bar itself denies targeting youngsters and says its packaging and marketing products must contain a warning indicating that “it is forbidden to sell this product to children”.
But the Labour Party said the names of the vapes were clearly aimed at a younger market.
In May – the same month the Supreme 8 donation was made to the Tories – the Prime Minister pledged to curb marketing of vapes aimed at under-18s.
Mr Sunak had said he was “deeply concerned” about a reported increase in children vaping and pledged the Government would regulate the market and promotion of vapes, adding: “[Companies] shouldn’t be deliberately targeting children, that’s illegal. If we need to take further action to do that, that’s what we will do.”
And in a tweet the Prime Minister had said: “My daughters are 10 and 12, and I don’t want the way vapes are marketed, promoted and sold to be attractive to them. That’s why I am launching a new crackdown today to protect children.”
Shadow Health Secretary Wes Streeting said: “We’re sleepwalking into a new generation of children getting hooked on nicotine. Yet the Tories are lining their own pockets ahead of protecting children’s health.
“How can Rishi Sunak pretend otherwise, when he’s taking money from a company selling Watermelon Bubblegum and Cotton Candy Ice flavoured vapes?
“Labour will come down like a tonne of bricks on those peddling vapes to kids. We will ban the marketing and branding of vapes to children and give every child a healthy start to life.”
The Conservative Party and Supreme PLC were both contacted for comment.
At the annual conference of the British Medical Association in July, delegates criticised vaping products targeted at children.
Dr Penelope Toff, chair of the BMA Public Health Medicine Committee, told the conference: “The area of most concern is that, with their bright colours and packaging, stylised designs, sweetshop-inspired flavours and relatively inexpensive price, these products are clearly being made to appeal to children and young people.”
In an article in the Times in May, Chief Medical Officer Professor Sir Chris Whitty wrote that marketing vaping products to children was “utterly unacceptable” adding: “Companies are marketing products targeted specifically at children using colours, flavours and cheap disposable options, whatever they may claim.” | Health Policy |
Eating disorders are both isolating and lonely - with many people wishing they had more of a community around them.
That's been the experience of Molly Smith who was diagnosed with anorexia at 14 years old.
Now 19, she hopes her podcast exploring disordered eating can break down stigmas and misconceptions.
And Molly says the series is something she wishes she'd had when she was younger.
"Since recovering, I've been so passionate about speaking openly on eating disorders because when I was poorly, I felt like nobody understood me," she tells BBC Newsbeat.
"There was no voice for me to really listen to. So I wanted to create a podcast to be that voice to people going through similar things."
'Not just about weight'
Molly feels she lacked a network of people she could relate to when she was unwell.
"Everything was either very serious or told by professionals and medical experts," she says.
"I really think if I could have listened to a podcast with someone really normal who's been through a similar thing, it would have helped me immensely."
Molly, who's from Cambridge, also wants to challenge the idea that eating disorders are purely physical.
"People think they are entirely about weight, but with so many people weight loss is just a side effect of the eating disorder."
Molly's series is called The Weigh Up: Eating Disorder Diaries and covers topics including binge eating and social media.
It also looks at the impact on families and friends - Molly doesn't want the podcast to just be for people with eating disorders.
"We've done episodes with my family members," she says.
"I think just to hear their perspectives was so eye-opening because anorexia, unfortunately, is a very selfish illness.
"And I just didn't even consider how my parents may be feeling that their daughter was so ill. So it was so insightful to hear how much upset I caused them."
Molly's series was made after she won the Rachael Bland New Podcast Award, launched in 2019 in honour of the BBC presenter who died in 2018 from breast cancer.
Rachael co-hosted You, Me And The Big C - an award-winning podcast which was praised for tackling the subject of cancer in an original and candid way.
Winners of the award get the opportunity to develop their podcast idea with the BBC.
"Rachael's podcast was just incredible, I learnt so much from it," Molly says.
"I'm so inspired by the work of her and her co-presenters and I really hope my podcast reaches that same level of community."
Listen to The Weigh Up: Eating Disorder Diaries on BBC Sounds. | Mental Health Treatments |
People 65 and over in England are being urged to get a top-up booster vaccine against Covid at a time when more people are coming into hospitals with the virus.
Those who are eligible can book via the NHS website, on the NHS app, or by calling 119.
The rollout has been brought forward as a precaution against a highly mutated new Covid variant called BA.2.86.
While hospital numbers are up, intensive care (ICU) ones are low.
Although the virus is mutating and changing, the vaccines still provide good protection against getting very sick with Covid, say experts.
How much Covid is there around?
Testing for Covid has been massively scaled back, making it difficult to know how many people in the UK might have it.
The continued rise in hospital rates over recent weeks suggests the virus is likely to be circulating more widely among the population.
Hospital admissions of patients testing positive for Covid are now at the highest rate since the end of April, at 4.6 per 100,000 people.
That is still below the level reached last winter - 11.8 per 100,000.
Rates remain highest among people aged 85 and over, followed by 75 to 84-year-olds.
Last autumn, all over-50s were offered a Covid booster, but the government's advisers on vaccines recommended that only over-65s and other "vulnerable groups" should be included automatically this year.
For most people, catching Covid, while unpleasant, is less risky. Past Covid infections and vaccines have trained the immune system to stop severe illness, even if it cannot stop infection.
What is the new BA.2.86 Covid variant?
It is a spin-off of Omicron. From the data the UK gathers, it does not appear to have taken off in a big way yet. There have been 37 cases recorded so far in England, while Scotland has recorded five cases.
Experts are keeping a watch on it and say it is too early to make predictions or draw conclusions.
Steve Russell, NHS director for vaccinations and screening, said: "The new Covid variant presents a new risk, but NHS staff are rising to the challenge once more to do all they can to protect the public.
"Vaccines are our best protection against flu and Covid-19, and I strongly encourage all eligible people to come forward for their life-saving winter vaccines as soon as they can."
Dr Gavin Dabrera, from the UK Health Security Agency, said there had been a continued increase in Covid cases in the past week. He added: "While hospital admissions have also continued to rise, ICU admissions remain low and stable. We will continue to monitor rates closely."
GP practices and other local NHS services will also be contacting people to offer both flu and Covid vaccines, and people can book the flu vaccine by searching online for a local pharmacy. | Vaccine Development |
'You can do it!' Gemma Collins shows off her incredible 3.5 stone weight loss in a black sports bra as she takes on another garden work out Published: 06:09 EDT, 14 June 2022 | Updated: 06:55 EDT, 14 June 2022 She recently revealed the secret to her 3.5st weight loss as she said her salad consumption has left her 'verging on a Kardashian'. And Gemma Collins showed off her slimmed-down physique as she took on another garden workout on Tuesday.The former TOWIE star, 41, looked slimmer than ever for the early morning workout session where she wore a black sports bra and patterned leggings. 3.5 stone weight loss: Gemma Collins showed off her slimmed-down physique as she took on another garden workout on TuesdayShe looked in great spirits as she lifted the weights up and down showing her followers the workout and gave them a motivational speech. The TV personality went makeup-free and wore her long blonde tresses in loose waves over her shoulders for the exercise session. Motivating her fans she wrote in the caption: 'YOU can do it! Another fabulous start to the day. I hope this video motivates you in some way small changes honeys small changes….' Exercise: The former TOWIE star, 41, looked slimmer than ever for the early morning workout session where she wore a black sports bra and patterned leggings Strong: She looked in great spirits as she lifted the weights up and down showing her followers the workout an gave them a motivational speechIt comes after last month Gemma revealed the secret to her recent 3.5st weight loss as she said her salad consumption has left her 'verging on a Kardashian'. Speaking exclusively to MailOnline as she launches a new line of vibrators with Durex, the former TOWIE star said that despite her health kick she still loves 'what her mumma gave her'. Discussing her healthier diet the star said: 'I think it comes down to being happy, now I manage my day and I make sure I have my breakfast in the morning. I'm verging on a Kardashian at the moment I've been eating so many Caesar salads'.When asked if she would ever consider undergoing weigh-loss surgery like her ex-boyfriend James Argent, 34, Gemma exclaimed: 'No! never'. Glowing: The TV personality went makeup-free and wore her long blonde tresses in loose waves over her shoulders for the exercise sessionJames, who dated Gemma on and off from 2011 until 2013, recently lost an incredible 14 stone after undergoing gastric sleeve surgery.Gemma continued: 'Some people need it [surgery] and I get it and they have to make their choices for them, but I don't need it. I'm beautiful, I'm big, I'm successful, what more could I want out of life?'Gemma, who is now dating business man Rami Hawash, 48, has teamed up with Durex in order to help de-stigmatise sex toys. She is also helping people gain 'body confidence in the bedroom', with her favourite product in the line the Dual Headed Vibrator. Happy: Motivating her fans she wrote in the caption: 'YOU can do it! Another fabulous start to the day. I hope this video motivates you in some way small changes honeys small changes….' Wow! It comes after last month Gemma revealed the secret to her recent 3.5st weight loss as she said her salad consumption has left her 'verging on a Kardashian'She exclaimed: 'They're waterproof which is great because I've got a hot tub.' However the reality star went on to say that she has never struggled with confidence in the boudoir, noting: 'I love what my mumma gave me. I've never been shy with my body, I've never had an ugly boyfriend or any complaints'. She added: 'I think if you have that extra body confidence a man loves it'.While she couldn't be happier with her figure Gemma admitted that she would never pose nude, saying: 'You can't put a price on it, I'm a goddess at the end of the day'.Her reluctance also comes following a photoshoot early in her career where she says she felt 'taken advantage of'.She recalled: 'I remember years ago doing a little TOWIE shoot and it was about body confidence and I feel I was sort of duped [to posing nude] and I don't know if I would do it again.'But I was very new to the industry and it was a bit near the mark. Do I think I was taken advance of? Yes I do – but I'm older now and wiser now'. Candid: Speaking exclusively to MailOnline, the former TOWIE star said that despite her health kick she still loves 'what her mumma gave her' Advertisement | Weightlifting & Bodybuilding |
lucentius/Getty Images
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Some people who take Ozempic and Wegovy report it tamps down their cravings for alcohol, and they're drinking less.
lucentius/Getty Images
Some people who take Ozempic and Wegovy report it tamps down their cravings for alcohol, and they're drinking less.
lucentius/Getty Images
During the COVID pandemic, J. Paul Grayson was hit with an avalanche of health problems – high blood pressure, prediabetes and a heart arrhythmia.
He also gained 40 pounds to his 6-feet 3-inches frame. "I felt like my weight was getting out of control," says the 73-year-old retiree, who lives on a ranch in Oklahoma. "I had to start taking all these medications that I never had to take before. I actually felt pretty depressed about my health."
About six months ago, Grayson began taking the popular weight-loss drug Ozempic. He knew the side effects could be rough, including nausea, constipation, and diarrhea. But he thought it would be worth it if he could stave off further heart problems by losing the extra weight.
"Right away, I started eating less and losing weight," he says. That was expected. But what Grayson hadn't expected was that the drug also immediately altered one of his other habits.
"I remember going to dinner for the first time [while taking Ozempic]," Grayson explains. "I ordered a beer, took a sip, and I couldn't finish it," he says. "You know how sometimes you taste a beer, and it's like, 'Oh my God, this tastes so good that I want to guzzle it.' Well, I didn't feel like guzzling. I just really felt like sipping it."
And, instead of having several beers with dinner, Grayson stopped at just one drink.
J. Paul Grayson
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J. Paul Grayson experienced an interesting side effect when he started taking Ozempic: He lost his taste for alcohol.
J. Paul Grayson
J. Paul Grayson experienced an interesting side effect when he started taking Ozempic: He lost his taste for alcohol.
J. Paul Grayson
In the past year, prescriptions for both the diabetes drug Ozempic, and its weight-loss counterpart Wegovy, have skyrocketed, despite the fact that each costs about $1,000 a month, and some health insurers recently stopped covering them. Both drugs contain the same active ingredient, semaglutide, which belongs to a class of drugs known as GLP-1 (a.k.a. "glucagon-like peptide 1"). These drugs regulate your blood sugar and make you feel satisfied after eating. Ozempic is approved for treating diabetes and, in some cases, excess weight.
With the drug's surge in popularity, doctors and patients have begun to notice a striking side effect of these drugs: They appear to reduce people's cravings for alcohol, nicotine and opioids. They may also reduce some types of compulsive behaviors, such as gambling and online shopping.
"There's really been a large number of clinical and anecdotal reports coming in suggesting that people's drinking behaviors are changing and in some instances pretty substantially while taking [Ozempic or Wegovy]," says Christian Hendershot, a psychologist and addiction researcher at the University of North Carolina.
He's leading one of six clinical trials now underway aimed at understanding how semaglutide may alter people's drinking and smoking habits.
"All these reports, for the most part, are anecdotal," Hendershot adds. "At the same time, it does seem like there's a pretty strong signal here."
Scientists are hopeful that a new class of treatments for alcohol use disorder or smoking may be on the horizon. Some doctors have even started prescribing these drugs for this specific purpose, even though evidence from large, randomized controlled trials are still years away.
Stopping at just one cookie or beer
To many doctors and patients, like J. Paul Grayson, Ozempic's effect on alcohol came as a big surprise.
"Before Ozempic, I could consume a whole bottle of wine in an evening without trying real hard, along with a bag of chocolates," he says laughing. "But with Ozempic, even one beer didn't feel good to me somehow," he says.
"I had no idea this would happen," he adds. "Nobody told me anything about the drug affecting alcohol, too."
But for scientists who study GLP-1 drugs, this striking side effect was exactly what they expected. "It's really not surprising," says pharmacologist Elisabet Jerlhag.
For more than a decade now, Jerlhag and her colleagues at the University of Gothenburg in Sweden, have been figuring out in great detail how GLP-1 drugs, such as Ozempic, reduce alcohol consumption in rats.
She and other scientists have published nearly a dozen studies, showing how these drugs stop binge drinking in rats or mice, prevent relapse in "addicted" animals, and overall decrease their consumption of alcohol. "So we see a reduction by over 50%, which is quite dramatic," Jerlhag says.
Other studies in animals have also found that GLP-1 drugs reduce the consumption of nicotine, opioids, as well as psychostimulants, such as cocaine and methamphetamine.
So why would a weight-loss drug do this? Turns out, these drugs (as well as the GLP-1 hormone) don't just work on blood sugar. "They also work in your brain," says Dr. Lorenzo Leggio, who's the clinical director of the National Institute of Drug Abuse.
"The mechanism in the brain that regulates overeating overlaps with those responsible for the development and maintenance of addiction, including alcohol disorder," he says.
The role of dopamine
Studies in animals, as well as a few in people, offer tantalizing clues to how this mechanism works for both food and alcohol.
Imagine for a second taking a bite of a chewy, chocolate cookie. It's buttery and very sweet.
That first bite triggers the release of dopamine inside the part of your brain that controls your motivation, says neuroscientist Alexandra G. DiFeliceantonio, an assistant professor at Virginia Tech. "That dopamine essentially tells you, 'Hey, do that again!' Take another bite.' " And so, you want another bite. Maybe even another whole cookie. It's hard to stop.
Now imagine you're a beer lover and you take a big gulp of a cold IPA on a hot day. It also triggers a dopamine spike in the motivation center of the brain – just like the cookie.
"Dopamine in the striatum [the brain's motivation center] is the motivation and learning signal for everything. Not just for food," DiFeliceantonio says. "All addictive drugs increase dopamine there. That's a common thing."
And so after the first taste of beer, the dopamine tells you, "Do it again! Have another gulp."
But studies have found that in animals and people, GLP-1 drugs reduce the release of dopamine in this region when you eat something sweet and fatty, or when you consume alcohol. "The drug talks with our brain and says, 'we've had enough food here. So let's slow down. Let's have less appetite, let's have less food. Less alcohol," says NIDA's Leggio.
So you don't really feel like another bite of cookie, or as J. Paul Grayson said, "I didn't feel like guzzling. I just really felt like sipping it."
Oftentimes, now, he doesn't even feel like drinking at all. "When I still had wine or chocolate in the refrigerator, sometimes I would think, 'Oh, I should have some wine. I should have some chocolate.' But there just wasn't anything that made me get up and go to the refrigerator," he explains.
The 'horse has already left the barn'
Ozempic's potential to reduce alcohol consumption is now so well known that some people are seeking out the drug to help with their drinking, says Christian Hendershot.
"We're also hearing about clinicians prescribing for that reason," he says. "In many ways this is really kind of the indication that the horse has already left the barn. This is something that's already appearing to happen, whether we like it or not."
But NIDA's Leggio advises against this off-label use of Ozempic and Wegovy. "It's too early," he says. Ozempic may not work against alcohol for everyone, including people who don't have obesity.
So far, there has only been only one small randomized controlled study, looking at whether another GLP-1 drug could treat alcohol use disorder in people in general, as compared to cognitive behavioral therapy. This drug, called exenatide, isn't as potent as semaglutide (Ozempic) at inducing weight-loss or penetrating inside the brain. In the study, the drug reduced drinking in people with obesity, but it actually increased drinking in people who don't have obesity.
"We don't know why," Leggio says. One hypothesis is that the semaglutide caused people to lose weight even though they had normal weight and that led them to seek more calories through drinking, Leggio says.
"But that's only speculation," he adds. "We have to realize that no medication is going to work for everybody, and it's very important to identify the sub-class of patients for who this medication might work."
And he notes, in the end, maybe a newer version of the GLP-1 drugs might work better for treating addictions than diabetes.
Elisabet Jerlhag at the University of Gothenburg notes that people with obesity tend to have less severe side effects while taking semaglutide than people who don't have obesity. "With these drugs there's also a risk of developing pancreatitis," she says. "A person with alcohol use disorder may be at [elevated] risk for pancreatitis. So a doctor would need to monitor that."
On the other hand, if you have diabetes and you want to curb your alcohol intake then definitely talk to your doctor about the option of semaglutide, Leggio says. "Even more so if you have obesity and alcohol use disorder. Absolutely. Speak with your doctor."
'Many days I don't drink at all'
Nicole Jackson/Meg Johnston
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Meg Johnston's weight-loss medication has reduced her desire to drink. "Alcohol just doesn't sound as appetizing or appealing," she says.
Nicole Jackson/Meg Johnston
Meg Johnston's weight-loss medication has reduced her desire to drink. "Alcohol just doesn't sound as appetizing or appealing," she says.
Nicole Jackson/Meg Johnston
That's exactly what Meg Johnston, age 37, did about a month ago. During COVID, she also gained weight. "I make this joke that food was the only thing that brought me joy," she says. But she also drank much more. "I would drink out of boredom, just total boredom."
So she began taking semaglutide at the end of June. A part of her goal was to curb drinking. "I was hoping that I would be one of the people that the drug affected this way," says Johnston, who's a real estate agent in Washington, D.C.
And indeed, the drug has not disappointed her. "Many days I don't drink at all," she says. "It's hard to explain why. Alcohol just doesn't sound as appetizing or appealing. And now my tolerance is lower, too.
"This has been a welcome change for me," she adds. "During those first couple of weeks of taking the drug, I was very much focused on not vomiting and making sure I continue to have bowel movements. I just knew alcohol was going to make me feel terrible afterwards." | Drug Discoveries |
Series: Uncovered
How the Insurance Industry Denies Coverage to Patients
When a stubborn pain in Nick van Terheyden’s bones would not subside, his doctor had a hunch what was wrong.
Without enough vitamin D in the blood, the body will pull that vital nutrient from the bones. Left untreated, a vitamin D deficiency can lead to osteoporosis.
A blood test in the fall of 2021 confirmed the doctor’s diagnosis, and van Terheyden expected his company’s insurance plan, managed by Cigna, to cover the cost of the bloodwork. Instead, Cigna sent van Terheyden a letter explaining that it would not pay for the $350 test because it was not “medically necessary.”
The letter was signed by one of Cigna’s medical directors, a doctor employed by the company to review insurance claims.
Something about the denial letter did not sit well with van Terheyden, a 58-year-old Maryland resident. “This was a clinical decision being second-guessed by someone with no knowledge of me,” said van Terheyden, a physician himself and a specialist who had worked in emergency care in the United Kingdom.
The vague wording made van Terheyden suspect that Dr. Cheryl Dopke, the medical director who signed it, had not taken much care with his case.
Van Terheyden was right to be suspicious. His claim was just one of roughly 60,000 that Dopke denied in a single month last year, according to internal Cigna records reviewed by ProPublica and The Capitol Forum.
The rejection of van Terheyden’s claim was typical for Cigna, one of the country’s largest insurers. The company has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials. Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show. The company has reported it covers or administers health care plans for 18 million people.
Before health insurers reject claims for medical reasons, company doctors must review them, according to insurance laws and regulations in many states. Medical directors are expected to examine patient records, review coverage policies and use their expertise to decide whether to approve or deny claims, regulators said. This process helps avoid unfair denials.
But the Cigna review system that blocked van Terheyden’s claim bypasses those steps. Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”
Not all claims are processed through this review system. For those that are, it is unclear how many are approved and how many are funneled to doctors for automatic denial.
Insurance experts questioned Cigna’s review system.
Patients expect insurers to treat them fairly and meaningfully review each claim, said Dave Jones, California’s former insurance commissioner. Under California regulations, insurers must consider patient claims using a “thorough, fair and objective investigation.”
“It’s hard to imagine that spending only seconds to review medical records complies with the California law,” said Jones. “At a minimum, I believe it warrants an investigation.”
Within Cigna, some executives questioned whether rendering such speedy denials satisfied the law, according to one former executive who spoke on condition of anonymity because he still works with insurers.
“We thought it might fall into a legal gray zone,” said the former Cigna official, who helped conceive the program. “We sent the idea to legal, and they sent it back saying it was OK.”
Cigna adopted its review system more than a decade ago, but insurance executives say similar systems have existed in various forms throughout the industry.
In a written response, Cigna said the reporting by ProPublica and The Capitol Forum was “biased and incomplete.”
Cigna said its review system was created to “accelerate payment of claims for certain routine screenings,” Cigna wrote. “This allows us to automatically approve claims when they are submitted with correct diagnosis codes.”
When asked if its review process, known as PXDX, lets Cigna doctors reject claims without examining them, the company said that description was “incorrect.” It repeatedly declined to answer further questions or provide additional details. (ProPublica employees’ health insurance is provided by Cigna.)
Former Cigna doctors confirmed that the review system was used to quickly reject claims. An internal corporate spreadsheet, viewed by the news organizations, lists names of Cigna’s medical directors and the number of cases each handled in a column headlined “PxDx.” The former doctors said the figures represent total denials. Cigna did not respond to detailed questions about the numbers.
Cigna's explanation that its review system was designed to approve claims didn’t make sense to one former company executive. “They were paying all these claims before. Then they weren’t,” said Ron Howrigon, who now runs a company that helps private doctors in disputes with insurance companies. “You’re talking about a system built to deny claims.”
Cigna emphasized that its system does not prevent a patient from receiving care — it only decides when the insurer won’t pay. “Reviews occur after the service has been provided to the patient and does not result in any denials of care,” the statement said.
"Our company is committed to improving health outcomes, driving value for our clients and customers, and supporting our team of highly-skilled Medical Directors,” the company said.
PXDX
Cigna’s review system was developed more than a decade ago by a former pediatrician.
After leaving his practice, Dr. Alan Muney spent the next several decades advising insurers and private equity firms on how to wring savings out of health plans.
In 2010, Muney was managing health insurance for companies owned by Blackstone, the private equity firm, when Cigna tapped him to help spot savings in its operation, he said.
Insurers have wide authority to reject claims for care, but processing those denials can cost a few hundred dollars each, former executives said. Typically, claims are entered into the insurance system, screened by a nurse and reviewed by a medical director.
For lower-dollar claims, it was cheaper for Cigna to simply pay the bill, Muney said.
“They don’t want to spend money to review a whole bunch of stuff that costs more to review than it does to just pay for it,” Muney said.
Muney and his team had solved the problem once before. At UnitedHealthcare, where Muney was an executive, he said his group built a similar system to let its doctors quickly deny claims in bulk.
In response to questions, UnitedHealthcare said it uses technology that allows it to make “fast, efficient and streamlined coverage decisions based on members benefit plans and clinical criteria in compliance with state and federal laws.” The company did not directly address whether it uses a system similar to Cigna.
At Cigna, Muney and his team created a list of tests and procedures approved for use with certain illnesses. The system would automatically turn down payment for a treatment that didn’t match one of the conditions on the list. Denials were then sent to medical directors, who would reject these claims with no review of the patient file.
Cigna eventually designated the list “PXDX” — corporate shorthand for procedure-to-diagnosis. The list saved money in two ways. It allowed Cigna to begin turning down claims that it had once paid. And it made it cheaper to turn down claims, because the company’s doctors never had to open a file or conduct any in-depth review. They simply denied the claims in bulk with an electronic signature.
“The PXDX stuff is not reviewed by a doc or nurse or anything like that,” Muney said.
The review system was designed to prevent claims for care that Cigna considered unneeded or even harmful to the patient, Muney said. The policy simply allowed Cigna to cheaply identify claims that it had a right to deny.
Muney said that it would be an “administrative hassle” to require company doctors to manually review each claim rejection. And it would mean hiring many more medical directors.
“That adds administrative expense to medicine,” he said. “It’s not efficient.”
But two former Cigna doctors, who did not want to be identified by name for fear of breaking confidentiality agreements with Cigna, said the system was unfair to patients. They said the claims automatically routed for denial lacked such basic information as race and gender.
“It was very frustrating,” one doctor said.
Some state regulators questioned Cigna’s PXDX system.
In Maryland, where van Terheyden lives, state insurance officials said the PXDX system as described by a reporter raises “some red flags.”
The state’s law regulating group health plans purchased by employers requires that insurance company doctors be objective and flexible when they sit down to evaluate each case.
If Cigna medical directors are “truly rubber-stamping the output of the matching software without any additional review, it would be difficult for the medical director to comply with these requirements,” the Maryland Insurance Administration wrote in response to questions.
Within the world of private insurance, Muney is certain that the PXDX formula has boosted the corporate bottom line. “It has undoubtedly saved billions of dollars,” he said.
Insurers benefit from the savings, but everyone stands to gain when health care costs are lowered and unneeded care is denied, he said.
Speedy Reviews
Cigna carefully tracks how many patient claims its medical directors handle each month. Twelve times a year, medical directors receive a scorecard in the form of a spreadsheet that shows just how fast they have cleared PXDX cases.
Dopke, the doctor who turned down van Terheyden, rejected 121,000 claims in the first two months of 2022, according to the scorecard.
Dr. Richard Capek, another Cigna medical director, handled more than 80,000 instant denials in the same time span, the spreadsheet showed.
Dr. Paul Rossi has been a medical director at Cigna for over 30 years. Early last year, the physician denied more than 63,000 PXDX claims in two months.
Rossi, Dopke and Capek did not respond to attempts to contact them.
Howrigon, the former Cigna executive, said that although he was not involved in developing PXDX, he can understand the economics behind it.
“Put yourself in the shoes of the insurer,” Howrigon said. “Why not just deny them all and see which ones come back on appeal? From a cost perspective, it makes sense.”
Cigna knows that many patients will pay such bills rather than deal with the hassle of appealing a rejection, according to Howrigon and other former employees of the company. The PXDX list is focused on tests and treatments that typically cost a few hundred dollars each, said former Cigna employees.
“Insurers are very good at knowing when they can deny a claim and patients will grumble but still write a check,” Howrigon said.
Muney and other former Cigna executives emphasized that the PXDX system does leave room for the patient and their doctor to appeal a medical director’s decision to deny a claim.
But Cigna does not expect many appeals. In one corporate document, Cigna estimated that only 5% of people would appeal a denial resulting from a PXDX review.
“A Negative Customer Experience”
In 2014, Cigna considered adding a new procedure to the PXDX list to be flagged for automatic denials.
Autonomic nervous system testing can help tell if an ailing patient is suffering from nerve damage caused by diabetes or a variety of autoimmune diseases. It’s not a very involved procedure — taking about an hour — and it costs a few hundred dollars per test.
The test is versatile and noninvasive, requiring no needles. The patient goes through a handful of checks of heart rate, sweat response, equilibrium and other basic body functions.
At the time, Cigna was paying for every claim for the nerve test without bothering to look at the patient file, according to a corporate presentation. Cigna officials were weighing the cost and benefits of adding the procedure to the list. “What is happening now?” the presentation asked. “Pay for all conditions without review.”
By adding the nerve test to the PXDX list, Cigna officials estimated, the insurer would turn down more than 17,800 claims a year that it had once covered. It would pay for the test for certain conditions, but deny payment for others.
These denials would “create a negative customer experience” and a “potential for increased out of pocket costs," the company presentation acknowledged.
But they would save roughly $2.4 million a year in medical costs, the presentation said.
Cigna added the test to the list.
“It’s Not Good Medicine”
By the time van Terheyden received his first denial notice from Cigna early last year, he had some answers about his diagnosis. The blood test that Cigna had deemed “not medically necessary” had confirmed a vitamin D deficiency. His doctor had been right, and recommended supplements to boost van Terheyden’s vitamin level.
Still, van Terheyden kept pushing his appeal with Cigna in a process that grew more baffling. First, a different Cigna doctor reviewed the case and stood by the original denial. The blood test was unnecessary, Cigna insisted, because van Terheyden had never before been found to lack sufficient vitamin D.
“Records did not show you had a previously documented Vitamin D deficiency,” stated a denial letter issued by Cigna in April. How was van Terheyden supposed to document a vitamin D deficiency without a test? The letter was signed by a Cigna medical director named Barry Brenner.
Brenner did not respond to requests for comment.
Then, as allowed by his plan, van Terheyden took Cigna’s rejection to an external review by an independent reviewer.
In late June — seven months after the blood test — an outside doctor not working for Cigna reviewed van Terheyden’s medical record and determined the test was justified.
The blood test in question “confirms the diagnosis of Vit-D deficiency,” read the report from MCMC, a company that provides independent medical reviews. Cigna eventually paid van Terheyden’s bill. “This patient is at risk of bone fracture without proper supplementations,” MCMC’s reviewer wrote. “Testing was medically necessary and appropriate.”
Van Terheyden had known nothing about the vagaries of the PXDX denial system before he received the $350 bill. But he did sense that very few patients pushed as hard as he had done in his appeals.
As a physician, van Terheyden said, he’s dumbfounded by the company’s policies.
“It’s not good medicine. It’s not caring for patients. You end up asking yourself: Why would they do this if their ultimate goal is to care for the patient?” he said.
“Intellectually, I can understand it. As a physician, I can’t. To me, it feels wrong.” | Health Policy |
On May 11, the U.S. will no longer officially be in a COVID-19 emergency for the first time since the pandemic began three years ago.
While hundreds of COVID-19 deaths are still reported each day in the U.S. -- adding to a toll of more than 1 million -- public health experts said the Biden administration is likely looking to end the national and public health emergencies related to COVID-19 because the omicron subvariants that are circulating are producing milder disease and the U.S. has high levels of immunity from previous vaccinations or infections.
The threat of the virus has also receded for many Americans, thanks to testing, treatments and vaccines.
Jen Kates, with the nonpartisan nonprofit Kaiser Family Foundation (KFF), called the end of the emergencies "symbolically a big change." But it will also alter systems that people have come to rely on without realizing they were temporary, at the same time that experts say that it's unclear what the future will hold.
"I think the administration is hoping that we are clearly transitioning into an endemic period, and that the pandemic period is in the past," Dr. William Schaffner, a professor of preventive medicine at the Vanderbilt University Medical Center in Nashville, Tennessee, told ABC News.
"Now, that said, those of us in infectious diseases and public health are a little nervous. And the reason is, here we are at the end of January predicting what the circumstances will be in May," Schaffner added. "This is a very unpredictable virus."
Here are the biggest impacts of the public health and national emergencies ending, according to experts:
Millions could lose Medicaid
After three years of major enrollment increases for Medicaid, anywhere from 5 to 14 million Americans could soon lose their access to the government's health insurance program for low-income people and others, according to KFF, which focuses on national health.
And according to estimates from the U.S. Department of Health and Human Services, nearly 7 million of these people could still be eligible but will fall through the cracks of the renewal process and lose their health insurance.
For context, almost 20 million people enrolled in Medicaid during the COVID-19 public health emergency, an increase of nearly 30% since before the pandemic, and uninsured rates dropped to record lows.
That increase was fueled by a rule under the public health emergency that barred states from removing anyone from Medicaid while the pandemic was at its worst -- allowing people to avoid the bureaucratic renewal processes that experts said could often lead to people losing their coverage even when they were still eligible.
But a recently passed law in Congress returned the right to states to disenroll people from Medicaid beginning on April 1, ending the continuous enrollment afforded to people during the public health emergency.
"This is going to lead to people who are eligible for the program losing out," said Kates, a senior vice president at KFF. "And so I think this is a concern right now, because they would lose coverage for all of their health care during that period," she said.
In the year after the Medicaid rules change, KFF estimates that enrollment will decline between 5% and 13%.
There are efforts to catch some of those people who lose their Medicaid insurance, like a special open enrollment period through the Affordable Care Act.
And some Americans will be disenrolled from Medicaid because they get a job that offers health insurance instead -- or because they then are making too much money to qualify for Medicaid.
"As a person on the street, I understand where the government is going. But as a physician, I'm a little bit worried, because [losing Medicaid] makes a difference between the haves and have nots," Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, told ABC News.
"Particularly with a price tag of $500 for a Paxlovid course [to treat COVID-19], $130 for a shot, we already know how much testing costs for going to Walgreens and CVS," he continued. "So I think all of these things together makes it difficult for everyone to protect not only themselves but each other."
New COVID costs for tests and treatments
The end of the public health emergency will mean that Americans start paying more for certain COVID-19 health measures, but the increase likely won't all be felt at once.
One of the most obvious new costs will be at-home rapid tests, which have been free for most of the time they've existed. People can get eight free tests a month covered by their insurance, for example, or order free tests in the mail from the government.
But that ends with the public health emergency on May 11, Kates at KFF said. The same is true for walking into a clinic or doctor's office to get a test. That could come with costs in the future, whereas it is free under the emergency order.
As for treatments, like the antiviral Paxlovid, that will depend on when the federal government's supply runs out, at which point insurance companies will change their policies. Until then, people will likely not see a huge cost increase on treatments.
"The federal declaration has big implications, mainly financial, that many people don't even realize," Chin-Hong said. "All of a sudden, you have to be paying for copays and office visits, or even lab tests," he added. "And then people may not want to seek health care because they are afraid of paying some sort of copay or being saddled with a huge bill."
But vaccines will remain free for people with insurance. Because of work in Congress and by the Centers for Disease Control and Prevention, COVID-19 vaccines are mandated to be covered by insurance -- through the end of the public health emergency and even once the government stops buying and distributing them for free.
Telehealth access remains through Medicare
Congress moved to ensure telehealth access for all Medicare recipients for the next two years, so the audio and video visits that those patients have come to rely on are not threatened by the end of the emergency.
As for people on private insurance, telehealth access will depend on state laws and insurance company policies. People can check with their providers for more information, as there's no one-size-fits-all answer.
Pandemic data may be harder to track
The public health emergency mandated that states share certain data with the CDC, like COVID-19 case counts and deaths. Though a senior Biden administration official said that the CDC will continue to encourage states to voluntarily share that information with them, some states will choose not to.
The result could be a cloudier picture of the pandemic, including less insight into possible infection surges and slower responses from health officials.
"It means that we won't be able to track simple things like hospital capacity," Chin-Hong said.
"So there'll be less ability to sound the alarm before the storm comes essentially," he said.
Schaffner, the professor of preventive medicine, said that the end of all the emergency measures will signal to the public that the pandemic is over -- when infections and deaths continue.
"Somewhere between 300 to 500 people die of COVID in the United States daily, at the present time," he said. "So we're going to have to keep our guard up. But if we declare an official end, I think the general public will hear that as a message that they don't have to worry about it anymore and that may lead, as you can imagine, to an increase in COVID."
Title 42 is still up in the air
The end of the COVID-19 emergencies is linked to a very different issue -- immigration.
The public health emergency has allowed both the Trump and Biden administrations to cite Title 42 of federal law to quickly expel migrants seeking asylum from the border based on the threat of spreading COVID-19.
While the Biden administration is now seeking to end Title 42, a group of mostly Republican-led states wants to keep it in place, arguing they would be harmed from the resulting immigration.
The issue is before the Supreme Court. Their decision will come sometime before June, when the court's term ends.
Student loan debt cancellation may get more complicated
Ending the COVID-19 emergencies could legally complicate the position the Biden administration has taken while arguing it has the ability to cancel government-held student loan debt for some 40 million Americans.
That plan has been challenged in court and goes before the Supreme Court next month.
The administration has been using the COVID-19 national emergency as justification for the secretary of education's authority to change the status and terms of the student debt.
"There was a national emergency that impacted millions of student borrowers. Many of those borrowers still face risk of default on their student loans due to that emergency. Congress gave the Secretary of Education the authority under the HEROES Act to take steps to prevent that harm, and he is," an administration official said in a statement to ABC News.
Nebraska and five other GOP-led states challenging the plan argued in court filings that the White House can't have it both ways, pointing to President Joe Biden's remarks last year suggesting Americans could live with the virus going forward.
"The government has been undermining what the [Department of Education] said in the rationale memo. As to the COVID-19 justification, the president declared 'the pandemic...over' in September 2022. And as to the current economic conditions, the White House announced that 'household finances are stronger than pre-pandemic,'" the GOP states argued. | Health Policy |
Ehsan Vaghefi, CEO and co-founder of Toku, grew up with a blind father who lost eyesight at the age of four due to congenital glaucoma. As a result of this, his dad was involved with the Blind Foundation in his home country of Iran. Vaghefi says most of his childhood friends were either blind or had a blind parent.
Vahefi thought of becoming a clinician to help people who were in a similar boat as his father, but he also had an interest in seeing how technology could be used to help more people than any single clinician could handle. Changing course, health technology became his focus, and he founded Toku to explore ocular imaging and the diagnostic role it can play.
“Early in life, I understood that if I became a clinician, I would be limited by the number of hours in my day, and [I] made it my mission to bring health to the masses through technology and innovation,” said Vaghefi, who is also an associate professor in Optometry and Vision Science at the University of Auckland who has to his name also five patents, 50 publications, and more than $15 million in grants received in research that centers around the early detection of disease through ocular imaging.
“I have worked every day of my adult life relentlessly to bring affordable and accessible disease screening to everyone, everywhere, so no child would grow up with a parent who is disabled or passed away.”
Toku’s starting point is that there is a strong link between glaucoma and heart-related conditions, so examining a patient’s eye can give a clinician an idea of how that patient’s cardiovascular system is working. Its main product is a non-invasive, AI-powered retina scan and technology platform it calls CLAiR, which can detect cardiovascular risks and related diseases such as stroke, type 2 diabetes.
The platform is groundbreaking in its approach: CLAiR uses AI to “read” tiny signals from the blood vessels captured in the retinal images, and Toku claims that it can calculate heart disease risk, hypertension, or high cholesterol in 20 seconds. And because the platform integrates with existing retinal imaging cameras, the diagnostics it measures can feasibly become a part of any routine eye exam.
The company raised an $8 million Series A funding round earlier this year from U.S. optical retailer National Vision and Japanese firm Topcon Healthcare. But it is still in its early stages.
The U.S. Food and Drug Administration (FDA), earlier this month, granted “breakthrough device status” to CLAiR, which can run on existing retinal imaging cameras.
The FDA’s breakthrough device designation “significantly shortens the de novo process” to reach the market, the CEO explained. It gives Toku access to “a designated FDA team of experts working with the startup to de-risk the accreditation process,” he added.
“Every product that obtains its final FDA approval through the breakthrough designation program has the opportunity to receive an automatic current procedural terminology (CPT) reimbursement code immediately after the final approval,” Vaghefi said.
But this also means that it’s not on the market yet. If ultimately cleared and accredited by the FDA, the startup claims it will be the first medical device company in the U.S. to offer an affordable, non-invasive way to detect the risk of CVD using the image of the retina located in the back of the eye.
The startup, which has 20 staff, started out in Auckland, New Zealand, in 2019. It moved its headquarters to San Diego, California, earlier this year.
Toku aims to begin its pivotal trial in mid-2024, bringing it to the market by 2025-end. It is currently working with strategic backers such as Topcon Healthcare and National Vision to prepare for that rollout after final approval.
Toku, notably, isn’t the first startup that has built a tool to predict cardiovascular disease by analyzing a person’s retina.
Five years ago, Google and Alphabet’s Verily said that they were developing an AI algorithm that could predict heart disease risks by scanning a patient’s eye. This has yet to roll out, however. Meanwhile, the new AI tool could also replace a series of conventional tests such as CT scans, MRIs and X-rays. MediWhale, a South Korea-based startup that has also built an AI-based non-invasive retina scan to diagnose cardiac and kidney disorders, is another similar company.
Toku’s typical end-users will be asymptomatic adults with routine eye exams: the plan is to deploy it at retail optometry, primary care offices, ophthalmology clinics, and pharmacies equipped with retinal cameras.
Once CLAiR identifies individuals with elevated cardiovascular risk, these patients will be referred to their primary care providers for additional tests. When asked about its privacy and data retention policy, Toku said it complies with the Health Insurance Portability and Accountability Act (HIPAA) and ISO 13483, ensuring that only authorized parties can access a patient’s health data.
“We do not use patient information for research or AI training unless explicitly immediately,” the CEO said. “The patient can request for their data to be deleted at any time, and it will be actioned immediately. We comply with data sovereignty in every jurisdiction, using local servers and infrastructure.” | Medical Innovations |
A couple whose baby died after he was starved of oxygen during a home birth are campaigning for risky breech deliveries to be spotted earlier.
Arthur Trott was an undiagnosed breech baby, born after a planned home birth in Burgess Hill on 24 May 2021.
An inquest into his death found a delay in transfer to hospital "materially contributed" to his brain injury.
The South East Coast Ambulance Service Trust said it welcomed "any changes to national breech birth guidance".
A breech delivery is when a baby's bottom or feet will emerge first.
Mrs Trott, 33, went into labour at home at 03:00 on 24 May 2021 when she was 37 weeks pregnant.
About two hours later, it was recognised Arthur was "an unanticipated footling breech", the Record of Inquest states.
A 999 call was made and the first paramedics attended at about 05:50.
'Panic and confusion'
Mrs Trott arrived at the hospital at about 06:30 and Arthur was delivered minutes later.
He was born in a very poor condition and died four days later.
Mrs Trott said: "Life without Arthur is very painful. There is a real gap in our family where he should be and it will forever feel like a part of us is missing."
Arthur's parents believe a breakdown in communication between the paramedics who attended and their control room meant Mrs Trott was kept at home too long.
Arthur's father, Matt Trott, said: "You could hear the panic and confusion in everyone's voices. One minute they were told to go to hospital, the next minute to stay."
As a result of Arthur's death, all planned home births in Sussex are being offered a presentation scan at 38 weeks.
Mrs Trott said: "I've since found out I had all the tell-tale signs of a footling breech, such as feeling kicks in my lower stomach and a hard swelling below my ribs, but I didn't know what they were."
A spokesman for Secamb: "We offer our sincere condolences to Mr and Mrs Trott and we welcome any changes to national breech birth guidance aimed at improving maternity care." | Women’s Health |
The parents of a woman who died in a psychiatric facility believe with different treatment she could have avoided hospital altogether.
Laura Davis, 22, from Cheltenham, took her own life at Arbury Court in Warrington on 20 February, 2017.
Ms Davis, who had borderline personality disorder, was previously at Wotton Lawn hospital in Gloucester.
Her parents say if she could have had psychotherapy in the community, she might not have needed inpatient care.
On Wednesday, a jury at Cheshire Coroner's Court returned a conclusion of suicide in an inquest into Ms Davis' death.
The jury highlighted failures in communication and record keeping at both hospitals, particularly regarding items that posed a suicide risk for Ms Davis.
Both hospital trusts expressed their condolences and said lessons had been learned since Ms Davis' death.
Speaking after the jury's decision, Ms Davis' mother Joanna Davis said her daughter had never received structured therapy.
She said lack of treatment both in the community and in hospitals was trapping people in a "revolving door" cycle of inpatient admissions.
Joanna spent 17 years as a mental health coordinator - helping people find accommodation and access services after discharge from psychiatric hospitals.
But she said the majority of this support has now been cut.
"I am just sad that services like that are not available anymore," she said.
Borderline personality disorder (BPD) is also known as emotionally unstable personality disorder (EUPD).
It is characterised by intense emotions that can change very quickly, fear of abandonment, deep feelings of insecurity, paranoia and difficulty building and maintaining stable relationships.
'Fear of aggression'
Those with the condition may act impulsively or engage in behaviours that can harm them such as drug and alcohol abuse, binge eating or risk taking.
Using self-harm to manage their feelings and suicidal ideation is also common among people with BPD.
Joanna said there was a misconception that people with BPD are violent, and that staff are trained not to show any emotion around these patients "because of the fear of aggression".
She said her daughter had not been offered emotional support through talking-based therapy while in hospital.
While in Wotton Lawn between June and November 2016, Ms Davis was admitted to A&E 48 times due to self-inflicted injuries.
'Negative bias'
Ms Davis' stepfather Darren Watts said research had shown people with a diagnosis of BPD faced "negative bias" from clinicians treating them.
"Clinicians have a tendency, out of frustration at patients not getting better, to 'blame the patient' rather than looking at whether they are getting the right support," he said.
"The lack of structured therapy means they are not giving the patient the opportunity to step out of that psychiatric hospital environment," Mr Watts said.
Joanna said in future, she hoped mental health workers would be given more training in EUPD.
"It is about understanding BPD is not a dangerous diagnosis - it is not a diagnosis where you don't give people emotional support," she said.
Joanna continued: "It is not down to people who are actually doing the job on the ground, that is down to the training that the leadership decide they have.
"I would go and find training if I felt I didn't have the resources to do my job. But people are so stretched and pushed, they just don't have the opportunity. They would love to learn, I am sure."
'Important lessons'
Elysium Healthcare - the private provider which runs Arbury Court - said it "apologised unreservedly" for the shortcomings in Ms Davis's care identified during the inquest.
It said "important lessons" had been learned and implemented since her death to improve communication between providers.
Following the inquest, a spokeswoman for Gloucestershire Health and Care NHS Foundation Trust, which runs Wotton Lawn, said it had conducted its own investigation into Ms Davis's death, as well as cooperating with other inquiries.
The spokeswoman said all learning had been "incorporated into our trust's policies and procedures and we are committed to ensuring that we do everything we can to prevent such an event taking place again". | Mental Health Treatments |
Oct. 12, 2023 â What if a pair of sticker-like sensors could transform your earbuds into a powerful health monitor capable of flagging brain or mood disorders, and treating them with sounds or electrical pulses in real time?Â
Engineers at the University of California, San Diego, are developing flexible sensors, small enough to fit on earbuds, that can record electrical brain activity and lactate levels in sweat. Someday, the sensors could monitor and treat conditions in the here and now, playing sounds or using electrical stimulation to influence brain activity, an emerging type of therapy known as electroceuticals.Â
âWe can hijack the auditory signal to drive brain states towards more desirable outcomes,â said Gert Cauwenberghs, PhD, a head engineer involved in developing the sensors and a professor of bioengineering at UCSD Jacobs School of Engineering. âThose things are possible now that we can close the loop between producing sounds and measuring brain activity.â
In a study published in NatureBiomedical Engineering, the sensors proved just as effective as traditional monitoring methods like electroencephalogram (EEG) headsets for brain activity and blood samples for lactate levels. But unlike those methods, the sensors could be worn continuously outside the clinic as patients go about their lives.Â
The sensors are âspring-loadedâ to maintain tight contact with the ear and covered with a hydrogel film to absorb sweat. They can send data to the earbuds, which then transmit it to a smartphone or laptop via Bluetooth.
Using in-ear devices to track health is not new. But this is the first to combine brain and body sensors, opening the door for all kinds of research and clinical advances.Â
What Could This Tech Do?
The researchers say this technology could be used to help diagnose and treat a long list of conditions, from brain-related diseases like Parkinsonâs, Alzheimerâs, and epilepsy to mood conditions like posttraumatic stress disorder, anxiety, and depression. It could also detect and treat strokes, tinnitus, sleep apnea, and traumatic brain injuries.Â
Plenty of research has explored wearables for remote patient monitoring, but in-ear wearables could be especially useful for conditions that impact the brain. Patients being tested for epilepsy, for example, could be monitored remotely, even wearing the sensors at night to catch seizures that may have gone undetected, said Erik Viirre, MD, PhD, a professor of neurosciences at UCSD who was not involved in the research.Â
When used with the EEG readings, changes in lactate could provide more evidence for a diagnosis. Lactate tends to rise after a seizure, for example. Higher lactate may also signal diabetes or heart disease. And tracking lactate may prove useful in sport performance.Â
But arguably the most exciting potential use is a âclosed loopâ system that can monitor and treat conditions automatically, without human intervention. In patients with tinnitus, a ringing in the ears due to abnormal brain activity, the device could monitor the condition and test a variety of sounds, playing those that reduce the markers of tinnitus, said Viirre.Â
The tech could treat sleep disorders, cognitive degeneration, panic attacks, or chronic pain in a similar way â delivering music, deep-breathing instructions, positive mantras, or electrical stimulation, and adjusting therapies based on real-time response.Â
When Can You Get This Tech?Â
It will likely take years for the device to be tested and approved for clinical use, Cauwenberghs said.Â
But everyday people could see in-ear wearables that track similar data sooner than that, as more companies enter the growing market of âhearables,â earbuds that double as health trackers.Â
The ear is a prime location, Cauwenberghs said. Itâs close enough to the brain to get a reading, and people already wear earbuds for long periods. So, tech adoption shouldnât be a big barrier.
The company NextSense is working on an EEG-reading hearable, and STAT Health recently announced an in-ear device that can track blood flow to the head and predict fainting spells. Viirre envisions a world where hearables can record even more bio data, like hormone levels, blood glucose, and stress markers.Â
âSmartwatches can give you a lot of data, but in a way itâs very limited,â said Cauwenberghs. âDoctors donât use it; itâs more like a gadget.â Adding the closed loop technology could be âthe difference between being able to see the weather forecast and being able to do something about the hurricane.âÂ
âWith this closed loop of biofeedback and neurofeedback, our vision goes way beyond monitoring," he said. | Medical Innovations |
The House on Thursday passed legislation that would permanently classify fentanyl related substances as Schedule I drugs that are subject to the toughest federal prison terms and penalties, over the objection of most Democrats.
Lawmakers approved the Halt All Lethal Trafficking of Fentanyl Act in an 289-133 vote that saw 132 Democrats oppose the bill even though the White House signaled support for it. In the final vote, 74 Democrats supported the bill and only one Republican voted against it.
Supporters of the bill have argued that there are thousands of fentanyl analogues that cannot be analyzed quickly enough to understand which are harmful and which are not, which is why all fentanyl related substances need to be classified in Schedule I. FRS has been temporarily classified that way on an emergency basis since 2018, and the House bill would make that permanent.
"The HALT Fentanyl Act would permanently schedule all fentanyl-related substances (FRS) not otherwise scheduled into Schedule I of the Controlled Substances Act as a class and expedite research into fentanyl-related substances, which the Administration has long supported," the White House said this week.
But during floor debate on the bill, several Democrats argued against the bill by saying the penalties it imposes for producing and selling fentanyl analogues would fall unfairly on minorities. Rep. Sydney Kamlager-Dove, D-Calif., said the bill is a repeat of the "war on drugs" from the 1980s that will result in jail time for "Black and Brown" people.
"Did we learn nothing from the war on drugs? I guess not," she said.
"Back then we enacted ineffective and punitive laws that only worked to expand mass incarceration, mostly of Black and Brown folks," she said. "This legislation will enact ineffective and punitive drug laws that only work to expand mass incarceration."
Rep. Frank Pallone, D-N.J., said Democrats support permanently classifying FRS on Schedule I, but only if the bill is "carefully designed to avoid exacerbating inequities in our criminal justice system."
He and other Democrats have argued for the last few months that the bill should have included language that only allowed for mandatory minimum sentences if the fentanyl analogue in question resulted in "serious bodily injury or death."
Pallone added that the Biden administration also supports policies aimed at making sure tougher drug sentencing rules don’t "exacerbate existing inequities," and helping people cope with drug addiction.
"We simply cannot incarcerate our way out of a public health crisis," he said. "The HALT Fentanyl Act does not provide any resources for research, prevention, treatment, recovery, or harm reduction."
"We need to be tough on inequality, but for true, systemic change, we have to be willing to consider different roads," added Rep. Barbara Lee, D-Calif. "We have to be willing to consider community-based, trauma-informed, and harm-reducing policies. We must resist the urge to hearken back to tough-on-crime rhetoric."
Republicans dismissed these worries and said tough penalties against FRS need to be made permanent because tens of thousands of Americans are dying every year due to fentanyl or FRS overdoses. Report language on the bill said more than 71,000 Americans died this way in 2021.
"If you are selling fentanyl to our kids, you deserve to be incarcerated," Rep. Brett Guthrie, R-Ky., said in response to Democrats’ arguments. "We don't apologize for that."
"Fentanyl is the top cause of death for Americans 18 to 49 years old," Guthrie added. "In my home State of Kentucky, illicit fentanyl overdoses represented 70 percent of all overdoses in 2020 and 2021."
"The fentanyl crisis is one of the foremost problems that the American public faces and has been made worse by the crisis at our southern border," he said. "Illicit fentanyl is turning virtually every community into a border community, with these poisons flooding streets across America and taking innocent lives, including the lives of our kids."
House passage sends the bill to the Senate, where it is likely to stall despite White House support given broad opposition in the House among Democrats. | Drug Discoveries |
When temperatures climb, many people reach for ice-cold beverages to cool down. But others put the kettle on: Hot tea is a go-to beverage year-round in countries such as Bangladesh, India, Japan and Saudi Arabia. Many people find hot tea refreshing on hot days — and in traditional Chinese medicine, specific teas are said to have cooling properties even when consumed hot. But can hot drinks really cool you down on a hot day?
It turns out, hot drinks can indeed have a cooling effect on the body, but it depends on the context, experts told Live Science.
According to Peter McNaughton, a professor of pharmacology at King's College London who studies thermoregulation, hot drinks really can cool you down. "It seems totally counterintuitive," McNaughton told Live Science. Still, "Drinking a hot drink really does make you drop your temperature" if it's not too humid out, he said.
If a drink is warmer than the body, at first, "Obviously, that drink makes you hotter," McNaughton said. But humans, like all warm-blooded animals, are constantly adjusting to maintain a consistent internal temperature. McNaughton found that hot drinks (and spicy chilis) activate a receptor in our nerves called TRPV1, which tells the body it needs to cool down. In response, humans sweat.
Sweat pooling on skin is uncomfortable, but add a breeze or a fan, and the air blowing past helps sweat evaporate, taking heat with it. In general, McNaughton said, "Your life depends on sweating." Sweating can help humans survive in some of the highest temperatures documented on Earth, at least in dry heat. Sweat is less effective in high humidity because the air is already full of water vapor and can't absorb as much from the skin; that's why in high humidity, the survivable temperature is much lower.
A 2012 study in the journal Acta Physiologica found that when sweat fully evaporates, hot drinks can help cool people off overall, at least temporarily. That study looked at cyclists biking quickly enough to create their own breeze in a climate with no humidity: ideal conditions for sweat evaporation.
In the reverse effect, cold drinks lower body temperature and then nudge the brain to reduce sweating in order to bring body temperature back to its baseline. A 2018 paper suggests that with less wind, more humidity, or other barriers to effective sweating — like the heavy clothing worn by firefighters — it may make more sense to cool off by drinking crushed ice. "Cold water will definitely make your body colder," McNaughton said. "It will tend to suppress sweating as well. If you're already dripping with sweat, that may be rather nice!"
There's another, crucial way that hot drinks can keep people cool: by keeping us hydrated enough to sweat in the first place. In normal circumstances, the body can quickly compensate for a hot chai or a cold milkshake — but it can't compensate for a lack of fluids. "The number-one priority: hot drink, cold drink, room-temperature drink — forget about that," McNaughton said. "Just drink."
Cini Bhanu, a clinical research fellow at University College London, studied hydration among older people in the U.K., for whom hot, caffeinated tea is often the drink of choice. "They drink a cup of tea thinking, 'Oh, I should just be drinking water," Bhanu told Live Science. But "If you are drinking no cups of water but 10 cups of tea, that's still great for your hydration status." Because the ability to sense thirst decreases with age, Bhanu suggests that older people drink throughout the day, regardless of whether they feel thirsty. Tea drinkers who add cream, sugar, or salt get an added benefit: they are replacing some of the electrolytes lost through sweating in the same way that sports drinks do.
Matt Brearley, who consults on workplace heat, has also seen misconceptions around drink temperature and hydration — but in the other direction. In a 2017 study in the journal Safety and Health at Work, he found that while many outdoor workers prefer cold water, they often avoid it because they think the cold will shock their systems. Because of this belief, they drank less overall and were less hydrated. Like Bhanu, Brearley recommended that people should feel confident sticking with their preferences in order to stay hydrated. But he also noted that hydration is not enough to keep outdoor workers cool on the hottest days: they also need other supports, such as longer rest breaks and access to air conditioning.
Brearley works in a hot, humid part of Australia, where extra sweat won't help workers cool down. He recommended people avoid drinking hot drinks while experiencing heat stress — which occurs when the body is unable to get rid of extra heat — but he said that this scenario is uncommon. While people may enjoy hot tea in the summer while they are resting, far fewer people choose it while working outside. "Where workers are free to consume their preferred fluid temperature," he wrote in an email, "tropical-based workers strongly prefer cool or cold fluids."
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Meg Duff is a freelance science journalist and audio producer based in Brooklyn and the San Francisco Bay Area. She holds an M.F.A from New York University's Arthur L. Carter Journalism Institute. Her stories have also appeared in Slate Magazine, Bedford+Bowery, the climate law podcast Damages, and Apartment Therapy. | Stress and Wellness |
- People on diabetes and weight loss drugs such as Ozempic and Wegovy should stop taking them before elective surgery to reduce the risk of serious complications, a prominent doctors group said.
- The group has received anecdotal reports from across the U.S. that patients taking the drugs, known as GLP-1s, during general anesthesia may be at increased risk of nausea, vomiting and aspiration.
People on diabetes and weight loss drugs such as Novo Nordisk's Ozempic and Wegovy should stop taking them before having elective surgery to reduce the risk of serious health complications, a prominent group of doctors said.
The guidance aims to help doctors manage patients on those drugs who are scheduled to undergo elective surgeries, which are non-emergency procedures such as kidney stone removal, joint replacement and cosmetic surgery.
The ASA said the guidance reflects concerns related to delayed stomach emptying, or when food sits in the stomach for longer than usual. That's one effect of diabetes and weight loss drugs, which mimic a hormone produced in the gut called GLP-1 and ultimately suppress a person's appetite.
Delayed stomach emptying may cause patients undergoing anesthesia to experience nausea, vomiting and aspiration, which is when a person accidentally breathes food into their lungs rather than swallowing it, according to the ASA. That's why patients are typically required to fast before undergoing anesthesia for procedures.
The ASA has received anecdotal reports from across the U.S. that patients taking the drugs during general anesthesia and deep sedation may be at increased risk of those "serious" complications, the group's president, Dr. Michael Champeau, said in the guidance.
Ozempic and Wegovy are already associated with stomach issues like diarrhea and constipation. But Champeau acknowledged that there is still a lack of scientific data on how exactly anesthesia interacts with those drugs, which are also known as GLP-1s.
Each day, about 60,000 people nationwide receive general anesthesia, or medication administered for pain relief during surgeries and other procedures.
It's unclear how many people take GLP-1 drugs each day, but their popularity skyrocketed over the last year for being weight loss "miracles." Now, Novo Nordisk's Ozempic and Wegovy are plagued by nationwide shortages. They also face growing competition from similar treatments like Eli Lilly's Mounjaro.
Under the ASA's guidance, people taking GLP-1 drugs on a daily basis should skip treatment on the day of elective surgery. Those taking GLP-1s weekly should stop treatment a week before the scheduled surgery, the group said.
Prior to surgery, doctors should consider consulting with an endocrinologist for guidance on patients who take GLP-1s for diabetes.
The group also said doctors should consider delaying a patient's procedure if that person experiences nausea, vomiting or abdominal bloating or pain on the day of their scheduled procedure.
If a patient has none of those symptoms but did not stop using GLP-1s before the surgery, doctors should consider using ultrasound to check if they have a "full stomach." | Drug Discoveries |
More than 1,000 GP practices and pharmacies have closed over the past seven years –forcing patients to travel further for care, a damning study reveals today.
A major audit of official data on new openings and permanent closures from 2015 to 2022 lays bare the damage done to primary care in England.
It found there has been a net loss of 670 pharmacies and 343 GP practices over this period, with the most deprived areas hit hardest.
Industry leaders and MPs last night warned the Government was ‘sleepwalking into a disaster’ and called for urgent action to arrest the decline.
The analysis by the Company Chemists’ Association, which represents large pharmacy operators such as Boots, found 37 per cent of the closures have been in the 20 per cent most deprived areas.
It blamed a lack of funding for the losses and fears some towns and villages could soon become ‘cold spots’ – where access to primary care is ‘significantly reduced or inadequate’.
It said primary care was ‘essential to both accessing the NHS but also the health and economic prosperity of the population’. The warning comes as the Government is preparing to publish a Primary Care Recovery Plan, expected to detail how ministers will tackle record low levels of public satisfaction with GP surgeries. It is likely to involve a greater role for pharmacists.
Malcolm Harrison, chief executive of the Company Chemists’ Association, said: ‘The Government is sleepwalking into a disaster within primary care, and we could soon see primary care cold spots emerge in different parts of England.’
Professor Kamila Hawthorne, chairman of the Royal College of GPs, said patients in deprived areas often had more complex health needs.
She added: ‘The loss of a GP practice or pharmacy in these areas will have a stark impact on the community.
‘Decades of underfunding and poor workforce planning have left general practice in crisis.’
A Department of Health and Social Care spokesman said the number of GPs had grown in the past few years when including trainees, adding ‘there remains twice as many pharmacies in deprived areas compared to less deprived areas’. | Health Policy |
It’s Past Time Scientists Admitted Their Covid Mistakes
(Bloomberg Opinion) -- During the pandemic years, Americans’ trust in scientists fell, according to a Pew poll released this month. In 2019, only 13% of Americans were distrustful enough to say they weren’t confident in scientists to act in the public’s best interest. Now that figure is 27% — despite recent triumphs in astronomy, cancer research, genetics and other fields.
It’s reasonable to assume the problem stems from Covid-era public health missteps. Some public health agencies took years to admit what had quickly become obvious: that the virus was airborne. Others suggested precautions, closing playgrounds and beaches, where any benefit would have been minimal. Some promoted policies, like sustained social isolation, that were hard to implement and endure — even for the prominent epidemiologists promoting them.
Public health researchers and officials seem to think that rebuilding trust is just a matter of clearer, more persuasive communication. That would help, but it’s not enough — they should admit to their mistakes.
There’s been reluctance to do so. Last week, I attended an international meeting at Boston University on pandemic preparedness, and a panel on communication never got into the mistakes of the pandemic. When I asked experts afterwards about various policies and declarations that look wrong in retrospect, I got a chorus of “We didn’t know” — an unsatisfying answer. Even at the time, scientists should have been clearer when they were basing policies on educated guesses.
Sandro Galea, dean of public health at Boston University, delves deep into what public health got wrong in his new book, , to be published Dec. 1.
He tackles the silencing of dissenting opinions which led to groupthink, and the encroachment of political and personal opinions into the arena of science. That led to policies that were not always within reason — restrictions on outdoor behavior, closed playgrounds and prolonged school closings.
In an interview, Galea told me that the reluctance to talk about such mistakes comes from a place of insecurity — a fear of giving in to the other side, equated here with former President Donald Trump. Public health officials were rightfully dismayed by Trump’s unreliable bombast. But the answer isn’t to pretend to be infallible.
Even as early as January and February of 2020, the US public health community was making unforced errors. Evidence mounted week after week that this disease was wreaking havoc in China and spreading around the world. Health authorities should have been scrambling to prepare hospitals and nursing homes, to create tests that worked, and to develop a strategy for contact tracing and virus monitoring. They should have warned people of possible business and school closures ahead.
Instead, we got reassurance from public health officials, including editorials claiming that seasonal flu was a worse threat.
New York’s major outbreak in March 2020 created the conditions for a U-turn. As people died despite the lockdowns, we got moralizing about the dangers of going outside, despite reasonable evidence that was not the problem.
Perhaps it’s misguided to expect people to trust scientists when trust in so many institutions has fallen. (Scientists are still more trusted than journalists.) And yet science works because the methods of science were developed to smooth out the work of fallible humans into a body of reliable, useful knowledge.
The double-blind clinical trial is an ingenious antidote to bias and our human tendency to see what we want rather than what’s really there. That’s why I got the Covid vaccine — not because I uncritically trust Anthony Fauci.
The same level of evidence didn’t support the implementation of vaccine mandates, and some institutions went beyond reasonable evidence in forcing workers and students at very low risk of severe disease to get second and third booster shots.
This public health excess fed into existing pockets of irrational paranoia, giving new power to gurus on YouTube, who proclaim that they government is covering up deadly vaccine side effects — as well as the “real” cure for Covid, UFO aliens and plots to take away everyone’s property.
Some of those spouting conspiracy theories are scientists — or at least people with the right degrees — which points to a flaw in the idea that people should trust the whole profession. Historian Edward Tenner calls them alt-thorities, and they show up not just on YouTube but Fox News and the popular Joe Rogan show.
So maybe the best we can hope for is more trust in scientists who appeal to that great body of established knowledge, and who present new knowledge when bolstered with multiple lines of evidence. And we should trust them not necessarily to act in the public interest, but to act in the pursuit of truth.
More From F.D. Flam at Bloomberg Opinion:
- Useless Decongestants Are Just the Tip of the Iceberg
- Let’s Stop Insulting Each Other as ‘Anti-Science’
- Want to Unravel Some Big Covid Mysteries? Check the Wastewater
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
F.D. Flam is a Bloomberg Opinion columnist covering science. She is host of the “Follow the Science” podcast.
©2023 Bloomberg L.P. | Epidemics & Outbreaks |
Commuters at the Times Square-42nd Street subway station in New York, US, on Wednesday, Dec 21, 2022. (Jeenah Moon/Bloomberg via Getty Images)WASHINGTON — On a recent evening, comedian Jimmy Fallon devoted a segment of his late-night talk show to launch into one of his ready-made-for-social-media ditties, this one devoted to the new XBB.1.5 variant of the coronavirus. Rendered in the campy style of the B-52s, the joking song contained a line many public health officials would like to see elected officials make with deliberate seriousness.“Put on your mask when inside a facility,” Fallon crooned.Three years into the pandemic, the question of whether to mask or not to mask shows no signs of heading toward a resolution, especially during a winter season that has seen a so-called tripledemic sweep across the United States. States dropped their mask mandates long ago; last spring, a court struck down a mask mandate on airplanes, planes and other forms of transit. Today, masking is still required in some institutions, like hospitals and theaters.But for the most part, masking has become purely a matter of choice.Ashish Jha, White House COVID-19 response coordinator, speaks during a news conference in the James S. Brady Press Briefing Room at the White House on Dec. 15, 2022. (Oliver Contreras/Sipa/Bloomberg via Getty Images)Not even the appearance of XBB.1.5 has spurred a shift toward mandates. Some school districts in Michigan and Massachusetts asked students to mask after they returned from the winter holiday break, but those mandates remain very much the exception, not the rule. So far, no major city has reimposed a mask mandate. Even the governors of the bluest states would rather talk about inflation than the pandemic, so gruelingly divisive has that topic become.Still, the virus persists. The emergence of XBB.1.5 is especially concerning because this newest Omicron subvariant is so transmissible. And it arrived in the United States as winter set in, when people are much more likely to gather indoors.“COVID is the thing that concerns us most as we look to the days and weeks ahead,” Dr. Ashish Jha, the White House pandemic response team coordinator, told NPR earlier this month.For public health officials concerned with a new winter spike, masking is an obvious solution to a recurrent problem. “When it comes to individual decisions, masks are among the most low-cost and most effective steps that can be taken to broadly reduce transmission of a multitude of viruses,” University of Michigan epidemiologists Emily Toth Martin and Marisa Eisenberg argued in a recent op-ed.People wear masks after New York City's health officials issued an advisory, strongly urging New Yorkers to use masks as COVID-19, flu and RSV cases rise, on Dec. 12, 2022, in New York. (Fatih Aktas/Anadolu Agency via Getty Images)Some believe that masks should not be a matter of personal choice, pointing to evidence that masking is most effective when it is practiced by everyone. A recently formed activist group called the “People’s CDC” — its very title is an implicit criticism of the Centers for Disease Control and Prevention — has called for mask mandates to be implemented in schools and other institutions.“The pandemic isn't over — and it's not going to be over for any of us until it's over for all of us,” People’s CDC member Dr. Zoey Thill, a New York physician, told Yahoo News. “We are only going to get through this pandemic with a collective approach.”She and other masking advocates believe that Americans’ resistance to masking has been overstated and that, more broadly, too many Democrats have forsaken aggressive mitigation measures because of political concerns, not public health realities.The White House recently announced that it was making coronavirus diagnostic tests available for free again. But officials like Jha who work on the pandemic have ceased to emphasize masking as a matter of course, the way they did in 2020 and early 2021. Incentives for vaccination disappeared long ago, and many Americans who received their initial inoculations decided against booster shots that were updated to fight new variances of the coronavirus.A medical worker administers a dose of flu vaccine at a medical center in Rosemead, Calif., on Dec. 10, 2022. (Xinhua via Getty Images)To some, all this is merely society returning to normal.To others, it’s surrender.“People don’t want to be dealing with this pandemic forever,” Thill acknowledged in a telephone interview. But she argued that unless measures like universal masking, improved ventilation and paid leave for sick workers were implemented, the coronavirus would continue to spread, giving rise to new variants and delaying the pandemic’s end.Even though many Americans continue to support masking, the resistance to mask mandates has become a political movement of its own. “Mask mandates were brazenly wrong 3 years ago and they’re wrong today,” tweeted Sen. Ted Cruz of Texas in response to the new school mandates. He and other Republicans have used disagreements over masking to launch culture war attacks that have galvanized the conservative base.Sen. Ted Cruz at the Republican Jewish Coalition annual leadership meeting on Nov. 19, 2022, in Las Vegas. (Scott Olson/Getty Images)Politics aside, even some medical professionals believe that the efficacy of masking was overstated to begin with. “Masks certainly can work on an individual level to reduce viral transmission (i.e. infecting another person), but only if the mask is well-fitted, high-grade, and worn consistently,” Dr. Lucy McBride, a physician in Washington, D.C., wrote in a recent newsletter.“In the real world, these conditions aren’t readily met — which explains why the real-world population data on mask effectiveness is weak.”Even Jha, the White House coordinator, has become something of a mask skeptic. “There is no study in the world that shows that masks work that well,” he said in December, in a comment that cheered some and dismayed others. (The White House notes, correctly, that it has no power to impose mask mandates, though the bully pulpit of 1600 Pennsylvania Avenue comes with no small amount of suasion.)Washington physician McBride is one of the founders of Urgency of Normal, a group started last year to advocate for doing away with pandemic restrictions. Last week, Urgency of Normal called for an end to all school mask mandates across the country. In an open letter, the organization argued that “continued pandemic mitigation measures like mask mandates are not justified for respiratory viruses. It is in children’s best interests to normalize the daily school experience and put an end to unnecessary and harmful restrictions.”Let Them Breathe, an anti-mask group, protests at the Redondo Beach Unified School District building on July 27, 2021, in Redondo Beach, Calif. (Jason Armond/Los Angeles Times via Getty Images)Urgency of Normal has plenty of detractors, who say that its arguments cater to wealthier, whiter communities that benefit from high-quality healthcare and the ability to work from home. The People’s C.D.C. has an information tool kit titled “The Urgency of Equity,” which serves both as an obvious allusion and a counterargument.So far, though, the imperative for normalcy seems to be winning out over pandemic worries in many parts of the country, frustrating advocates who believe that individualized approaches to the pandemic are bound to fail.“We all need to do our own part to minimize risk for everyone,” Thill said. “It’s only until we do that that we’re going to get through this." | Epidemics & Outbreaks |
- Thousands of people have paid $2,500 for full-body MRI scans from Prenuvo, whose technology can detect more than 500 conditions.
- The scans take about an hour and are reviewed by one of Prenuvo's licensed radiologists.
- "When you're catching stage one cancer, what you're doing will save lives," said Prenuvo CEO Andrew Lacy.
While celebrating the July Fourth holiday last year on a boat in Tyler, Texas, Dr. Julianne Santarosa received the results from her full-body MRI scan. What she saw put a damper on the festivities.
Radiologists at Prenuvo, which performed the scan, had identified a nodule in her lungs. Santarosa, who works as a spinal access surgeon in Dallas, could see the spot circled as she looked at the images from the patient portal on her phone.
"I was like, unless I swallowed a taco chip, that something should not be there," she told CNBC in an interview.
Before paying $2,500 for the Prenuvo scan, Santarosa, who was 41 at the time, hadn't felt any pain in and around her lungs and had no reason to suspect anything specific was wrong. Rather, she'd felt generally off since going through in vitro fertilization and had a gut feeling she should do the scan after seeing a Prenuvo ad on Facebook.
The day after seeing her Prenuvo results, Santarosa had a follow-up CT scan at a local hospital. The nodule was cancerous. She had it removed the following week.
Curious and concerned patients like Santarosa are flooding Prenuvo's nine clinics in the U.S. and Canada. There's so much demand that the 5-year-old Silicon Valley-based company has announced 11 more locations opening by 2024, including one in London and another in Sydney.
Kim Kardashian called Prenuvo a "life saving machine" in an August post on Instagram that's generated more than 3.4 million likes. Actress and model Cindy Crawford is an investor, alongside Google ex-Chairman Eric Schmidt, 23andMe co-founder Anne Wojcicki and Nest Labs founder Tony Fadell. The company raised $70 million late last year in a funding round led by Felicis Ventures.
Prenuvo CEO Andrew Lacy said he wants to help customers understand what's going on beneath their skin, which his company's technology can do by identifying more than 500 conditions like cancer, multiple sclerosis and brain aneurysms. As of now, the scans have a limited audience because they aren't covered by insurers, requiring patients to pay out of pocket.
For Santarosa, the imaging was worth every penny and more. Her cancer was detected early enough that she didn't need to undergo treatments like chemotherapy or radiation. More importantly, it hadn't spread to the point that it was life threatening.
"There's no screening test for this," Santarosa said. "I would've been stage 4. I would've figured this out when I was coughing up blood."
An MRI, which stands for magnetic resonance imaging, is traditionally used when ordered by a doctor. Interpreting the images is a complex science, and the scan alone can take more than an hour, even if it covers just part of the body.
Prenuvo's custom MRI machines, which received clearance from the U.S. Food and Drug Administration in 2018, can scan a person's entire body in about an hour. Once a scan is complete, the images are reviewed by one of the company's 30 licensed radiologists. Customers usually receive their results back within five to 10 business days.
Waitlists are long. According to Prenuvo's website, the next available slot for a full-body scan in New York is in March. The same is true for the Los Angeles clinic. In the Dallas suburb of Irving, there's availability starting in mid-December.
Lacy said the business has spiked as awareness in the past 12 months has grown "incredibly."
"These days, when people ask me what I do, and I say I work at Prenuvo, it's 'Oh, I heard that on this podcast,' or 'That influencer talked about it,'" he said.
In addition to full-body scans, Prenuvo offers a head and torso scan for $1,800 and a scan of just the torso for $1,000.
Lacy said Prenuvo is working to bring prices down through "old-fashioned scaling."
Some companies have started offering Prenuvo scans as a perk for employees, which has helped increase access to the technology. Lacy said it works for companies with self-funded insurance plans, because they're able to customize their offerings while assuming the risks.
Traditional insurance companies are paying attention.
"Over time, that data helps inform insurance companies about whether this should be something that would be covered across the insurance plans that they offer," Lacy said.
Prenuvo is looking for other ways to lower costs through artificial intelligence and by potentially reducing the durations of the scans even further. Lacy said the cost is directly correlated to the amount of time customers spend in the expensive machines.
Radiologists are at the core of Prenuvo's business. That brings its own challenges.
Many radiologists are fighting burnout as an aging population has led to mounting caseloads. Emerging technologies like AI have also discouraged some young physicians from pursuing the practice. By 2034, the U.S. could see an estimated shortage of up to 35,600 radiologists and other specialists, according to a report from the Association of American Medical Colleges.
So far, it's a problem Prenuvo has managed to avoid.
Lacy said Prenuvo has a backlog of radiologists who want to work for the company. In traditional medicine, radiologists are often diagnosing patients with serious and advanced diseases, so identifying conditions early can be a welcome change, he said.
"When you're catching stage 1 cancer, what you're doing will save lives," Lacy said.
Prenuvo is still in its early days. Medical experts caution that, in addition to the steep price, full-body MRI scans won't catch everything and aren't meant to replace targeted screenings like colonoscopies and mammograms.
"It is a tool that your physician and you can use, but it does not replace a full diagnostic examination," said Dr. Jasnit Makkar, an assistant professor of radiology at Columbia University Medical Center, in an interview. "It is a work in progress."
Dr. Kimberly Amrami, vice chair of the department of radiology at Mayo Clinic Rochester, said that because of the limitations, patients' expectations have to be set accordingly. She said it can be challenging to identify lesions in the lungs, for instance, and scanning different body parts like the knee, the pelvis, the breasts and the prostate all require different techniques.
"There's always a wish to do an exam that's going to answer every question," Amrami said in an interview. "It's just not really the way that it works with MRI in particular, because the way that you evaluate different body parts in different disease states is quite different."
Prenuvo doesn't use contrast, a heavy metal that's injected into the blood vessels, when conducting its scans. Contrast can help radiologists visualize certain conditions better, but there's controversy surrounding its use, and the company doesn't want to deter people.
Lacy said Prenuvo's hardware was designed to do "almost as good a job" as contrast by using other techniques.
"We believe that that's the best possible solution for screening patients who are at normal risk and asymptomatic," he said. "If we find something that's very concerning, oftentimes, we will suggest that the patient gets some type of follow-up dedicated imaging that might involve contrast."
Amrami said people should consult with their physicians to determine what kind of imaging works best for them.
"There is no one-size-fits-all for MRI," Amrami said.
A look inside a Prenuvo clinic
Lacy said he was inspired to create Prenuvo after he started to wonder about how his high-stress lifestyle was affecting his body. He previously started an internet search company and helped found a gaming company, among other ventures.
He found a radiologist who was offering an early version of a full-body MRI scan. Lacy said he learned a lot from that experience.
"Although my lifestyle was impacting my health, there was nothing crazy going on," Lacy said. "I remember just this incredible feeling of peace of mind."
Prenuvo designed its experience for relaxation. Its New York location has the feel of a cross between a spa and a doctor's office.
Upon arrival at the clinic, patients are led from a cozy waiting room to a private area where they can change into scrubs and remove their jewelry.
While lying down in the machine, patients are given a pair of headphones and can choose to listen to music or watch TV during the scan.
Dr. Eduardo Dolhun, a family physician in San Francisco, decided to get his first Prenuvo scan more than five years ago after Lacy stopped by his office. He said he was skeptical but intrigued by the technology, so he decided to fly to Vancouver, British Columbia, to try an early version of it.
After going through his results with a Prenuvo radiologist, Dolhun called one of his medical school peers at the Mayo Clinic.
"I think this is going to change medicine,'" Dolhun said, recalling the conversation.
Dolhun said he gets a scan every 18 months or so and recommends it to some of his patients. He still advises them to get screening exams like physicals and mammograms as well.
"Good science takes time," he said. | Medical Innovations |
By Mariska Breland, as told to Camille Noe Pagán
I was diagnosed with multiple sclerosis in 2002, but Iâd had symptoms for at least 3 years before that. Iâm 45 now, but I was just 27 at the time. Most of my symptoms, like numb fingers or feet, never lasted long and were easy to dismiss. But that year, I got a weird pins and needles sensation in my left thigh, which my doctor thought was shingles.
Then I moved to Washington, DC, to work as a freelance video and event producer. Soon after I arrived, my vision got weird. I couldnât really focus, and after a few days, I realized that every time I looked left I was seeing double. I went to see an ophthalmologist, who told me point-blank that I probably had MS. When I started crying, she said in a rude voice, âIt isnât fatal.â
It was devastating. But I went to see another doctor, a neuro-ophthalmologist who was really wonderful. She said to me, âListen, Mariska, I see a lot of people with MS, and the vast majority are still walking years and years after their diagnosis.â As a young woman, thatâs exactly what I needed to hear. Losing mobility was my biggest fear, and I realized it was time to take action and do whatever I could to keep that from happening. The neuro-ophthalmologist referred me to Georgetown, where I was diagnosed with relapsing-remitting multiple sclerosis (RRMS).
It wasnât easy to be open at first. I was interviewing for a job after I was diagnosed, and I really needed better insurance than I had at the time. I recall asking the owner of the company specifically what insurance they offered so that I could see if the MS drug my doctor wanted me to take was on that plan. The employer said âWell, I canât ask you about your health, but I just want to make sure weâre not buying a lame horse.â He couldnât legally ask me that, but I needed the insurance, so I was quiet about my MS after that.
Outside of that, it was easier to just be open about what I was going through. I had visible bruising from medication I was taking. I wasnât drinking when I went out with friends, either. It always seemed easiest to me to just say why.
What was harder for me, at least right after I was diagnosed, was being around other people with MS. I didnât want to hear about or notice their symptoms. I think I was afraid, deep down, that Iâd develop the same problems they were having. That would change for me soon enough.
After my diagnosis, I started practicing yoga right away. Iâd read that it was good for MS, and I felt better as soon as I started doing it. Back then, doctors told you not to push yourself or exercise too hard because it made MS worse. Now we know thatâs not true. You have to be careful about what you do, of course. But regular exercise can help manage and even ward off some symptoms. And itâs OK to push yourself.
After doing yoga for a while, I started doing Pilates to get stronger and decided to get certified as an instructor in 2005. Iâll be honest: one of the things that I loved was that I got really strong and fit and people would compliment me about that. It made me feel less like my body was broken.
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But thatâs not why I stuck with it. Around 2008, I started having MS-related mobility issues. Pilates helped a lot. As I trained, I began to realize that you can train to help your brain and body create ways to compensate for disabilities through things like repetition and sensory feedback. I knew I had to show other people with MS and neurological conditions that this could help.
I started taking courses to learn the science of neurological conditions. In 2013, I created the Pilates for Neurological Conditions training program. Around that time, my business partner and I opened The Neuro Studio. We offer disease-specific trainings, programs for specific symptoms, and continuing education for fitness instructors. Since then, Iâve taught more than 700 instructors how to teach people with MS, Parkinsonâs, and other neurological conditions.
Even today, many doctors donât talk about the role of exercise in preventing MS-related symptoms and disability. Very few MS patients get physical therapy. If they do, itâs usually short and simple. Exercise isnât a magic bullet. But by working on balance and strength over time, you can make a difference in symptoms like leg weakness, foot drop, balance issues, and more.
I call myself a reluctant advocate. I went from not wanting to be around people with MS to knowing hundreds of them. My lifeâs work is helping people with neurological disabilities.
Mariska Breland, a nationally certified Pilates teacher, is co-owner of TheNeuroStudio.com and the researcher and creator of Pilates for Neurological Conditions.
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SOURCE:
Mariska Breland, co-owner of TheNeuroStudio.com and the researcher and creator of Pilates for Neurological Conditions. | Medical Innovations |
The latest surge in COVID-19 cases in China is not surprising to researchers, who say that China will see an infection cycle every six months now that all COVID-19 restrictions have been removed and highly infectious variants are dominant. But they caution that rolling waves of infection carry the risk of new variants emerging.
“Unfortunately, a new reality with this virus [is that] we will have repeated infections,” says Ali Mokdad, an epidemiologist at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “The fear is that this virus will produce a new variant that can compete with the current ones and is more severe.”
The current surge is caused mainly by a highly infectious subvariant of Omicron called XBB.1.5, first identified in India last August. According to Nanshan Zhong, a prominent respiratory physician in China, as many as 65 million people could become infected per week by the end this month.
This is the first major reinfection wave that China has seen since the central government dropped all its COVID-19 control measures in December, prompting a widespread Omicron outbreak.
China has vaccinated more than 90% of its population, and the outbreak in December infected at least 85% of its people, says Zhong. But immunity is waning, and XBB can evade protection from vaccines and prior infections. Mokdad says that, although XBB has not caused a major rise in hospitalizations and deaths, the sheer number of infections could put pressure on China’s health-care system.
XBB is also causing minor waves in other parts of the world, such as Singapore and the United States.
“This is what we see everywhere, but with a large population such as China, it is more apparent,” says Mokdad.
Yunlong Cao, an immunologist at Peking University in Beijing, and his team have found that antibodies generated against Omicron variants BA.5 and BF.7, the dominant strains during the December wave in China, can provide about four months of protection against strains such as XBB1.
Kayoko Shioda, an epidemiologist at Boston University in Massachusetts, says that previous COVID-19 surges in other countries have shown that XBB is more transmissible than earlier forms. “Once it enters the population, XBB spreads and becomes the predominant variant much quicker than other variants,” she says.
Last December, more than 200 million people in China contracted COVID-19 in 20 days. This time, the wave is spanning several months, owing to the differences in people’s immune backgrounds, such as antibody levels, says Cao. “The peak of COVID-19 waves will generally become flatter and more stretched out after each cycle, which is a pattern we see in countries like the US. People are still getting infected in the US, just not all at once,” he adds. A flatter wave would also lessen the burden on health-care systems, Cao says.
New boosters
Because China no longer publishes its COVID-19 case count, it is unclear how many people are becoming infected in the latest wave; however, the Beijing health authority says the number of COVID-19 cases reported in the capital city quadrupled between late March and mid-April. Cao says it’s hard to make estimates without accurate data. But on the basis of his past research, he estimates that at least 30% of the population could become reinfected in this wave, amounting to more than 400 million people.
Scientists say having a good surveillance system to monitor and track emerging virus variants is very important, given that infection cycles will continue to happen. A new variant that could supersede current ones remains a concern, says Mokdad. “Imagine a Delta type of variant with XBB capacity of spreading. This will cause us a lot of damage.”
Tracking the virus’s evolution also means that scientists can update booster vaccines accordingly.
Facing the ongoing COVID-19 wave, several major Chinese cities, including Beijing and Shanghai, have started to inoculate residents with a quadrivalent COVID-19 booster, made by the Chinese biotechnology company Sinocelltech Group. The vaccine, first approved for emergency use in March, is designed to provide broad-spectrum protection against the Alpha, Beta, Delta and Omicron BA.1 coronavirus variants. Sinocelltech announced last month that one booster shot using this jab can prevent 82% of SARS-CoV-2 infections — including ones caused by XBB — for up to four months. The final results from the vaccine’s clinical trial are not yet available.
Zhong says that China is developing vaccines targeting XBB. Although current vaccines can provide good protection against severe disease and death, they are not very good at providing long-lasting protection against infection. “But that doesn’t mean we should just give up. Repeated infections, even with a mild virus like XBB, can still lead to health problems like long COVID. Vulnerable people, such as older adults, are still at risk of getting very ill,” Cao says. | Epidemics & Outbreaks |
Any travel lover will know the frustration of arriving in an exciting new location and wanting to explore – before being hit by debilitating jetlag.
Fortunately, scientists in the US think they finally have a solution – and they claim it's all about what and when you eat.
They say having a single, larger meal in the early morning for three days after landing can knock jetlag on the head – although the older you get the less likely it is to work.
The experts agree taking a walk in the sunshine is another good tip, so combining this with the new advice puts flyers on the best course for recovery.
It's already known that one of the worst things you can do for jetlag is refusing to assimilate with your new time zone – such as going to sleep during the day.
The new study was conducted by experts at Northwestern University in Evanston, Illinois, and the Santa Fe Institute in New Mexico.
'Having a larger meal in the early morning of the new time zone can help overcome jetlag,' said study author Yitong Huang at Northwestern University.
'Constantly shifting meal schedules or having a meal at night is discouraged, as it can lead to misalignment between internal clocks.'
Jetlag is caused by disruptions to the innate biological clock in humans, called the circadian rhythm, which regulates when we become sleepy and when we're more alert.
Modern research has shown that circadian clocks are present in almost every cell and tissue in the human body – and can vary from organ to organ.
For instance, the main clock in the brain is a group of about 20,000 nerve cells that form a structure called the suprachiasmatic nucleus (SCN), which receives direct input from the eyes.
The brain's clock can be reset by exposure to sunlight, which is why jetlag sufferers are recommended to soak up daylight in their new location rather than succumbing to sleep.
Specifically, sunlight affects the production of a hormone called melatonin (produced by the pineal gland in the brain) which helps to regulate sleep.
When we're exposed to sunlight, the production of melatonin is suppressed, which helps us to stay awake during the day.
Meanwhile, peripheral organs such as the stomach and the liver have their own separate clocks that are recalibrated by food – namely, what and when we eat.
Jet lag can result when these clocks drift out of sync with each other, the research team say.
'Conflicting signals, such as warm weather during a short period of light or nighttime eating – eating when your brain is about to rest – can confuse internal clocks and cause desynchrony,' said Huang.
For the study, the authors used computer software to study interactions between multiple internal clocks with jetlag – and how this is affected by aging.
They built a model consisting of two 'oscillators' stacked one above the other – one representing the clock controlled by sunlight and the other the clock controlled by food.
Using this model, the team was able to explore how such a coupled system could be disrupted and what makes the effect worse.
Results suggested having one meal a day in the early morning during the first three days – but containing three times the volume of food – is the best option.
However, getting older results in weaker signals between circadian clocks and a lower sensitivity to light, they also found.
This means older people who are jetlagged after a long flight may need more days to recover compared with younger people.
The authors plan to investigate the other side of the equation and identify the factors that result in more resilient internal clocks.
Such discoveries could result in recommendations to prevent jetlag in the first place, or to keep the circadian system healthy into old age.
The team admit that little is known about how the body's various internal clocks affect each other, although the refer to the brain as the 'central clock' because it coordinates all the other clocks.
'Experimental data clearly demonstrate a hierarchical network of clocks in mammalian animals and these clocks respond to different external stimuli,' they say in their paper, published in the journal Chaos.
'Therefore, a mathematical framework containing both the central clock and peripheral clocks is necessary to advance our knowledge of circadian rhythms.'
Specialist sleep researcher Dr Yu Sun Bin from the University of Sydney says long-haul travellers can reduce their alcohol intake to help avoid severe jetlag (stock image) Going for a walk in the sunshine is better than taking a nap to combat jet lag, airline research in 2019 found. Qantas and University of Sydney fatigue specialists from the Charles Perkins Centre released their findings into how passengers cope with long, overseas flights. Specialist sleep researcher Dr Yu Sun Bin, from the university team, said less than half of Qantas passengers surveyed took a walk outside after arriving at their destination. 'We know that going outdoors for sunlight at the destination is one of the most important strategies for syncing the body clock, but only 47 per cent of passengers made the effort to do it,' she said. Sleep experts recommend walking outside after a long flight so a traveller can adjust to a new time zone. Dr Sun Bin also recommended that passengers cut back on the amount of beer and wine they consume on a long flight. 'Drinking more than a few glasses of alcohol will make jet lag worse,' she said. 'It might make us fall asleep faster but beyond a certain point, it also disrupts the quality of sleep and causes dehydration.' The NHS says: 'Do not drink too much caffeine or alcohol - they can make jet lag worse.' Lemons have properties that will help to fight off dehydration, bananas are rich in potassium and magnesium, which act as natural muscle relaxants, and cherries a natural food source of melatonin, a hormone that helps to reset the body's clock. Goji berries can enhance sleep quality and fresh ginger is another source of melatonin, according to luxury hotel chain Swissotel. If jet lag has affected your digestive problems, munching on super grain, quinoa, can offer some relief. Melatonin is a natural hormone released by the body in the evening to let your brain know it's time to sleep - and it comes in tablet form as a method to reduce jetlag. According to the Mayo Clinic, melatonin aids sleep during times when you wouldn't normally be resting, making it beneficial for people with jet lag. 'As a jet lag remedy and sleep aid, melatonin has been widely studied, and it's now a commonly accepted part of effective jet lag treatment,' Mayo Clinic says. 'Your body treats melatonin as a darkness signal, so melatonin generally has the opposite effect of bright light.' However, the NHS says melatonin tablets are not recommended for jet lag because there's not enough evidence to show they work. NHS tips to prevent jetlag are drinking plenty of water, keeping active by stretching and regularly walking around the cabin and trying to sleep if it's night time at your destination. When arrived at your location, the NHS also advises changing your sleep schedule to the new time zone as quickly as possible, setting an alarm to avoid oversleeping in the morning and going outside during the day to soak up the natural light. | Nutrition Research |
CBS Mornings June 13, 2022 / 10:29 AM / CBS News Wyoming abortion provider facing challenges Women's health care providers face new challenges in Wyoming ahead of Roe v. Wade decision 03:29 Casper, Wyo. — The Supreme Court's upcoming opinion on abortion rights will have far reaching consequences, especially across rural America, where abortion access is already sparse. Right now, there are six states with just one abortion provider. Oklahoma has none.In windswept and wide-open Wyoming, opposition to abortion rights is fervent -- but the need for care is no different than in other parts of the country. Abortion in this conservative, rugged state is currently legal up to viability (usually 24 weeks of pregnancy) -- but no providers here offer surgical abortions. Julie Burkhart, president of Wellspring Health Access, is trying to change that, just as the Supreme Court considers the fate of Roe v. Wade, the landmark 1973 decision that granted women the right to choose to have an abortion."Services have been lacking here," Burkhart told CBS News. Her group is behind the effort to open a women's health clinic in Casper, which would make it the only abortion provider for hundreds of miles. It was scheduled to open this week.But in late May, the clinic site became a crime scene. Police at the scene of an overnight fire that severely damaged a building in Casper, Wyoming, on May 25, 2022. It was being renovated to house a new clinic that would provide abortions among its services. Mead Gruver / AP A fire ripped through the building, scalding its walls, singeing floorboards and setting back the opening date as much as six months -- long after the Supreme Court's pending decision."Do I want to be here talking about someone who committed an act of domestic terrorism in our building? Absolutely not," Burkhart said. "I wanted to be moving furniture in." Law enforcement is investigating the fire as a case of possible arson. Surveillance video released by the Casper Police Department shows someone carrying a gas can through the clinic's waiting area in the middle of the night. The federal Bureau of Alcohol, Tobacco, Firearms and Explosives is offering a $5000 reward for information that leads to an arrest. An apparent arsonist -- a masked, hooded woman -- is seen in image taken from May 25, 2022 surveillance video released by Casper, Wyoming police. She's in a clinic that was being renovated before its scheduled opening. It would offer abortions among its services. Casper, Wyoming police "I am not deterred, and neither are the other members of our team," Burkhart said defiantly.When it opens, the clinic will offer a range of women's health services, including abortions. That is, if they're still legal in Wyoming once Roe's fate is decided.Wyoming's Republican-dominated legislature and governor enacted a "trigger" law in March that would ban nearly all abortions if the Supreme Court overturns the longstanding precedent enshrined in Roe v. Wade. Wyoming's law makes exceptions for cases of sexual assault, incest and the physical health of the mother. Twelve other states have enacted so-called trigger bans.Opposition to the clinic in Casper is vocal, and on most Thursdays, demonstrators gather outside to protest."We've prayed that some way the Lord would prevent this place from opening. So if it happens to be vandalism and a fire, I'm good with that," Mike Pyatt, a self-described anti-abortion rights activist, said during a recent demonstration. Pyatt said he even called Burkhart to try to dissuade her from opening the clinic in Casper."Casper is a strong pro-life community, so don't expect open arms," he added.Wyoming's so-called "trigger ban," should it take effect, wouldn't shut down the clinic in Casper, but would still mean people like 24 year-old Hannah, whose identity is being withheld due to concerns for her safety, would have to seek abortions out of state.Hannah told CBS News her pregnancy earlier this year worsened her already-complicated health issues. And she feared it could even kill her."It was pretty much a death sentence," she said. "I was withering away. I was completely – I was a wreck of a human being. If it would have been an option to carry it to term, I would have."So in February, she drove seven hours from her home in Gillette, Wyoming, to a Planned Parenthood in Montana, nearly 500 miles away."Any woman, any uterus holder who's had to have an abortion, does not think it's the easy choice. It's never the easy choice," Hannah said. She also chafes at the link between religious doctrine and abortion rights."My abortion does not affect my conversation with God. I will always have a very, very strong conversation with my God," Hannah said.The clinic in Casper will be about two hours from Hannah's home. In: Abortion Wyoming Thanks for reading CBS NEWS. Create your free account or log in for more features. Please enter email address to continue Please enter valid email address to continue | Women’s Health |
News of a troubling case reaches Steerpike. Earlier this month the Administrative Court handed down judgment in the case of R (AI) -v- London Borough of Wandsworth and Secretary of State for Education [2023] EWHC 2088 (Admin). It’s a complex ruling on a complex case, not likely to catch the attention of the public. But that judgment does contain details that raise some striking questions about medical treatment as it relates to issues of sex and gender.
This relates to the claimant in the case, a 22-year-old with a heart-rending personal history and a string of serious problems. The claimant, named only as AI, was born female and now identifies as a transgender man. The judgment uses male pronouns for AI.
Here’s the court on AI’s background:
The circumstances of his early life are significantly distressing and can only provoke profound sympathy. Although he cannot yet read or write he has been able to make a statement through his solicitor. He records that his childhood was chaotic. His mother was a recovering drug addict, he saw her subjected to domestic violence and witnessed her taking drugs. He would go back and forth between her and his grandmother and when around 11 or 12 years old, AI went into his grandmother’s care. He records moving all the time, living in numerous different places in the South East and spending a lot of time with his grandmother, who is disabled, whom he cared for, and with whom he is in fact, once again, currently living, although he reports difficulties with that relationship. At about 13 or 14 AI went into the care system.
Here’s a summary of AI’s conditions:
He has a total of 14 diagnoses and continues to have complex needs. His difficulties have been medically described as Mild Mental Retardation, Attachment Disorder, Emotion Dysregulation, Attention Deficit Hyperactivity Disorder (“ADHD”), Oppositional Defiant Disorder (“ODD”) and (Autism Spectrum Disorder (“ASD”), dyslexia, severe anxiety, Post Traumatic Stress Disorder (“PTSD”) and low self-esteem. In 2021, he was diagnosed with disturbance of activity and attention, minimal impairment of behaviour and reactive attachment disorder of childhood.
The combined impact of those conditions is that AI is unlikely to be able to live unsupported. The judgment says: ‘Mental health professionals have previously advised he may likely need 24-hour support in the foreseeable future.’ In sum, AI is deeply troubled and faces multiple psychological, behavioural and emotional challenges. AI cannot read or write.
AI cannot function as an independent adult, meaning the State must provide additional support: Wandsworth Council duly provides an Extended Health and Care Plan, a legally binding plan to help meet those additional needs. In that context, consider these words from that court judgment:
The Claimant was assigned female gender at birth, but identifies as male. He was referred to the Gender Identity Clinic (“GIC”) at the Tavistock and Portman NHS Foundation Trust (“the Tavistock”), when he was about 14… He has been approved for testosterone treatment with gender affirming surgery known as a Subcutaneous Mastectomy.”
Here, it seems appropriate to summarise the facts set out in that court judgment as they relate to the person known as AI. This is a 22-year-old with more than a dozen diagnosed clinical conditions, who cannot read or write, who cannot function independently and who may well require 24-hour support in order to live. This person has been approved for surgery to remove healthy breast tissue, as well as for hormone treatment that the NHS says can lead to blood clots, gallstones and infertility.
The matters of administrative law involved in the case of AI vs Wandsworth are unlikely to trouble many people beyond a few corners of the law and the public sector. But you don’t need to understand the legal details to look at the story of AI and ask how on earth we have created a system that means a struggling and vulnerable young person who cannot live independently can give consent to life-changing but physically unnecessary surgery and medical treatments, in the name of ‘gender identity’?
Don’t expect an answer to that question anytime soon… | Medical Innovations |
Touching moment JCB digger carries coffin of retired machine driver, 77, through the street of village where he lived his entire life in fitting tribute for his funeral following battle with cancerRaymond Albert Goodlet, 77, lost his battle with cancer in October last yearAfter 60 years of machine work, he wanted his coffin to be carried by one Granddaughter Lauren Goodlet said: 'It was amazing and special' Published: 06:22 EST, 6 January 2023 | Updated: 06:24 EST, 6 January 2023 A former machine driver was laid to rest in an emotional tribute as a digger carried his coffin through the village he lived in for his entire life.Raymond Albert Goodlet, was a machine driver from Wrexham, who lost his battle with cancer in October last year.The 77-year-old man worked with diggers and machines for roughly 60 years of his life and even continued to work on them with friends once retired.His granddaughter, Lauren Goodlet, recorded the heartfelt moment Raymond made his last journey in a JCB digger as part of a funeral procession. The solemn clip shows a crowd of people in black walking behind the digger which is carrying Raymond's coffin and an array of colourful flowers.Lauren said: 'My Grandad worked on the diggers and machines for about 60 years, he absolutely loved his job and only retired a few years ago but still liked to help out friends on the machines. 'One of his friends from his village a few years ago did the same thing in the JCB so since then he always said that's what he wanted.' Lauren continued: 'It was amazing and special. It was his last journey through his village he lived in his whole life and was very well known and loved by the community.'Raymond Albert Goodlet, 77, was a machine driver who lost his battle with cancer in 2022 The 77-year-old man worked with diggers and machines for roughly 60 years of his life and was carried in a JCB digger to his funeral in a fitting send off. It was recorded by his granddaughter Lauren Goodlet (pictured centre) said: 'One of his friends from his village a few years ago did the same thing in the JCB so since then he always said that's what he wanted'Raymond's battle with cancer was extremely difficult, having his bladder removed along with his prostate and lymph nodes.Just when things were looking up, the cancer returned and he succumbed to the disease, passing away holding his son's hand. Lauren continued: 'He had to wait about a month to go to another hospital to have his bladder removed as well as his prostate and lymph nodes, they then had to operate again the next day to move his bowel over.'They didn't think he'd survive as they were big operations and he was weak because of the cancer. This was in August 2022 and he got slightly better but wasn't eating or able to walk.'The granddaughter said that the hospital was really busy at the time and he was left 'unable to move' with bed sores.Around October last year, Raymond caught Covid which made the situation even more difficult as no one was able to visit. The emotional video shows the 77-year-old making his final journey in a digger It was said that Raymond's battle with cancer was extremely difficult, having his bladder removed along with his prostate and lymph nodes A number of people followed behind the JCB digger carrying the former machine driver Raymond passed away holding the hand of his son's hand at 3am in October 2022 Raymond's son Shaun (pictured) standing next to his father's coffin at the emotional tribute Lauren added: 'His daughter demanded to see him so went in and he was unable to talk or move, he was in a really bad way.'They then decided to tell us his cancer had returned but now in his stomach and that he didn't have long to live so my dad spent two to three days at his bedside without leaving at all - even sleeping there.'My Grandad passed away holding my dad's hand at 3am on the 10th October 2022.' Advertisement | Disease Research |
Good morning. Yesterday afternoon, a private jet crashed in the Tver region near Moscow, killing all 10 passengers on board. Among them, according to Russian authorities, was Yevgeny Prigozhin, the Wagner paramilitary chief who launched an armed mutiny in June. For the latest on his dramatic yet somehow unsurprising death, visit our live blog.
For today, I’ll be looking at a very different story, the UK’s first ever womb transplant. It’s been hailed as a fertility landmark and the dawn of a new era, offering dozens of infertile women the chance to have babies every year. The recipient was a woman born without a womb; the donor was her elder sister, who already has two children.
Organ donation is a very precise science. Though the law changed in 2020 so that all adults are automatically assumed to be organ donors unless they opt out, only 1% of all people who die in the UK every year are eligible for their organs to be used to save someone’s life. Living donors, like the sister in this story, now make up 40% of donors in the UK, putting their own health at risk for an act of altruism.
I’ve spoken to Adam Balen, professor of reproductive medicine and surgery at Leeds teaching hospitals NHS trust, who has a patient on the waiting list for a womb transplant. He explains why the operation is so tricky, and sets out the obstacles to broadening such surgery out to men and transgender women.
In depth: ‘It’s an alternative to surrogacy for women wishing to carry their own babies’
The 34-year-old woman receiving the womb (also known as a uterus) was born with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), a rare condition affecting about one in every 5,000 women. Her 40-year-old sister offered to donate her womb after completing her own family.
The transplant took place in February, at the Oxford transplant centre, but the surgeons only went public with the news on Wednesday, after details were published in an obstetrics and gynaecology journal and doctors were able to report both patients were recovering well.
The surgery took nine hours and 20 minutes and the woman will need to take immunosuppressant drugs throughout any future pregnancy to prevent her body rejecting the donor organ, with the transplant expected to last a maximum of five years before the womb is removed.
Uterine transplantations have been carried out in more than 90 cases internationally over the past 10 years, with most involving a living donor. About 50 babies have been born as a result. The team in Oxford practised the procedure on animals first, including rabbits, pigs and sheep.
Balen, who runs a clinic for girls born with congenital abnormalities such as the absence of a uterus, sees the procedure “as an alternative to surrogacy for women wishing to carry their own babies”. The first ever procedure was pioneered in Sweden in 2013, where surrogacy is illegal, he said.
What happens next?
The ultimate test will be whether the recipient can get pregnant and carry a baby to full term in her new womb. She underwent IVF before the operation, using her own eggs (she was born with ovaries, just no womb), and hopes to have the resulting embryos implanted in her donated womb soon.
She has since had three periods, which doctors see as a positive sign that her reproductive system is functioning well.
If she does get pregnant, the baby will need to be delivered by caesarean section, according to Balen. “The transplanted uterus is usually removed after the family is complete to avoid the prolonged use of anti-rejection medication,” he said.
Does this open the door for men or trans women to carry babies?
To date, only biologically female recipients have been used in animal and human trials of uterine transplant, and Balen thinks transplants for men or trans women is “still a little way off”. Some scientists think it will one day be possible for someone born male to carry a child in a donated womb, but there are plenty of biological hurdles to overcome first.
The main one, says Balen, is the male pelvis, which is not designed to carry a baby. The other difficulty with a womb transplant is what he calls the “plumbing”. Someone born without a womb will also be missing the necessary uterine vessels, which carry blood to the uterus. It is the reason the UK woman at the centre of this story had to have her donated womb connected to blood vessels in her legs, says Balen.
What does this mean for transplant technology?
Uterine transplants will probably become more common, though experts expect this could be limited to a maximum of 30 UK operations each year due to a shortage of donors.
Having your uterus removed – a hysterectomy – is a big operation that can prompt early menopause. There are a number of different reasons to have the procedure and a small survey of trans men who had undergone a hysterectomy as part of gender-affirming surgery found that 88% would be willing to donate their wombs.
Transplant technology is developing rapidly in the UK. Last year, the country’s first sternum transplant took place, with the chest wall of a dead woman being implanted in 34-year-old Nathalie Brett, who was diagnosed with metastatic (stage four) breast cancer.
A corneal transplant is the most frequently performed transplant surgery in the UK, with 3,529 operations last year. This is despite corneas being the part of the body that most people specifically chose not to donate after death, with one in 10 people on the NHS Organ Donor Register making that request. For the squeamish: the NHS says that it never takes full eyes, just corneas, and the procedure can be done without delaying a funeral or the donor looking any different.
Balen is excited about the future of transplants, saying the Oxford success story “opens the door” for more women to carry their own babies.
What else we’ve been reading
Girl dinner? Normcore? Bed rotting? These aren’t random words but trends taking the internet by storm. Arwa Mahdawi pithily lets us know how we can capture the zeitgeist by turning the most banal concept into our very own micro-fads. Nimo
Anita Chaudhuri visits New Ground, Britain’s first co-housing community exclusively for women over 50 (pictured above). Is it a trailblazer for a society in which ever more older people are living alone? Helen
ICYMI: Ronan Farrow’s New Yorker (£) deep dive into Elon Musk’s ever expanding ties with the US government is a must read. Farrow explores how politicians who became reliant on the tech billionaire are now struggling to keep him in check. Nimo
Recently there’s been a glut of first-person reports from electric car owners struggling to find EV charging points, so it is refreshing to read Charlotte Naughton’s dispatch from a trip to Ireland where nothing went wrong. Helen
Summer is on its way out but ice-cream is a treat that we should all enjoy year-round. Felicity Cloake sets out the perfect recipe to make strawberry ice-cream at home – no fancy machines required. Nimo
The front pages
“Wagner chief Prigozhin reported dead after jet crash near Moscow” is the top story in the Guardian print edition. Thursday’s Financial Times has “Wagner boss Prigozhin was aboard crashed plane, say Russian officials” while the i says “Putin critic killed 60 days after mutiny”. “Putin’s revenge” says the Sun, while also calling it a “riddle”. The Daily Mirror also uses “Putin’s revenge” while the Daily Mail poses the question: “Was this Putin’s terrible revenge?”. “Prigozhin killed in plane crash, says Russia, as allies blame Putin” – that’s the Daily Telegraph while the Times goes with “Wagner boss who crossed Putin ‘killed’ in jet crash”. “No Surprise” – that’s more or less what Joe Biden said and so does the Daily Express, adding “Warlord enemy of Putin ‘dies’ in crash”. Prigozhin gets a little mention on the front of the Metro – the story’s inside – while its lead is “India over the moon” after the landing of its spacecraft.
Today in Focus
Cotton Capital: Reparations – episode 6
Revisited: In the final episode of the series, Cotton Capital editor and Guardian journalist Maya Wolfe-Robinson looks at the subject of reparations. What do they mean for communities and descendants of transatlantic enslavement – and what is the Guardian planning to do in its own programme of measures?
Cartoon of the day | Steve Bell
The Upside
Kenya has one of the world’s highest maternal mortality rates but traditional midwives are helping to make deliveries safer. Their skills and the respect they engender in rural communities are being used to encourage pregnant women to give birth in cleaner, safer local clinics.
According to one nurse, this has led to the number of hospital deliveries to increase by 90% which has led to a reduction in child and maternal mortality as well as a decline in the spread of HIV and hepatitis among low-income families.
Sign up here for a weekly roundup of The Upside, sent to you every Sunday | Medical Innovations |
The government is on track to break a key election promise from Boris Johnson to build 40 new hospitals in England by the end of the decade, a damning report by the public spending watchdog has found.
Delays to projects mean the target is unlikely to be met, with work on buildings in the second cohort of the scheme yet to have started as of May, according to the National Audit Office.
The approach to achieving objectives at the lowest possible cost could also result in hospitals that are too small, the watchdog warned, as modelling assumptions may be unrealistic about the extent to which care in future will be provided outside hospitals.
The government failed to achieve good value for money, with the scheme having cost £1.1bn by March this year, and progress has been slower than expected, the report concluded.
Steve Barclay’s department was said to have taken a “maximum risk” approach to the project. Analysis by the NAO found that of the 32 projects announced in 2020 that are being taken forward, just 11 qualify as “whole new hospitals”.
It said 20 amounted to rebuilds of existing hospitals, erecting major new buildings at existing sites or a major redevelopment of existing buildings. One scheme did not meet any of those criteria, according to the report.
The watchdog cautioned that larger hospital projects may have to take place simultaneously – making it harder to find builders and ramping up costs.
The hospitals could be forced to run at very high occupancy levels, as much as 95%, which were said by the NAO to be “highly undesirable and indicative of crisis”.
NHS England has prioritised reducing occupancy rates to 92% over the current financial year, leading the report to warn: “There is a risk that running hospitals very full in future may affect their smooth operation and reduce the amount of spare capacity for coping with normal variations in demand, unexpected shocks and health crises.”
The claim will ignite concerns that the new hospitals would struggle to cope in the event of another pandemic, given England already has one of the highest rates of hospital bed occupancy among countries in the Organisation for Economic Co-operation and Development.
Gareth Davies, the head of the NAO, said: “By the definition the government used in 2020, it will now deliver 32 rather than 40 new hospitals by 2030.”
In May, a reset of the scheme was conducted by Barclay. He revealed eight of the original cohort of 40 hospitals would be delayed into the next decade.
In a bid to save face and claim the government would still hit its target, he included five other hospitals in the programme. Five are built with concrete that is well past its 30-year lifespan, and three are schemes for mental health facilities.
Trusts will be concerned by the findings in the new report and are already being forced to stump up “eye-watering” sums to patch up out-of-date facilities, said Julian Hartley, chief executive of NHS Providers.
He argued ministers “could have better managed expectations” about funding issues with the project – given the delayed timelines and impact of inflation.
Hartley added: “The government must future-proof new hospitals and care settings and heed the NAO’s warning that hospitals may be too small given high levels of bed occupancy.”
Labour said the report showed just one hospital is on track to be built by the general election. Wes Streeting, the shadow health secretary, said: “The Conservatives have overpromised, under-delivered, and they’ve been found out. Meanwhile patients are being treated in outdated, crumbling hospitals. Labour will make our NHS fit for the future.”
A spokesperson for the Department of Health and Social Care said: “The NAO’s report acknowledges that, despite changes to the original programme, 40 new hospitals are still expected to be delivered by 2030 and praises the programme’s innovative plans to standardise hospital construction, deliver efficiencies and improve quality.
“We remain firmly committed to delivering these hospitals, which are now expected to be backed by over £20bn of investment – helping to cut waiting lists so people can get the treatment they need quicker. Three new hospitals have already opened and more will open this year so patients and staff can benefit from major new hospital buildings, equipped with the latest technology.” | Health Policy |
Leprosy could be endemic to the US. Here’s what to know
Cases of leprosy have been on the rise in the Southeast, particularly in Florida, and scientists at the Centers for Disease Control and Prevention (CDC) say the disease could be endemic to the region.
Leprosy, scientifically known as Hansen’s disease, is rare in the U.S. and has usually been found in residents with a history of foreign travel or in people who immigrated from areas where it is more common.
But according to a new case report from the CDC, that may be changing and physicians should be aware.
The report found that about 34 percent of new patients between 2015 and 2020 appeared to have acquired the disease locally.
“Travel to Florida should be considered when conducting leprosy contact tracing in any state,” the report said.
In the past decade, the number of reported cases has more than doubled in the Southeastern states. To be sure, the disease is still rare: Only about 150 to 250 cases are reported each year.
Florida was among the top reporting states in 2020, with 27 cases. Central Florida in particular accounted for 81 percent of those.
“Leprosy is here in the United States. It’s very low incidence and a very low endemic country, but it is here,” said Linda Adams, chief of the National Hansen’s Disease Program (NHDP) Laboratory Research Branch.
Leprosy is not highly contagious, and 95 percent of the human population has a natural immunity. It responds well to treatment and, if diagnosed and treated early, does not cause disability.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae that primarily affects the skin and peripheral nervous system. Treatment is usually a three-antibiotic cocktail, which is free to patients in the U.S. It kills the bacteria within a few days, so the person is no longer contagious.
But part of the problem is that leprosy can be a very slow-developing disease, making it hard to trace where people contracted it from. Because of that slow growth, treatment can last up to two years.
Adams said a person could have a subclinical case for years before it develops into symptomatic disease.
Early symptoms are a rash and possible loss of feeling in the hands or feet. Yet the rash often resembles other skin diseases, and leprosy is so rare in the U.S. it could get misdiagnosed.
“So that is more of a problem. Many times in the United States, because it is a rare disease, physicians don’t consider leprosy as the first instance. So there is a delayed diagnosis. That is more of a problem than anything,” said Ramanuj Lahiri, senior research scientist at NHDP’s Laboratory Research Branch.
“We have fantastic treatment … It’s not a problem to cure a patient. The main issue is to diagnose,” he said.
Federal statistics show incidence of leprosy in the U.S. peaked in the mid 1980s, with 434 cases in 1985. A drastic reduction in the annual number of documented cases followed, bottoming out in 2000 with just 77 cases.
In the past 20 years, the numbers have been increasing, but the averages have been steady over the past decade.
The CDC’s report suggested scientists look into environmental reservoirs, like plants, soil, and water as a potential source of transmission.
Still, it’s not fully known how leprosy is transmitted, because of how rare it is. It’s thought that prolonged exposure is needed, but there’s also no way to know if a person is among the 5 percent of the world susceptible to it.
Diagnosis comes from a biopsy of the rash. There is no vaccine or a blood or skin test that will tell if you have been exposed or if you have preclinical disease.
The CDC report said physicians can help identify and reduce the spread of the disease through their efforts to report cases and their support in further research to assess routes of transmission.
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. | Disease Research |
May 25 (Reuters) - The U.S. Food and Drug Administration on Thursday granted full approval to Pfizer's (PFE.N) oral antiviral COVID-19 treatment, Paxlovid, clearing the way for the drugmaker to sell the drug at market rates once U.S. government supplies dwindle.
The full approval for the antiviral drug to treat adults at high risk of progression to severe disease will also help the company expand its marketing campaign.
U.S. officials have said they plan to work through much of the inventory of Paxlovid bought from Pfizer, which is available for free at pharmacies around the country, before moving to a normal commercial market for the drug.
Pfizer has sold the U.S. government nearly 24 million courses of Paxlovid at around $530 a course. It is not clear yet what the commercial price will be for the drug.
As of May 21, around 14 million courses had been distributed and more than 9 million courses of the drug had been administered, according to federal data.
The approval shows that Paxlovid has met the agency's rigorous standards for safety and effectiveness, said FDA's Patrizia Cavazzoni, adding that it remains an important treatment option for people at high risk of progression to severe COVID-19.
The green light comes nearly six months after the health regulator extended the review period for the drug and is in line with the recommendation earlier this year by a panel of advisers who voted in favor of granting full approval.
The pill was initially authorized in late 2021 for emergency use in the U.S. Sales are expected to significantly drop this year.
Data presented by both the FDA and Pfizer during the advisory meeting in March helped ease safety concerns around a potential rebound in COVID-19 symptoms after a five-day Paxlovid course.
Our Standards: The Thomson Reuters Trust Principles. | Drug Discoveries |
Low immunity against Covid-19 and a growing population of frail elderly is driving a surge in coronavirus deaths in Japan which had, for a long time, upheld some of the strictest pandemic restrictions.
Japan once boasted one of the lowest Covid-19 mortality rates, but the figure has been trending upwards since the end of 2022.
It hit an all-time high on 20 January this year, surpassing the UK, US and South Korea, according to Harvard University's Covid database, Our World in Data.
Japan was largely closed to foreign visitors from 2020 till mid-June last year. It opened its borders cautiously - at first, travellers had to be part of a package tour, buy medical insurance, and be masked in all public places.
Some schoolchildren had meals in silence for over two years as schools imposed bans on lunchtime conversations.
As restrictions are eased, however, the population's low Covid-19 immunity may be causing infections to spike, local health experts told the BBC.
Most of the latest Covid-19 fatalities are elderly people with underlying medical conditions, experts said. This contrasts with the initial spate of deaths that were due to pneumonia and were often treated in intensive care.
"It is also difficult to prevent these deaths by treatment," says Hitoshi Oshitani, one of Japan's leading virologists, adding that Covid was only the trigger.
"Due to the emergence of immune-escaping variants and sub-variants and the waning of immunity, it is getting more difficult to prevent infections," he says.
"Immune escape" is when the human host's immune system becomes incapable of responding against an infectious agent. New versions of the Omicron variant are known to be masters of immune evasion.
Before the Omicron variant struck, Covid-19 deaths mostly occurred in cities like Tokyo and Osaka, but there are now cases across the country, said Dr Oshitani, who was once regional adviser to the WHO on communicable disease surveillance and response.
"In smaller prefectures and rural areas, the proportion of the elderly population is even higher than the national average. This changing geographic pattern may also contribute to the increasing trend of deaths," he said.
Japan is the oldest society in the world by various measures, and its share of elderly people has been increasing every year since 1950.
Elderly people who are getting infected in nursing homes or in community clusters are not receiving prompt treatment, says epidemiologist Kenji Shibuya, a director at the Foundation for Tokyo Policy Research.
Faster treatment can help, he says, but because of Japan's classification of Covid as a Class 2 or "very dangerous" illness, only government-designated hospitals can treat the infected. And they have been overwhelmed by the surging caseload.
Dr Shibuya has called for Covid to be downgraded and treated as a form of influenza, allowing all clinics and hospitals to treat patients who have the virus.
Prime Minister Fumio Kishida announced earlier this month that the classification would be lowered, but only on 8 May. Experts, including Japan's top coronavirus adviser Shigeru Omi, have been calling for this since last year.
Dr Oshitani and Dr Shibuya also say that the death rate could have been inflated by under-reporting of Covid-19 cases due to asymptomatic infections and tweaks to physicians' reporting requirements last year. That said, Japan is one of few countries still providing daily Covid-19 tallies.
Yasuharu Tokuda, a physician at the Health and Global Policy Institute, noted that the Japanese population's natural immunity - acquired through infection - had been low before the middle of last year.
He says natural immunity is stronger than that obtained from vaccination - and so low infection rates have led to low immunity in Japan, which in turn is causing more deaths.
Dr Oshitani pointed to a similar phenomenon in Australia, where the Covid-19 death rate has been creeping up since it reopened borders early in 2022 after keeping them shut for two years.
Experts are divided on the trajectory of Covid in Japan. Dr Tokuda, for instance, believes future rates of infection and death will be lower.
Dr Oshitani, on the other hand, expects a bigger surge in deaths in the months ahead as affordable antiviral drugs are still not widely available. | Epidemics & Outbreaks |
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