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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!"
"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 |
Scrolling through social media can feel like a nightmare these days. You’re reading about the horrors of the Israel-Hamas war, and then you’re reading about the horrors of the war between Ukraine and Russia. You’re learning about the latest devastating climate news. Democracy is under threat in America. It can feel like everything is falling apart.This, of course, can have a significant effect on your mental health. You start to feel overwhelmed. Not only are you dealing with the regular stresses of daily life—your job, your finances, your personal relationships—but now you’re thinking about the most serious problems the world is facing. Social media algorithms tend to elevate the most contentious content, so these feeds are showing you things that will elicit a visceral response—they’re putting the doom in doomscrolling.According to psychology experts, this has become a serious problem. People are ingesting too much negative news, and it’s not only affecting them personally but impacting society at large. People can handle some bad news, but what if it’s a lot of bad news? And what if a lot of people are doing this while trying to function in the world together?Matthew Price, a professor of psychological science at the University of Vermont, says that stress is cumulative. One thing starts stressing you out, and then it’s another thing, and then one more thing. Suddenly, you’re spiraling. He says the stress can continue throughout your day even when you’ve stopped bingeing on bad news on social media.“Some of the work that we have done has shown it definitely increases your stress in the moment. It could increase your stress throughout the rest of your day,” Price says. “When you doomscroll, it gets much easier to reach your limit than I think you would if you weren’t doing that.”Price says ingesting a lot of negative news can cause anxiety and depression, at least for some period of time, but it’s especially likely to “exacerbate” anxiety, depression, and PTSD in people who have a history of experiencing those conditions. He says that people often doomscroll because there’s something bad going on and they want to find a way to fix the problem they’re reading about.“When we’re doomscrolling, we’re kind of looking for the resolution to the issue. Read some more posts. Read some more articles. If I get more information, then maybe I’ll understand the problem,” Price says, describing the doomscrolling cycle.This doesn’t just affect individuals. When a lot of people are experiencing the stress of the news of the world at once, it can make them more likely to “snap at each other,” Price says. We may not realize it, but the reason that guy was rude to you at Starbucks might be that he has read too many damn scary news articles.“When you have multiple people who are struggling, they’re going to have a harder time communicating together,” says Bethany Teachman, a professor of psychology at the University of Virginia. “We have to think of these things from a systemic perspective or we’re not going to be very effective at making change.”Teachman says doomscrolling can “skew our sense of what’s going on.” You start to think everything and everyone is the worst, but it’s quite possible little of it is actually affecting you personally. Perhaps terrible news from around the world would not be changing your daily life unless you were reading about it, and it’s important to recognize when it’s time to log off.“We do need to stay informed, but when we move past informed to feeling overwhelmed and often paralyzed and feeling like we’re under constant threat, it’s clearly crossed over into a negative place,” Teachman says. “I think part of what’s happening is most of the news stories tend to be negative, so it gives us this sense that we’re in a constant state of danger and that we are vulnerable and the world is a very dangerous place.”In terms of solutions, Teachman says people need to limit their exposure to social media and the news to keep their lives balanced. It’s OK to read some news to stay informed and check out what people are saying online, but it can get unhealthy if you overdo it. Once you’ve read enough to know what’s going on, think of other things that you enjoy doing and that help you maintain your mental health, she says.“It’s not about ‘this is a bad thing and this is a good thing.’ It’s about how you engage with it and how it fits in with the rest of what’s going on in your life,” Teachman says. “How are you living the rest of your life, and what are the impacts on that?”If you’re feeling overwhelmed by the news, Teachman says it’s important to consider what your values are and how you can act on those values in your daily life. Think about who you want to be and what you want to accomplish. This can focus your mind when you’re feeling overwhelmed.If you’re not feeling like you’re who you want to be right now, she says, think of small things you can do to get closer to becoming that person. Think about the things you can do to get closer to that goal so you’re more capable of handling stress and feeling mentally well, and about the things you can do to help solve the problems you’re worried about.“Take a step back from your social media. Take a step back from your phone. Take a step back from the stressors unless the thing that’s stressful is imminently going to harm you,” Price says. “And get more local.”Price says that acting locally on issues you’re concerned about can help you maintain your mental health because otherwise things can feel too far away and too difficult to solve. Maybe you can’t end a war, but perhaps you can help some people in your community or get your community to do something that helps a bigger problem.People are overwhelmed. They’re tired. Sometimes you want to just curl up in a ball and pull your comforter over your head. Teachman says that’s the worst thing you can do for your mental health. It’s important to connect with people to maintain your mental health, she says, and sometimes you can connect with people and be part of the solution to a problem at the same time. | Mental Health Treatments |
More than 23,000 died in A&E in England last year, figures obtained by Labour show.
The opposition party has released data it obtained through freedom of information requests, which show an increase in deaths compared to previous years.
The Royal College of Emergency Medicine previously said 23,000 "excess patient deaths" may have occurred partly due to A&E delays in England in 2022.
Data provided by NHS trusts to Labour shows a total of 23,316 lives were lost in emergency departments.
This is around 4,000 more than 2021, and 5,500 more than 2019.
NHS targets say 95% of people in A&E should be seen within four hours. Labour claims this target has not been hit since 2015.
Health service data visualised by the Sky News data team shows that at its peak - in December 2022 - more than half of people in A&E waited longer than the target.
Shadow health secretary Wes Streeting said: "People turning to the NHS in an emergency should know they will be seen and treated before it's too late. The Conservatives' failure over 13 years to properly staff or reform the NHS has a cost in lives.
"When Labour was last in government, patients in an emergency were treated in good time.
"It took 13 years for the Conservatives to break the NHS, it won't be fixed overnight. But it will be the mission of the next Labour government to build an NHS that is there for you when you need it once again."
Prime Minister Rishi Sunak has made tackling NHS waiting lists one of his five priorities, although this also refers to elective procedure waiting lists.
Health minister Maria Caulfield said: "The uncomfortable truth is where Labour are in power, the NHS is worse.
"In Wales, Labour have consistently failed to meet waiting targets since their introduction 14 years ago and caused higher excess death rates than in England.
"Meanwhile, we are delivering a record number of tests, speeding up discharge from hospitals, and cutting waiting lists as we also work to halve inflation, grow the economy, reduce debt and stop the boats." | Health Policy |
If you or someone you care about has a substance use disorder and wants to get better, maybe youâve wondered if a rehabilitation center is the answer. Itâs a treatment facility for people who have an addiction disorder involving alcohol or drugs. Some people go daily (or even less often) to an outpatient center for care, while others live at a center for a period of residential care.
Some people with a substance use disorder really need residential care. But there are many facilities to choose from, and not all of them may have your best interests in mind.
"The ethics piece is really important," says Marvin Ventrell, CEOÂ of the National Association of Addiction Treatment Providers (NAATP), "because as treatment centers have boomed, there are some charlatans out there. Theyâre not the majority, but they are out there."
But quality treatment does exist, and there are ways to find reputable centers and avoid scams. Hereâs how to get started.
Find Out if Rehab Is Right for You
There are a wide range of treatments for substance use disorders. Not everybody needs to start by going away to a residential program, which is the most expensive option, says Margaret A. E. Jarvis, MD, DFASAM, chief of addiction services for Geisinger Addiction Medicine and the Geisinger Neuroscience Institute.
Paul H. Earley, MD, DFASAM, agrees. Heâs the past president of the American Society of Addiction Medicine (ASAM), a professional medical organization that creates widely used guidelines to improve the addiction treatment system. You may know about their ASAM criteria, a set of guidelines to help determine the best course of action for a person with addiction.
Some people who donât have urgent and severe physical or psychiatric problems are able to reach "remission" by getting regular care from an addiction specialist like a therapist or a recovery coach, Earley says. Remission is when you go a certain number of months without meeting the medical benchmarks for having a substance use disorder, other than cravings.
If that doesnât work, the specialist can work with your primary care doctor to gradually ramp up the level of care. A residential rehabilitation center may be an option to consider down the road.
If you decide you want to look into treatment centers right away, an addiction specialist might be able to recommend a program matched to your needs. You could also ask for recommendations from people you know who are in recovery.
"If you have friends who have been through a type of program, ask them what worked and what they thought of that program," Earley says.
Jarvis and Earley both recommend using the online tool ATLAS (Addiction Treatment Locator, Assessment, and Standards Platform) on the nonprofit site Shatterproof.org. It can help you get an idea of the level of care you might need and where you can find a facility that provides it.
Tips to Search Safely Online
Proceed with caution if you decide to search the internet for a drug or alcohol rehab center.
"Online can be a dangerous place to be," Jarvis says, especially when it comes to treatment facility advertisements. "If it looks too good to be true, then it is. If there are promises of cures, [addiction] is not a disease that can be cured. It can be managed."
Be skeptical of ads that emphasize the creature comforts a center offers, like a detoxification diet, yoga, or equine therapy. Those things are fine in and of themselves, Earley says, but thereâs no research to show that they're specifically helpful to treat the core of someoneâs substance use disorder.
"The things that tend to have glamor around them tend to be things that donât have an evidence base around them," he says. Theyâre expensive, too.
Some ads claim that you can get treatment in your area, but the advertiser doesnât actually have a treatment center there.
"If youâre in any location, you donât have to fly 500 miles or 1,000 miles to treatment. Thereâs probably a good treatment program in your area," he says. "This idea that you have to go to Florida or Southern California if youâre not there is not accurate."
Ventrell also suggests you check the NAATPâs industry directory. The association is a nonprofit professional membership group of addiction treatment providers, including treatment centers.
"All NAATP members are licensed and accredited for everything they do in every location. They follow our quality assurance guidebook, and they follow our ethics code."
Rehab facilities that are members of the NAATP are prohibited from posting deceptive or misleading ads. They also have to deliver the services they promise and follow a number of other ethical rules meant to protect patientsâ health, rights, and finances.
Beware of âPatient Brokersâ
"There are people in this world," Jarvis says, "who are hired by rehabs simply to get patients. And they get some sort of financial compensation for each body they deliver to the rehab."
This is patient brokering, and itâs not an ethical business practice, she says. Ventrell agrees.
"A broker is bringing in a patient based on the treatment providerâs promise to pay, not on the clinical assessment of what a patient needs," he says. "It is fundamentally problematic and not allowed in any area of medicine."
The NAATP forbids its members from offering or receiving financial rewards, gifts, or other types of compensation for patient referrals.Â
So how do you know if you might be talking to a patient broker? To start, they may sound far more eager to make a sales pitch than to discuss your health and needs.
"If itâs a high-pressure sell, thatâs something to be concerned about," Jarvis says. "If the person youâre speaking to doesnât start asking you enough to do some kind of a [health] assessment, thatâs an issue too."
Ventrell recommends that you:
- Ask the person youâre talking to who they work for. Make sure theyâre employed by the treatment center that youâre considering.
- Be suspicious if they try to tempt you with perks like plane tickets to an out-of-state facility or offer to waive your insurance deductible.
- Call a treatment center directly. If you find a phone number online, compare it to the number listed on the centerâs official site.Â
What a Rehab Center Should Ask You
Once you know youâre talking to a representative at a treatment center, itâs important that they assess your health and life circumstances. Jarvis says a reputable facility would ask you things like:
- How severe your substance use disorder is
- What other physical or mental health conditions you have
- Whether you have a place to live, transportation, and resources to manage your life
"If those kinds of things arenât being considered, then thatâs a sign something may not be well," she says.
And if the representative says that "everybody who calls needs to go to residential treatment, thatâs not credible," Ventrell adds.
What to Ask a Center
Whether youâre visiting a facility or talking to a representative on the phone, ask questions like these:
Are you licensed and accredited? The center should be licensed for providing addiction treatment, Ventrell says. It should also be accredited by an outside organization that makes sure its staff meet certain standards for care and performance.
What evidence-based treatments do you use? These are science-backed treatments for substance use disorders. Some of them are:
- Cognitive behavior therapy (CBT), which can help you spot and change negative thoughts
- Dialectical behavioral therapy, which can help you control strong emotions Â
- A type of counseling called motivational interviewing
- Medications that treat opioid and alcohol use disorders
If a representative at a residential rehabilitation center tells you they donât believe in using FDA-approved meds for alcohol or opioid addiction, thatâs a red flag, Jarvis says.Â
Do you have specialty programming for me? "Ask about your specific circumstance and how they would manage it," Earley says.
For example, if youâre a young adult who began abusing drugs or alcohol in your teens, your treatment needs are going to be different than a 50-year-old whoâs had a substance use disorder for 30 years, he says. Or, if you have depression or anxiety, itâs important that the center has an addiction psychiatrist on staff.
Make sure the facility can meet your specific needs and that they have experience treating people whose age and life circumstances are similar to yours, Earley says. | Mental Health Treatments |
NHS workers log concerns about short staffing on more than 21,000 occasions
Figures uncovered by the Scottish Liberal Democrats show the last financial year saw the highest number of reports, with at least 7,116 logged.
There were 1,244 reports logged in Lothian and 2,156 in Glasgow in 2022/23 alone.
It came as a group of senior doctors raised the alarm over staff shortages at NHS Grampian. They told the BBC that staff were in an “impossible situation”, with unacceptable delays and even avoidable deaths.
One said: "We are witnessing ongoing harm with unacceptable delays to the assessment and treatment of patients. There have been avoidable deaths and at other times there are too long delays getting to patients who may be suffering from a serious condition like stroke or sepsis."
NHS Grampian said it recognised that emergency departments “are under tremendous pressure”, but added it was “confident in the services they provide to the public”. The health board said: "The key recent pressure area has been the recruitment of doctors in training who are entering higher specialist training.
"These are nationally recruited and the levels across Scotland have been particularly low this year, leading to a significant shortfall. This group of doctors are particularly important in the provision of night cover, which is supported by a resident on-call consultant."
Figures obtained by the Lib Dems using Freedom of Information legislation show there were 21,265 reports relating to short staffing across Scotland in the past five financial years.
Lanarkshire, Lothian and the Borders all saw an increase last year, while the number of reports in Glasgow remains extremely high.
Alex Cole-Hamilton, the leader of the Scottish Lib Dems, said: “NHS workers are raising the alarm about safe staffing on wards across the country. Behind these red flags are patients waiting in pain, wards dangerously understaffed and NHS workers pushed to breaking point.
“These figures show the toll of 16 years of ministerial disinterest on our NHS. Even although the alarm was sounded 10,000 times in the two years that he was health secretary, Humza Yousaf utterly failed to take any meaningful action. We simply cannot go on like this.
“Scottish Liberal Democrats have set out positive plans for staff retention and workforce planning.
"The Scottish Government must listen to our calls for a staff burnout prevention strategy and a health and social care staff assembly. By putting the experience and expertise of those who know our health service at the heart of recovery, we can begin to rebuild our NHS.”
A Scottish Government spokesperson said: “We have historically high levels of staff in our NHS and in March last year, we published the National Health and Social Care Workforce Strategy, which sets out a long-term vision for achieving a sustainable health and social care workforce.
“As well as this we are delivering long-term, sustainable interventions on wellbeing, leadership and equalities, to support staff and to improve workplace culture, which will contribute to staff retention and service recovery.
“The Health and Care (Staffing) (Scotland) Act 2019 will come into force in April 2024 which will require health boards to report annually to Ministers on a number of duties relating to appropriate staffing. This information will then be presented to Parliament including details of how it has been taken into account when designing policies for staffing in the NHS.”
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Minks in Spain, seals in Scotland, sea lions and dolphins in South America: a number of mammal species have recently been found to be infected with H5N1, a highly pathogenic strain of avian influenza. Avian flu is not new; epidemiologists have been studying it for decades. But the detection of the virus in mammals has many concerned about the potential that it could spill over to humans and cause a larger outbreak.
As the world enters the fourth year of a global pandemic caused by a virus that likely came from an animal, concern over another virus potentially uprooting our lives is valid. H5N1 has infected humans before, although human-to-human transmission has rarely been observed. And while the World Health Organization (WHO) reports that the mortality rate of avian flu in humans is around 56 percent, many experts believe it’s likely to be much lower if the virus becomes more transmissible. One reason avian flu is so lethal is that it infects the lower respiratory tract, which can lead to respiratory failure. If it were to mutate to infect the upper respiratory tract and spread more easily, it would probably cause milder illness. Yet even a virus that causes mild or moderate illness in many people can have a serious toll, as we’ve seen with the COVID pandemic. So efforts are underway to develop vaccines to protect against such a form of bird flu.
“Each time we see this happen, we get these spurts of cases, [and] people say, ‘Here it comes; it’s going to happen,’” says Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. But he stressed that H5N1 is likely not an imminent threat to humans.
Others agree. “I’m keeping a close eye on it as an expert, but as a member of the community, as a parent and someone who [has been] recently experiencing the COVID-19 pandemic, I’m not worried about this right now,” says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “This is an animal health issue right now that has a theoretical risk to become a human health issue.”
Avian influenza viruses infect birds by attaching to a receptor in their respiratory tract. In order for the virus to become a human virus and start circulating from person to person in the population, it would have to be able to attach itself to the human version of this receptor—something it hasn’t yet evolved to do.
“It’s a really dangerous time to be a bird,” Andrew Pavia, chief of the division of pediatric infectious diseases at the University of Utah, adds. “But as of today, the risk to humans remains very low. Our concern is what’s going to happen as it circulates more and more.”
It’s unfortunately nearly impossible to predict when this jump could happen. “None of us know when the next influenza pandemic will emerge. It could be tomorrow [or] it could be years from now, and we don’t know which of the viruses will become the next pandemic virus,” Osterholm says. “At the outset, you have to say there is uncertainty, with one exception: there will be a pandemic.”
The U.S. is somewhat equipped to handle avian flu: there is a stockpile of egg-based flu vaccines for the H5N1 strain. Eggs are one of the most common ways to make a flu vaccine. To create it, manufacturers inject an inactivated or weakened virus into a fertilized chicken egg, incubate the egg for a few days while the virus multiplies and then harvest the virus to use for the vaccine. The country has a secret chicken stockpile in undisclosed locations across the U.S. just in case we need to make egg-based vaccines quickly—such as during a flu pandemic. It may be concerning that this vaccine strategy depends on an animal that is highly susceptible to the flu in question. But several experts told Scientific American that there are high levels of biosecurity at the chicken facilities in order to avoid bird flu contamination.
Alternatives to egg-based vaccines exist. Since the early 2010s, the U.S. Department of Health and Human Services has been partnering with CSL Seqirus, one of the largest influenza vaccine manufacturers, to develop vaccines grown in cells in a laboratory. The pandemic preparedness vaccine AUDENZ, which targets the H5N1 subtype specifically, is approved by the Food and Drug Administration. And although it’s impossible to determine which virus will cause the next pandemic, CSL Seqirus has a library of viruses that have the potential to infect humans. And the company is constantly looking for candidate vaccine viruses that it can tailor to a specific pathogen.
“We use data [for] one of the avian strains to create a mock-up file,” says Marc Lacey, who runs CSL Seqirus’s pandemic preparedness and response team. The team members basically identify certain viruses, use them to create vaccines and conduct some of the early safety studies so that if an avian flu strain evolves into a true pandemic strain transmitting between humans, they will be ready to go with an adequate vaccine. Lacey says that his company would be able to supply the U.S. government with 150 million doses within the first six months of a pandemic being declared, but he thinks the scale-up potential could be higher, especially if multiple manufacturers could help produce it. Because there are eight billion people in the world, scale-up and widespread collaboration across countries would be necessary to make enough vaccine.
There are also efforts to apply messenger RNA (mRNA) technology—such as that used for some of the COVID vaccines—to flu vaccines. According to University of Washington microbiologist Deborah Fuller, these efforts range from developing a universal flu vaccine to creating a “multivalent” vaccine that targets only a few subtypes—or versions of the virus (like a typical seasonal flu vaccine does). One advantage of mRNA technology is its speed of production. And because of the COVID pandemic, there is now more infrastructure to mass-produce doses. “RNA vaccines can be designed extremely quickly—you only need the genetic sequence of what the new variant is that’s emerging, and within weeks, [you] can have a vaccine already tested in animal models,” Fuller says.
Scott Hensley, a professor of microbiology at the University of Pennsylvania, is also investigating mRNA flu vaccines. He’s part of a research team developing a 20-subtype mRNA flu vaccine that includes an H5N1 strain (although not the one currently circulating in birds). The team recently published its findings in Science. Hensley’s lab is now developing a single-strain vaccine tailored to the current bird flu strain—and is already testing it in laboratory animals. He emphasizes that, as with the COVID vaccines, his vaccines are meant to prevent serious illness and death, not infection.
But even the 20-subtype vaccine is expected to provide some protection against the new strain. “When we developed [that] vaccine, the idea was to create one that could induce a certain level of immune memory against every subtype,” Hensley says. “Our goal wasn’t to predict which influenza subtype would cause the next pandemic or which strain would cause it. Rather the vaccine [would induce] some level of immune memory against every subtype so that it would limit disease and death caused by new pandemic strains.”
A vaccine is only part of pandemic preparedness—you also need effective treatments. As Pavia says, researchers aren’t working from scratch trying to create something like the COVID antiviral Paxlovid, which took nearly two years to get to market. FDA-approved antivirals for influenza, such as Tamiflu, already exist and will be important for reducing deaths during a flu pandemic. Pavia is also hopeful that the U.S. could quickly adapt diagnostic tests to match an outbreak strain of pandemic flu.
“We have better tools and better knowledge about influenza than we did about coronaviruses. In many ways, we would be a step ahead,” Pavia says. “But what I worry about is our political capacity to respond. We need to continue to [increase] awareness and continue preparation efforts. And if things start to accelerate, we need a concerted, nonpoliticized effort to move quickly and effectively.” | Vaccine Development |
Pfizer nixes more study of twice-daily obesity pill treatment
Pfizer shares sank Friday when the drugmaker announced that it was abandoning a twice-daily obesity treatment after more than half the patients in a clinical trial stopped taking it
Pfizer shares sank Friday when the drugmaker said it would abandon a twice-daily obesity treatment after more than half the patients in a clinical trial stopped taking it.
The pharmaceutical company said it will focus instead on a once-daily version of the pill, danuglipron, instead of starting a late-stage study of the other version. Late-stage studies are usually the last and most expensive trials a drugmaker undertakes before seeking regulatory approval.
Obesity treatments are one of the hottest and more lucrative areas of medicine. Pfizer rivals Novo Nordisk and Eli Lilly already have injectable drugs on the market. But Novo and Pfizer are also trying to develop pill versions that would be easier for patients to take.
Pfizer said it saw patient discontinuation rates topping 50% across all doses in a mid-stage study of twice-daily danuglipron. That compares to about 40% for the placebo or fake drug.
The drugmaker also said side effects for the pills were mild but common. Up to 73% of patients experienced nausea and 47% dealt with vomiting.
Researchers did see statistically significant weight loss in adults with obesity but without type 2 diabetes. It ranged from nearly 7% to more than 11% in patients taking the pills.
By comparison, obese patients without diabetes lost about 18% of their weight compared to a placebo when taking taking Eli Lilly’s Zepbound in late-stage research.
The Food and Drug Administration approved Zepbound for obesity last month.
Pfizer Chief Scientific Officer, Dr. Mikael Dolsten, said in a statement Friday that they believe a once-daily version of danuglipron could play an important role in treating obesity, and the company would focus on that.
A Pfizer spokeswoman said the company was conducting early-stage research on that version and expected to have results early next year.
Shares of New York-based Pfizer Inc. slipped nearly 5% to $28.98 in midmorning trading while broader indexes were mixed.
That drop continued a rough year for the drugmaker. Pfizer shares had already slid 40% before Friday. | Drug Discoveries |
Boris Johnson was worried that he had "blinked too soon" in plunging Britain into a second national lockdown on the basis of data that scientists had warned him was "very wrong".
The prime minister made the observation on Nov 1 2020 – one day after he had announced a national lockdown due to come into force on Nov 4. Despite his fears, the lockdown went ahead and lasted for a month.
In another exchange, the then prime minister appeared to express a desire to lift the country out of lockdown earlier than planned, but said his media advisers – Lee Cain and James Slack – warned him that such a move is “too far ahead of public opinion”.
When Mr Johnson broached the subject of opening schools before the summer, his health secretary argued against doing so, saying “everyone’s accepted there won’t be more on schools until September”.
The exchanges call into question the prime minister’s insistence that lockdown decisions were made on the basis of the best scientific evidence.
It also raises the prospect that Britain spent many weeks living under restrictions that could have been avoided.
The cache of WhatsApp messages obtained by The Telegraph includes group messages between Mr Johnson; Professor Sir Chris Whitty, the Chief Medical Officer for England; Sir Patrick Vallance, the Chief Scientific Adviser; Dominic Cummings, the prime minister's chief adviser, and Matt Hancock, the then health secretary.
In one exchange, on Nov 1 2020, Mr Johnson explained that he had been on a video conference call with scientists Dr Raghib Ali and Dr Carl Heneghan.
He told the WhatsApp group that Dr Heneghan said “the death modelling you have been shown is already very wrong", as it was out of date having been drawn up three weeks previously.
The previous day, Mr Johnson had announced an impending national lockdown and partly justified his decision by showing the public modelling predicting that 4,000 people a day could die if no action was taken.
Mr Johnson shared a link with the group that suggests the modelling, which had been drawn up three weeks prior to the press conference, was out by a factor of four. A newer Cambridge study suggested 1,000 deaths a day.
“The attack is going to be that we blinked too soon,” wrote Mr Johnson – a reference to the idea that he will be criticised for announcing a national lockdown too early.
The data Mr Johnson used to justify his decision was modelling that predicted what could happen in the event of no restrictions being ordered.
Three weeks earlier - on Oct 10 - separate WhatsApp messages show Mr Hancock asking Baroness Harding to create a “do nothing” death toll.
Earlier messages show how Mr Johnson was told that lifting lockdown restrictions earlier than planned was not what the public wanted.
On June 6 2020, Mr Johnson sent a message to Mr Hancock saying he is “thinking hard about the 15th June”.
On June 15, the Government was planning on opening non-essential retail, but Mr Johnson’s messages suggest he wanted to do more.
The prime minister then wrote: “At the moment we could do non-essential retail, some more for families, a bit of outdoor hospitality and announce that we can’t do all primary schools by July,” comments that suggest he believed opening these areas before the set date of mid-June.
However, Mr Johnson followed this by saying that James Slack, his official spokesman, and Lee Cain, his director of communications, “still think the whole package will be too far ahead of public opinion”.
Mr Hancock responded by saying the reproduction rate – known as R – is “very close to one” and therefore “I think Slackie and Lee have a point”.
The then health secretary continued: “I think it’s too soon for outdoor hospitality - and they’re not expecting it until next month.”
On schools, he added: “Everyone’s accepted there won’t be more on schools until Sept.”
The health secretary concluded that: “My view is the public are right and we need to hold our nerve.”
After being warned it was not what the public expected, the Government did not allow outdoor hospitality to open until July 4. However, he told the public that this was because it was as early as the evidence allowed.
“The next set of changes – step three – will not begin until the 4th July at the earliest, as the evidence allows,” he told a press conference.
Messages appear to be in contrast to public statements
The comments in the WhatsApp messages appear to be in contrast to what the Government said publicly.
Two days later – on June 8 2020 – in response to a question about the opening of schools, the then health secretary said there were “very difficult policy judgments based on the best available science, always guided by that science”.
Four days later, on June 10 2020, the then prime minister gave the impression that the Government was not opening schools before September for scientific reasons – in contrast to Mr Hancock saying over WhatsApp that Mr Johnson should not be looking at schools again because “everyone’s accepted there won’t be more on schools until Sept”.
Responding to a question by Laura Kuenssberg, the BBC journalist, about schools, Mr Johnson said: “Of course we would have liked to have been in a position where we could have got the rest of primary back for a couple of weeks before the summer holidays, we wanted to do that if that was going to be possible.” | Epidemics & Outbreaks |
Scientists conducting research on novel coronaviruses at the Wuhan Institute of Virology were the first humans to contract COVID-19, according to a new report.
“Patients zero” included Ben Hu, Ping Yu and Yan Zhu — scientists researching SARS-like viruses at the institute, according to an investigation by journalists Michael Shellenberger and Matt Taibbi published on the Substack newsletter Public.
The three scientists were researching “gain-of-function” experiments with the virus — which increases its infectiousness and makes pathogens stronger in order to better understand their dangers — when they became sick in the fall of 2019, multiple US government officials reportedly told the journalists.
The new details were revealed about four months after FBI Director Christopher Wray said the bureau believes that the horrific COVID-19 virus responsible for millions of deaths likely originated from an accidental outbreak at a Chinese lab.
“The FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident in Wuhan, China,” Wray said in an interview with Fox News’ Bret Baier.
In 2019, two of the allegedly infected scientists, Hu and Yu, co-authored a paper about the genetic lineage of SARS-related coronavirus in bats across China that they had studied.
Hu studied under virologist Shi Zhengli who is known as “the bat woman of China” for her research on SARS-like coronaviruses of bat origin. Zhengli has come under intense scrutiny since the outbreak of COVID-19 was traced back to Wuhan.
“Ben Hu is essentially the next Shi Zhengli,” Alina Chan, a molecular biologist at the Broad Institute of MIT and Harvard, told Public. “He was her star pupil. He had been making chimeric SARS-like viruses and testing these in humanized mice. If I had to guess who would be doing this risky virus research and most at risk of getting accidentally infected, it would be him.”
A 2017 video aired by Chinese state-run television reportedly shows Hu watching a lab worker handle specimens while neither is wearing protective gear, according to Public.
“If they were worried about being infected in the field, they would need full body suits with no gaps,” said Chan, who co-authored the book “Viral: The Search for the Origin of Covid-19.”
She added that scientists at the Wuhan Institute of Virology conducted their research at a lower biohazard safety level of BSL-2 “when we now know that the pandemic virus is even capable of escaping from a BSL-3 lab and infecting fully vaccinated young lab workers.”
The US State Department has previously acknowledged suspicions that the COVID pandemic may have originated from a lab leak.
“The US government has reason to believe that several researchers inside the [Wuhan Institute of Virology] became sick in autumn 2019, before the first identified case of the outbreak, with symptoms consistent with both COVID-19 and common seasonal illnesses,” the department stated in a now-archived fact sheet published on Jan. 15, 2021.
The Department of Energy, in late February, determined with “low confidence” that the virus responsible for the pandemic originated in a Chinese laboratory.
Dr. Shi has repeatedly denied the allegations that her or her students’ research caused the devastating pandemic due to a lab leak.
She called the allegations that multiple of her colleagues had gotten ill with similar symptoms to COVID-19 before the outbreak emerged baseless and said that her lab did not hold any source of the strain that caused the pandemic in a June 2021 interview with the New York Times.
“I don’t know how the world has come to this, constantly pouring filth on an innocent scientist,” she said over text.
China has also slammed the lab-leak theory and accused the FBI of “politicizing” the issue.
The alternate origin theory suggests that the virus was transmitted from animals to humans at one of Wuhan’s many animal markets which sold dozens of species known to carry pathogens that were dangerous to people.
US officials are still investigating the disease’s origins. Following the FBI director’s remarks, the White House said there remains no “consensus” as to where COVID-19 came from.
The National Intelligence Council, and at least four other government agencies, contend with “low confidence” that the virus spread as a result of natural transmission from an infected animal to a human.
The Chinese government has refused to allow any independent investigators to look into the accusations that COVID-19 originated at the Wuhan Institute of Virology — which has fueled international speculation and demands for transparency.
President Biden signed a bill in March that requires the Office of the Director of National Intelligence to declassify all information relating to investigations between the Wuhan Institute and the origins of COVID-19 and send the info in a report to Congress. The law specifically requests details on the identities and roles of the researchers who got sick in the fall of 2019.
The unclassified report is due to Congress by Sunday. | Epidemics & Outbreaks |
LONDON -- It was in early March when Fereshteh, a 42-year-old mother of two, said she received a phone call from a friend claiming there had been a chemical gas attack at a girls' school in their small town in Iran's Isfahan Province. She ran all the way to her daughter's high school, fearing for her only daughter's safety.
"I felt my heart coming out of my chest with fear. I don't know how my feet dragged me to Roshana's (her daughter) school," Fereshteh said. ABC News has agreed to use pseudonyms for her and her 16-year-old daughter so that they could speak freely of their experience.
Even after finding her daughter safe, Fereshteh told ABC News she did not let either Roshana or her 11-year-old son go to school for five weeks, fearing for their wellbeing.
Over 7,000 students in Iran have been affected by at least 290 similar incidents at schools involving "poisonous substances" from November through March, according to the Human Rights Activists News Agency (HRANA), a press association established by Iranian human rights advocates. The mysterious poisonings have primarily targeted schools for girls, the agency said.
Hundreds of schoolgirls have been hospitalized as a result of these "targeted chemical attacks," United Nations officials said in a statement March 16.
"We are deeply concerned about the physical and mental well-being of these schoolgirls; their parents and the ability of the girls to enjoy their fundamental right to education," the U.N. statement said.
Some protesters and activists allege that the gas attacks are an attempt by government forces to close schools after mass protests that roiled the country in the wake of the suspicious death of Mahsa Amini, a 22-year-old woman who died under mysterious circumstances shortly after being arrested in September for allegedly not wearing a hijab.
Women's rights activist Masih Alinejad claimed in an interview with ABC News that the attacks are the Islamic Republic’s "revenge" on women for their leading role in the ongoing anti-regime movement.
The Iranian government initially dismissed the reported attacks as rumors, but Iran's Supreme Leader Ayatollah Ali Khamenei has since called the poisonings an "unforgivable crime." "If there are any people involved in the matter, and there certainly are... the perpetrators must be given the most severe of punishments," he warned in a statement March 6.
Amid the closing of schools for the two-week Persian New Year holidays in late March, many parents and observers had said they hoped the gas attacks would be over. However, a series of apparent attacks were reported in several cities across the country in early April, especially in the Kurdish town of Saqez, the hometown of Amini.
Despite her mother's reluctance for her to attend school, Roshana said she decided to return to school after the New Year break. "I know I am not safe, but I think if these attacks mean that there are people who do not want girls to get educated, I'd be giving them what they want by not going to my classes," she said.
"It is very tough. I do not know what is right and what is wrong. But I do trust my daughter's decision," Fereshteh said. However, she still does not let her son go to school. "I know it damages his learning procedure, especially at this age, but he has respiratory problems, and a gas attack can make him very sick."
The alleged gas attacks were first reported in November in the holy city of Qom when 18 schoolgirls were hospitalized after feeling sick at a school. Similar events soon spread to over 100 cities, affecting both girls' and boys' schools and university students, according to activists.
The attacks have re-ignited new protests against the Islamic Republic. The regime was already under pressure with the women-led protests over the suspicious death of Amini.
Videos shared online by activists and human rights groups appear to show students on hospital beds suffering from respiratory problems, dizziness, nausea, with some complaining they feel numb in their limbs. Some victims said they smelled citrus fruit or rotten fish before feeling sick, according to Iranian media reports.
"No dystopian novel can beat the story our students live now. Poisoning defenseless girls at schools by chemical gases is the worst thing that one can possibly imagine," Said Shadi, a 26-year Tehran-based tutor, told ABC News.
In February, Iran education minister Yusef Noubri dismissed the first alleged gas attacks as "rumors," saying the students had underlying illnesses. "A smell was felt in some schools, and some students went to the hospital. Some of these students have underlying diseases and are being treated; then rumors are raised," he said. The government's position on the issue changed as the attacks spread throughout the country.
Authorities announced the arrest of several suspects in connection with the suspected poisonings shortly before the Persian New Year. However, some Iranians have expressed doubt that the main culprits have been arrested amid the ongoing attacks.
Some said they do not believe the regime has a "real intention" of arresting or punishing those involved in the poisonings.
"They (authorities) use the traffic cameras and their intelligence to arrest women who do not wear a hijab. If they are serious in their claim, why they do not use these resources to identify the ones attack on innocent kids," Shadi said.
In early March, Iranian President Ebrahim Raisi ordered the Interior Ministry to probe the incidents, with the assistance of the health and intelligence ministries, the state-run IRNA news agency reported.
"We talk about the attacks a lot. Some of us think it is them (the regime). Some of us believe they want us to stay at home just like what the Taliban is doing to the girls in Afghanistan," Roshana said.
The White House said last month that the Biden administration does not know what is causing the apparent attacks and called for the Iranian government to conduct a thorough and transparent investigation.
"It's deeply concerning news coming out of Iran," National Security Council spokesperson John Kirby said. "Little girls going to school should only have to worry about learning. They shouldn't have to worry about their own physical safety, but we just don't know enough right now. | Epidemics & Outbreaks |
Thousands of people in Oregon have signed up to experience tripping on magic mushrooms at America's first license psilocybin service center. The Associated Press reports: Epic Healing Eugene -- America's first licensed psilocybin service center -- opened in June, marking Oregon'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. No prescription or referral is needed, but proponents hope Oregon's legalization will spark a revolution in mental health care. 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.
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. 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. [...] The report notes that costs can be high, with some clients paying over $2,000 and annual licenses for service centers and growers costing $10,000, with a half-price discount for veterans.
As for doses, state regulations allow up to 50 milligrams but it will ultimately depend on the facility and client. One of the facility's first clients took 35 milligrams and described seeing a "kind of infinite-dimension fractal that just kept turning and twisting."
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. 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. [...] The report notes that costs can be high, with some clients paying over $2,000 and annual licenses for service centers and growers costing $10,000, with a half-price discount for veterans.
As for doses, state regulations allow up to 50 milligrams but it will ultimately depend on the facility and client. One of the facility's first clients took 35 milligrams and described seeing a "kind of infinite-dimension fractal that just kept turning and twisting." | Mental Health Treatments |
Six in 10 Americans say their sleep routines feel different during the winter than in other seasons.
That’s according to a survey of 2,000 U.S. adults, commissioned by Mattress Firm and conducted by OnePoll between Sept. 26 and Sept. 29, as reported by SWNS.
Respondents are also more willing to make sacrifices for better sleep. Nearly half of Americans would give up the internet for a year if only they could get better slumber at night.
Another 43% would trade their phone, 41% would give up their car and 37% would pass up a job promotion.
How winter impacts sleep
The recent end of daylight saving time could have something to do with people’s willingness to make sacrifices for extra sleep — 48% of survey respondents said they feel tired earlier, while 41% move up their bedtimes when it gets dark earlier.
Nearly four in five of the participants (78%) said they can discern when their circadian rhythm is thrown off.
A quarter of people said it is most difficult to wake up during the winter compared to any other time of year.
Additionally, winter tends to make people feel especially tired (21% of respondents) or sad (20%), the survey found.
"It's truly remarkable how keenly attuned we are to the impact of circadian rhythm disruptions, particularly when they stem from the change in seasons and length of daylight," said Dr. Jade Wu, sleep advisor at Mattress Firm in North Carolina, as reported by SWNS.
"Our bodies' acute awareness of these changes serves as a reminder of the intricate connection between our internal clocks and the external environment."
Among the survey respondents, 40% said they have been diagnosed with seasonal affective disorder (SAD), while a total of 53% believe they have it.
Among the most commonly cited "winter feelings" were apathy (32%), general discontent (32%), loneliness (29%), mood swings (28%), loss of interest (26%), anxiety (22%), sadness (16%), excess sleepiness (15%) and fatigue (10%).
Those despondent feelings appear to negatively impact sleep, with 49% of people burrowing under blankets, 48% not sleeping as long as they should and another 48% finding themselves tossing and turning.
"Winter often comes with a gloomy feeling because it’s a prolonged lull in daytime activity levels, which can also make your nights less restful," continued Wu, per SWNS.
"One of the best things you can do for your body is to get active during the day and give it a relaxing environment for sleep."
OnePoll conducts quantitative research and runs online surveys, its website details. | Stress and Wellness |
A San Francisco biotech firm has created a drug that can make your dog live longer - and humans are the next step in their groundbreaking life longevity research.
On Tuesday - the FDA Center for Veterinary Medicine agreed that the company's data supports 'reasonable expectations of effectiveness' for their drug - which aims to extend dogs' lifespans.
This landmark decision by the FDA is the final box that Loyal - the biotech firm pioneering this research - needed to check before veterinarians can start prescribing the miracle drug to our four-legged friends.
The drug by Loyal that has achieved 'reasonable expectations' of effectiveness is known as LOY-001 - one of the three drugs they've been working on.
LOY-001 - which is estimated to be launched in 2026 - intends to extend the lifespan and health span for large and giant breed dogs.
The product is a long-acting drug that would be administered by vets every three to six months.
LOY-001 could potentially reduce the metabolic changes that come with aging - which.
Aging is associated with poor digestion and absorption of nutrients, so a drug that lessens the effect that aging has on the metabolism could lead to improved health and a longer life.
Other products that the company are continuing to work on are LOY-002, which is a daily pill that focuses on older dogs of all breeds except the smallest ones, and LOY-003, which is a daily pill for large and giant breeds of dogs only.
Loyal's CEO is Celine Halioua, 29, from Austin, Texas. She studied at Oxford University, the University of Texas and Uppsala Universitet in Sweden before founding the biotech startup in San Francisco at the age of 24.
Halioua believes that dogs are just the first step in our ability to elongate lives - she thinks that humans will be next.
The CEO said: 'Dogs are unquestionably considered the best model of human aging.
'We have co-evolved with them, and they have a shared environment with us. They also develop age-related diseases over time. If we can do this for dogs, people will want it, too.'
She was reluctant to provide a specific age range that dogs would survive until - but said: 'We are not going to make 80-year-old dogs'.
Halioua also avoided the specifics on pricing, revealing that Loyal's products will be 'affordable but not dirt cheap'.
Insulin growth factor-1, or IGF-1, is the growth-related compound that the extended-release implant aims to target.
IGF-1 declines to low-levels in older ages - a process known as 'somatopause' - which is associated with diseases like cancer, dementia and cardiovascular or metabolic diseases.
The pathway is thought to possess certain anti-aging and performance-boosting effects, including helping to build and retain muscle mass and bone mass.
However - in dogs IGF-1 is believed to reduce lifespan. For large dogs, this is because bigger breeds have 28 times more of the compound than smaller dogs have.
Smaller dogs usually lead longer lives than bigger dogs - which is why LOY-001 specifically focuses on elongating the lives of large breeds and looking at IGF-1 levels to do that.
The biotech firm is currently in the 'companion dog clinical study' stage of their medications development.
During this stage - they are conducting a large-scale nationwide study to evaluate the drug's safety and effectiveness in real-world veterinary settings with pets.
The company is recruiting pups to take part in their study - but the dogs must be at least 10 years old, weigh 14 pounds or more and live near a participating trial site - which there are 62 of all across the U.S.
Over 1,000 dogs nationwide are currently involved in the four year study - all of them receive regular wellness visits and associated lab tests along the way.
Before testing the products in real life - Loyal did preclinical studies in controlled laboratory settings to prove that the drug will have an effect on the canines it aims to help.
Next - it did a pilot study to confirm that the study was safe and effective through data.
After the companion dog and clinical study - the company will work with the FDA to approve the drug so it can be prescribed to dogs - a process that can go into action now that the government agency has given the green light.
Loyal is a clinical-stage veterinary medicine company developing drugs intended to extend the health span and lifespan of dogs.
The company's website states: 'Our mission is to help dogs everywhere live longer, healthier lives.'
Loyal is part of another company called Cellular Longevity - which is a San Francisco-based biotech firm which researches how drugs can lead to longer lives by controlling the mechanisms of pathological aging.
The drugs created by the biotech companies aim to 'delay the onset' and 'reduce the severity of age-related diseases'. | Longevity |
In many ways, Ronin and Ethan are typical young boys. They love Hot Wheels toy cars, Shaun the Sheep, rude noises and pizza nights. Nine-year-old Ethan dotes on the family pets. Ronin, seven, is always booting a soccer ball around the back yard. “They’re two absolutely lovable friendly kids, very affectionate and can be very loving when they’re happy and when things are going their way,” their mother, Teresa Lloyd, says.
But Ronin and Ethan have dementia. When Ethan was two or three, his parents noticed his speech wasn’t developing properly. Now, at nine, he has the language skills of a toddler. He’s still walking unaided but this, Lloyd expects, will not last. He has no sense of personal safety and will dart out in front of a car without any awareness of the danger. He needs help with activities such as dressing and eating, the latter which requires constant supervision in case he doesn’t swallow properly and chokes.
Ronin, for now, is not showing obvious signs of his development slowing.
Dementia is term that conjures images of elderly people in aged care, unable to recognise family or friends, lost in a fog of confusion and disorientation. It does not evoke pictures of young children bursting with energy and joy and life.
But childhood dementia takes more young lives each year in Australia than childhood cancer. It affects one in 2,800 children, and around 2,300 young Australians are currently living with childhood dementia. Three-quarters of them will die before their 18th birthday.
Childhood dementia is caused by any one of around 70 rare genetic diseases. Most people will have never heard of them – Tay-Sachs disease, Sanfilippo syndrome, Farber’s disease, Rett syndrome and juvenile Parkinson’s disease, to name a few – and each is characterised by a different inherited genetic mutation. But what unites them is the gradual degradation they cause in young brains – and the lack of treatments or cures.
“The line that I hear every Sanfilippo family say is that they tell you ‘There’s nothing we can do, there’s no cure; just go home and love your boys’,” Lloyd says. This is what Teresa and husband, Steven, were told when Ethan was diagnosed. Their immediate response was utter shock, then distress. “You mean there’s nothing? There’s absolutely no treatment?” she recalls saying. They became determined to fight as hard as they could for their boys.
‘Why are we not grouping them together?’
Megan Maack is director and CEO of the Childhood Dementia Initiative, an organisation she set up in 2020 when she realised how many of these rare genetic diseases led to the same neurodegeneration that affected her two children, who had been diagnosed with Sanfilippo syndrome.
“I knew a lot of families who had conditions – either Sanfilippo, or other conditions that cause dementia in kids – and I could see we all had the same challenges, we all had the same needs,” Maack says. “I started to think, why are we not grouping them together like we do with other conditions like childhood cancer?”
As soon as the Childhood Dementia Initiative grouped these conditions, the devastation of childhood dementia became clear. “I think everybody was quite surprised at how, as a collective group, the impact was significant,” Maack says. “It’s more common than cystic fibrosis.”
Adult dementia itself is also an umbrella term for a range of neurodegenerative diseases. The neuroscientist Prof Kim Hemsley says it makes sense to group these diseases in children under one overarching term. “They lead to dementia, so we need to start talking about them in a way that everyone understands what they are [and] the tragic consequences of them,” says Hemsley, who leads the Childhood Dementia Research Group at the Flinders Health and Medical Research Institute in Adelaide. “Hopefully that leads to momentum and real change for these families.”
It can also help researchers working on treatments and cures for the otherwise rare genetic diseases that leading to childhood dementia, many of whom are working in isolation around the world. Hemsley is one of a growing number of researchers trying to understand the mechanisms behind the neurodegeneration of childhood dementia.
Each underlying genetic disease affects a different aspect of brain function, but there are some patterns. For example, the largest group of diseases are lysosomal storage disorders. Lysosomes are the waste disposal units inside cells, containing enzymes that break down cellular waste into nutrients and resources that can then be reused by the cell. If a mutation compromises the function of those enzymes – as occurs in diseases such as Tay-Sachs disease and mucopolysaccharidosis – it can lead to a build-up of waste materials inside the cells of the brain, which eventually becomes toxic to the cell.
Other forms of childhood dementia result from mutations affecting the function of the mitochondria – structures within the cell that generate the energy it needs to function – or altering production of key neuronal proteins, as occurs in juvenile Huntington’s disease. Others affect inflammation or the production of amino acids. Some are still not well understood.
Searching for support
This general lack of understanding extends to support services. When parents need to explain to disability services why their child still needs a support worker or occupational therapist or a wheelchair, using the term “childhood dementia” can make that process a little easier. But there’s still a huge gap in both understanding and provision of services that recognise the unique needs of this group of children.
“When you’re trying to get services or trying to make people understand the impact of it, you will end up having to say all the terrible things that come with it in order to justify the support,” Vanita Connery says.
Connery is a mother of three, two of whom are affected by childhood dementia. Her oldest son, Jordan, died last year aged 18. Her youngest daughter, Olivia, has Rett syndrome. The two diseases have different genetic causes, but Connery found it useful having a single phrase to describe the effects of both. “People will understand what that means and I don’t have to use a lot of terms to get them there,” she says.
There are particular challenges when it comes to respite for parents and, at the end stages, palliative care for their children. When Jordan’s condition worsened, Connery sought help from a facility that cares for children with life-limiting illnesses.
“He ran around and bashed into the glass doors and we said, ‘Well, he is dying,’” she recalls. “And they said, ‘Yeah, but we can’t cope with him.’” Paediatric palliative care was well set up for children with cancer, but less so for a child with a degenerative neurological disease, whose body was still functional, growing and extremely active.
Teresa and Steven Lloyd have also experienced obstacles when trying to get respite care for their two boys. They need a break sometimes from the 24-hour supervision that they have to provide, while also trying to work and juggle life’s other demands. “If we use the word respite, the NDIA go, ‘No, that’s parental responsibility, it’s your child, you need to look after him,’” Teresa says.
Hope on the horizon?
The federal government is putting together its 10-year National Dementia Action Plan. For the first time, the consultation report explicitly acknowledges children with dementia but, Maack says, it is light on details about actions to improve care and outcomes for children and their families.
She is calling for an increase in data collection on childhood dementia, which is currently not included in national dementia data sets, and more funding for research into the condition. “We looked at the funding from the government between 2019 and 2021, and there was 20 times more funding that went into cancer than childhood dementia, but the same amount of children die,” she says.
The child neurologist Prof Michelle Farrar says there needs to be better and earlier diagnosis of childhood dementia to spare parents the often years-long rollercoaster of trying to get answers. “It’s about expediting diagnosis to make it timely so they’re not having an experience of seeing multiple professionals over many years without a diagnosis,” says Farrar, professor of paediatric neurology at the University of New South Wales.
Ethan and his parents experienced this frustrating journey for years. First he was diagnosed with global development delay, then another specialist suggested autism, another one diagnosed intellectual disability, and finally a paediatrician did a couple of tests that showed he had Sanfilippo syndrome.
“You go and see somebody and again, you’ve got to wait, you’ve got to get a referral, [then] that wasn’t necessarily their field and then it’d be like, ‘I don’t know what it is’,” Steven Lloyd says. “And then you’d start again.”
While there are almost no treatments available for childhood dementia, some are approaching the stage of human clinical trials. Two strategies showing the most promise involve gene replacement – in which the faulty gene is replaced with a functional one – and enzyme replacement, in which children receive doses of the missing enzymes. One such therapy is being developed in Australia by researchers from the South Australian Health and Medical Research Institute, Adelaide’s Women’s and Children’s hospital and the University of Adelaide. Researchers, including Hemsley, are working on a treatment approach that involves cultivating stem cells from affected children, engineering them to replace the faulty gene, then reintroducing those stem cells back into the child.
Hemsley and her colleagues are also engaged in a needle-in-a-haystack hunt for existing treatments for other diseases that might also influence the disease processes in childhood dementia. “You’re already a long way down the track if you can use a drug where its safety profile is known and the dosing is known,” she says.
For now, the Lloyd parents are entirely focused on making life as normal and wonderful as possible for Ethan and Ronin – visiting their grandparents, holidaying in Queensland.
“As a parent, you have to have that in the back of your mind that this is a journey that ends,” Steven says. He has to pause, and breaks down. The grief and pain are clear. That is a future, Teresa says, they try not to think about too much.
“It is more about the here and now and how are we helping the boys now,” she says. “What can we do?” | Disease Research |
I give my 11-year-old cannabis to stop him having 500 seizures a month - he would punch, kick and scream at me
- EXCLSUIVE: Alfie Dingley endured 500 seizures a month before using cannabis
- He became the first person to be prescribed the medication on the NHS in 2018
- Four years later, mother, Hannah Deacon said it's given her family 'a better life'
An 11-year-old boy used to suffer from 500 seizures a month before he became the first first person to get the Class B drug prescribed on the NHS.
Mother-of-two Hannah Deacon, 43, from Kenilworth won her fight for the NHS to prescribe medical cannabis after seeing how well it improved her son's epilepsy symptoms.
In November 2018, Alfie Dingley, now 11, became the first person to receive the prescription after the law changed to allow the prescribing of unlicensed cannabis based medicinal products in certain circumstances.
Four years later, Hannah details how her family has 'a better life' now that 11-year-old Alfie Dingley's health has improved as a result of the drug.
At eight months old Alfie suffered from his first epileptic seizure.
Hannah Deacon, 43, (right) said her family's lives have changed for the better since her son, Alfie, 11, (centre) was prescribed medical cannabis on the NHS for his epilepsy
In 2018, Hannah campaigned to have the laws around prescribing the medicinal drug changed
The family found themselves at loss as doctors could not detect what was causing his seizures - which were putting him in hospital around 50 times a year.
At the age of five, Alfie was diagnosed with PCDH19 - a severe refractory epilepsy condition. Hannah said: ‘We were told by our then neurologist that he may get better with age and there’s nothing else we can do.’
As the years and his condition progressed, he began having up to 500 violent seizures a month.
Hannah explained to manage his condition hospitals would treat him with steroids and antiepileptics, but they would only keep his seizures at bay for a short while and give him ‘severe side effects’.
She said: ‘He was always either having hundreds of seizures or was at home with me as his full-time carer. He was hitting, punching and kicking me, screaming, not sleeping - there was just no quality of life for him.’
‘I just thought at that point well no, I’m not going to accept that, I’m not going to accept that I just hope for the best and hope he doesn’t die.
The 43-year-old added: ‘I needed to know as a mother that I did everything in my power to give him a better life and that’s why I went to Google.’
After thorough research and speaking to other parents with epileptic children, Hannah raised funds to travel to the Netherlands in 2017, where medical cannabis oil is legal, so that her son could benefit from the controversial treatment.
Before his treatment, he was suffering from 500 seizures a month. Pictured: Alfie and his younger sister, Annie Dingley, 8
At the age of five, Alfie was diagnosed with PCDH19 - a severe refractory epilepsy condition
Hannah said she saw an immediate improvement in Alfie - reducing his 30 seizures a day down to one a month.
But when forced to return home and come off cannabis oil, Alfie's condition immediately deteriorated, which was the motivation for his mother's tireless campaign to get medicinal cannabis prescribed on the NHS.
In 2018, Alfie became the first person to receive an NHS prescription for cannabis. He has recently celebrated two and a half years seizure free since being prescribed medicinal cannabis.
Explaining how her family’s life has changed for the better, the mother-of-two said: ‘Since he’s been on this medicine, he is going to school every day, he’s learning, he’s creating relationships with his peers. I get regular updates from the school with how impressed they are.
‘On the whole his life is very normal which is all we’ve ever wanted as parents.’
As well as improving Alfie’s day-to-day life, Hannah's has changed drastically too. She explained: ‘It has enabled me to get back to work, to pay my tax, to become someone in society that I want to be.
Alfie has recently celebrated two and a half years seizure free since being prescribed the drug
Since the campaign proved to be a success, Alfie has been living a normal and happy life
‘Something that is also very close to my heart is helping him, but also to help me have a better life for my family and this medicine has done that.’
Since returning to work, she has earned the role as the Executive Director of The Medical Cannabis Clinicians Society and works within the medicinal cannabis sector where she continues to campaign for the use of the drug.
She added: ‘When you have a child with a disability you have no normality in our life - especially a chronic disability like Alfie where he’s in hospital all the time.
'My partner and I had no normality in our lives. We weren’t able to go out and do nice things together.'
Both Hannah and her husband, Drew Dingley, 44, are now able to nurture friendships when they did not previously have the opportunity to.
She said: ‘I think society looks at parent carers and thinks “that’s your job, you’re a mother”, but actually none of us go into having children thinking we’ll have a disabled child.
‘I now feel very lucky to be in a position where my son is well and I’m able to be the person in society I want to be.’
Hannah said that Alfie's medicine has provided 'a better life for her family'. Pictured left to right: Hannah Deacon, Alfie Dingley, Drew Dingley, and Annie Dingley | Medical Innovations |
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Nationwide, more than 1.2 million people are estimated to live with HIV, making them eligible to receive medication that can prevent the spread of life-threatening infection. But only roughly a third of those eligible are currently accessing preexposure prophylaxis, or PrEP, which is seen as key to eventually ending the HIV epidemic in the United States.
A set of new recommendations from the U.S. Preventive Services Task Force endorsed two additional medications approved for PrEP: an oral medication and a long-acting injectable, choices that could help narrow existing disparities and enhance access, particularly in communities of color.
“PrEP is the ultimate implementation science challenge,” the task force wrote in the journal JAMA. “At more than 90 percent efficacy when used properly, the only barrier to drastically reducing HIV incidence in the U.S. is addressing the systemic low coverage.”
Graphic by Megan McGrew/PBS NewsHour
Some people prefer to take PrEP as one more pill they take daily, especially if they are needle-averse, said Dr. John Wong, a task force member and a primary care clinician at Tufts Medical Center. But for others, an injection of PrEP medication once every two months may make more sense.
“PrEP is a safe and highly effective way to prevent HIV for people with increased risk,” Wong said. “The good news is we have two new ways to take PrEP.”
In 2019, the task force gave the first oral PrEP medication an A grade, which often acts as a signal to health insurance companies to cover well-vetted medications without asking patients for out-of-pocket costs, Wong said. Since then, the Food and Drug Administration has approved two new forms of the medication – an additional oral form as well as a long-acting injectable formulation. When crafting recommendations, the task force does not consider insurance coverage and instead strictly weighs harms and benefits of a medical intervention, such as a medication or preventative screening. However, the Affordable Care Act compels private insurance companies to cover preventive services that receive the task force’s A or B grade recommendations.
Chart by Megan McGrew/PBS NewsHour
Despite the medical confidence backing this treatment, people’s willingness and awareness of PrEP and its potential might be shaped by an historic lack of trust in the health care system and mistreatment by health care providers, Wong said. Fear of stigma also prevents people from taking full advantage of this medication.
Among people who are eligible to receive PrEP, 78 percent of white people already had begun taking this medication by 2021, according to federal data. By comparison, only 11 percent of Black people who are eligible to take PrEP had started.
This discrepancy may be especially pronounced for vulnerable populations, including people who are unhoused or who are struggling with substance use, as well as people whose work situations make getting a prescription refill logistically difficult, said Carl Schmid, executive director for the HIV+Hepatitis Policy Center.
The task force stressed that the medical community must devote greater efforts to relaying its safety and effectiveness, as well as to explore ways to overcome barriers to access.
“People seeking PrEP must not face any additional barriers as they seek to access the form of PrEP that best meets their individual needs,” Schmid said.
Laura Santhanam is the Health Reporter and Coordinating Producer for Polling for the PBS NewsHour, where she has also worked as the Data Producer. Follow @LauraSanthanam
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Learn more | Disease Research |
- CVS Health is partnering with drugmaker Sandoz to produce a near identical version of the blockbuster arthritis treatment Humira.
- It will be priced more than 80% lower than the current list price of Humira, which is made by drugmaker Abbvie.
- CVS is looking to strengthen its foothold in the biosimilars market, which is expected to grow to $100 billion over the next six years.
CVS Health is partnering with drugmaker Sandoz to produce a near identical version of the blockbuster arthritis treatment Humira that will sell for 80% below the price of the brand-named drug.
The move is part of the company's new venture focused on securing, and in some cases co-producing, biosimilar drugs, which are the equivalent of generic versions of complex gene or protein-based therapies known as biologics.
"We've invested in committing to certain volumes for the U.S. marketplace so that we have a durable supply of product. We want to ensure that once we bring this into the U.S. marketplace, we don't have any supply issues, we have a high-quality biosimilar product available, and it'll be launched at a much lower ... price than the originator molecule that exists," said Prem Shah, CVS Health EVP and chief of pharmacy.
CVS is already one of the leading players when it comes to sourcing generic drugs through Red Oak, its joint venture with Cardinal Health. But it's looking to strengthen its foothold in the biosimilars market, which is expected to grow to $100 billion over the next six years.
The company said Wednesday it's launching a new subsidiary called Cordavis, which will specialize in securing supply of the new biosimilar drugs and will invest in Novartis Pharmaceuticals' generic manufacturing unit, Sandoz.
Sandoz, currently a unit of Novartis, is expected to be spun off as an independent publicly traded firm later this year.
CVS did not disclose the size of the investment for the new biosimilar, trademarked Hyromiz.
The company pledges that the list price of Cordavis Hyromiz will be more than 80% lower than the current list price of Humira, which is made by drugmaker Abbvie. It will launch in the first quarter of 2024.
The first FDA-approved biosimilar for Humira, Amgen's Amjevita, went on sale in January. Eight more biosimilars are expected to come online within the next year, including Hyromiz.
Amgen executives have said demand for the company's biologic appears to be growing, but that securing coverage from health insurers has posed a challenge.
"We're obviously very early innings still in this biosimilar market with Amjevita. And we're seeing clearly what is new payer behavior in light of such a large product having biosimilar competition," said Murdo Gordon, Amgen EVP of commercial operations, on the company's second-quarter earnings call. "The clarity of how pharmacy benefit works with biosimilar uptake, or lack thereof, is becoming clear to us and to other biosimilar manufacturers and other onlookers."
Abbvie reported more than $4 billion in Humira sales in its most recent quarter, which was slightly better than expected. The company says it continues to be offered on health insurer plans at parity with the new biosimilars.
The launch of Cordavis has long been in the works, before the news last week from Blue Shield of California that it was dropping CVS as its pharmacy benefits manager and switching to Mark Cuban's Cost Plus Drug Company, Amazon Pharmacy and others in an effort to save on drug costs.
The news sent CVS shares plunging, but analysts like John Ransom of Raymond James say the selloff was overblown.
At this point, the potential threat from upstarts is not as big as some might fear, especially when it comes to the current biosimilar market for drugs like Humira, Ransom said.
"They either get a big rebate from Abbvie, or they get a big discount from one of the competing biosimilar manufacturers. And that's really where they have the advantage," said Ransom.
Cuban's Cost Plus doesn't have the scale to buy generic or enough shelf space from the manufacturers, he said. | Drug Discoveries |
Unlocking pathways to break down problem proteins presents new treatment opportunities
When targeting problem proteins involved in causing or spreading disease, a drug will often clog up a protein's active site so it can't function and wreak havoc. New strategies for dealing with these proteins can send these proteins to different types of cellular protein degradation machinery such as a cell's lysosomes, which act like a protein wood chipper.
In a new study published in Science on Oct. 20, Stanford chemists have uncovered how one of the pathways leading to this protein "wood chipper" works. In doing so, they have opened the door to new therapeutics for age-related disorders, autoimmune diseases, and treatment-resistant cancers. These findings may also improve therapeutics for lysosomal storage disorders, which are rare but often serious conditions mostly affecting babies and children.
"Understanding exactly how proteins are shuttled to lysosomes to be broken down can help us harness the innate power of a cell to get rid of proteins that cause the human body so much harm," said Carolyn Bertozzi, the Anne T. and Robert M. Bass Professor in the School of Humanities and Sciences and Baker Family Director of Sarafan ChEM-H. "The work done here is a clear look into a typically opaque intracellular process, and it's shining a light on a new world of possible drug discovery."
"The ability to understand the biology of this process means we can use inherent biology that already exists, and harness it to treat disease," said Steven Banik, assistant professor of chemistry in the School of Humanities and Sciences. "These insights offer a unique window into a new type of biology that we haven't really understood before."
Stopping proteins from going rogue
While proteins often do a body good, like help us digest our food or repair torn muscles, they can also be destructive. In cancer, for example, proteins can either become part of the tumor and/or allow for its unchecked growth, cause devastating diseases like Alzheimer's, and build up in the heart to affect how it pumps blood to the rest of the body.
To stop rogue proteins, drugs can be deployed to block a protein's active site and thus stop it from interacting with a cell, which was the standard of therapeutic research for decades. Then 20 years ago, proteolysis targeting chimeras (PROTACs) burst onto the scene, which can engage bad-acting proteins that are already inside a cell, and send them off to be broken down in the lysosome.
PROTACs are currently in clinical trials and have shown efficacy in treating cancer. But they can only target a protein if it is inside the cell, which is only 60% of the time. In 2020, Stanford ChEM-H researchers pioneered a way to reach the other 40% of those proteins through lysosome targeting chimeras (LYTACs), which can identify and mark proteins that are hanging out around the cell, or on a cell's membrane, for destruction.
These findings kicked off a new class of research and therapeutics, but exactly how the process worked wasn't clear. Researchers also noticed that it was difficult to predict when LYTACs would be highly successful or fail to perform as anticipated.
New therapeutic targets
In this work, Green Ahn, Ph.D., then a Stanford graduate student and now a postdoctoral fellow at the University of Washington Institute for Protein Design, and lead author on the study, used a genetic CRISPR screen to identify and characterize the cellular components that modulate how LYTACs degrade proteins.
Through this screening, the team identified a link between the level of neddylated cullin 3 (CUL3)—a protein that plays a housekeeping role in breaking down cellular proteins—and LYTAC efficacy. The exact tie isn't clear yet, but the more neddylated CUL3 present, the more effective LYTACs were.
Measuring the level of neddylated CUL3 could be a test given to determine which patients are more likely to respond to LYTAC therapy. This was a surprise finding, said Bertozzi, as no previous research pointed to this correlation before.
They also identified proteins that block LYTACs from doing their job. LYTACs work by binding to certain receptors on the outside of the cell, which they use to shuttle bad proteins into lysosomes for degradation. However, the researchers saw that proteins bearing mannose 6-phosphates (M6Ps), sugars that decorate proteins destined for lysosomes, will take a seat on those receptors, meaning LYTACs have nowhere to bind. By throwing a wrench into M6P biosynthesis, an increased fraction of unoccupied receptors resulted on the cell surface which could be hijacked by LYTACs.
New biology, new pathways for treatment of disease
In addition to helping develop LYTACs into more effective therapeutics, these discoveries could also lead to new and more effective treatments for lysosome shortage disorders—genetic conditions where the body doesn't have enough or the right enzymes in lysosomes for them to work properly. This can cause toxic build ups of fat, sugars, and other harmful substances, which can lead to heart, brain, skin, and skeletal damage. One common treatment is enzyme replacement therapy, which utilizes similar pathways as LYTACs to travel to lysosomes where they can operate. Understanding how and why LYTACs work means that these enzymes could be delivered more effectively.
The researchers likened this work to an important discovery of how exactly the drug thalidomide works. It was originally prescribed in the 1950s for morning sickness to pregnant women, mostly in the United Kingdom, but was taken off the market in 1961 when it was linked to severe birth defects. However, in the 1990s, it was found to be an effective treatment for multiple myeloma. In 2010, researchers understood how: through degrading proteins, an observation which contributed substantially to the growing field of PROTAC research.
"LYTAC evolution is where the story of thalidomide and PROTACs was 15 years ago," Bertozzi said. "We're learning human biology that wasn't known before."
More information: Green Ahn et al, Elucidating the cellular determinants of targeted membrane protein degradation by lysosome-targeting chimeras, Science (2023). DOI: 10.1126/science.adf6249
Journal information: Science
Provided by Stanford University | Drug Discoveries |
A new study sheds light on the intricate relationship between body weight and reward processing in the brain. The findings, published in Brain Imaging and Behavior, provide evidence that individuals with obesity tend to have more pronounced brain responses to monetary rewards
Obesity is a global health concern with severe public health implications, affecting millions of people. It’s associated with a range of health problems, including heart disease, diabetes, and mental health issues. Researchers were motivated to conduct this study because they wanted to gain a deeper understanding of how our brains are involved in obesity and how they respond to rewards, like delicious food or even monetary incentives.
The new study focused on reward processing, which is how our brains react to pleasurable experiences. This includes the anticipation and enjoyment of things like a tasty meal or receiving a monetary prize. Previous research has shown that reward processing is closely linked to obesity. People with obesity often struggle with impulse control and have altered perceptions of rewarding food cues, which can lead to overeating.
“Obesity is a topic that fascinates us due to its implications in both physical and mental health,” said study author Maike Richter, a licensed clinical psychologist and member of the Translational Psychiatry research group at the Friedrich Schiller University Jena. “We aim to gain a deeper understanding of the neural pathways and mechanisms that are associated with obesity. Reward processing is of particular interest in this regard, as it has consistently been associated with obesity and may lend itself well to concrete avenues for behavior change interventions.”
To dig deeper into this connection between the brain and obesity, the researchers examined specific brain regions known to be involved in reward processing. These regions include the insula, orbitofrontal cortex (OFC), and striatum. They are part of what’s called the “hedonic pathway,” which plays a vital role in our experiences of pleasure and reward.
The insula is known for its role in hunger regulation, emotional processing, and craving, making it a particularly intriguing region for studying reward processing in relation to obesity. The OFC is involved in decision-making and valuing specific rewards, such as tasty foods. The striatum, which includes the nucleus accumbens, caudate, and putamen, is associated with reward anticipation and general pleasure.
The study involved 383 participants recruited in Germany as part of the Münster Neuroimaging Cohort. These participants underwent functional magnetic resonance imaging (fMRI) while engaging in a card guessing game designed to simulate reward processing.
During the game, participants had to make guesses, and they received either monetary rewards or no rewards based on their choices. This setup allowed the researchers to observe how the participants’ brains reacted to the prospect of winning rewards and how these reactions were related to their body mass index (BMI), a measure of body weight relative to height.
The researchers discovered a significant positive relationship between BMI and insula activation. In simpler terms, the more overweight a person was, the more their insula region responded when presented with the possibility of a reward. This finding suggests that the brains of individuals with higher BMIs might be more sensitive to rewarding stimuli.
“The major take away from our study should be that the brains of people with obesity respond more strongly to rewards (money, not just food rewards!) than those of people within the normal weight range,” Richter told PsyPost. “This finding supports previous studies that found aberrations in brain volume in areas that process rewards in participants with obesity.”
Interestingly, when the researchers excluded participants with obesity from their analysis, the link between BMI and heightened reward responses disappeared. This indicates that the connection between body weight and reward processing may be more pronounced in individuals with clinical obesity, rather than those with less severe weight issues.
“Although we found a linear association between BMI and reward response, we were surprised to discover that this association appeared to be mainly driven by participants with obesity,” Richter said. “Changes in brain structure (as opposed to function) have been uncovered across the weight spectrum, so it was surprising that aberrant reward processing seemed to be specific for participants with obesity (BMI over 30).”
The implications of this research are promising, as they open the door to more personalized and effective interventions for obesity. By better understanding how our brains respond to rewards, scientists may unlock new ways to address this pressing public health issue. Nonetheless, it’s crucial to acknowledge the study’s limitations and the need for continued research to uncover the full story behind the brain’s role in obesity.
“This was a cross-sectional study,” Richter explained. “We do not yet know whether an over-responsiveness to rewards is a factor that makes people more prone to overeating and therefore developing obesity, or whether it is a consequence of having obesity. This should be addressed in future longitudinal research with several times of measurement.”
The study, “Higher body weight-dependent neural activation during reward processing“, was authored by Maike Richter, Sophia Widera, Franziska Malz, Janik Goltermann, Lavinia Steinmann, Anna Kraus, Verena Enneking, Susanne Meinert, Jonathan Repple, Ronny Redlich, Elisabeth J. Leehr, Dominik Grotegerd, Katharina Dohm, Harald Kugel, Jochen Bauer, Volker Arolt, Udo Dannlowski, and Nils Opel. | Nutrition Research |
Hospital bosses failed to investigate allegations against Lucy Letby and tried to silence doctors, the lead consultant at the neonatal unit where she worked has told the BBC.
The hospital also delayed calling the police despite months of warnings that the nurse may have been killing babies.
The unit's lead consultant Dr Stephen Brearey first raised concerns about Letby in October 2015.
No action was taken and she went on to attack five more babies, killing two.
Letby has been found guilty of murdering seven babies and attempting to murder six others in a neonatal unit at the Countess of Chester Hospital's, in Cheshire.
The first five murders all happened between June and October 2015 and - despite months of warnings - the final two were in June 2016.
BBC Panorama and BBC News have been investigating how Letby was able to murder and harm so many babies for so long.
Baby serial killer Lucy Letby
We spoke to the lead consultant in the unit - who first raised concerns about Letby - and examined hospital documents. The investigation reveals a catalogue of failures and raises serious questions about how the hospital responded to the deaths.
Dr Brearey says he demanded Letby be taken off duty in June 2016, after the final two murders. Hospital management initially refused.
The BBC investigation also found:
- The hospital's top manager demanded the doctors write an apology to Letby and told them to stop making allegations against her
- Two consultants were ordered to attend mediation with Letby, even though they suspected she was killing babies
- When she was finally moved, Letby was assigned to the risk and patient safety office, where she had access to sensitive documents from the neonatal unit and was in close proximity to senior managers whose job it was to investigate her
- Deaths were not reported appropriately, which meant the high fatality rate could not be picked up by the wider NHS system, a manager who took over after the deaths has told the BBC
- As well as the seven murder convictions, Letby was on duty for another six baby deaths at the hospital - and the police have widened their investigation
- Two babies also died while Letby was working at Liverpool Women's Hospital
Summer 2015: 'Not nice Lucy'
Before June 2015, there were about two or three baby deaths a year on the neonatal unit at the Countess of Chester Hospital. But in the summer of 2015, something unusual was happening.
In June alone, three babies died within the space of two weeks. The deaths were unexpected, so Dr Stephen Brearey, the lead consultant at the neonatal unit, called a meeting with the unit manager, Eirian Powell, and the hospital's director of nursing Alison Kelly.
"We tried to be as thorough as possible," Dr Brearey says. A staffing analysis revealed Lucy Letby had been on duty for all three deaths. "I think I can remember saying, 'Oh no, it can't be Lucy. Not nice Lucy,'" he says.
The three deaths seemed to have "nothing in common". Nobody, including Dr Brearey, suspected foul play.
But by October 2015, things had changed. Two more babies had died and Letby had been on shift for both of them.
By this point, Dr Brearey had become concerned Letby might be harming babies. He again contacted unit manager Eirian Powell, who didn't seem to share his concerns.
In an email, from October 2015, she described the association between Letby and the unexpected baby deaths as "unfortunate". "Each cause of death was different," she said, and the association with Letby was just a coincidence.
Senior managers didn't appear to be worried. In the same month - October 2015 - Dr Brearey says his concerns about Letby were relayed to director of nursing Alison Kelly. But he heard nothing back.
Dr Brearey's fellow consultants were also worried about Letby. And it wasn't just the unexpected deaths. Other babies were suffering non-fatal collapses, meaning they needed emergency resuscitation or help with breathing, with no apparent clinical explanation. Letby was always on duty.
In February 2016, another consultant, Dr Ravi Jayaram, says he saw Letby standing and watching when a baby - known as Baby K - seemed to have stopped breathing.
Dr Brearey contacted Alison Kelly and the hospital's medical director Ian Harvey to request an urgent meeting. In early March, he also wrote to Eirian Powell: "We still need to talk about Lucy".
Three months went by, and another two babies almost died, before in May that year Dr Brearey got the meeting with senior managers he had been asking for. "There could be no doubt about my concerns at that meeting," he says.
But others at the meeting appeared to be in denial. Dr Brearey said Mr Harvey and Ms Kelly listened passively as he explained his concerns about Letby. But she was allowed to continue working.
June 2016: The tipping point
By early June, yet another baby had collapsed. Then, towards the end of the month, two of three premature triplets died unexpectedly within 24 hours of each other. Letby was on shift for both deaths.
After the death of the second triplet, Dr Brearey attended a meeting for traumatised staff.
He says while others seemed to be "crumbling before your eyes almost", Letby brushed off his suggestion that she must be tired or upset. "No, I'm back on shift tomorrow," she told him. "She was quite happy and confident to come into work," he says.
For Dr Brearey and his fellow consultants, the deaths of the two triplets were a tipping point. That evening, Dr Brearey says he called duty executive Karen Rees and demanded Letby be taken off duty. She refused.
Dr Brearey says he challenged her about whether she was making this decision against the wishes of seven consultant paediatricians - and asked if she would take responsibility for anything that might happen to other babies the next day. He says Ms Rees replied "yes".
The following day, another baby - known as Baby Q - almost died, again while Letby was on duty. The nurse still worked another three shifts before she was finally removed from the neonatal unit - more than a year after the first incident.
The suspicious deaths and collapses then stopped.
Letby still wasn't suspended, however.
Instead, she was moved to the hospital's risk and patient safety office. Here she is believed to have had access to sensitive documents relating to the hospital's neonatal unit. She also had access to some of the senior managers whose job it was to investigate her.
On 29 June 2016, one of the consultants sent an email under the subject line: "Should we refer ourselves to external investigation?"
"I believe we need help from outside agencies," he wrote. "And the only agency who can investigate all of us, I believe, is the police."
But hospital managers thought otherwise. "Action is being taken," wrote medical director Ian Harvey in his reply. "All emails cease forthwith."
Two days later, the consultants attended a meeting with senior management. They say the head of corporate affairs and legal services, Stephen Cross, warned that calling the police would be a catastrophe for the hospital and would turn the neonatal unit into a crime scene.
Rather than go to the police, Mr Harvey invited the Royal College of Paediatrics and Child Heath (RCPCH) to review the level of service on the neonatal unit.
In early September 2016, a team from the Royal College visited the hospital and met the paediatric consultants.
The RCPCH completed its report in November 2016. Its recommendations included: "A thorough external independent review of each unexpected neonatal death."
In October 2016, Ian Harvey also contacted Dr Jane Hawdon, a premature baby specialist in London, and asked her to review the case notes of babies who had died on the neonatal unit.
The result was a highly caveated report. According to Dr Hawdon, her report was "intended to inform discussion and learning, and would not necessarily be upheld in a coroner's court or court of law".
It was not the thorough review the consultants had wanted - or the thorough external independent review that the RCPCH had recommended. But even the limited case-note report by Dr Hawdon recommended that four of the baby deaths be forensically investigated.
That did not happen.
Early 2017: Still no police inquiry
In early January 2017, the hospital board met and Mr Harvey presented the findings of the two reviews. Both had recommended further investigation of some of the baby deaths - and yet that message did not reach board members.
Records of the meeting show Mr Harvey saying the reviews concluded the problems with the neonatal unit were down to issues with leadership and timely intervention.
A few weeks later, in late January 2017, the seven consultants on the neonatal unit were summoned to a meeting with senior managers, including Mr Harvey and the hospital's CEO Tony Chambers.
Dr Brearey says the CEO told them he had spent a lot of time with Letby and her father and had apologised to them, saying Letby had done nothing wrong.
According to the doctor's account, the CEO also insisted the consultants apologise to Letby and warned them that a line had been drawn and there would be "consequences" if they crossed it.
Dr Brearey says he felt managers were trying to "engineer some sort of narrative" that would mean they did not have to go to the police. "If you want to call that a cover-up then, that's a cover-up," he says now.
Managers also ordered two of the consultants to attend mediation sessions with Letby, in March 2017. One of the doctors did sit down with the nurse to discuss her grievance, but Dr Brearey did not.
Yet, the consultants didn't back down. Two months after the apology, the hospital asked the police to investigate. It was the consultants who had pushed them into it.
Dr Brearey and his colleagues finally sat down with Cheshire Police a couple of weeks later. "They were astonished," he says.
The next day, Cheshire Police launched a criminal investigation into the suspicious baby deaths at the Countess of Chester Hospital. It was named Operation Hummingbird.
Spring 2018: Evidence of a poisoner
Letby had not yet been arrested and was still working at the hospital's risk and patient safety office. But Operation Hummingbird was in full swing and Dr Brearey was helping the police with their investigation.
Late one evening, he was going through some historic medical records when he discovered a blood test from 2015 for one of the babies on his unit. It recorded dangerous levels of insulin in the baby's bloodstream.
The significance of the test result had been missed at the time.
The body produces insulin naturally, but when it does, it also produces a substance called C-Peptide. The problem with the insulin reading that Dr Brearey was looking at was that the C-Peptide measurement was almost zero. It was evidence the insulin had not been produced naturally by the baby's body and had instead been administered.
"It made me feel sick," Dr Brearey recalls. "It was quite clear that this baby had been poisoned by insulin."
A few months later, Letby was finally arrested and suspended by the hospital. But three years had passed since Dr Brearey had first sounded the alarm.
When a new medical director and deputy chief executive, Dr Susan Gilby, began work the month after Letby's arrest, she was shocked at what she found.
She says her predecessor, Mr Harvey, had warned her she would need to pursue action with the General Medical Council, the doctor's regulator, against the neonatal unit's consultants - those who had raised the alarm.
However, inside a box of files left in his office, she found evidence the problems lay elsewhere. Marked with the word "neonates", the files revealed how a meeting of the executive team in 2015 had agreed to have the first three deaths examined by an external organisation. That never happened.
The management team had also failed to report the deaths appropriately. It meant the wider NHS system could not spot the high fatality rates. The board of the hospital trust was also unaware of the deaths until July 2016.
Dr Gilby says the trust's refusal to call police appeared to be heavily influenced by how it would look. "Protecting their reputation was a big factor in how people responded to the concerns raised," she says.
Later in 2018, after Tony Chambers resigned, Dr Gilby was appointed chief executive and she stayed in post until 2022. She is now suing the trust for unfair dismissal.
Dr Brearey, says hospital managers had been "secretive" and "judgemental" throughout the period leading up to the nurse's arrest.
"There was no credibility given to our opinions. And from January 2017, it was intimidating, and bullying to a certain extent," he tells BBC News. "It just all struck me as the opposite of a hospital you'd expect to be working in, where there's a safe culture and people feel confident in speaking out."
Letby would ultimately be charged with seven murders and 15 attempted murders between June 2015 and June 2016.
She was found guilty of all seven murders and seven attempted murders. She was found not guilty of two counts of attempted murder.
The jury also failed to reach a verdict on a further six counts of attempted murder, including all charges related to babies K and Q.
In a statement, Tony Chambers, the former CEO, said: "All my thoughts are with the children at the heart of this case and their families and loved ones at this incredibly difficult time. I am truly sorry for what all the families have gone through.
"The crimes that have been committed are appalling and I am deeply saddened by what has come to light."
He added: "I will co-operate fully and openly with any post-trial inquiry."
Ian Harvey said: "At this time, my thoughts are with the babies whose treatment has been the focus of the trial and with their parents and relatives who have been through something unimaginable and I am sorry for all their suffering.
"As medical director, I was determined to keep the baby unit safe and support our staff. I wanted the reviews and investigations carried out, so that we could tell the parents what had happened to their children. I believe there should be an inquiry that looks at all events leading up to this trial and I will help it in whatever way I can."
The Countess of Chester Hospital is now under new management and the neonatal unit no longer looks after such sick babies. Since Letby left the unit, there has been only one death in seven years.
Editing and production by Joseph Lee | Epidemics & Outbreaks |
Lawrence Faucette, the 58-year-old patient with terminal heart disease who was the second person to receive a genetically engineered pig heart, died on Oct. 30, according to a statement from the University of Maryland Medical Center in Baltimore, where the transplant was performed.Faucette received the transplant on Sept. 20 and lived for six weeks—less time than the first recipient, despite extra precautions by the Maryland team. Initially, Faucette made progress following his surgery. He was doing physical therapy, spending time with family members, and playing cards with his wife, according to the university. But in the days leading up to his death, his heart began to show signs of organ rejection; in other words, his immune system recognized the pig heart as foreign and attacked it. Rejection is also the biggest challenge with traditional transplants involving human organs.At the University of Maryland Medical Center and elsewhere, researchers have been studying the possibility of transplanting animal organs into people—known as xenotransplantation—as a way to ease the human organ shortage. In the United States alone, more than 103,000 people are on the national transplant waiting list, and 17 people die each day waiting for an organ. Because donor organs are a scarce resource, doctors want to select patients for transplants who are likely to survive the transplant and go on to do well after surgery.Faucette was in end-stage heart failure when he first came to the University of Maryland Medical Center on Sept 14. His heart stopped and he required resuscitation, but he was deemed ineligible for a traditional heart transplant because he was too sick to qualify. A day later, the US Food and Drug Administration granted an emergency authorization for him to receive a genetically engineered pig heart in the hope of extending his life. Faucette consented to the procedure after being fully informed of the risks, according to the university.During the first month of Faucette’s recovery, the pig heart performed well without any initial evidence of rejection. Faucette was even working toward regaining his ability to walk.“We intend to conduct an extensive analysis to identify factors that can be prevented in future transplants,” said Muhammad Mohiuddin, who oversees the university’s xenotransplantation program, in the statement.The first person to receive a genetically engineered pig heart, David Bennett, survived for two months after undergoing the groundbreaking procedure in January 2022. He died of sudden heart failure. The Maryland team concluded that Bennett’s poor health before the transplant and a pig virus found in his transplant heart may have contributed to his death.When speaking with WIRED in December, Bartley Griffith, the surgeon who conducted both transplants, said: “We believe we can avoid some of the pitfalls that we had with David because he did so well for so very long.”The donor pigs used in both surgeries were bred with 10 genetic edits to make their organs more compatible with the human body. Three genes involved in immune rejection were knocked out, while six human genes responsible for immune acceptance were added. The last edit involved removing a gene to prevent excessive growth of the pig heart tissue.With Faucette’s surgery, the Maryland team was taking new steps to screen the donor pig heart for viruses. They were also using a novel antibody therapy, along with conventional anti-rejection drugs, to prevent Faucette’s body from damaging or rejecting the organ. Transplant experts who were not involved with Faucette’s surgery told WIRED last month that they were optimistic about his outcome.This year, researchers at New York University and the University of Alabama at Birmingham have carried out short-term experiments involving genetically engineered pig organs in brain-dead people. The groups hope to launch trials in living patients soon, but Faucette’s death may be a setback for the prospect of xenotransplantation. | Medical Innovations |
An anonymous reader quotes a report from MIT Technology Review: Egbert Edelbroek was acting as a sperm donor when he first wondered whether it's possible to have babies in space. Curious about the various ways that donated sperm can be used, Edelbroek, a Dutch entrepreneur, began to speculate on whether in vitro fertilization technology was possible beyond Earth -- or could even be improved by the conditions found there. Could the weightlessness of space be better than a flat laboratory petri dish? Now Edelbroek is CEO of SpaceBorn United, a biotech startup seeking to pioneer the study of human reproduction away from Earth. Next year, he plans to send a mini lab on a rocket into low Earth orbit, where in vitro fertilization, or IVF, will take place. If it succeeds, Edelbroek hopes his work could pave the way for future space settlements.
"Humanity needs a backup plan," he says. "If you want to be a sustainable species, you want to be a multiplanetary species." Beyond future space colonies, there is also a more pressing need to understand the effects of space on the human reproductive system. No one has ever become pregnant in space -- yet. But with the rise of space tourism, it's likely that it will eventually happen one day. Edelbroek thinks we should be prepared. Despite the burgeoning interest in deep space exploration and settlement, prompted in part by billionaires such as Elon Musk and Jeff Bezos, we still know very little about what happens to our reproductive biology when we're in orbit. A report released in September by the US National Academies of Science, Engineering, and Medicine points out that almost no research has been done on human reproduction in space, adding that our understanding of how space affects reproduction is "vital to long-term space exploration, but largely unexplored to date."
Some studies on animals have suggested that the various stages of reproduction -- from mating and fertilization to embryo development, implantation, pregnancy, and birth -- can function normally in space. For example, in the very first such experiment, eight Japanese medaka fish developed from egg to hatchling aboard the space shuttle Columbia in 1994. All eight survived the return to Earth and seemed to behave normally.Yet other studies have found evidence that points to potential problems. Pregnant rats that spent much of their third trimester -- a total of five days -- on a Soviet satellite in 1983 experienced complications during labor and delivery. Like all astronauts returning to Earth, the rats were exhausted and weak. Their deliveries lasted longer than usual, likely because of atrophied uterine muscles. All the pups in one of the litters died during delivery, the result of an obstruction thought to be due in part to the mother's weakened state.
To Edelbroek, these inconclusive results point to a need to systematically isolate each step in the reproductive process in order to better understand how it is affected by conditions like lower gravity and higher radiation exposure. The mini lab his company developed is designed to do exactly that. It is about the size of a shoebox and uses microfluidics to connect a chamber containing sperm to a chamber containing an egg. It can also rotate at different speeds to replicate the gravitational environment of Earth, the moon, or Mars. It is small enough to fit inside a capsule that can be housed on top of a rocket and launched into space.After the egg has been fertilized in the device, it splits into two cells, each of which divides again to form four cells and so on. After five to six days, the embryo reaches a stage known as a blastocyst, which looks like a hollow ball. At this point, the embryos in the mini lab will be cryogenically frozen for their return to Earth.
"Humanity needs a backup plan," he says. "If you want to be a sustainable species, you want to be a multiplanetary species." Beyond future space colonies, there is also a more pressing need to understand the effects of space on the human reproductive system. No one has ever become pregnant in space -- yet. But with the rise of space tourism, it's likely that it will eventually happen one day. Edelbroek thinks we should be prepared. Despite the burgeoning interest in deep space exploration and settlement, prompted in part by billionaires such as Elon Musk and Jeff Bezos, we still know very little about what happens to our reproductive biology when we're in orbit. A report released in September by the US National Academies of Science, Engineering, and Medicine points out that almost no research has been done on human reproduction in space, adding that our understanding of how space affects reproduction is "vital to long-term space exploration, but largely unexplored to date."
Some studies on animals have suggested that the various stages of reproduction -- from mating and fertilization to embryo development, implantation, pregnancy, and birth -- can function normally in space. For example, in the very first such experiment, eight Japanese medaka fish developed from egg to hatchling aboard the space shuttle Columbia in 1994. All eight survived the return to Earth and seemed to behave normally.Yet other studies have found evidence that points to potential problems. Pregnant rats that spent much of their third trimester -- a total of five days -- on a Soviet satellite in 1983 experienced complications during labor and delivery. Like all astronauts returning to Earth, the rats were exhausted and weak. Their deliveries lasted longer than usual, likely because of atrophied uterine muscles. All the pups in one of the litters died during delivery, the result of an obstruction thought to be due in part to the mother's weakened state.
To Edelbroek, these inconclusive results point to a need to systematically isolate each step in the reproductive process in order to better understand how it is affected by conditions like lower gravity and higher radiation exposure. The mini lab his company developed is designed to do exactly that. It is about the size of a shoebox and uses microfluidics to connect a chamber containing sperm to a chamber containing an egg. It can also rotate at different speeds to replicate the gravitational environment of Earth, the moon, or Mars. It is small enough to fit inside a capsule that can be housed on top of a rocket and launched into space.After the egg has been fertilized in the device, it splits into two cells, each of which divides again to form four cells and so on. After five to six days, the embryo reaches a stage known as a blastocyst, which looks like a hollow ball. At this point, the embryos in the mini lab will be cryogenically frozen for their return to Earth. | Medical Innovations |
For most people, the first drink or two of alcohol produces a pleasant buzz. The sensation is caused by the feel-good chemical dopamine flooding the brain’s reward system. But for some, drinking loses its euphoric effects. Chronic alcohol abuse lowers dopamine levels, and it takes heavier drinking to maintain those good feelings. Counseling, residential treatment programs, support groups, and medication can help those with alcohol abuse disorder, but many people relapse. What if there were a more long-term fix?“We know that we can get people with alcohol use disorder to stop drinking for short periods of time,” says Kathleen Grant, a neuroscientist at Oregon Health & Science University. “But the desire to drink again often supersedes taking their medications.”Now, Grant is among a group of US researchers who are trying a new approach: using gene therapy to reset the brain's dopamine pathway. In a study published today in the journal Nature Medicine, they found that an experimental therapy injected into the brains of monkeys dramatically curbed their drinking over the course of a year.Researchers gave the gene therapy to four rhesus macaques who had been given increasing doses of alcohol until they developed an addiction to it. The animals were then allowed to drink as much as they wanted.The group’s approach involved delivering a gene that makes the GDNF protein, short for glial-derived neurotrophic factor. In previous studies, this protein has been shown to stimulate the production of dopamine. For this experiment, researchers packaged the GDNF gene into engineered viruses, which are used for their ability to carry genetic material into cells. After making two small holes in either side of each animal’s skull, they injected the viruses into a bundle of neurons near the brainstem known as the ventral tegmental area. Neurons there are involved in reward processing, making dopamine and distributing it throughout the brain.At the start of the experiment, the macaques were voluntarily consuming the equivalent of about nine drinks a day for a human. After administering the therapy just once, the team imposed an initial abstinence phase of eight weeks on the monkeys, and then allowed them to drink again for four weeks, offering water alongside alcohol. They repeated this challenge five more times over the course of a year, alternating between a four-week abstinence period and a four-week drinking period.The first time alcohol was reintroduced, the monkeys who had received the gene therapy decreased their drinking by about 50 percent compared to a control group of monkeys that didn’t get the therapy. Every time researchers reintroduced alcohol after an abstinence period, the animals that got the gene therapy drank less than they did before the treatment. By the end of the year, their alcohol consumption dropped by more than 90 percent compared to the control group.Grant was stunned. She had previously studied how primates respond to other drugs for alcohol use disorder, but had never seen such a big dropoff. Not only did it work, but the therapy’s efficacy seemed to improve over time. “It was as if they were learning that the alcohol just wasn't something they wanted to engage in anymore,” says Grant, a senior author on the new paper. Scientists from Wake Forest School of Medicine, The Ohio State University, and University of California, San Francisco, also collaborated on the study.When they conducted postmortem examinations of the monkeys’ brains, the team also confirmed that the treated animals had replenished levels of dopamine. In the untreated animals, dopamine levels remained low.Donita Robinson, a professor of psychiatry and researcher at the University of North Carolina Bowles Center for Alcohol Studies, is impressed that the effects lasted for a year. “These findings support the idea that normalizing dopamine, or perhaps just boosting the levels of beneficial growth factors like GDNF, could be a useful strategy for reducing the drive to drink alcohol,” says Robinson, who wasn’t involved with the experiment.But the dopamine pathway is broadly involved in movement and motivation, so this kind of therapy could potentially influence other behaviors. In fact, the study authors found that the treated monkeys drank less water than their untreated counterparts, and also weren’t as interested in a sugary solution. They drank about 20 percent of the sweet solution compared to untreated animals, who drank all of it. They also lost about 18 percent of their body weight compared to animals in the control group, which is at least partly due to less alcohol consumption. Such changes to dopamine-related behaviors are not necessarily all desirable or positive. Robinson says any further studies should look for changes in mood, mindset, and general activity levels.A handful of one-dose gene therapies are already approved for certain rare cancers and genetic disorders, such as hemophilia B and spinal muscular atrophy. Others are in the works for sickle cell anemia and Type 2 diabetes. The hope is that each treatment’s effects will last for years, or potentially decades.But there are risks to delivering gene therapy to the brain: bleeding, infection, severe immune reactions, and potentially cancer. These treatments can cost hundreds of thousands of dollars—with some in the millions—making them out of reach for anyone whose insurance will not cover them. And it’s not yet clear if they will last long-term. Since the alcohol abuse study was stopped after one year, it’s not known if the benefits would be permanent.Gene therapy’s long-lasting effects are a double-edged sword, says Susan Ferguson, a professor of psychiatry and director of the Addictions, Drug & Alcohol Institute at the University of Washington. “It’s one and done. You can give someone this therapy and they don't have to worry about it,” she says. But if it causes side effects, there’s no way to inactivate it.And Ferguson says any sort of drug should be used alongside therapy or other strategies that address the psychological and behavioral aspects of alcohol abuse.There are already other medical treatments on the market, all of which can be discontinued if needed. The drugs acamprosate and naltrexone also act on the brain. A third medication, disulfiram, works by blocking the body from processing alcohol and creating an unpleasant reaction to it.A gene therapy for addiction raises ethical questions, too. Unlike other gene therapies, this one would involve rewiring the brain and, arguably, influencing a person’s choices and potentially their behavior. Without a way to remove or stop the therapy, would people still choose to undergo it?Grant admits it would be an extreme form of treatment. But some people with alcohol use disorder are very sick and pose a harm to themselves or others. If it moves forward to human testing, she sees the therapy being limited to those with the most severe cases of addiction. “This would be a last resort if all other treatment options fail,” she says. | Drug Discoveries |
New research links the rare neurological condition Guillain-Barré syndrome to covid-19. The study tracked millions of people in Israel, finding that those with a recent history of covid-19 infection were noticeably more likely to develop Guillain-Barré than those without one. Conversely, covid-19 vaccination appeared to be associated with a reduced risk of later having it.
Guillain-Barré syndrome (GBS) is caused when the immune system mistakenly attacks the peripheral nervous system, the network of nerves that connect most everything else to the brain and spinal cord. This damage results in rapid muscle weakness and paralysis that can sometimes be life-threatening when it affects the muscles that control our breathing. Most people with GBS do fully recover, though it can take years for some, and about one-fifth of sufferers can be left with long-term symptoms. Musician Sufjan Stevens revealed last month that he had been receiving treatment for the syndrome.
The condition is incredibly rare, with only around 3,000 to 6,000 cases estimated to occur annually in the U.S. There are several risk factors for GBS, such as being over the age of 50, but the most common seems to be a recent infection. About two-thirds of cases are preceded by having a gastrointestinal or respiratory illness days or weeks earlier. Many germs are considered potential GBS triggers, including the Epstein-Barr virus, influenza, and the foodborne bacteria Campylobacter jejuni.
Given the recent emergence of a new viral disease with covid-19, the study authors wanted to know if the SARS-CoV-2 coronavirus should be added to this lengthy list.
“We wanted to study whether this new virus may lead to GBS like others before it, especially since it was our subjective impression that there is a rise in GBS cases in our everyday practice and we wanted to see whether there was an association or it was merely coincidental,” lead study author Haya Bishara, a neurologist at the Lady Davis Carmel Medical Center in Israel, told Gizmodo in an email.
GBS is thought to be sometimes a rare complication of certain vaccines as well, such as the flu vaccine, though this risk is generally lower than the risk associated with the target disease. So Bishara’s team also investigated any potential connection between the syndrome and the mRNA covid-19 vaccine developed by Pfizer and BioNTech.
The researchers used data from the largest healthcare provider in Israel to track the health of over 3 million people in the country with no previous history of GBS between January 2021 to June 2022. Seventy-six patients in total were newly diagnosed with GBS during that time, and the authors compared their recent medical history (six weeks back) to matched controls in the same population. This comparison revealed a clear pattern in terms of both covid-19 infection and vaccination.
“Our results showed that patients infected with covid-19 have a six-fold increase in their likelihood to develop GBS, while people vaccinated with the Pfizer-BioNTech vaccine had their risk of developing GBS reduced by over 50%,” Bishara said.
Their findings, published Wednesday in the journal Neurology, do line up with past research and case reports suggesting a link between covid-19 and GBS. Other research has similarly found no clear link between GBS and mRNA covid-19 vaccination, though a possible one with other vaccines. And while GBS of any kind is a very rare problem, simply establishing a connection is important, especially given that covid-19 will be a regular part of our lives for the foreseeable future. Bishara also hopes that their research will comfort people worried about the risks of covid-19 vaccination, which will remain a key strategy to reduce the risk of illness and death caused by the disease.
“Misinterpretation of a vaccine’s consequences can lead to very severe repercussions, including abandonment of vaccines altogether and severe preventable diseases. We hope that people reading this article would be more confident now regarding vaccines in terms of both safety and efficacy,” Bishara said.
The team is now focusing on different research, but Bishara would like to see other scientists further investigate why mRNA covid-19 vaccines seem to reduce the chances of GBS. Is it because vaccination is simply reducing the risk of catching covid-19, for instance, or is there another, more direct effect it’s having? | Disease Research |
SEOUL, July 6 (Reuters) - South Korea is suffering from a shortage of paediatricians, partly a result of the world's lowest birth rate and increasingly a factor behind it, leaving hospitals unable to fill posts and raising risks for children's health, doctors say.
The number of paediatric clinics and hospitals in the capital has fallen by 12.5% over the five years to 2022, to just 456. Over the same period, the number of psychiatry clinics increased by 76.8%, while anaesthesiology centres saw a 41.2% rise, according to the Seoul Institute, a public administration think tank.
At the root of the problem is a birth rate that fell to 0.78 in 2022 - that's the average number of babies expected per woman - combined with the failure of the insurance system to adapt to it, leaving paediatrics starved of resources and doctors shunning a field they think has no future, seven paediatricians told Reuters.
The Ministry of Health and Welfare acknowledged "limitations" in the system and said measures were being implemented to address them.
According to ministry data, hospitals were only able to secure the services of 16.3% of the paediatricians they sought in the first half of this year, down from 97.4% in 2013.
For parents, the shortage can mean long waits for treatment for sick children.
One recent morning, the waiting room at a hospital in Seoul's outskirts was packed with dozens of children, many on intravenous drips.
"We had to wait two weeks," said Lee Bo-mi, a 35-year-old mother with a sick 3-year-old boy, at the Healthy Children's Hospital.
"I was really scared. It felt like the sky was falling."
Dr Song Dae-jin at Korea University Guro Hospital said he worried that staff shortages could soon cripple his team's ability to provide emergency care.
"At this rate, we won't be able to last the year," Song said. "It's not a big deal if mild diseases are not seen for a day or two but the consequences of not seeing serious diseases or emergency patients in a timely manner can be devastating."
A five-year-old boy with a respiratory infection died in May after failing to find a hospital bed, sparking a public outcry.
"Patients dying while bouncing around multiple emergency rooms, dying when it's not a serious disease, it's a travesty," said Dr Choi Yong-jae, vice president of the Korea Children's Hospital Association.
'I'M WORRIED'
Doctors say the low fee problem is particular to paediatrics as the insurance system hasn't been revised to reflect fewer child patients. When more babies were growing up, paediatricians could sustain a low price, high volume model but that doesn't apply now.
"In foreign countries, the government pays enough to maintain the hospital even if you see 20 patients a day," said Dr Lim Hyun-taek, president of Korean Pediatric Association, who said fees had not been raised significantly for 30 years.
"But it's about $10 per treatment in Korea so clinics have to see about 80 patients a day."
By comparison, it costs about A$335 for initial standard consultation with an Australian paediatrician, while observation at Nationwide Children's Hospital in the U.S. costs $208 per hour, according to its website.
The health ministry said measures had been introduced this year on fees and insurance compensation to supplement "limitations". It said it had proposed more state-backed centres and requirements for major hospitals to maintain emergency paediatric treatment.
"We understand that there are opinions from doctors saying it is not enough to cope with difficulties in the field. The government plans to steadily implement and continue to supplement the announced measures,” it said.
Data from the Health Insurance Review and Assessment Service shows paediatricians are South Korea's lowest paid doctors, making 57% less than the average doctor's salary.
Hospitals are feeling the crunch.
Sowha Hospital, South Korea's oldest children's hospital, recently suspended Saturday afternoon and Sunday treatment for the first time in 77 years due to a lack of staff.
Some hospitals have reduced night-time treatment and shut children's emergency rooms.
The situation is so alarming that some couples say it is adding to their doubts about having babies despite government efforts to reverse the sliding birth rate with billions of dollars a year on childcare subsidies.
"I'm worried," said Kim Eun-ji, a 34-year-old mother of a baby boy, referring to the prospect of a second child.
"If the number of children's hospitals decreases and the number of doctors falls, it's going to be difficult to get children treated."
'TOO RISKY'
Echoing that, Lee Ju-yul, professor of health administration at Namseoul University, said the failure to allocate resources to paediatric care undermined the impact of the "huge" amounts spent on boosting the birth rate.
"We must take some of the budget so parents feel there's going to be no difficulty with healthcare when they give birth," Lee said.
The Korean Pediatric Association recently organised a seminar for hundreds of members looking to switch into new areas including the booming beauty business.
Its president, Lim, said paediatrics was just too much of a gamble given the income prospects.
"Some doctors love to treat children ... Now, it's too risky," he said.
Our Standards: The Thomson Reuters Trust Principles. | Global Health |
Ohio will vote on marijuana legalization. Advocates say there's a lot at stake
Voters in Ohio will decide next week whether to legalize recreational marijuana
COLUMBUS, Ohio -- Voters in Ohio will decide next week whether to legalize recreational marijuana, but people on both sides of the issue say more hangs in the balance than simply decriminalizing the drug.
Supporters of legalization say Ohio can reclaim tax revenue being lost to states such as Michigan, where marijuana is legal, and take power from illegal drug markets through government regulation. But opponents warn of increased workforce and traffic accidents by people under the influence, and argue much of the revenue will land in the pocket of the marijuana industry, not taxpayers.
Issue 2 on the Nov. 7 ballot would allow adults 21 and over to buy and possess up to 2.5 ounces (71 grams) of cannabis and 15 grams (about a half-ounce) of extract, and to grow up to six plants per individual through a government program. A 10% tax would be imposed on any purchases, with those proceeds going toward administrative costs and addiction treatment in the state and to municipalities that host dispensaries.
It would also create a social equity program to give a financial boost to people who want to start a business selling or growing cannabis and who meet certain criteria. They or a family member would need to have had a past run-in with the law for marijuana, and be part of a disadvantaged group based on race, gender, disability or economic considerations.
The program would fall under the Division of Cannabis Control in the state Department of Commerce, an office that will fashion the rules around licensing, testing and product standards, among other regulations.
If it passes, Ohio would become the 24th state to legalize recreational marijuana for adult use, a move that supporters say socially and financially makes sense for the state.
“We’re taking money away from drug dealers and Michigan dispensary owners and putting it back into the pockets of our local governments,” said Tom Haren, spokesperson for the pro-legalization campaign Regulate Marijuana Like Alcohol.
The measure also gives those with marijuana-related arrests and convictions, as well as their loved ones, a chance to benefit from the industry once possession of cannabis is no longer illegal. Haren said a marijuana charge can make life much harder for people and has a “downstream effect” on their families.
Issue 2, should it pass, would also create greater access for those who may not be able to afford medical marijuana through their insurance or get a doctor to sign off on it. This includes veterans, according to Haren, who usually get their insurance through the federal government — which has not cleared marijuana for medical or recreational use.
But even if it gets the needed votes Tuesday, the future of marijuana use will not be entirely set.
As a citizen-initiated statute, the measure went first to the Republican-dominated Legislature. Lawmakers had four months to pass it, under state law. But with many — if not all — GOP legislators heartily against it, the measure did not move.
After the election, if it passes, state law calls for the measure to return again to the Legislature, where lawmakers can tweak it to their liking. They can also vote to repeal it entirely, as GOP Senate President Matt Huffman has indicated could happen.
Opponents of Issue 2, including Ohio prosecutors and the Ohio Chamber of Commerce, are in line with Huffman.
“There's legalization, which generally people have a live-and-let-live attitude about. And then there's Issue 2,” said Scott Milburn, spokesperson for Protect Ohio Workers and Families, the main campaign against the issue.
The measure, opponents say, gives around one third of the revenue in that 10% tax revenue back to the marijuana industry — making it more of a benefit to marijuana corporations and small businesses than to taxpayers.
And according to Ohio Treasurer Robert Sprague, the portion allotted for costs such as addiction treatment and administration under the 10% tax isn't enough, and the tax would at least need to be doubled to pay for what the measure says it would.
The Ohio Prosecuting Attorneys Association has also cautioned that legalization could lead to greater traffic and workforce accidents, as well as increased substance abuse among state residents.
Last year, a study by the by the National Highway Traffic Safety Administratio n found that 54% of injured or killed drivers had drugs or alcohol in their systems, with tetrahydrocannabinol (THC), an active ingredient in marijuana, the most prevalent.
The study looked at over 7,000 cases from seven different hospitals around the country from 2019 to 2021, but the authors of the study cautioned that it's not indicative of drivers nationwide, especially when tracking data on marijuana use and traffic accidents is still so new.
___
Samantha Hendrickson is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues. | Health Policy |
As if you needed another reason to avoid picking your nose, the unsanitary habit could increase the risk of contracting COVID, according to a new study from Amsterdam University Medical Centers.
A total of 219 health care workers in the Netherlands completed a survey on their habits and physical features, then were later tested for COVID antibodies between March and October 2020.
A total of 185 respondents (85%) admitted to "habitual" nose-picking on a monthly, weekly or daily basis. These health care workers were found to have a higher incidence of COVID infections compared to those who refrained from the habit, according to a discussion of the findings in the journal PLOS ONE.
Younger respondents were more likely to pick their noses — and more males than females did so.
Among the types of workers, doctors were the most likely to be nose-pickers, followed by medical residents, specialists, support staff and nurses.
There was no association found between COVID and other behavioral or lifestyle features, such as nail-biting, wearing glasses or having a beard, per the study findings.
The researchers determined that the nasal cavity is a "main transit port" for SARS-CoV-2, the coronavirus that causes COVID-19.
"Nose-picking may facilitate viral entry by directly introducing virus particles present on the hands to the nose, thus facilitating infection," they wrote.
"The viral load in the nasal mucosa is high in the days after contracting a SARS-CoV-2 infection, even before the onset of symptoms and in patients who remain asymptomatic."
Health care workers who have COVID and who pick their noses could "contaminate the work environment" — and cause further spread of the virus, the journal entry stated.
"SARS-CoV-2 transmission (among health care workers) is an important problem in hospitals; perhaps the role of nose-picking is underestimated in this regard," the researchers wrote.
Dr. Joseph P. Iser, recently retired chief health officer for the Southern Nevada Health District (SNHD) and a member of the ACPM Board of Regents, was not involved in the study but said the findings did not surprise him.
"When someone picks his or her nose, they do often scratch the mucosa with their nail," he told Fox News Digital.
"Even washing hands may not completely prevent environmental contamination."
"They can also pull out nose hair, and they likely spread mucous around their nose. Some people actually do ingest their dried (or even wet) mucous."
He added, "We already have known for years that people, especially health care workers, can spread other facial or nasal bacteria, such as Staphylococcus, to others nearby."
Nose-picking in general should be avoided, Iser said.
"Even washing hands may not completely prevent environmental contamination," he said. "Scratching the mucosa or pulling out embedded hairs can cause significant infections. This could be true, especially in people with some range of immune deficiency, including those with diabetes and people who use steroids or are taking immunosuppressive medications."
COVID-19, influenza and RSV are the three main respiratory viruses causing most illnesses, Iser noted.
"There are now vaccines for all three, with RSV being the most recently approved vaccine," he said. "I’d strongly recommend that people get all three. Talk to your doctor about any risks and benefits."
Given the increased risk of COVID spread posed by nose-picking, the study investigators recommend that health care facilities create more awareness through educational sessions and guidelines that recommend against the behavior. | Epidemics & Outbreaks |
One More Infected With Nipah In Kerala; Efforts On To Save Life Of Critically Ill Nine-year-old Boy
A 24 year-old health worker has become Kerala's fifth confirmed Nipah case since its recent outbreak, as the government stepped up its efforts to cure a 9 year-old boy suffering from the deadly infection by ordering the only anti-viral treatment available.
A 24 year-old health worker has become Kerala's fifth confirmed Nipah case since its recent outbreak, as the government stepped up its efforts to cure a 9 year-old boy suffering from the deadly infection by ordering the only anti-viral treatment available.
The government has ordered monoclonal antibody from ICMR to treat the child. It is the only available anti-viral treatment for Nipah virus infection, though it has not been clinically proven yet.
The virus strain seen in the state was the Bangladesh variant that spreads from human to human and has a high mortality rate, though it is less infectious, the government said.
The health worker employed at a private hospital in Kozhikode has been confirmed with Nipah virus infection after his samples turned positive, a statement from Kerala Health Minister Veena George said.
George further said the 9 year-old boy is on ventilator support at a hospital in Kozhikode, and his condition remains critical.
'We have ordered the monoclonal antibody with the ICMR (Indian Council of Medical Research) and it would be brought to Kozhikode soon. The imported medicine is already available with the ICMR,' she said.
The minister said the condition of all 76 people who are in the high-risk contact category remains stable.
She said 13 persons who have mild symptoms are now being monitored in the hospital, and only the child is in the Intensive Care Unit.
Testing of the samples is done regularly in the labs at Kozhikode Medical College and Thonnakkal virology lab, she said, adding the samples of those with intense symptoms will be sent to National Institute of Virology (NIV), Pune.
She was talking to the media in Thiruvananthapuram after attending a review meeting chaired by Chief Minister Pinarayi Vijayan in the wake of the brain-damaging virus that killed two people and infected as many in Kozhikode district.
The minister said the district collector has been authorised to issue orders directing people to avoid mass gatherings in Kozhikode till September 24.
'The district collector can decide whether to issue such a direction and the duration as per her analysis of the situation,' George said.
The high-level meeting chaired by the CM analysed the situation thoroughly and 'we have come to the conclusion that all the possible prevention measures are in place and there is no need to panic', she said.
Volunteer teams will be set up in the containment zones with the help of the people in the area, and these persons will be selected by the panchayats.
None of the 156 health workers who came into contact with the Niapah patients are in the high-risk category, as they had followed the basic infectious disease control protocol.
She said long-term surveillance is already in place, and any patient who comes in with symptoms of encyphalitis is tested for a possible Nipah virus infection.
The minister also said the WHO and ICMR studies had found out that the entire state of Kerala is prone to getting such infections, not just Kozhikode.
People living in forest areas have to take the highest precautions, George said, adding the latest case of the Nipah virus originated within five kilometres of a jungle area.
More than 200 persons have been given counselling through the call centres, the minister said.
She said some members of a central team have already reached Kozhikode, and others were expected on Thursday. The centre team also consists of a bat surveillance unit, which will be visiting the containment zones on Thursday.
Meanwhile, four more wards—three in Villyapally and one in Purameri Panchayats in Kozhikode district have been declared as containment zones in addition to those announced on Tuesday.
Considering the serious nature of the disease, the Kozhikode administration has already declared seven village panchayats--Atanchery, Maruthonkara, Tiruvallur, Kuttiyadi, Kayakkodi, Villyapalli, and Kavilumpara as containment zones.
No travel in or out of these containment zones will be allowed till further notice. The police have been asked to cordon off these areas.
Only stores selling essential commodities and medical supplies will be allowed to function.
Shops selling essential goods will be allowed to function from 7 am to 5 pm. No time bar has been given for pharmacies and health centres.
Local self-government institutions and village offices can function with minimum staff. Banks, other government or quasi-government institutions, educational institutions, and anganwadis should not operate, the district collector said.
The public should use online services and avoid going to local self-government institutions, she said.
Buses or vehicles plying on national highways through the containment zones should not stop in the affected areas.
Earlier in the day, responding to a query regarding the Nipah infection in the assembly, George said the virus strain seen in Kerala was the Bangladesh variant that spreads from human to human and has a high mortality rate, though it is less infectious.
She said that besides the teams from NIV, Pune, a group of epidemiologists would reach Kerala from Chennai to carry out a survey.
Additionally, the ICMR has agreed to fly down the monoclonal antibodies that are required to treat Nipah patients, she told the House.
Responding to submissions, George said that the state has two labs -- the Institute of Advanced Virology at Thonnakkal here and the Kozhikode Medical College -- to test and confirm Nipah, but they do not have the permission to declare the same.
'That permission is only with NIV, Pune. We are taking steps to obtain permission to declare Nipah at the two labs here,' she said.
George also said that the treatment protocols were first issued in 2018, during the Nipah outbreak then, and later it was improved upon in 2021 and that was being followed presently also.
'There have been no complaints about the protocols. They are formulated by medical and health experts. If any changes are required to be made to them, the same will be done,' she said. | Epidemics & Outbreaks |
Maria Stavreva/Getty Images
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A study of nearly 300,000 people in the U.K. found that people who maintained at least five of seven healthy habits cut their risk of depression by 57%.
Maria Stavreva/Getty Images
A study of nearly 300,000 people in the U.K. found that people who maintained at least five of seven healthy habits cut their risk of depression by 57%.
Maria Stavreva/Getty Images
If an ounce of prevention is worth a pound of cure, here's a strategy that may help boost your mental health: Spend the next week observing your daily habits. You can jot them down in a journal to keep track.
How well are you sleeping? Are you eating foods that nourish you? Did you make time for a favorite hobby and exercise? Did you gather with friends or loved ones?
Your answers to these questions may help explain your mood — and your risk of depression too. In fact, a new study finds that people who maintain a broad range of healthy habits, from good sleep to physical activity to strong social connections, are significantly less likely to experience episodes of depression. Researchers used Mendelian randomization — using genetics to study behavior — to confirm a causal link between lifestyle and depression. They found a reduction in the risk of depression held up even among people who have genetic variants that make them more susceptible.
"I think the biggest surprise is that if you have a favorable lifestyle, you can reduce the risk of your getting depression by 57%, which is really quite a massive amount," says study author Barbara Sahakian, a clinical psychologist and neuroscientist at the University of Cambridge.
The study included data from nearly 300,000 people in the UK Biobank database initiative. Researchers identified seven healthy habits and found that people who maintained most of them — five or more— cut their risk of depression by 57%. Researchers also analyzed markers of inflammation, including C-reactive protein, which is linked to depression, and found that a healthy lifestyle is linked to better scores. C-reactive protein concentrations rise in response to inflammation.
Of course, serious depression needs to be treated, and medications and therapy help many people feel better. But in recent years, as science has evolved, it has become clear that depression is not just a chemical imbalance. It's much more complex, and increasingly, a body of evidence points to the importance of habits and behaviors to help keep mental health strong.
1. The power of rest
At the top of the list is a good night's rest. Sleeping seven to nine hours per night, on average, reduced the risk of depression by about 22% in the study. "A lot of us think of sleep as a kind of a passive process, but it's an incredibly active process," Sahakian says.
Not only does sleep enable us to consolidate memories, helping us remember what we've learned during the day, but research shows it plays a key role in keeping our immune systems strong. For instance, a well-rested person is better at fending off the common cold. And though dreaming is still a bit of a mystery, the idea that dreams may help us regulate our emotions goes back decades.
If you have insomnia or trouble sleeping, there's lots of evidence that these strategies, based on cognitive behavioral therapy, can help.
2. Exercise is an elixir
There's a solid body of evidence linking physical activity to improved moods. A previous study, based on data from Centers for Disease Control and Prevention surveys, found that people who exercise regularly report fewer days of bad mental health.
And a recent meta-analysis found that physical activity was more effective than medications in reducing symptoms of depression. Antidepressant medicines tend to be faster in treating an episode of depression, says Douglas Noordsy, a psychiatrist with the Stanford Lifestyle Medicine Program. "But physical exercise has more durable effects than an antidepressant does," he says.
For some people, medication gives them a benefit in the beginning, but then it fades over time, Noordsy says. "Whereas a lifestyle change can have a more permanent and lasting effect." Noordsy and his colleagues use a range of evidence-based recommendations and tools, from medicines to therapy to behavioral approaches including fitness, nutrition, sleep and stress management, to help empower patients.
3. Good nourishment is a necessity
The researchers found that people who maintained a healthy pattern of eating were less likely to have an episode of depression. "I always recommend the Mediterranean diet or the MIND diet," says Sahakian. Multiple studies show that a plant-forward approach — full of greens, vegetables, berries, whole grains, lean proteins including beans and healthy fats including nuts — can help reduce the risk of disease.
The MIND diet is a mashup of a Mediterranean diet and the DASH diet, which has been shown to reduce hypertension, diabetes, heart attack and stroke. One study found that eating a salad each day is tied to sharper memory and slower cognitive decline among healthy seniors.
And a randomized controlled trial found that college students who followed a Mediterranean diet improved their depression scores after three weeks, whereas depression scores among students who continued to eat lots of refined carbohydrates, ultraprocessed foods and sugary snacks and drinks remained higher.
4 & 5. Limit alcohol and don't smoke
Having a glass of wine or a beer helps many people feel relaxed, but limiting alcohol consumption to one drink a day or less for women and two drinks a day or less for men is the recommendation in the Dietary Guidelines for Americans. People who regularly consume more than this amount have an increased risk of certain cancers and a higher risk of depression. Why?
People think of alcohol as a pick-me-up, but actually alcohol is a central nervous system depressant that slows down brain activity. The more you drink, the more you chase the temporary high, which can increase the risk of dependence.
There are lots of strategies to help people drink less, and increasingly, as the sober-curious movement grows, there are people taking a break from drinking.
And when it comes to smoking, there's loads of evidence that tobacco is not a healthy habit. And there are programs to help people quit, including medications, therapy and smoke-free apps.
6. Limit sedentary time by cutting back on screen time
At a time when cultural norms and the pull of technology are leading to more time in front of screens, there's growing evidence that this can harm our physical and mental health. "Sedentary behavior is very bad," Sahakian says.
Humans are meant to move, and though binge-watching your favorite streaming shows may be fun in the moment, if this behavior sets in as a daily habit, you're probably spending too much time on the sofa and not enough time interacting with people or moving.
"The rate of mental health problems is increasing in close correlation with the deterioration in lifestyle factors," Noordsy says. As helpful as smartphones and internet-based technologies are in making our lives convenient, it's common for people to sit for hours and hours playing video games or scrolling.
"We know that long periods of being sedentary are an independent risk factor for depression, independent from how much exercise you get," Noordsy says. So even if you go out for a 30-minute jog or bike ride every day, if you then spend most of the day in front of a screen, it can have a deleterious effect on your mental health.
This is a particular concern for young people who spend a lot of time on social media. At a time when teenagers are facing high rates of depression, anxiety and loneliness, there is mounting evidence that social media can exacerbate and even cause these problems.
Here are some effective strategies to help people cut back on screen time, including scheduling a one-day break each week and turning off notifications, bells and chimes, so we feel less tethered to our devices.
7. Cultivate friendships and social connections through hobbies
This may sound obvious, but spending time with people we like, especially when we're engaged in activities we like, helps boost our mood. Another new study, published in Nature Medicine, based on surveys of people in 16 countries, finds that people 65 and older who have hobbies report higher life satisfaction and less depression.
Noordsy says people tend to know about the connections between crossword puzzles and the slowing of cognitive decline, but there's not as much awareness that hobbies, whether it's gardening, knitting, painting, playing games or volunteering, can help boost our moods. As the authors of the study point out, hobbies involve imagination, novelty, creativity, relaxation and stimulation.
"It's really nice to have a specific effect on mental health," Noordsy says of the new study. "Hobbies really involve aspects of creativity and engagement," compared with the passive pursuits of watching TV or scrolling social media, he says. Whether it's knitting or playing bridge — hobbies that may be familiar to our grandparents — "they keep us connected in ways that people have been connected over generations," Noordsy says.
The takeaway
Just as we can take steps to reduce our risk of chronic diseases, the research shows we can also take steps to reduce the risk of depression, Sahakian says. And oftentimes, the same strategies that promote physical health are also good for our mental health.
It's probably not possible to eliminate depression, which afflicts millions of Americans. Many people do improve with medicines and therapy, and now there's a growing body of evidence to show lifestyle medicine can help people alter their behaviors. "I certainly see some people who can effectively manage their symptoms with lifestyle interventions," Noordsy says. The key is for people to get the support they need to navigate change. | Mental Health Treatments |
Senators hail federal recommendation to ease restrictions on marijuana
The U.S. Department of Health and Human Services has delivered a recommendation to the Drug Enforcement Administration on marijuana policy, and Senate leaders hailed it Wednesday as a first step toward easing federal restrictions on the drug.
Health Secretary Xavier Becerra said Wednesday on X, the platform formerly known as Twitter, that his agency has responded to President Biden’s request “to provide a scheduling recommendation for marijuana to the DEA.”
“We’ve worked to ensure that a scientific evaluation be completed and shared expeditiously,” he added.
Senate Majority Leader Charles E. Schumer said in a statement that Health and Human Services had recommended that marijuana be moved from a Schedule I to a Schedule III controlled substance.
“HHS has done the right thing,” Schumer (D-N.Y.) said. “DEA should now follow through on this important step to greatly reduce the harm caused by draconian marijuana laws.”
California’s legalization of recreational cannabis in 2016 ushered in a multibillion-dollar industry. But many of the promises of legalization have proved elusive.
Rescheduling the drug would reduce or potentially eliminate criminal penalties for possession. As a Schedule I drug, marijuana is currently classified alongside heroin and LSD.
According to the DEA, Schedule I drugs “have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.”
Schedule III drugs “have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence.” They currently include ketamine and some anabolic steroids.
Biden requested the review in October 2022 as he pardoned thousands of Americans convicted of “simple possession” of marijuana under federal law.
Biden urged governors to follow suit in his announcement, just weeks before elections that will decide whether Democrats retain control of Congress.
Senate Finance Committee Chairman Ron Wyden (D-Ore.) issued a statement calling for marijuana to be completely descheduled.
“However, the recommendation of HHS to reschedule cannabis as a Schedule III drug is not inconsequential,” he added. “If HHS’s recommendation is ultimately implemented, it will be a historic step for a nation whose cannabis policies have been out of touch with reality.”
Bloomberg News first reported on the Health and Human Services Department recommendation.
In reaction to the Bloomberg report, the nonprofit U.S. Cannabis Council said: “We enthusiastically welcome today’s news. ... Rescheduling will have a broad range of benefits, including signaling to the criminal justice system that cannabis is a lower priority and providing a crucial economic lifeline to the cannabis industry.” | Drug Discoveries |
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SHREVEPORT, La. (AP) — The U.S. Drug Enforcement Administration has allowed one of the nation’s largest wholesale drug distributors to keep shipping highly addictive painkillers for nearly four years after a judge recommended it be stripped of its license for its “cavalier disregard” of thousands of suspicious orders fueling the opioid crisis.
The DEA did not respond to repeated questions from The Associated Press about its handling of the case against Morris & Dickson Co. or the involvement of a high-profile consultant the company had hired to stave off punishment and who is now DEA Administrator Anne Milgram’s top deputy.
But the delay has raised concerns about how the revolving door between government and industry may be impacting the DEA’s mission to police drug companies blamed for tens of thousands of American overdose deaths.
“If the DEA had issued its order in a timely manner, one could then credibly believe that its second-in-command was not involved despite an obvious conflict of interest,” said Craig Holman, an ethics expert at the watchdog group Public Citizen in Washington. “The mere fact that its action has been delayed four years just raises red flags. It casts the entire process under grave suspicion.”
Last week, after the AP reached out to the DEA for comment, the agency broke its silence on the issue and abruptly notified Morris & Dickson that it has decided to revoke its registration to distribute controlled substances, according to two people familiar with the development who spoke on the condition of anonymity to discuss the exchange. However, no final order has yet been published. The company has described revocation as a “virtual death sentence” and is almost certain to challenge the decision in federal court.
READ MORE: Myths about fentanyl persist as opioid continues to cause overdose deaths
Louis Milione, who was named DEA’s principal deputy administrator in 2021, did not respond to requests for comment. He retired from the DEA in 2017 after a storied 21-year career that included two years leading the division that controls the sale of highly addictive narcotics. Like dozens of colleagues in the DEA’s powerful-but-little-known Office of Diversion Control, he quickly went to work as a consultant for some of the same companies he had been tasked with regulating, including Morris & Dickson.
Milione was brought in by Morris & Dickson as part of a $3 million contract to save its registration to supply painkillers after the DEA accused the company in 2018 of failing to flag thousands of suspicious, high-volume orders.
Testifying in 2019 before federal Administrative Law Judge Charles W. Dorman, Milione argued that Morris & Dickson “spared no expense” to overhaul its compliance systems, cancel suspicious orders and send daily emails to the DEA spelling out its actions.
But those efforts were too little, too late, the judge wrote in a 159-page recommendation which has not been previously reported and was recently obtained by the AP. Anything less than the most severe punishment, he said, “would communicate to DEA registrants that despite their transgressions, no matter how egregious, they will get a mere slap on the wrist and a second chance so long as they acknowledge their sins and vow to sin no more.”
“Acceptance of responsibility and evidence of remediation are not get-out-of-jail-free cards that erase the harm caused by years of cavalier disregard,” Dorman wrote. “Allowing the respondent to keep its registration would tell distributors that it is acceptable to take a relaxed approach to DEA regulations until they are caught, at which point they only need to throw millions of dollars at the problem to make the DEA go away.”
Shreveport, Louisiana-based Morris & Dickson, the nation’s fourth-largest wholesale drug distributor with $4 billion a year in revenue and nearly 600 employees, has said losing its license would effectively shut it down and have a “catastrophic” effect on patients in 29 states.
In a statement to AP, the company said it has invested millions of dollars in compliance systems, executives and advisors. “If DEA attempts to revoke our license for previous actions, the company will vigorously appeal and seek a stay in federal court,” it said. “We are confident we will achieve an outcome that safeguards the supply chain for all of our healthcare partners and the communities they serve.”
READ MORE: How the opioid crisis is driving deaths and abuse in prisons
Neither Milgram nor two DEA administrators who preceded her have taken any enforcement action since Dorman’s 2019 recommendation, allowing Morris & Dickson to continue operating even as it pursued a potential settlement. Former DEA officials told AP a nearly four-year wait in such a case is highly unusual, noting it rarely takes the agency more than two years to issue a final order.
Milgram’s management of DEA has been called into question on another front. AP reported last month that a federal watchdog is investigating whether the agency improperly awarded millions of dollars in no-bid contracts to hire Milgram’s past associates.
As for Milione, federal ethics rules bar government employees from taking part in decisions that could benefit companies where they previously worked. But DEA did not comment about whether Milione has recused himself from matters involving Morris & Dickson. He would have also faced restrictions on his interactions with the DEA when he left government as a senior official — an issue the agency’s own lawyers raised in an attempt to disqualify his testimony in support of Morris & Dickson.
Milione, a lawyer and former bit Hollywood actor, impressed fellow DEA agents for his risk taking and toughness. Among his achievements was running the overseas sting that in 2008 nabbed Russia’s notorious arms trafficker Viktor Bout, aka “The Merchant of Death.”
But after taking over as the head of Diversion Control in 2015, he ended his predecessor’s refusal to meet with drug manufacturers and distributors and opened the DEA’s doors to the industry it was charged with regulating.
Among those Milione met with on at least two occasions was Paul Dickson Sr. — then-president of Morris & Dickson. That included a 2016 visit to the Louisiana headquarters with DEA investigators to discuss the company’s compliance program.
John Gray, the head of the Healthcare Distributors Alliance, a lobbying group that includes Morris & Dickson, recounted in a 2015 email how Milione, under orders from then-incoming DEA Administrator Chuck Rosenberg, wanted to “reset” relations with the drug industry. And Milione even delivered the keynote speech at the group’s annual meeting.
“Overall, he was engaging, exceedingly pleasant and seemed genuinely concerned that we had lost touch with each other,” Gray wrote. “It is a very different tone and approach than we have all seen in the past 8-10 years.”
Morris & Dickson had been punished for its mishandling of addictive drugs before. In 2019, before Dorman issued his recommendation, the company agreed to pay $22 million in civil penalties to resolve federal prosecutors’ claims that it violated the Controlled Substances Act by failing to report suspicious orders of hydrocodone and oxycodone. The company also agreed to multimillion-dollar upgrades of its compliance program to ensure it reports suspicious orders moving forward.
The case drew far less attention than the enforcement actions DEA took in recent years against Morris & Dickson’s larger competitors, a trio of pharmaceutical distributors who have agreed to pay the federal government more than $1 billion in fines and penalties for similar violations. Cardinal Health, AmerisourceBergen and McKesson also agreed to pay $21 billion over 18 years to resolve claims as part of a nationwide settlement.
Among the more than 12,000 suspicious orders that Dorman said Morris & Dickson should have reported to the DEA were 51 unusually large orders of opioids made by Wilkinson Family Pharmacy in suburban New Orleans.
Wilkinson purchased more than 4.5 million pills of oxycodone and hydrocodone from Morris & Dickson between 2014 and 2017, and federal prosecutors say during that time owner Keith Wilkinson laundered more than $345,000 from illegal sales made with forged prescriptions or written by “pill mill” doctors.
In one month, as many as 42% of all prescriptions filled by Wilkinson were for painkillers and 38% of those were paid for in cash. The DEA considers a pharmacy’s sales of controlled substances suspicious whenever they surpass 15% or cash transactions exceed 9%.
Yet Morris & Dickson never suspended any shipments to the pharmacy. Over three years, it filed just three suspicious order reports to the DEA – none of which resulted in shipments being suspended.
“Anybody with half a brain could’ve seen something wasn’t right,” said Dan Schneider, a retired pharmacist near New Orleans whose fight to hold drug companies accountable for the opioid epidemic was featured in a Netflix documentary series. “They were way out of line.”
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The multicellular bots move around and help heal ‘wounds’ created in cultured neurons
Researchers at Tufts have created tiny biological robots that they call Anthrobots from human tracheal cells that can move across a surface and have been found to encourage the growth of neurons across a region of damage in a lab dish.
The multicellular robots, ranging in size from the width of a human hair to the point of a sharpened pencil, were made to self-assemble and shown to have a remarkable healing effect on other cells. The discovery is a starting point for the researchers’ vision to use patient-derived biobots as new therapeutic tools for regeneration, healing, and treatment of disease.
The work follows from earlier research in the laboratories of Michael Levin, Vannevar Bush Professor of Biology, and Josh Bongard at the University of Vermont, in which they created multicellular biological robots from frog embryo cells called Xenobots, capable of navigating passageways, collecting material, recording information, healing themselves from injury, and even replicating for a few cycles on their own. At the time, researchers did not know if these capabilities were dependent on their being derived from an amphibian embryo, or if biobots could be constructed from cells of other species.
In the current study, published in Advanced Science, Levin, along with Ph.D. student Gizem Gumuskaya, discovered that bots can be created from adult human cells without any genetic modification and demonstrated that they have some capabilities beyond what was observed with the Xenobots.
The discovery starts to answer a broader question that the lab has posed—what are the rules that govern how cells assemble and work together in the body, and can the cells be taken out of their natural context and recombined into different “body plans” to carry out other functions by design?
In this case, researchers gave human cells, after decades of quiet life in the trachea, a chance to reboot and find ways of creating new structures and tasks. “We wanted to probe what cells can do besides create default features in the body,” said Gumuskaya, who earned a degree in architecture before coming into biology. “By reprogramming interactions between cells, new multicellular structures can be created, analogous to the way stone and brick can be arranged into different structural elements like walls, archways or columns.”
Anthrobots in movement in the lab. Video: Gizem Gumuskaya
The researchers found that not only could the cells create new multicellular shapes, but they could move in different ways over a surface of human neurons grown in a lab dish and encourage new growth to fill in gaps caused by scratching the layer of neuronal cells.
Exactly how the Anthrobots encourage growth of neurons is not yet clear, but the researchers confirmed that neurons grew under the area covered by a clustered assembly of Anthrobots, which they called a “superbot.”
“The cellular assemblies we construct in the lab can have capabilities that go beyond what they do in the body,” said Levin, who also serves as the director of the Allen Discovery Center at Tufts and is an associate faculty member of the Wyss Institute at Harvard University. “It is fascinating and completely unexpected that normal patient tracheal cells, without modifying their DNA, can move on their own and encourage neuron growth across a region of damage,” said Levin. “We’re now looking at how the healing mechanism works, and asking what else these constructs can do.”
The advantages of using human cells include the ability to construct bots from a patient’s own cells to perform therapeutic work without the risk of triggering an immune response or requiring immunosuppressants. They only last a few weeks before breaking down, and so can easily be re-absorbed into the body after their work is done.
In addition, outside of the body, Anthrobots can only survive in very specific laboratory conditions, and there is no risk of exposure or unintended spread outside the lab. Likewise, they do not reproduce, and they have no genetic edits, additions, or deletions, so there is no risk of their evolving beyond existing safeguards.
How Are Anthrobots Made?
Each Anthrobot starts out as a single cell, derived from an adult donor. The cells come from the surface of the trachea and are covered with hairlike projections called cilia that wave back and forth. The cilia help the tracheal cells push out tiny particles that find their way into air passages of the lung. We all experience the work of ciliated cells when we take the final step of expelling the particles and excess fluid by coughing or clearing our throats. Earlier studies by others had shown that when the cells are grown in the lab, they spontaneously form tiny multicellular spheres called organoids.
An Anthrobot moves through a “wound” in a neuron field grown in a laboratory dish. Video: Gizem Gumuskaya
The researchers developed growth conditions that encouraged the cilia to face outward on organoids. Within a few days they started moving around, driven by the cilia acting like oars. They noted different shapes and types of movement—the first important feature observed of the biorobotics platform. Levin says that if other features could be added to the Anthrobots—for example, contributed by different cells—they could be designed to respond to their environment, travel through and perform functions in the body, or help build engineered tissues in the lab.
The team, with the help of Simon Garnier at the New Jersey Institute of Technology, characterized the different types of Anthrobots that were produced. They observed that bots fell into a few discrete categories of shape and movement, ranging in size from 30 to 500 micrometers, filling an important niche between nanotechnology and larger engineered devices.
Some were spherical and fully covered in cilia, some were irregular or football shaped with more patchy coverage of cilia, and some were covered with cilia just on one side. They traveled in straight lines, moved in tight circles, combined those movements, or just sat around and wiggled. The spherical ones fully covered with cilia tended to be wigglers. The Anthrobots with cilia distributed unevenly tended to move forward for longer stretches in straight or curved paths. They usually survived about 45-60 days in laboratory conditions before they naturally biodegraded.
The advantages of using human cells include the ability to construct bots from a patient’s own cells to perform therapeutic work without the risk of triggering an immune response or requiring immunosuppressants.
“Anthrobots self-assemble in the lab dish,” said Gumuskaya, who created the Anthrobots. “Unlike Xenobots, they don’t require tweezers or scalpels to give them shape, and we can use adult cells—even cells from elderly patients—instead of embryonic cells. It’s fully scalable—we can produce swarms of these bots in parallel, which is a good start for developing a therapeutic tool.”
Little Healers
Because Levin and Gumuskaya ultimately plan to make Anthrobots with therapeutic applications, they created a lab test to see how the bots might heal wounds. The model involved growing a two-dimensional layer of human neurons, and simply by scratching the layer with a thin metal rod, they created an open “wound” devoid of cells.
To ensure the gap would be exposed to a dense concentration of Anthrobots, they created “superbots,” a cluster that naturally forms when the Anthrobots are confined to a small space. The superbots were made up primarily of circlers and wigglers, so they would not wander too far away from the open wound.
Although it might be expected that genetic modifications of Anthrobot cells would be needed to help the bots encourage neural growth, surprisingly the unmodified Anthrobots triggered substantial regrowth, creating a bridge of neurons as thick as the rest of the healthy cells on the plate. Neurons did not grow in the wound where Anthrobots were absent. At least in the simplified 2D world of the lab dish, the Anthrobot assemblies encouraged efficient healing of live neural tissue.
According to the researchers, further development of the bots could lead to other applications, including clearing plaque buildup in the arteries of atherosclerosis patients, repairing spinal cord or retinal nerve damage, recognizing bacteria or cancer cells, or delivering drugs to targeted tissues. The Anthrobots could in theory assist in healing tissues, while also laying down pro-regenerative drugs.
Making New Blueprints, Restoring Old Ones
Gumuskaya explained that cells have the innate ability to self-assemble into larger structures in certain fundamental ways. “The cells can form layers, fold, make spheres, sort and separate themselves by type, fuse together, or even move,” Gumuskaya said.
“Two important differences from inanimate bricks are that cells can communicate with each other and create these structures dynamically, and each cell is programmed with many functions, like movement, secretion of molecules, detection of signals, and more,” she added. “We are just figuring out how to combine these elements to create new biological body plans and functions—different than those found in nature.”
Taking advantage of the inherently flexible rules of cellular assembly helps the scientists construct the bots, but it can also help them understand how natural body plans assemble, how the genome and environment work together to create tissues, organs, and limbs, and how to restore them with regenerative treatments. | Medical Innovations |
UVA Health researchers have developed a powerful new tool to understand how medications affect men and women differently, and that will help lead to safer, more effective drugs in the future.
Women are known to suffer a disproportionate number of liver problems from medications. At the same time, they are typically underrepresented in drug testing. To address this, the UVA scientists have developed sophisticated computer simulations of male and female livers and used them to reveal sex-specific differences in how the tissues are affected by drugs.
The new model has already provided unprecedented insights into the biological processes that take place in the liver, the organ responsible for detoxifying the body, in both men and women. But the model also represents a powerful new tool for drug development, helping ensure that new medications will not cause harmful side effects.
"There are incredibly complex networks of genes and proteins that control how cells respond to drugs," said UVA researcher Jason Papin, PhD, one of the model's creators. "We knew that a computer model would be required to try to answer these important clinical questions, and we're hopeful these models will continue to provide insights that can improve healthcare."
Harmful Effects From Drugs
Papin, of UVA's Department of Biomedical Engineering, developed the model in collaboration with Connor Moore, a PhD student, and Christopher Holstege, MD, a UVA emergency medicine physician and director of UVA Health's Blue Ridge Poison Center. "It is exceedingly important that both men and women receive the appropriate dose of recommended medications," Holstege noted. "Drug therapy is complex and toxicity can occur with subtle changes in dose for specific individuals."
Before developing their model, the researchers first looked at the federal Food and Drug Administration's Adverse Event Reporing System to evaluate the frequency of reported liver problems in men and women. The scientists found that women consistently reported liver-related adverse events more often than did men.
The researchers then sought to explain why this might be the case. To do that, they developed computer models of the male and female livers that integrated vast amounts of data on gene activity and metabolic processes within cells. These cutting-edge liver simulations provided important insights into how drugs affect the tissue differently in men and women and allowed the researchers to understand why.
"We were surprised how many differences we found, especially in very diverse biochemical pathways," said Moore, a biomedical engineering student in Papin's lab. "We hope our results emphasize how important it is for future scientists to consider how both men and women are affected by their research."
The work has already identified a key series of cellular processes that explain sex differences in liver damage, and the scientists are calling for more investigation of it to better understand "hepatotoxicity" -- liver toxicity. Ultimately, they hope their model will prove widely useful in developing safer drugs.
"We're hopeful these approaches will be help address many other questions where men and women have differences in drug responses or disease processes," Papin said. "Our ability to build predictive computer models of complex systems in biology, like those in this study, is truly opening all kinds of new avenues for tackling some of the most challenging biomedical problems."
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In a new report, a social media watchdog group details how steroid content is exploding in some TikTok communities, promoting potentially dangerous and often illegal substances while propagating unattainable body image ideals to boys and young men.
Researchers with the Center for Countering Digital Hate (CCDH) found that videos tagged with hashtags promoting the use of steroid-like drugs have racked up more than 580 million views among U.S. users in the last three years, the bulk of which come from young men between the ages of 18 and 24. Data for views from under-18 users isn’t available.
“Young women and girls aren’t the only group of young people who are being exposed to potentially damaging and dangerous content online,” CCDH CEO Imran Ahmed said.
“A growing – and chronically understudied – crisis is being fomented among young boys and men, wrapped in toxic ideas of masculinity, strength, and misogyny, and amplified by unaccountable algorithms.”
The CCDH groups the substances in question together under the umbrella of “steroid-like drugs” rather than calling them “performance-enhancing drugs” — a term that can be misleading, given the health risks associated with their use. Drugs examined in the report include anabolic-androgenic steroids, peptides and Selective Androgen Receptor Modulators (SARMs).
In April, the FDA issued a warning about the use of steroid-like drugs among teens and young adults, citing the impact of social media influencers. In the FDA’s warning, the agency noted a rash of adverse event reports that linked SARMs in particular to increased heart attack risk, infertility and psychosis.
“Targeting teenagers and young adults, videos on social media platforms tout SARMs as a quick or easy way to improve physical appearance, gain muscle mass, or increase athletic performance,” the FDA wrote. “The reality is SARMs are potentially dangerous.”
In the U.S., anabolic-androgenic steroids require a prescription while peptides and SARMs are illegal when sold as dietary supplements. According to the U.S. Anti-Doping Agency, “there are no [FDA]-approved SARMs currently available for prescription. All SARMs are investigational drugs.” In spite of restrictions and dangers associated with their use, the substances are regularly sold as “research chemicals” that aren’t approved by regulatory agencies and aren’t for human consumption, in spite of clearly encouraging buyers to ingest them.
That loophole might not fool the FDA. The agency has written warning letters to companies selling SARMs that attempt to leverage that loophole, prompting criminal charges in some instances.
While the vendors selling these drugs generally don’t target underage users directly according to the report, they increasingly rely on social media influencers on apps like TikTok to promote their products through affiliate marketing. The CCDH found 35 influencers on TikTok with ties to websites that sell illegal steroid-like drugs. Together, that set of accounts commands a TikTok following of 1.8 million users, which they leverage to push affiliate links and discount codes, earning hefty commissions on sales.
“The accounts all belong to users who post videos displaying their physiques or techniques for gaining muscle,” the report states. “Many openly documented their own experiences with SLDs or uploaded videos in an educational style that highlighted supposed benefits of SLDs, often ignoring or downplaying the health risks.”
Across example videos, TikTok users shared gym and workout videos encouraging their followers to use steroid-like drugs. Some of these targeted under-18 users directly with captions like “teenagers lied about their age just to fight in WW2 but you are too scared to take S4RMs [SARMs]” and “Just tell your parents they’re vitamins.” Researchers also found videos from users who identified themselves as under the age of 18 who promoted the use of steroid-like drugs in their bodybuilding routines.
One bodybuilding influencer identified in the report explicitly tailors his content to teenage users and his 40,700 followers using hashtags like #teenbodybuilding and #teenfitness. The account veers deeply into dangerous pseudo-science, encouraging teens to start using steroids early in order to boost their height and genital size.
“Ultimately, this is a story of TikTok’s stark failure to govern their own platform and enforce their rules,” Ahmed said. “…TikTok must start enforcing its own rules prohibiting the promotion and sale of potentially dangerous drugs for profit — and it needs to be much more transparent about how many children and teenagers are routinely exposed to this content through the platform’s algorithms.” | Weightlifting & Bodybuilding |
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Chairman of the Senate Health, Education, Labor and Pensions Committee Sen. Bernie Sanders, a Vermont Independent, questions Dr. Monica Bertagnolli during her confirmation hearing to become director of the National Institutes of Health.
Kevin Dietsch/Getty Images
Chairman of the Senate Health, Education, Labor and Pensions Committee Sen. Bernie Sanders, a Vermont Independent, questions Dr. Monica Bertagnolli during her confirmation hearing to become director of the National Institutes of Health.
Kevin Dietsch/Getty Images
Can the National Institutes of Health bring down drug prices? It doesn't approve new medicines or pay for them, but its role in drug research gives it surprising leverage.
Sen. Bernie Sanders, chairman of the Health, Education, Labor and Pensions committee, voted against confirmation of Dr. Monica Bertagnolli as NIH director. Sanders, a Vermont independent who caucuses with the Democrats in the Senate, said that he didn't think Bertagnolli was prepared to stand up to the pharmaceutical industry.
But Sanders tells NPR he plans to work with Bertagnolli, who was confirmed Nov. 7. He says something has to change at the NIH, which spends billions of dollars each year on biomedical research that lays the foundation for lucrative profits for the drug industry.
"And yet, despite the huge amount of money that taxpayers spend developing these drugs, the drug companies get the product and they end up charging us the highest prices in the world for it," Sanders says.
Government contracts could exert leverage
The Moderna COVID vaccine is an example of the problem, he says. The vaccine was developed with the National Institute of Allergy and Infectious Diseases, part of the NIH. And the government agreed to buy 100 million doses even if it failed clinical trials, wasn't authorized by the Food and Drug Administration and all those doses wound up in the trash.
Ameet Sarpatwari, assistant director of the Program on Regulation, Therapeutics and Law at Harvard Medical School, says the government could have made more use of its leverage as a funder. "That could have been to ensure reasonable pricing for Americans at the very least, ensuring that Americans aren't paying more than people in other countries," he says.
Moderna increased the price of its COVID shot this year from about $26 a dose to $130 a dose. The company has downplayed NIH's role.
Generally, the pharmaceutical industry discounts the importance of NIH-funded research in its work. But Sarpatwari says the NIH is actually the largest single funder of biomedical research in the world.
A lot could be built into NIH contracts to protect Americans. "It's quite possible to at least put in terms that will ensure fair access to the fruits of all of that support," he says, adding the NIH has been hesitant to flex its muscles on pricing.
Sanders asks for scrutiny of licensing deal
Sanders wants that to change and says he hopes that the agency will be less cozy with the pharmaceutical industry under new leadership. He sent a letter last month asking for the administration to investigate NIH moves to grant an exclusive patent license for a cervical cancer drug developed at the agency to a mysterious startup incorporated in Delaware with no website.
The startup, Scarlet TCR, has a relationship with a former NIH employee and the deal could allow the company to someday charge high prices for a government invention.
The agency says no decision has been made regarding Scarlet TCR.
"NIH shares concerns about high drug prices and the burden they place on patients and their families," NIH spokesperson Renate Myles wrote in an email to NPR. "As stated during her Senate confirmation hearing, Dr. Bertagnolli has expressed her commitment to ensuring that the benefits of NIH-funded research are affordable and available to all the Americans."
Bertagnolli will work with Congress, Myles added. | Health Policy |
The World Health Organization warned on Friday that cases of dengue fever could reach close to record highs this year, partly due to global warming and the way that climate has helped the mosquitoes that spread it, Reuters reported.
Rates of the disease are climbing worldwide, "with reported cases since 2000 up eight-fold to 4.2 million in 2022," according to the same source.
"Europe has reported a surge in cases and Peru declared a state of emergency in most regions."
However, international travelers in the U.S. who are looking for protection against this tropical infectious disease spread by mosquitoes will have to wait a little longer.
On July 11, the Japanese drug-maker Takeda voluntarily withdrew its application to the Food and Drug Administration (FDA) for its dengue vaccine candidate in the U.S. after the agency requested more data that the current trial could not capture, according to a press release.
A dengue vaccine from the company is already approved in multiple endemic and non-endemic areas, such as the European Union, United Kingdom, Brazil, Argentina, Indonesia and Thailand.
There is only one dengue vaccine approved by the FDA in the U.S., but it is indicated only for children and teenagers ages six to 16 living in endemic areas — mainly Puerto Rico — who have previously had the infection.
‘Occurring in urban areas where it did not exist before’
The World Health Organization listed dengue fever as one of the top 10 threats to global health in 2019.
Roughly half the world’s population, or about 4 billion people, live in places that are at risk for dengue fever, with some 400 million people infected every year.
Dengue is flourishing because "it’s so crowded that anything can happen," said one medical expert.
One country, Peru, is currently battling its worst outbreak in history.
"Dengue is occurring in urban areas where it did not exist before," Dr. Coralith García, associate professor at the school of medicine at Cayetano Heredia University in Lima, Peru, told Fox News Digital.
Experts blame warmer temperatures and increased rainfall, but even in Lima, the second largest desert city in the world, dengue is flourishing because "it’s so crowded that anything can happen," she added.
"But Peru had the highest COVID mortality rate [in] the world and now we have several patients dying of dengue, confirming that the Peruvian health system is very weak."
Most Americans get infected with dengue fever while traveling internationally.
Yet it can spread locally in several states with hot, humid climates, such as Florida, Hawaii, Texas, and Arizona — although this is not common, according to the Centers for Disease Control and Prevention (CDC).
From January to June 1 of this year, there were 129 reported cases in the U.S. and 256 reported cases in Puerto Rico, according to the CDC.
What is dengue fever?
Dengue fever is caused by four viruses: dengue virus 1, 2, 3, and 4.
It is spread primarily by the bite of the Aedes aegypti mosquito, which bites generally during the day, per the CDC.
International travelers often complain of a fever with dengue within two weeks after returning home, but symptoms generally resolve within one week.
A person can get infected as many as four times because one virus strain only confers immunity against that specific serotype; people are at higher risk for a life-threatening condition called dengue hemorrhagic fever when they are infected twice, per the CDC.
About one in four people with dengue fever become sick, which can be either a mild or severe illness; but some 40,000 die from severe disease every year, according to the CDC.
Dengue fever is the leading cause of fever among returning travelers to Europe from all continents except Africa, according to a recent study on the tropical disease.
International travelers often complain of a fever with dengue within two weeks after returning home, but symptoms generally resolve within one week.
Know the critical phase
Dengue has 3 phases of disease: 1) fever phase; 2) critical phase; and 3) recovery phase.
The fever phase, named after its most common symptom, is characterized by severe joint pain and headaches, but most patients recover without complications, Dr. David O. Freedman, professor emeritus of infectious diseases at the University of Alabama at Birmingham, told Fox News Digital.
The disease’s hallmark bone and joint pains have earned it the nickname "breakbone fever."
The disease’s hallmark bone and joint pains have earned it the nickname "breakbone fever."
"In a small proportion of patients, just as the fever is resolving, a second critical phase develops where fluid leaks out of the circulation and gets into body spaces, such as the chest and abdominal cavities," he added.
During this phase, the blood pressure drops; severe bleeding may also occur.
Warning signs and symptoms
Freedman recommends watching for abdominal pain or tenderness; 2) persistent vomiting; 3) fluid in body spaces; 4) bleeding from the mouth or rectum; and 5) lethargy and restlessness.
Any of these combined with a fever increase the likelihood of patients becoming very sick and needing to be hospitalized.
He also reminds people that "a total body rash often develops during the critical or early recovery phase."
Freedman noted, "If the patient survives the critical phase usually with medical intervention, the third phase, recovery, occurs about 3-4 days after that."
Most have an ‘uncomplicated course’
A recent paper analyzed nearly 6,000 returning travelers with dengue using the GeoSentinel network surveillance platform.
The network is a collaboration between the CDC and the International Society of Travel Medicine. It monitors infectious diseases in 29 countries on six continents that affect international travelers and migrants.
"If you have any of the warning signs, you or the doctor should monitor them very closely, preferably by hospitalization."
The researchers looked at the patients with dengue fever, which was relatively mild illness without any complications, or "complicated dengue," which included those who had warning signs or severe illness.
They found only 2% of dengue cases were considered "complicated," but approximately 99% had warning signs, with 31% classified as severe.
"Most of the time it is an uncomplicated course," lead author Ralph Huits, M.D., PhD, department of infectious tropical diseases and microbiology at IRCCS Sacro Cuore Don Calabria Hospital in Negrar, Verona, Italy, told Fox News Digital.
"You can feel very sick, such as [with] a headache, anorexia, but then get better," he added.
"But some 2% of travelers can have a severe dengue," he continued.
"What you should remember is if you have any of the warning signs, then you or the doctor should monitor them very closely, preferably by hospitalization." | Epidemics & Outbreaks |
Patients are supposed to be at the heart of everything the NHS does. This is considered such an important principle that, a decade ago, the fledgling NHS constitution was rewritten after the mid-Staffs scandal, in which so many patients died, to make clear it should frame every aspect of NHS work.
Yet, last week, the NHS Confederation, the membership body for NHS providers, published guidance that appears to cut this ethos adrift. Its stated objectives are incredibly important: supporting trans staff by helping healthcare leaders to understand their needs and address any workplace discrimination they may face. But it also includes guidance on how to handle requests for same-sex care that gets the law badly wrong and could lead NHS trusts to unlawfully discriminate against female patients.
There are many reasons why some women may prefer female staff, particularly with intimate care such as smear tests. They may be victims of sexual assault and find male contact traumatic. They may have religious beliefs that prohibit it. They may simply have a preference relating to privacy and dignity. And Henrietta Freeman, who is paralysed from the chest down, has written about the importance of same-sex care for many disabled women. This is recognised in law, and in guidance from the Care Quality Commission that says health and care providers must make every effort to respect a patient’s preferences for same-sex intimate care.
The NHS Confederation cannot override the law and is not a statutory body like the CQC. Yet its guidance directly contradicts it. It claims it would be “discriminatory” for a patient to refuse to be treated by a trans healthcare professional of the opposite sex unless “evidenced clinical harm may result”. This is legal gibberish – individuals are not directly bound by equalities law in their conduct as patients – and the law does not say providers should only accept requests if there would otherwise be clinical harm.
Its guidance wrongly claims it would probably be discriminatory for a provider to honour a request for same-sex care by excluding trans staff of the opposite sex if the request has “no clinical merit”, opines without basis that there will be “extremely few circumstances” where this request is lawful and says “patients expressing any such view should be informed of the discriminatory nature of their request [and] that such behaviour is unacceptable”. It does not even mention the law on consent.
Naomi Cunningham, a barrister specialising in discrimination law, says: “This guidance encourages NHS providers to unlawfully discriminate against female patients requesting same-sex care and wrongly says they don’t have the right to know the sex of staff providing intimate care.”
The Equality and Human Rights Commission is the statutory regulator of equalities law. In relation to same-sex care, a spokesperson told me: “Failure to meet a patient’s request could amount to unlawful indirect sex or religion or belief discrimination, if it could not be objectively justified.”
In regards to trans staff, protected under the characteristic of gender reassignment in the Equality Act, they said: “The Equality Act makes provision for employers to restrict particular roles to men or women, or to people without the protected characteristic of gender reassignment, where that is an occupational requirement and a proportionate way of meeting a legitimate objective.” They added: “Accommodating service users’ requests for healthcare to be provided by a man or a woman, or by a person who is not trans, affects staff members who do not meet those requirements. This could in some circumstances result in claims of unlawful discrimination.
“Service providers can minimise this risk by having clear policies in place about when such requests will be met, ensuring that staff are aware of such policies and the reasons for them, and mitigating any possible negative impact on individual staff members.”
So the law is absolutely in the right place when it comes to balancing rights: it is unlawful not to honour a request for same-sex intimate care without good reason, but NHS providers should take steps to mitigate the impacts for trans staff. How has the NHS Confederation, which told me it stands by its interpretation of the law, got it so wrong?
Like so many organisations grappling with the delicate conflict of rights between women who want to access single-sex services, and trans people who want to be treated according to their gender identity, not their sex, for all purposes, the NHS Confederation has fallen into the trap of engaging with one perspective to the exclusion of all others. Any guidance on same-sex care should have been produced based on an accurate understanding of the law and after consultation with the range of groups affected, including patients. Instead, its production was outsourced to a single campaigning charity, the LGBT Foundation, which adopts the controversial worldview that gender identity can replace sex for all purposes in society and lobbies for changes to the law on this basis. The tender even asked for “ideas for supporting NHS organisations when they face opposition from anti-trans groups and individuals”; “anti-trans” is language commonly used by gender identity campaigners to describe the perfectly legitimate perspective shared by most of the public – and NHS patients – that sex cannot be wholly replaced by gender identity in society.
It isn’t just the NHS Confederation. NHS England has itself effectively adopted a blanket policy that trans or non-binary male patients should be placed on female-only wards. This is despite the fact that it may be unlawful discrimination for a hospital not to accommodate female patients on female-only wards; the Equality Act explicitly states it is lawful for hospitals to provide single-sex wards; and there are compromises that could balance everyone’s needs, such as using private rooms.
Other institutions have got equalities law wrong on the basis of incorrect advice from campaigning charities such as Stonewall: for example, an independent review found Essex University discriminated against women with employment policies that misstated the law “as Stonewall would prefer it to be”.
There remain some ambiguities in equalities law relating to this conflict: whether “sex” in the Equality Act refers to biological sex or whether someone with a gender recognition certificate must be treated as the opposite sex for discrimination purposes. A proposal to clarify that sex means biological sex – with all trans people robustly protected against discrimination under the protected characteristic of gender reassignment – will be debated in parliament tomorrow after a petition garnered more than 100,000 signatures. That major organisations are still getting the law seriously wrong should prompt MPs to support this.
“The NHS belongs to the people” is the first line of the NHS constitution, not just to people who believe gender identity should replace sex in society. It is unlawful to deny a female patient same-sex care on the basis that such a request is somehow bigoted or transphobic and to suggest otherwise is to prioritise the validation of staff identities over and above legitimate patient preferences relating to their privacy, dignity and safety. The NHS Confederation should retract its guidance and start again.
Sonia Sodha is an Observer columnist
Do you have an opinion on the issues raised in this article? If you would like to submit a letter of up to 250 words to be considered for publication, email it to us at [email protected] | Health Policy |
A Scottish NHS board has been fined £180,000 over the death of a pensioner who fell from his hospital bed three times.
NHS Highland had previously admitted a breach of health and safety regulations at Inverness Sheriff Court.
The court was told 78-year-old Colin Lloyd was admitted to Raigmore Hospital on 6 February 2019 following a fall at home.
He was assessed as unsuitable for bed rails but was at "high risk" of falling and required one-to-one care and observation.
The room Mr Lloyd was transferred to was managed by a staff nurse who was looking after two rooms of six beds and assisting in triage in another room, meaning he did not receive the one-to-one care needed.
During his time in hospital, he fell from the bed three times.
He suffered bleeding in the brain, and after his condition worsened, he died on the ward on 16 February 2019.
'The tragic death could have been prevented'
The Crown Office claimed staff repeatedly made requests for additional nurses to help provide the care Mr Lloyd needed as there were new admissions to look after and other patients with enhanced needs.
The prosecutor stated at the time there was no apparent overall view of staffing requests across wards or formal system in place to escalate unfilled staffing requests or to review the situation to look for alternative solutions.
Speaking after sentencing, Debbie Carroll, of the Crown Office and Procurator Fiscal Service, said: "The tragic death of Colin Lloyd could have been prevented had suitable and sufficient measures been put in place.
"Highland health board failed to have effective arrangements and control measures in place to prevent or mitigate falls to patients identified as being at risk and, as a result, Colin Lloyd suffered fatal head trauma.
"This prosecution should remind duty holders that a failure to manage and implement effective measures can have fatal consequences and they will be held accountable for this failure."
Read more:
Factory fined after staff hurt in chocolate accident
Firm fined £80,000 after surveyor killed in 'entirely avoidable' electrical explosion
'We are deeply sorry'
NHS Highland apologised for the failures made during Mr Lloyd's care.
Fiona Hogg, director of people and culture, said: "We are deeply sorry for the failures identified in our care that led to the death of a patient at Raigmore Hospital in 2019.
"We recognise the lasting hurt this will have caused to those who loved and cared for Mr Lloyd and we are sorry for letting them down. Our internal review following the incident identified several areas of improvement and, as a result, we have made a number of changes to our systems and practice.
"This includes clearer, more responsive processes for escalating staff shortages, the introduction of volunteers to provide additional support and companionship for older people in the acute hospital setting, and enhanced training for staff caring for people who are at risk of falling." | Health Policy |
Obesity drug Wegovy cut risk of serious heart problems by 20%, study finds
A new large study finds that the popular weight-loss drug Wegovy reduced the risk of serious heart problems by 20% in certain patients
The popular weight-loss drug Wegovy reduced the risk of serious heart problems by 20% in a large, international study that experts say could change the way doctors treat certain heart patients.
The research is the first to document that an obesity medication can not only pare pounds, but also safely prevent a heart attack, stroke or a heart-related death in people who already have heart disease — but not diabetes.
The findings could shift perceptions that the new class of obesity drugs are cosmetic treatments and put pressure on health insurers to cover them.
“It moves from a kind of therapy that reduces body weight to a therapy that reduces cardiovascular events,” said Dr. Michael Lincoff, the study’s lead author and a heart expert at the Cleveland Clinic.
Wegovy is a high-dose version of the diabetes treatment Ozempic, which already has been shown to reduce the risk of serious heart problems in people who have diabetes. The new study looked to see if the same was true in those who don't have that disease.
Experts have known for years that losing weight can improve heart health, but there hasn’t been a safe and effective obesity medication proven to reduce specific risks, said Dr. Francisco Lopez-Jimenez, a heart expert at the Mayo Clinic. He expects the new findings to change treatment guidelines and “dominate the conversation” for years to come.
“This is the population who needs the medicine the most,” said Lopez-Jimenez, who had no role in the study.
In the U.S., there are about 6.6 million people like those tested in the study, experts said.
The results were published Saturday in the New England Journal of Medicine and presented at a medical conference in Philadelphia. Novo Nordisk, the maker of Wegovy and Ozempic, has asked the U.S. Food and Drug Administration to include the heart benefits on Wegovy's label, like on Ozempic's.
The new study, paid for by the company, included more than 17,500 people in 41 countries. Participants were age 45 and older, had a body mass index of 27 or higher and were tracked for more than three years on average. They took typical drugs for their heart conditions, but they were also randomly assigned to receive weekly injections of Wegovy or a dummy shot.
The study found that 569, or 6.5%, of those who got the drug versus 701, or 8%, of those who received the dummy shot had a heart attack or stroke or died from a heart-related cause. That’s an overall reduction of 20% in the risk of those outcomes, the researchers reported.
The drop appeared to be fueled primarily by the difference in heart attacks, but the number of serious health complications reported were too small to tell whether the individual outcomes were caused by the drug or by chance.
Study volunteers who took Wegovy lost about 9% of their weight while the placebo group lost less than 1%.
The Wegovy group also saw drops in key markers of heart disease, including inflammation, cholesterol, blood sugars, blood pressure and waist circumference, noted Dr. Martha Gulati, a heart expert at Cedars-Sinai Medical Center in Los Angeles. Changes in those markers began early in the study, before participants lost much weight.
“It means to me that it's more than just weight loss, how this drug works,” said Gulati, who had no role in what she called a landmark study.
Still, “it remains unclear” how much of the results were a benefit of losing weight or the drug itself, an editorial accompanying the study noted.
About a third of all study volunteers reported serious side effects. About 17% in the Wegovy group and about 8% in the comparison group left the study, mostly because of nausea, vomiting, diarrhea and other stomach-related problems.
Nearly three-quarters of participants were men and nearly 84% were white. Gulati and others said future research needs to include more women and racial and ethnic minorities.
Wegovy is part of a new class of injectable medications for obesity. On Wednesday, the U.S. Food and Drug Administration approved Eli Lilly's Zepbound, a version of the diabetes drug Mounjaro, for weight control.
Both carry high price tags — monthly costs are about $1,300 for Wegovy and about $1,000 for Zepbound. And both have been in shortage for months, with manufacturers promising to boost supplies.
The medications are often not covered by private health insurance or subject to strict preauthorization requirements. Medicare, the government health plan for older Americans, is prohibited from covering drugs for weight loss alone. But drugmakers and obesity treatment advocates have been pushing for broader coverage, including asking Congress to pass legislation to mandate that Medicare pay for the drugs.
Results from the latest study and others that show the obesity drugs have a direct effect on costly health problems could be a factor in shifting the calculus of coverage, said Dr. Mark McClellan, former chief of the Centers for Medicare and Medicaid Services and the FDA. In 2006, Medicare was allowed to cover weight-loss surgery to treat the complications of severe obesity, if not obesity itself, he noted.
That approach "may end up being relevant here,” he said.
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content. | Drug Discoveries |
"Even though I watched my mum battle from a young age, I never used to check my breasts. We didn't even talk about it."
When Sonia Bhandal was 14, her mum passed away from breast cancer, six years after being diagnosed. Then, when she was 27, Sonia found out she had the same cancer.
Cancer can be a tricky issue to discuss in the Asian community - and when it comes to breast cancer there is added stigma.
Sonia feels Asian women face added pressures when they have a long-term illness because their marriage or fertility prospects are often questioned.
"I was dating during my treatment and remember being super-ill, fresh out of hospital and an aunt saying 'will his parents accept you?'," she tells BBC Asian Network.
"I was already just trying to survive day by day and to have questions about my future, my marriage and fertility from people close to you, it's heartbreaking.
"And that's why people don't want to talk about it, because they don't want their aunt or anyone else to give these opinions."
'Fear around cancer'
Research by Breast Cancer Now suggests there is a lower uptake of breast screening among south Asians, which means they are often diagnosed at a later stage and have reduced survival rates than white women.
It suggested cultural and language barriers could play a part in this.
"There are barriers around talking about breasts in the community and checking breasts is often seen as a sexual thing," says Manveet Basra, the charity's associate director of public health.
"There's fear around cancer generally and a feeling of fatalism.
"So some cultural or religious beliefs that a cancer diagnosis is off the back of a sin from a past life and karma."
Sonia says she was "getting a lot of pain in my breast" before she discovered she had inherited an altered gene called BRCA that increased her risk of developing breast cancer.
Both her mum and aunt had previously died from the disease.
"I rolled over in bed and my arm scraped my breast and it felt like a stone," she says.
"I just burst into tears, my gut just knew what it was."
Having that particular gene also means there is a higher than average chance of the cancer returning, and put Sonia at increased risk of cervical cancer too.
So she opted to have a double mastectomy - having both breasts removed - because she "didn't want to risk having to go through chemo again".
Sania Ahmed is a doctor trying to use her platform to raise awareness of how breast cancer is perceived in the south Asian community.
"I was 24 years old when I was diagnosed and it felt like I was labelled with a life sentence," she says.
"Women in our culture don't prioritise their health. And because the breast is seen as a private area, breast examination [often] doesn't exist.
"I've grown up in a loving Muslim family but women are still seen as fulfilling the role of a wife and having kids."
Sania says she tries to use her role in the community to encourage better healthcare.
"As a doctor, I'm always encouraging my patients to check their breasts," she says.
"If something feels odd then just get it looked at."
For Dipika Saggi, breast cancer wasn't something she had dealt with in her immediate family.
She had a "shooting pain" during the Covid pandemic and her GP referred her for a biopsy straight away.
Dipika, who was 35 at the time, was then told she was already "quite far along", with the tumour being at 8cm.
"It was a rapid emotional rollercoaster of confusion, pain and acceptance," she says.
"You don't think you can get cancer when you're young. Maybe that's why I got help a lot later."
Dipika says some comments from people around her also made things harder, including references to karma or "God's will".
"I often heard from elders 'everything happens for a reason' or 'God only challenges his strongest' and I would think 'so you think God thinks I deserve to have cancer?'" she says.
Manveet feels younger members of the community like Sonia, Dipika and Sania can help to change mindsets.
"Being breast aware, knowing the signs and symptoms can potentially help you and others in your family," she says. | Women’s Health |
People overeat and become overweight for a variety of reasons. The fact that flavorful high-calorie food is often available nearly everywhere at any time doesn't help. Buck researchers have determined for the first time why certain chemicals in cooked or processed foods, called advanced glycation end products, or AGEs, increase hunger and test our willpower or ability to make healthy choices when it comes to food.
"This research, done in tiny nematode worms, has immense implications for human dietary choices and the propensity to overeat certain foods," said Buck professor Pankaj Kapahi, PhD, the senior author of the study. "Processed modern diets enriched with AGEs are tempting to eat but we know very little about their long-term consequences on our health." The work is currently published in eLife.
"Humans evolved certain mechanisms that encourage us to eat as much food as possible during times of plenty. We store the excess calories as fat that we use to survive times of fasting," explained Muniesh Muthaiyan Shanmugam, PhD, a postdoctoral research fellow in the Kapahi laboratory, and the lead author of the study. "Natural selection favored genes that makes us preferentially consume flavorful food, especially those with higher sugar content. But what is the mechanism that makes it so hard to say 'no' to them?"
AGEs are metabolic by-products that occur when a sugar combines with part of a protein, lipid or nucleic acid. They occur naturally when we metabolize sugars in a cell, but AGEs are also created during baking, frying and grilling, and are in many processed foods. "The brown color that occurs during cooking, which makes food look and smell delicious is a result of AGEs," said Shanmugam. "Basically, we are finding that AGEs make food more appetizing and harder to resist."
The "browning" reaction that occurs when sugar and protein interact with heat, beloved among chefs, is called the Maillard reaction. It results in the formation of hundreds to thousands of enticing AGEs.
But while the Maillard reaction's claim to fame is its ability to make foods taste delicious, the resulting chemicals wreak all kinds of havoc in the body. They cause inflammation and oxidative damage, contributing to the development of blood vessel stiffening, hypertension, kidney disease, cancer, and neurological problems. The accumulation of these metabolic by-products in several organs is probably one of the major drivers of aging of various organs and the organism as a whole, said Kapahi, whose lab focuses on how nutrients influence health and disease.
"Once advanced glycation products are formed, they cannot be detoxified," Shanmugam said. Just as toasted white bread becomes brown, the process can't be reversed to make the bread white again. "Similarly, there is no way to reverse the AGEs," adding that the body's ability to clear AGEs declines with age, providing another link to age-related disease.
Even the tiny worms in the Kapahi lab could not escape the allure and damages caused by AGEs. Researchers observed that these chemicals, in addition to causing disease and decreasing longevity, also increased the worms' appetite for more of the same. The researchers wanted to know the mechanism by which AGEs spur preferential overeating.
To uncover the biochemical signaling pathway responsible for overeating in normal healthy worms, the researchers purified some well-studied AGEs and found two of them that increased eating. They further explored one of the compounds to find out the signaling mechanism. They showed that a particular mutation (called glod-4) increased food intake, mediated by a particular AGE (called MG-H1). Further analysis revealed a tyramine-dependent pathway was responsible.
Their work is the first to identify the signaling pathway mediated by specific AGEs molecules to enhance feeding and neurodegeneration. They also found that mutant worms that have no way to process even naturally occurring AGEs have approximately 25-30 percent shorter lifespans. The work is being extended into mice where researchers will look at the connection between AGEs and fat metabolism.
"Understanding this signaling pathway may help us to understand overeating due to modern AGEs-rich diets," said Kapahi. "Our study emphasizes that AGEs accumulation is involved in diseases, including obesity and neurodegeneration. We think that overall, limiting AGEs accumulation is relevant to the global increase in obesity and other age-associated diseases."
The message that Shanmugam takes from his work is profound. "We are not controlling our food intake, instead it is the food that is attempting to control us," he said.
As a result of this and previous research from the lab, Shanmugam and Kapahi have changed the way they view their own diets. They both practice intermittent fasting, which gives the body a chance to use fat instead of sugars. There are simple things that anyone can do to reduce the burden of AGEs in their bodies, said Kapahi, including eating whole grains (the fiber helps maintain stable glucose levels), cooking with wet heat rather than dry (i.e., steaming vs. frying or grilling), and adding acid when cooking foods which slows the reaction that leads to the formation of AGEs.
"We are naturally attracted to delicious food, but we could be more mindful that we do have the ability to make healthy choices when we eat," said Shanmugam.
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In February, a dermatologist in New York City contacted the state’s health department about two female patients, ages 28 and 47, who were not related but suffered from the same troubling problem. They had ringworm, a scaly, crusty, disfiguring rash covering large portions of their bodies. Ringworm sounds like a parasite, but it is caused by a fungus—and in both cases, the fungus was a species that had never been recorded in the US. It was also severely drug-resistant, requiring treatment with several types of antifungals for weeks. There was no indication where the patients might have acquired the infections; the older woman had visited Bangladesh the previous summer, but the younger one, who was pregnant and hadn’t traveled, must have picked it up in the city.That seemed alarming—but in one of the largest and most mobile cities on the planet, weird medical things happen. The state reported the cases to the Centers for Disease Control and Prevention, and the New York doctors and some CDC staff wrote up an account for the CDC’s weekly journal.Then, in March, some of those same CDC investigators reported that a fungus they had been tracking—Candida auris, an extremely drug-resistant yeast that invades health care facilities and kills two-thirds of the people infected with it—had risen to more than 10,000 cases since it was identified in the US in 2016, tripling in just two years. In April, the Michigan Department of Health and Human Services rushed to investigate cases of a fungal infection called blastomycosis centered on a paper mill, an outbreak that would grow to 118 people, the largest ever recorded. And in May, US and Mexican health authorities jointly rang an alarm over cases of meningitis, caused by the fungus Fusarium solani, which seemed to have spread to more than 150 clinic patients via contaminated anesthesia products. By mid-August, 12 people had died.All of those outbreaks are different: in size, in pathogen, in location, and the people they affected. But what links them is that they were all caused by fungi—and to the small cadre of researchers who keep track of such things, that is worrisome. The experts share a sense, supported by incomplete data but also backed by hunch, that serious fungal infections are occurring more frequently, affecting more people, and also are becoming harder to treat.“We don’t have good surveillance for fungal infections,” admits Tom Chiller, an infectious disease physician and chief of the CDC’s mycotic diseases branch. “So it’s hard to give a fully data-driven answer. But the feeling is definitely that there is an increase.”The question is: Why? There may be multiple answers. More people are living longer with chronic illnesses, and their impaired immune systems make them vulnerable. But the problem isn’t only that fungal illnesses are more frequent; it is also that new pathogens are emerging and existing ones are claiming new territory. When experts try to imagine what could exert such widespread influence, they land on the possibility that the problem is climate change.Fungi live in the environment; they affect us when they encounter us, but for many, their original homes are vegetation, decaying plant matter, and dirt. “Speculative as it is, it's entirely possible that if you have an environmental organism with a very specific ecological niche, out there in the world, you only need a very small change in the surface temperature or the air temperature to alter its niche and allow it to proliferate,” says Neil Stone, a physician and fungal infections lead at University College London Hospitals. “And it's that plausibility, and the lack of any alternative explanation, which makes it believable as a hypothesis.”For this argument, C. auris is the leading piece of evidence. The rogue yeast was first identified in 2009 in a single patient in Japan, but within just a few years, it bloomed on several continents. Genetic analyses showed the organism had not spread from one continent to others, but emerged simultaneously on each. It also behaved strikingly differently from most yeasts, gaining the abilities to pass from person to person and to thrive on cool inorganic surfaces such as plastic and metal—while collecting an array of resistance factors that protect it from almost all antifungal drugs.Arturo Casadevall, a physician and chair of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health, proposed more than a decade ago that the rise of mammals over dinosaurs was propelled by an inherent protection: Internally, we’re too hot. Most fungi flourish at 30 degrees Celsius or less, while our body temperature hovers between 36 and 37 degrees Celsius. (That’s from 96.8 to the familiar 98.6 degrees Fahrenheit.) So when an asteroid smashed into the Earth 65 million years ago, throwing up a cloud of pulverized vegetation and soil and the fungi those would have contained, the Earth’s dominant reptiles were vulnerable, but early mammals were not.But Casadevall warned of a corollary possibility: If fungi increased their thermotolerance, learning to live at higher temperatures as the climate warms, mammals could lose that built-in protection—and he proposed that the weird success of C. auris might indicate it is the first fungal pathogen whose adaptation to warmth allowed it to find a new niche.In the 14 years since it was first spotted, C. auris has invaded health care in dozens of countries. But in that time, other fungal infections have also surged. At the height of the Covid pandemic, India experienced tens of thousands of cases of mucormycosis, commonly called “black fungus,” which ate away at the faces and airways of people made vulnerable by having diabetes or taking steroids. In California, diagnosis of coccidioidomycosis (also called Valley fever) rose 800 percent between 2000 and 2018. And new species are affecting humans for the first time. In 2018, a team of researchers from the US and Canada identified four people, two from each country, who had been infected by a newly identified genus, Emergomyces. Two of the four died. (The fungus got its name because it is “emerging” into the human world.) Subsequently, a multinational team identified five species in that newly-named genus that are causing infections all over the world, most severely in Africa.Fungi are on the move. Last April, a research group from the Washington University School of Medicine in St. Louis examined the expected geographic range in the US of what are usually called the “endemic fungi,” ones that flourish only within specific areas. Those are Valley fever in the dry Southwestern US; histoplasmosis in the damp Ohio River valley; and blastomycosis, with a range that stretched from the Great Lakes down the Mississippi to New Orleans, and as far east as the Virginia coast. Using Medicare data from more than 45 million seniors who sought health care between 2007 and 2016, the group discovered that the historically documented range of these fungi is wildly out of step with where they are actually causing infections now. Histoplasmosis, they found, had been diagnosed in at least one county in 94 percent of US states; blastomycosis, in 78 percent; and Valley fever in 69 percent.That represents an extension of range so vast that it challenges the meaning of endemic—to the point that Patrick Mazi, an assistant professor of medicine and first author on the paper, urges clinicians to cease thinking of fungal infections as geographically determined, and focus on symptoms instead. “Let’s acknowledge that everything is dynamic and changing,” he says. “We should recognize that for the sake of our patients.”Without taking detailed histories from those millions of patients, it can’t be proven where their infections originated. They could have been exposed within the fungi’s historic home ranges and then traveled; one analysis has correlated the occurrence of Valley fever in the upper Midwest with “snowbird” winter migration to the Southwest. But there is plenty of evidence for fungal pathogens moving to new areas, via animals and bats, and on winds and wildfire smoke as well.However fungi are relocating, they appear to be adapting to their new homes, and changes in temperature and precipitation patterns may be part of that. Ten years ago, CDC and state investigators found people in eastern Washington state infected with Valley fever, and proved they had acquired it not while traveling, but locally—in a place long considered too cold and dry for that fungus to survive. A group based primarily at UC Berkeley has demonstrated that transmission of Valley fever in California is intimately linked to weather there—and that the growing pattern of extreme drought interrupted by erratic precipitation is increasing the disease’s spread. And other researchers have identified cases of a novel blastomycosis in Saskatchewan and Alberta, pushing the map of where that infection occurs further north and west.The impact of climate change on complex phenomena is notoriously hard to prove—but researchers can now add some evidence to back up their intuition that fungi are adapting. In January, researchers at Duke University reported that when they raised the lab temperatures in which they were growing the pathogenic fungus Cryptococcus deneoformans—the cause of a quarter-million cases of meningitis each year—the fungus’s rate of mutation revved into overdrive. That activated mobile elements in the fungus’s genome, known as transposons, allowing them to move around within its DNA and affect how its genes are regulated. The rate of mutation was five times higher in fungi raised at human body temperature than at an incubator temperature of 30 degrees Celsius—and when the investigators infected mice with the transformed fungi, the rate of mutation sped up even more.Researchers who are paying attention to rising fungal problems make a final point about them: We’re not seeing more cases because we’ve gotten better at finding them. Tests and devices to detect fungi, especially within patients, haven’t undergone a sudden improvement. In fact, achieving better diagnostics was top of a list published by the World Health Organization last fall when it drew up its first ranking of “priority fungal pathogens” in hopes of guiding research.Multiple studies have shown that patients can wait two to seven weeks to get an accurate diagnosis, even when they are infected with fungi endemic to where they live, which ought to be familiar to local physicians. So understanding that fungi are changing their behavior is really an opportunity to identify how many more people might be in danger than previously thought—and to get out in front of that risk. “Patients are being diagnosed out of traditional areas, and we are missing them,” Mazi says. “All of these are opportunities to achieve better outcomes.” | Epidemics & Outbreaks |
When seasonal sickness hits your home, how do you stop the cold and flu from spreading among family members?
Fox News medical contributor Dr. Marc Siegel, a clinical professor of medicine at NYU Langone, reiterated the basics of preventing virus spread in comments to Fox News Digital.
Among his top tips: Wash your hands often and disinfect household surfaces.
Those who are sick should remain separated from others or wear a high-grade face mask if they must be in proximity to housemates, Siegel advised.
"Flu has a 25% attack rate, meaning that for everyone who gets it, a quarter of people who are in close contact will get it," he said.
Cedars-Sinai pediatrician Santhosh Nadipuram, M.D., who is based in California, said in a separate conversation with Fox News Digital that sick people should especially keep their distance from high-risk individuals in the household.
This includes children under 6 months old and adults over 65 years old, as well as anyone with severe obesity, poorly controlled diabetes, lung disease or heart disease.
"Flu has a 25% attack rate, meaning that for everyone who gets it, a quarter of people who are in close contact will get it."
Pregnant women and immune-suppressed people also fall into this category.
Nadipuram shared some other best practices to prevent spread, including covering coughs and sneezes, even though this may be challenging with small children.
He also advised families to keep their homes well-ventilated and avoid sharing food or drinks with infected people.
Frequent handwashing is key, the doctor added. He recommends washing for at least 20 seconds, especially before and after eating, before contact with vulnerable people and after touching your face while experiencing active symptoms.
In the case of the flu, Nadipuram encouraged annual vaccinations to help reduce the risk of severe disease.
Flu vaccines are recommended for all individuals over 6 months old, according to the Centers for Disease Control and Prevention (CDC).
"If you have someone in the home at high risk for severe infection, the ill person can isolate in a well-ventilated room with minimal contact until their cough and sneezing are very diminished, and they can wear a mask if they need to interact with other family members in a closed room," Nadipuram said.
"For little kids, they should be able to ‘control’ their secretions, meaning any runny noses should be minimal, so the child or parent/caregiver can easily clean them, throw away the paper napkin and clean their hands," the doctor added.
Siegel advised that in the case of sudden fatigue, muscle aches, headache, sore throat or upper respiratory congestion, individuals should consult a medical professional.
"Differentiation between flu, RSV and COVID may help in terms of potential treatment if you are at risk of severe disease," he also said.
With several respiratory illnesses floating around this time of year, Nadipuram agreed that knowing when to seek medical attention is crucial.
He added, "Speak with your doctor if you have any worries and ask for guidance, especially if you feel your symptoms are concerning or severe." | Epidemics & Outbreaks |
Terry Strong just wanted to put petrol in his car. He stood at the bowser and put the nozzle into the neck of the fuel tank, but the pump didn’t start. The service station attendant waved him away when he asked for help. He tried again. It still didn’t work.
Strong’s patience was thin these days. His fuse was short. After a second rebuff – “Just move to another bowser, mate” – Strong, frustrated, got back into the car. But he had forgotten to replace the nozzle. The car accelerated forward, fuel hose still attached, and wrenched the entire bowser out of the ground with a tremendous jolt.
The fire brigade arrived, the fuel station was shut down, and Strong was mortified. A retired Telstra estimator, truck driver, erstwhile rugby league player, father of two and grandfather, Strong had been forgetting things for years. How to turn on the air conditioning. How to make spaghetti bolognese. How to score during his weekly game of golf. His own phone number.
He’d started hallucinating, too. Paranoid outbursts would overtake him suddenly and he would rant and rage, accusing his wife and children of all kinds of crimes. At night, his body didn’t seem to understand that it was dreaming and he would thrash about violently, sometimes leaping out of bed to chase down intruders only he could see.
Strong’s family told few people about the petrol station incident, hoping to protect his dignity. They didn’t talk about the things that happened at night. They didn’t speak openly about the startling and profound decline of their beloved husband and father until two weeks ago, when Kathy Strong, Terry’s wife, and his son Michael, gave evidence on the first day of public hearings for the commonwealth Senate inquiry into concussions and repeated head trauma in contact sports.
Terry Strong died on 12 December 2021, aged 68. In life, he had been diagnosed with REM sleep behaviour disorder and probable Lewy body dementia. But after his death, an autopsy found the overwhelming pathology was severe chronic traumatic encephalopathy (CTE), the neurodegenerative disease caused by head trauma and linked to the repeated impacts of contact sport.
“My dear, wonderful husband of 44 years became a shell of a man and I watched him being slowly tortured by his brain,” Kathy Strong wrote in her submission to the inquiry. “It is time the long term effects of concussion and repeated head trauma are investigated and addressed.”
A history of hard knocks
“Dad was a man of action more than a man of words,” his son Michael tells Guardian Australia. That didn’t mean words weren’t important. Terry was painstaking about things like greetings cards, lingering over the messages inside to ensure he perfectly encapsulated what he wanted to say.
His primary medium of communication, though, was sport. Michael remembers his father teaching himself and his brother Mark how to play various sports and avidly watching their games: “A man that was always there and always supporting me as his boy in every endeavour that I undertook.”
Terry Strong grew up on a dairy farm in rural New South Wales with five siblings. His primary sport as a young adult was rugby league, from schoolyard teams and the Lismore under-18s and later the Campbelltown City Kangaroos. He played first-grade club football and representative group six football in the 1970s and early 1980s. He hopped between clubs depending on where he was working, including stints at regional towns Jamberoo and Hay. He played in a premiership with one team and was a leading try scorer in another, occasionally getting paid to play. His last game was in 1984, aged 31.
“He was really proud of his own achievements. But he had this beautiful humility,” Michael Strong says. “He never, ever talked himself up.”
Strong was a hard tackler. As an outside centre, he played defensively – a sought-after teammate for those playing inside. In the late 70s, after breaking his jaw playing touch football, he moved to the forward line. Michael believes his father received the hardest knocks there. “It was pretty rough and tumble back then in the 70s, the way they played football,” Michael says. “A lot more thuggery happened in those days.”
Strong was often concussed, sent back on to the field after smelling salts were waved under his nose. He was also often only paid for the games he won. That provided even more of an incentive to get back into the game, no matter in what condition he’d come off.
The family believes Strong first started to experience cognitive difficulties in his early 50s, even leaving a job he loved because he was having trouble with computers. It wasn’t until his 60s, however, that he could no longer hide his issues. He and Kathy sought help after an overseas holiday on which Terry twice found himself outside their hotel in the middle of the night with no idea how he got there.
Clinical concerns
It was a 60 Minutes documentary about Shane Tuck that got Terry and Kathy thinking about CTE.
“We had a big discussion about his football and his concussions,” Kathy said. The sporting concussions weren’t his only head injuries: as a kid, Terry had fallen off horses and on at least one occasion, split open his head after a tumble off a shed roof.
“That’s when I started doing the research about CTE. And I discovered the [Australian] sports brain bank … We talked about him donating his brain. And it was an easy decision for him. He said, I want to donate it because I don’t want you to spend the rest of your life wondering what happened to me.”
The head of Royal Prince Alfred Hospital’s neuropathology department and executive director of the Australian Sports Brain Bank, Dr Michael Buckland, performed the autopsy on Strong’s brain. He says Strong’s pathology was complex, showing a lot of overlapping degeneration, but the tau protein deposits that characterise CTE were “everywhere”.
All neurodegenerative diseases are difficult to diagnose clinically, but CTE especially. “It’s the newest and no one really understands it, and it does seem to have the most diverse range of manifestations,” Buckland says.
Strong’s cause of death was recorded as advanced Lewy body dementia, but like CTE, Lewy can only be diagnosed definitively after death. Buckland says the pattern and intensity of the Lewy deposits, which were contained only in the brain stem, didn’t correlate with Strong’s dementia symptoms, which originated from other parts of the brain.
“I would say the CTE was doing all that,” Buckland says. “He had a heavy burden of disease, of CTE, and he was only in his 60s. That’s certainly not normal at all.”
‘Let’s just look after people’
In August 2021, Strong fell off a boating platform and broke his hip. At hospital he was given strong painkillers, which triggered a psychotic episode lasting hours. He was assigned a permanent wardsman while in intensive care and transferred to the geriatric unit at Shoalhaven hospital after two weeks. He was never the same afterwards and while the family tried to take him home briefly, they realised it was beyond them after an extreme episode late at night saw Terry fashioning a weapon out of a hatstand.
There were still glimpses of the loving family man: the nurses told Kathy that he would walk around the ward with his hands cupped, saying he was carrying her with him, explaining she had made him a better person. But he was deteriorating rapidly. His body started to shut down. He died four months after going into hospital, with his family at his bedside, telling stories about the man he used to be.
The Strongs speak very highly of the sleep specialist and the geriatricians who treated Terry, especially during his final months. Since his death, Terry’s doctors at Shoalhaven, who see other younger dementia patients with behavioural issues, have started collaborating with the brain bank.
But Kathy also describes the uphill battle in the earlier phases of Terry’s disease to find medical practitioners who took his night episodes and aggressive outbursts seriously. And there was little understanding among their social circle about the specifics of Terry’s condition.
Terry loved sport. His family say they don’t want to take that away from anyone. They decided to speak out about Terry’s illness because they didn’t want other families to go through what they did. They worry that, by being slow to recognise the science showing the relationship of CTE to contact sport – if they accept it at all – sporting organisations, from amateur to professional, are not fulfilling a duty of care to their players.
In her submission to the inquiry, Kathy Strong argued for greater financial investment in concussion research, saying the government needed to ensure sporting organisations were “responsible and accountable for the welfare of players”.
“They have these concussion protocols yet they’re not accepting that concussions cause damage to the brain in terms of CTE,” says Michael. “Your normal punter at the pub knows that these blokes are getting long-term damage from getting knocked in the head over and over and over again. Why can’t we just accept it and come up with a solution?
“Let’s just look after people. That’s our responsibility to each other as human beings.” | Disease Research |
A first-time mother told how she was left in bloody sheets for three days at a maternity unit that was nearly shut down in January over safety concerns.
Philippa Chapman said staff refused to clean her bed after she had given birth at the William Harvey hospital in Ashford, Kent, in March last year.
She said the birth was "horrendous", and she would not return to the unit as she would fear for her life.
The trust apologised to Mrs Chapman and for its wider failings.
Mrs Chapman recalled her harrowing ordeal after it emerged that health inspectors considered shutting down the William Harvey's maternity unit earlier this year over safety concerns.
The Care Quality Commission instead called for "immediate improvements" following a visit.
The watchdog's inspection came weeks after a review in October found at least 45 babies might have survived at the two hospitals run by the East Kent Hospitals Trust.
'It was horrific'
After Mrs Chapman went into labour, she asked for an epidural, but was told there were no staff around to help her.
She said she was told she would need to "wait until either your life is in danger or his (her son) life is in danger before we can bump you up the queue. It was horrific".
Her son, Ambrose, was born hours later after an episiotomy. But shortly after his birth, he developed jaundice and both mother and baby had to stay in the William Harvey for five days.
However, Mrs Chapman was left in blood-stained sheets for three days, despite asking for clean bedding.
"I was still in the sheets that they'd done the episiotomy on," she said.
The inspection of East Kent's William Harvey hospital laid bare multiple instances of inadequate practices at the unit, including staff failing to wash their hands after each patient, and life-saving equipment not being in the right place.
Days after the visit, the watchdog raised safety concerns and threatened the trust with enforcement action to ensure patients are protected.
Helen Gittos, whose newborn daughter died in the care of the East Kent Hospitals Trust, said there were "fundamental" problems at the trust.
Ms Gittos, whose baby Harriet was born at the East Kent trust's Queen Elizabeth the Queen Mother Hospital (QEQM) in 2014 and died eight days later, said: "When my daughter Harriet was born, the then head of midwifery was so concerned about safety that she thought that the William Harvey in particular should be closed down."
She told BBC Radio 4's Today programme: "Here we are, almost nine years later, in a similar kind of situation. What has been happening has not worked."
The inspectors' key findings included:
- At the William Harvey hospital, inspectors found bloodstains on toilets
- In day care and triage, inspectors "routinely" saw staff did not always clean their hands or use aprons and gloves while delivering care
- Resuscitaires were not available in the right place, nor were they cleaned and checked regularly
- Staff at the hospital did not always ensure a second opinion was sought
- Staff morale was low across both hospitals
- At The QEQM, equality and diversity were not always promoted
After it was threatened with closure by the CQC, the trust promised to make immediate improvements to care. The CQC ultimately decided that weekly monitoring of its services would suffice.
The overall CQC rating for maternity services at both the William Harvey and The QEQM in Margate has dropped from 'requires improvement' to 'inadequate' following the inspection.
Deanna Westwood, the CQC's director of operations south, said the watchdog has now used "urgent enforcement powers" to "require immediate improvements" at the trust.
Tracey Fletcher, East Kent Hospitals trust chief executive, said: "I am sorry that despite the commitment and hard work of our staff, when they inspected in January, the CQC found that the trust was not consistently providing the standards of maternity care women and families should expect."
She said the trust has since increased doctor staffing in the triage service at William Harvey. The trust also said it has ensured better access to emergency equipment and improved cleaning.
Ms Fletcher also said she was "truly sorry" for Ms Chapman's experience.
"I am committed to making the improvements needed to ensure we are consistently providing high standards of care for every family, every time. I am sorry that this was not the case for Philippa," she said.
'Sub-optimal care'
Niall Dickson, chair of the trust, said: "This is a sobering and highly critical report."
He told the BBC's Today programme: "We knew that some of this would take time, but this report underlines both how much more we need to do, but also frankly we need to concentrate on the basics.
"There's a new director of midwifery and her deputy, who have both come from outstanding trusts, and I know their focus is on getting those basics right and getting those basics in place."
October's independent review, which was chaired by Dr Bill Kirkup CBE, examined an 11-year period from 2009 at the two hospitals.
It found that of the 202 cases that were examined, up to 45 babies might have survived if they had received better care from the trust.
The review uncovered a "clear pattern" of "sub-optimal" care that led to significant harm, and said families were ignored.
Ms Gittos said: "There ought to be a nine-year-old girl with me, getting ready for school, and I wish there were."
Analysis
By Mark Norman, health correspondent, BBC South East
It is another awful report from inspectors.
More condemnation of managers and a reminder that the trust doesn't have enough maternity staff or medical staff with the right qualifications, skills, training and experience.
But two things concern me.
This inspection came two months after the publication of Dr Bill Kirkup's report. It begs the question why simple safety changes had not been initiated by senior managers in the weeks following that report.
Secondly, NHS England have had "maternity improvement advisors" supporting the trust for the last four years. It's worrying that with a huge amount of support and scrutiny that these problems still exist and don't appear to be improving.
Have you been affected by any of the issues raised in this story? Share your experiences by emailing [email protected].
Please include a contact number if you are willing to speak to a BBC journalist. You can also get in touch in the following ways: | Women’s Health |
Uncovering the link between cell biomechanics and wound healing
An interdisciplinary team of researchers from the Indian Institute of Science (IISc) has uncovered how the stiffness of a cell's microenvironment influences its form and function. The team was led by Namrata Gundiah, Professor at the Department of Mechanical Engineering and Paturu Kondaiah, Professor at the Department of Developmental Biology and Genetics. The findings provide a better understanding of what happens to tissues during wound healing.
Inefficient wound healing results in tissue fibrosis, a process that can cause scar formation, and may even lead to conditions like cardiac arrest. Changes in the mechanical properties of tissues—like stiffness—also happen in diseases like cancer.
In the study, published in Bioengineering, the team cultured fibroblast cells—the building blocks of our body's connective tissue—on a polymer substrate called PDMS with varying degrees of stiffness. They found that a change in the stiffness altered cell structure and function.
Fibroblast cells are involved in extensive remodeling of the extracellular matrix (ECM) surrounding biological cells. The ECM, in turn, provides the mechanical tension that cells feel inside the body. The team found that fibroblasts cultured on substrates that had lower stiffness were rounder and showed accompanying changes in the levels of cytoskeleton proteins such as actin and tubulin. Moreover, fibroblasts grown on such substrates showed cell cycle arrest, lower rates of cell growth, and cell death.
To pinpoint the "master regulator" that drives changes in the cell when substrate stiffness changes, the team focused their attention on an important signaling protein called Transforming Growth Factor-β (TGF-β). Previous work has shown that the activity of fibroblasts and the downstream ECM architecture is regulated by TGF-β.
"The thing is, people talk about the chemical changes … but not about biomechanical," says Brijesh Kumar Verma, former Ph.D. student at the Department of Developmental Biology and Genetics, IISc, and first author of the study. For example, while the TGF-β signaling cascade has been studied extensively in cancer, the influence of mechanical forces—such as substrate stiffness—has not been studied so far, Verma adds.
The ECM surrounding different tissues has different levels of stiffness—from being soft around the muscle, to very hard around bone. To mimic this diversity, the team fabricated PDMS substrates of varying stiffness on which fibroblasts were grown. "You can use PDMS to create biocompatible materials with substrate stiffness over large orders of magnitude, from 40 kilopascals to more than 1.5 megapascals," explains Aritra Chatterjee, former Ph.D. student at the Department of Bioengineering, IISc, and another author.
At first, the researchers did not observe any changes in the total TGF-β levels. "[Interestingly], when we did the activity-based assay for TGF-β, we were quite surprised," says Verma. They found that when substrate stiffness increased, TGF-β activity also increased—in other words, the levels of the active form of the protein started rising.
Verma adds that this could explain why wound healing occurs at different rates in different tissues. This means that bone tissue, which grows on a stiffer ECM, may be less prone to scarring upon injury when compared to muscle tissues, which reside in a softer biomechanical environment.
The team also found that there was an uptick in the production of several ECM components when the substrate stiffness increased—fibroblasts growing on an already stiff substrate also start secreting more ECM components, in a positive feedback loop. "The most novel finding was the fact that the signaling [between the fibroblast and ECM] was actually sensitive to a mechanical stimulus, which is substrate stiffness," Chatterjee explains.
In the future, the researchers seek to understand how other mechanical factors, such as surface properties and cell stretch, can also influence TGF-β activity.
"The microenvironment of the cell is very complicated as it is experiencing a lot of different forces," says Chatterjee. Understanding their influences and tracking the biophysical parameters of the cell can also provide a useful tool to distinguish between healthy and cancer cells.
A tumor mass can be targeted more efficiently if we understand how stiffness changes in diseased cells, Verma explains. "I'm very optimistic about this."
More information: Brijesh Kumar Verma et al, Substrate Stiffness Modulates TGF-β Activation and ECM-Associated Gene Expression in Fibroblasts, Bioengineering (2023). DOI: 10.3390/bioengineering10090998
Provided by Indian Institute of Science | Medical Innovations |
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In the first research to look at constipation’s impact on the aging brain, scientists have found some concerning links.
Being chronically constipated, defined by the authors as having a bowel movement only every three or more days, has been linked with a 73% higher risk of subjective cognitive decline, according to research presented Wednesday at the Alzheimer’s Association International Conference in Amsterdam.
“Our study provided first-of-its-kind evidence that examined a wide spectrum of bowel movement frequency,” said Dr. Chaoran Ma, the research’s first author and assistant professor in the department of nutrition at the University of Massachusetts Amherst, via email. “We were surprised at how strong the associations were, especially for those with very infrequent bowel movements.”
About 16% of the worldwide adult population experiences constipation, but it’s even more common among older adults due to age-related factors such as lack of exercise and dietary fiber, and the use of medicines that can cause constipation as a side effect.
Chronic constipation has been linked with inflammation and mental disorders such as anxiety and depression, but there have been many unanswered questions about the relationship between digestive health and long-term cognitive function, according to a news release.
Cognitive function refers to a person’s mental capacity for learning, thinking, reasoning, problem-solving, decision-making, remembering and paying attention.
To find clues to these queries, the authors assessed more than 112,000 adults who had participated in the Nurses’ Health Study, Nurses’ Health Study II and Health Professionals Follow-Up Study. The first two studies investigated risk factors for major chronic diseases among women in North America, while the latter study is looking into the same topics but for men. The authors of the latest research collected data on participants’ bowel movement frequency from 2012 to 2013, participants’ self-assessments of cognitive function between 2014 and 2017, and details on some participants’ objectively measured cognitive function between 2014 and 2018.
Compared with people who pooped once a day, constipated participants had significantly worse cognition equivalent to three years more of chronological cognitive aging, the authors found. Increased risk was also found among those who pooped more than twice daily, though these higher odds were small.
“The more we learn about the gut-brain access, the more we understand that it’s just so important to ensure that (preventing or addressing cognitive decline) is a system approach,” said Maria C. Carrillo, chief science officer of the Alzheimer’s Association, who wasn’t involved in the research. “The brain is not completely isolated from what’s happening in your blood flow.”
Bowel movements and the brain
This research wasn’t “designed to test the causal relationship between bowel movements, the gut microbiome and cognitive health, so we cannot firmly draw conclusions regarding the precise causal sequence underlying this association,” Ma said.
But bowel movement frequency and subjective cognitive function were also linked with the participants’ gut microbiomes, the authors found. Among those with infrequent bowel movements and worse cognitive function, there was a depletion in good bacteria that produce butyrates, fatty acids which support the gut barrier that prevents bacteria and other microbes from entering your bloodstream, according to the Cleveland Clinic.
Butyrates also significantly aid in digestive health by providing the main energy source for colon cells. Those can be found in high-fiber foods, fiber supplements, prebiotics and full-fat dairy products — eaten in moderation — such as butter, cheese, milk or ghee. Ghee is clarified butter, made by isolating pure butterfat from the milk solids and water in butter.
Those who pooped twice or more per day and had worse cognitive function had a higher amount of species that promote inflammation and are related to dysbiosis, an imbalance in gut microbes associated with disease.
Other research presented at the same conference Wednesday had similar findings. In one abstract of 140 middle-aged adults, having lower levels of neuroprotective gut bacteria Butyricicoccus and Ruminococcus was associated with elevated levels of Alzheimer’s disease biomarkers.
In another, of more than 1,000 adults, those with poor cognition had abnormally high amounts of the bacteria Alistipes and Pseudobutyrivibrio compared with other participants. Alistipes bacteria have previously been linked with anxiety, chronic fatigue syndrome, depression and hypertension.
“It makes sense that individuals that are having those movements so much less frequently are going to have less of the good bacteria and more of the bad bacteria that’s caused by inflammatory conditions,” Carrillo said.
“Further studies are needed to identify the microbes involved, and their function,” Ma said concerning her research.
Regarding neurological and digestive health, “good food not only feeds our brain, but it also promotes healthy bowel movements,” Carrillo said.
Eating enough fiber from vegetables, fruits, whole grains and nuts can prevent constipation. Total fiber intake should be at least 25 grams per day, according to the US Food and Drug Administration. And being hydrated enough softens stool so you can pass it without straining.
CNN’s Sandee LaMotte contributed to this report. | Nutrition Research |
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A Food and Drug Administration advisory committee will meet Wednesday to weigh in on Covid vaccines for children under 5. The committee's endorsement is a crucial step before the FDA can authorize the shots, from both Pfizer-BioNTech and Moderna, for the age group. Children under 5 are the only group in the United States who remain ineligible to get vaccinated. Full coverage of the Covid-19 pandemicSome parents of the roughly 18 million children in the age group have been eagerly awaiting the shots to become available. However, a recent Kaiser Family Foundation survey found that only about 1 in 5 parents with children under 5 say they intend to get their child vaccinated “right away" once federal regulators authorize it.While children are less likely than adults to become seriously ill from Covid, some do suffer from complications — and an infected child can spread the virus to family members, giving an urgency to vaccinating this age group, health experts note. “The sooner we can get our youngest vaccinated, the less stress families will be under after an already long two years,” said Dr. Nusheen Ameenuddin, a pediatrician at the Mayo Clinic in Rochester, Minnesota.Vaccinations for young children could begin as early as next week, according to White House Covid coordinator Dr. Ashish Jha.The FDA is expected to authorize the shots quickly after Wednesday's meeting of its Vaccines and Related Biological Products Advisory Committee. The Centers for Disease Control and Prevention's advisory committee is expected to meet Friday and Saturday to decide how the vaccines should be used for children under 5. If all goes as hoped, CDC Director Dr. Rochelle Walensky will sign off on the authorization, sometimes within hours of the committee's clearance. Pfizer is asking the FDA to authorize a three-dose vaccine for children ages 6 months to 4 years, while Moderna is requesting authorization for a two-dose vaccine for kids ages 6 months to 5 years.Over the weekend, FDA scientists released their own analysis of both vaccines, saying in briefing documents posted online that the Pfizer and the Moderna shots appear to be safe and effective in young children. Early clinical trial results found that Pfizer's three-dose vaccine, given in 3 microgram doses, appeared to be 80 percent effective in preventing symptomatic Covid in kids, according to the FDA briefing documents. Moderna's two-dose vaccine, given at 25 micrograms, was shown in trials to be around 40 to 50 percent effective at preventing milder infections, according to the FDA documents, though the company has said it is testing a booster dose for the age group.Are Covid vaccines linked to myocarditis in kids? The vaccine should protect little children against the worst outcomes of Covid. And overall, the data on the safety profile of the vaccines has so far been “very encouraging,” Ameenuddin said.The vaccines were generally tolerated well, with pain at the injection site, irritability and sleepiness among the most common side effects reported, according to the FDA documents.The agency noted, however, that there is currently not enough data for the age group for it to assess the risk of a rare heart inflammation condition called myocarditis. Pfizer's and Moderna’s vaccines have been linked to rare instances of myocarditis, particularly in teen boys and young men. There were no safety concerns about heart inflammation in either of the Pfizer or the Moderna pediatric trials, which each tested the vaccines in a few thousand children. Dr. Jesse Goodman of Georgetown University, a former FDA vaccine chief, said on a call with reporters Monday that it was "reassuring" there were no documented myocarditis cases in the clinical trials, though he noted it wouldn't be expected to be detected in such a small trial.Should kids who have had Covid get vaccinated? A recent CDC report found that roughly 75 percent of children 11 and under had evidence of an infection by February, up from 44 percent in December.Dr. Paul Offit, a member of the FDA's advisory committee, said on the call Monday that studies in adults have shown that there appears to be an advantage to giving vaccinations to those who have been previously infected with the virus.But he also questioned the efficacy of both vaccines in kids, noting that the trials took place before the omicron subvariants, BA.4 and BA.5, began rapidly spreading in the U.S. Dr. Anna Durbin, a vaccine researcher at Johns Hopkins University in Baltimore, said that while the vaccine data looks "encouraging," young children and other groups will eventually need to get vaccinated with updated vaccines that are designed to target newer variants.On June 28, the FDA’s advisory committee is scheduled to meet to discuss what strain or strains should be included in Covid booster shots for the fall.Pfizer and Moderna are both working on updated shots that target the omicron variant.Follow NBC HEALTH on Twitter & Facebook. | Vaccine Development |
Cabinet minister Michael Gove has disputed claims Boris Johnson was "incapable of making decisions" about lockdowns during the pandemic in evidence to the Covid inquiry.
He said introducing a lockdown was "difficult" for Mr Johnson because it went against his "political outlook".
But he accepted lockdowns came too late both in March and November 2020.
Mr Gove also apologised to victims and bereaved families for the government's "mistakes" during the pandemic.
He said as a senior minister who was "close to many of the decisions that were made, I must take my share of responsibility for that".
Mr Gove said politicians were "human beings" who were "fallible", and "every decision was difficult and every course was bad" at the time.
Personal responsibility
While some mistakes were "unique and specific to the UK government", Mr Gove said "we need to remember that governments everywhere made errors".
Mr Gove was the first senior cabinet minister at the centre of the UK government's response to the pandemic to give evidence in this part of the inquiry.
As cabinet office minister he was part of a core team of key decision makers in 2020 along with Mr Johnson, former Health Secretary Matt Hancock and Rishi Sunak, who was chancellor and is now prime minister.
His admission to errors and his own personal responsibility at the time was a significant moment in the inquiry, as well as his apology to bereaved families.
More on the Covid inquiry
Much of Mr Gove's testimony focused on how decisions were made by senior ministers and civil servants in Mr Johnson's government in the first year of the pandemic.
In previous testimony, some of Mr Johnson's most senior advisers - including Dominic Cummings and Lee Cain - have characterised the former prime minister as indecisive and liable to change his mind.
Lee Cain, No 10's former director of communications, said Mr Johnson had been "torn" between the scientific evidence and public opinion, describing the pandemic as the "wrong crisis" for the former prime minister.
But in his testimony on Tuesday, Mr Gove was loath to criticise his former cabinet colleagues.
When asked about the lockdown announced by Mr Johnson in March 2020, Mr Gove said: "A decision to restrict freedoms in an unprecedented way went against his instincts and the principles that governed his political outlook."
The levelling up secretary said Mr Johnson preferred "gladiatorial decision-making" and wanted to see opposing arguments "rehearsed in front of him".
Mr Gove also said he had a "high opinion of Matt Hancock and believe many of the decisions he made displayed foresight and wisdom".
Mr Hancock is due to begin his evidence to the inquiry on Thursday, with Mr Johnson and Mr Sunak to appear before Christmas.
Mr Gove told the inquiry ministers like himself who believed the government should have acted earlier had a responsibility to point out to the then-prime minister the need for action.
"I don't think that one can single out the prime minister at the time for criticism," Mr Gove said. "We all deserve our share retrospectively of criticism."
Admissions of failure
The senior Conservative MP said the UK was not well enough prepared for the pandemic, that testing should have been better planned and that there were errors with PPE procurement.
He acknowledged there was not enough focus on the impact on children.
In a foul-mouthed WhatsApp exchange with Mr Cummings at the beginning of the pandemic, Mr Gove said the government was "missing golden opportunities" to act.
He wrote: "I will carry on doing what I can but the whole situation is even worse than you think and action needs to be taken or we will regret it for a long time."
When asked to expand on his comments, Mr Gove said at the time he was concerned about the "ability and structure" of the Cabinet Office to deliver government's priorities.
He then apologised for his language and added he feared the "weaknesses" in government would be further exposed by Covid.
At one point, the Surrey Heath MP noted there was a significant body of evidence that believes Covid was "man-made", only to be told the issue was not part of the inquiry's terms of reference.
Where and how the Covid virus originated is still a matter of intense scientific debate.
One controversial school of thought - which has been described as a "likely" explanation by the FBI - is that the virus was accidentally leaked by a Chinese laboratory which was researching similar viruses.
When asked about Mr Gove's comments, the prime minister's spokesperson said the World Health Organisation "needs to continue to examine all possibilities" about the origins of Covid.
Former deputy chief medical officer Professor Dame Jenny Harries began giving evidence after Mr Gove.
She was asked about comments she made at a Downing Street press conference in April 2020 when she said the UK was a "very highly prepared" for the pandemic.
She said the claim felt wrong "in retrospect" and had been based on an "external objective assessment".
Prof Harries will return to the inquiry at 10:00 GMT on Wednesday.
Later this week, the inquiry will also take evidence from Mr Hancock and the former Deputy Prime Minister Dominic Raab.
The inquiry is taking evidence as part of its second module on core UK decision-making and political governance. | Epidemics & Outbreaks |
Republican Conference Chair Elise Stefanik (R-N.Y.)Bill Clark/CQ Roll Call via AP Images Facts matter: Sign up for the free Mother Jones Daily newsletter. Support our nonprofit reporting. Subscribe to our print magazine.One week after the mass shooting tragedy in Uvalde, Texas, Rep. Elise Stefanik (R-N.Y.), the House Republican Conference chair, reiterated her opposition to gun control during a press conference that was focused on milk choice in school lunches for New York students. But lest anyone think she was indifferent to the slaughter of children, she insisted that this time, she and her Republican colleagues in Congress were not just offering thoughts and prayers. “What we are focusing on is making sure that we have increased resources for mental health,” she said, ticking off a number of measures Congress has passed, with help from Republicans, to improve the mental health system over the past few years, including improving the mental health records that went into the national background check system. Today when I asked Rep. @EliseStefanik about passing new firearm legislation in Congress in the wake of the Buffalo and Uvalde mass shootings, she had this to say- pic.twitter.com/2Maw9cZH8f
— Thomas Connolly (@tom_connolly418) May 31, 2022 Her comments were immediately criticized as another sop to the gun lobby (the same industry that employs her husband) and code for Republicans’ intention once more to obstruct any meaningful efforts to combat the nation’s gun violence epidemic. After all, Republicans invoke mental illness after every mass shooting. In 2019, after two mass shootings over a single weekend that left 31 people dead and dozens injured, President Donald Trump insisted, “Mental illness and hatred pulls the trigger.” But the funny thing is that Stefanik was right about one thing: Republicans in Congress have quietly done some good work on mental health in the past several years. After the mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, in December 2012, which left 20 first-graders and six adults dead, it seemed for a brief moment like the country’s political leaders might actually pass some aggressive measures to address gun violence. But then, like now, they fell back on muted calls for better mental health services in lieu of real solutions, like, say, an assault weapon ban. Data from the National Center for Health Statistics show that between 2000 and 2010, only five percent of gun-related murders were caused by someone with a mental illness. And yet, a few Republicans did follow through and introduce legislation to start to reform the tattered mental health system in the years after Sandy Hook, acknowledging that it was failing huge numbers of Americans with serious mental illnesses.
Leading the charge was former Rep. Tim Murphy (R-Pa.), a child psychologist who was forced to resign from Congress in 2017 after having had an affair with a woman half his age and then asking her to have an abortion during a pregnancy scare. But before all that, in 2013, around the one-year anniversary of the Sandy Hook shooting, Murphy introduced the “Helping Families in Mental Health Crisis Act” to try to plug some of the gaping holes in the mental health system. The bill wasn’t sexy; it launched a host of innovation grants to fund pilot projects and other evidence-based efforts to fix the system. It required the federal government to collect more data to figure out where new reforms were needed. And it would have updated the Health Insurance Portability and Accountability Act to address some parts of the privacy law that prevent families of adults with mental illness from communicating with doctors about their loved ones. Plus it proposed strengthening measures that require insurers and federal health programs to treat mental illness on par with other diseases.
Then-House Majority Leader Paul Ryan lent his support to Murphy’s bill in 2015, after yet another mass shooting, this one in San Bernardino, California, in which 14 people died and 21 others were injured. “I think we need to improve our mental health laws so we can address these problems before they get out of control,” Ryan said. “Mental health is a component to a lot of these shootings that, I think, we have not looked at seriously enough.”
It took three years, but finally, a watered-down version of Murphy’s bipartisan bill was rolled into the omnibus 21st Century Cures Act, which added funding to the National Institutes of Health and tackled everything from Lyme disease to opioid overdoses to prescription drug development. President Barack Obama signed the bill in December 2016. Among other things, the measure created the first cabinet-level position of Assistant Secretary for Mental Health and Substance Abuse Disorders at the US Department of Health and Human Services to coordinate mental health research and programs across the federal government. Other provisions were designed to help people with serious mental illnesses such as schizophrenia and bipolar disorder get treatment in the community. The bill authorized suicide prevention grants and created new requirements for various government agencies to collect data on everything from psychiatric bed availability to the involvement of mental illness in homicides.
“The federal legislation that makes up the Cures Act is very much systemically focused,” says Lisa Dailey, executive director of the Treatment Advocacy Center, a nonprofit focused on mental health reform and research. “It’s addressing many years of kind of business-as-usual that wasn’t working very well. A lot of the things that were addressed might not be very easily visible, but they were things that needed to be addressed.”
The law, which is up for reauthorization this year and has bipartisan support, became the most significant mental health reform measure in the US in 50 years. And yet, even with these efforts, data indicate that about 40 percent of people suffering from a serious mental illness never received any sort of mental health care in 2020. Moreover, you’d be hard-pressed to make the case that the law prevented a single mass shooting, given how many of them there have been since Obama signed it. There were 45 such episodes between January 2017 up to and including the Uvalde shooting in which three or more people were killed in an indiscriminate public rampage, according to this Mother Jones database. There were 31 such shootings in the six years before the bill passed.
If Republicans are serious about wanting to do more to improve the mental health system, that’s great. From a dire lack of psychiatric hospital beds to a shortage of mental health professionals and school counselors and research on brain diseases, the need is obvious. But none of those initiatives are likely to put a dent in the nation’s gun violence problem without a concomitant effort to control access to firearms. Just consider the recent school shooting that took place a few miles from the US Capitol a month before the Uvalde elementary school bloodbath.
In April, a 23-year-old man named Raymond Spencer set up a sniper’s nest in an apartment across the alley from the Edmund Burke School, a private school in northwest DC. At 3:15 p.m., just at dismissal time, he fired hundreds of bullets into the school with a semi-automatic weapon he’d purchased legally in Virginia. Set up on a tripod, the gun was equipped with a scope with a camera attached to it that he used to record a video he posted of the shooting on 4chan. The circumstances of this shooting contradict nearly all of the GOP talking points about preventing school shootings with mental health care and armed guards. Burke had two security guards on duty that day, both armed—one a retired Metropolitan Police Department officer, the other an off-duty DC cop. Retired officer Antonio Harris, who was outside the building helping direct traffic when the shooting started, became one of the first victims and the most seriously injured after being hit from hundreds of feet away.
Three other people were injured, including a 12-year-old student. By some miracle, no one was killed, but it took police hours to find the shooter, leaving kids locked down in terror in the school waiting to be rescued until long into the evening. When police finally found Spencer’s apartment, he killed himself with a handgun as they opened the door. Police found four assault weapons, two handguns, and nearly a thousand rounds of ammo among Spencer’s possessions.
More than a month later, we still don’t know much about Spencer other than that he worked as a lifeguard in Montgomery County, Md., during high school. He’d updated the Burke Wikipedia page while he shot at its students to reflect the shooting, but no one seems to know why he targeted the school. He’d never been a student there. Estranged from his family for more than a year, he wasn’t in school. He didn’t have a job, a partner, or any current friends who have come forward to talk to the media about him. He’d had no previous encounters with the police or mental health services.
“This guy was just an absolute loner,” D.C. Police Chief Robert J. Contee III told the Washington Post. “A lone, motivated person,” Contee said, with “no history of law enforcement contact, decides to go off the rails. How do you prevent something like this?”
The answer, of course, is not more psychiatric beds or even more psychologists. The one thing—the only thing—that served as a red flag in Spencer’s case was the fact that he had bought enough high-powered weapons and ammo to effectively arm a small cell of Ukrainian resistance fighters. If he hadn’t been able to buy assault weapons with high-capacity magazines and massive amounts of ammo legally, Raymond Spencer might not just be alive, but he might have simply remained an unhappy loner who someday might have been able to take advantage of some of the mental health reforms Republicans have succeeded in passing. | Mental Health Treatments |
Junior doctors in Scotland want change. They want better pay, kinder working conditions and for the Scottish government to take their demands for full pay restoration of just under 35 per cent seriously. Otherwise, they say, they’ll simply up and leave to greener pastures – or hotter beaches, as the exodus to Australia continues.
It was revealed last week that 97 per cent of those medics who had voted in the BMA strike ballot cast their votes in favour of industrial action. The turnout was high at 71 per cent but could have been higher still, as it is understood that Civica, the external organisation in charge of posting ballot papers, ran into problems meaning an as yet unquantified number of medics never received their voting cards.
While the BMA has been criticised for choosing to focus entirely on pay as the sole negotiating ground in these disputes, the bigger picture should not be overlooked: the toll that poor working conditions is having on NHS workers is significant. Just under 75,000 NHS staff have taken time off work in the last five years due to mental health-related illnesses, as revealed by a freedom of information request made by the Scottish Conservatives. Burnout is increasing amongst doctors UK-wide: in 2022, 39 per cent of junior doctors said they had experienced burnout to a high or very high degree due to the work – an increase of six per cent on the previous year.
In Scotland, 44 per cent of junior doctors surveyed by the BMA have actively researched leaving the NHS in the last 12 months. A trend is emerging: once doctors have finished their foundation programme – the initial two years of training medics have to complete in the UK after graduating – many turn their attention to sourcing locum work or long-term specialty training jobs overseas.
‘Australia offers more favourable working conditions,’ one foundation year medic planning to move abroad told me. ‘Junior doctors in the NHS are made to feel as if they can only begin to plug gaps in an underfunded system, whereas Australia offers junior doctors a chance to professionally develop themselves in a system where they are valued. The fact that well over half of the doctors I know are moving across the world tells its own story.’
And healthcare providers in Australia have no qualms about capitalising on the dissatisfaction of medics here: using emails and adverts to entice junior doctors over. Dr Sophie Nicholls, a UK-based sexual health doctor, said online: ‘I have daily emails from Australia with tempting offers. Our doctors will move with their feet if they are not recognised for the work they do and paid appropriately.’
Doctor-turned-comedian Dr Adam Kay recently shared a picture of an advert placed in the British Medical Journal by Blugibbon Medical Recruitment. ‘Got that Dr Adam K feeling? Come to Australia!’ the jolly bubble font cried. ‘Work 10 x shifts per month & travel, swim and surf in the sun for 20 x days! $240,000 annual salary package. Accommodation provided. $5,000 sign-on bonus for 12 months of commitment.’
You can’t say it’s not tempting. Dr Kay hinted at the ‘big question’ facing both the UK and Scottish governments: ‘If you don’t address doctors’ very reasonable pay concerns, alongside their conditions and wellbeing, guess where they’re going?’
Scotland has so far avoided healthcare worker strikes, which First Minister Humza Yousaf points to as one of his few successes as health secretary. The impression amongst junior doctors north of the border is that the Scottish government is more serious than Westminster about their demands. Scotland’s health secretary Michael Matheson has already met with the doctors’ union last Thursday, though it’s currently unclear how the negotiations are proceeding. How much will the Scottish government be prepared to offer junior doctors? Matheson refused to commit to a figure, saying only that ‘negotiations to agree a pay uplift are already underway’.
Dodging strike action is only a short-term goal, of course; long term, the real problem remains: how to make sure more doctors are trained in the UK – and that they stay here. During his leadership campaign, Yousaf described the Scottish government’s ‘three pronged strategy’: to increase medical graduates by 100 per year, to recruit domestically and to recruit internationally. But Scotland sees approximately 700 doctors leave the country to work elsewhere each year and in 2016, a fifth of doctors finishing their foundation programme in Scotland left to find better jobs elsewhere – some for England, and some for much further afield.
‘We’ve got to make sure we’re not filling up a leaky bucket,’ Yousaf admitted to me outside a Dundee GP practice during the leadership contest. While the former health secretary said he wouldn’t give medics the full pay restoration they were looking for, he accepted that the system for junior doctor allocation to hospitals post-graduation could be examined ‘so we don’t spend years and years training somebody up only to lose them because we’re being inflexible’.
So how to stop the exodus? Scottish Labour’s deputy leader and health spokesperson, Jackie Baillie, said that she was ‘not adverse’ to considering options that would see Scotland-trained medics obliged to work in the country’s NHS for a certain number of years after qualifying. ‘Do I think if we’ve spent hundreds of thousands of pounds training a junior doctor – which we have – that we should expect some longevity of service to the NHS? I think that’s perfectly reasonable.’ But Baillie makes clear that this wouldn’t be a policy introduced without movement on pay: ‘You can only apply the golden handcuffs if you are fair about the pay that you give people. I would want to talk to the BMA, and to junior doctors, about how we land this in the best possible way. I don’t want anything we do to accelerate people leaving.’
A common thread unites the Scottish political parties across the divide on the junior doctor issue: firstly, that some sort of pay rise is needed (though no one wants to be the first to name their price), and secondly, that the workforce crisis cannot be solved by wage increases alone. Baillie discussed rota complaints, missed breaks and unpaid – and often unplanned – overtime as being key areas to sort out, while Dr Sandesh Ghulane, the health spokesperson for the Scottish Conservatives, pointed to ‘the little things’ that need changed, like food provision for those working night shifts and better rota organisation. Free accommodation offered by hospitals – an incentive offered in the above advert from Australia – is another concession that could help relieve pressures from medics, Ghulane suggested.
Another problem is managing the expectations of BMA members: while some medics in Scotland have admitted that they would accept a pay rise of less than 35 per cent (with others admitting that it was their work-life balance rather than their pay checks that most concerned them) there are groups of members within the doctors’ union who remain vocal in their demands to accept nothing short of full pay restoration (FPR).
‘As unrealistic as it may seem, I really hope the BMA remains strong for genuine FPR,’ one junior doctor wrote. ‘It’s honestly the bare minimum needed to keep us going in the NHS. It’s just not a viable career anymore in the UK.’ Agreeing, another medic responded: ‘Frankly, if we were to get an offer close to but not quite FPR and the BMA asked us to vote on it, I would personally vote no. It’s unaffordable to be a doctor in the UK and we have the ability to work for better pay and less hours elsewhere.’
Health secretary Michael Matheson says he has been frank in negotiations so far and remains firm that ‘the recruitment issues are not all about pay’. Perhaps aware that this line of discussion may not fly with the BMA, Matheson has also revealed that he’s already asked NHS boards to start preparing contingency plans should the strikes go ahead.
The workforce crisis is at the heart of the dispute over wages and working conditions in the NHS. There are over 133,000 vacancies in the health service and both junior and senior doctors are feeling the strain. In fact, the BMA announced today that now consultants in England are now being ballotted on strike action. While it’s all very well looking for international recruits to plug gaps, there is a real tragedy here: Scotland, and the UK, are home to some of the best medical schools in the world. Something has gone very wrong when it is only Australia’s patients who feel the advantages of that. | Health Policy |
First locally transmitted malaria cases detected in US in decades: What you should know
The Centers for Disease Control and Prevention (CDC) has issued a health advisory over the spread of a few malaria cases in Florida and Texas, marking the first time locally acquired infections of the disease have been detected in the U.S. in 20 years.
Five cases of malaria caught by people in the U.S. have been identified so far, four in Florida and one in Texas, in the past two months. The fact these individuals were infected in the U.S. is what is causing concern among health officials as infections like these haven’t been seen since 2003.
As the CDC noted in its alert, malaria infections in the U.S. aren’t unheard of. The country saw about 2,000 annual malaria cases every year before the COVID-19 pandemic.
However, cases in the U.S. are almost always found in people who travelled outside of the country to regions where malaria transmission is more common. The five infections in Florida and Texas being caught locally indicates indicate mosquitoes acquired the parasite and spread them to
Effective treatments and mitigation strategies against malaria are available in the U.S, though treatment for the disease can be unpleasant. One expert worries these cases are indicative of a larger problem.
Malaria was once extremely common in the U.S., but its status as an endemic disease in the country was ended after the National Malaria Eradication Program that took place during the 40’s and 50’s.
Malaria is considered a “medical emergency” by the CDC that can be fatal, particularly among children under five and pregnant women. Symptoms can range from mild to life-threatening. Symptoms can be flu-like and also include an enlarged spleen, enlarged liver or mild jaundice.
One of the hallmark symptoms of malaria is what’s called a “malaria attack” in which an infected individual experiences a distinct period of illness that lasts six to 10 hours.
These attacks are defined by three stages: a cold stage of chills and shivering; a hot phase of fever, headaches, vomiting and potentially seizures in children; and a sweating stage in which they return to a normal temperature. Patients cycle through these attacks over the course of their infection.
There are four kinds of malaria and the cases detected in the U.S. have been caused by the parasite P. vivax. Of the more 200 species of mosquitoes in the continental U.S. and territories, there are two that can carry and spread P. vivax.
“It can get out of control really quickly if these cases go undetected for long periods of time. And vivax, some strains can be very non-virulent, so people can be infected and not really realize they’re infected,” said John Adams, professor at the University of South Florida College of Public Health.
The P. vivax parasite takes about 10 to 15 days to develop inside of a mosquito and become transmissible, meaning the potential spread of malaria may not be immediately noticeable, especially if the symptoms are ignored.
The anti-malaria drug chloroquine is effective against infections caused by P. vivax, but cases associated with this parasite will likely require additional treatment.
P. vivax is also one of two forms of malaria that can remain dormant in the liver, potentially causing recurring illness for months or years. Nearly all malaria cases will require medical intervention to be resolved and P. vivax cases will require treatment by another drug — such as one called primaquine — to target the dormant parasite in the liver.
This course of treatment has issues associated with it as well.
Adams noted that primaquine “has a lot of toxicity associated with it.” Side effects can include fatigue; a weak pulse; discoloration of the skin and eyes; seizures; confusion; and blurred vision.
Primaquine also shouldn’t be administered to people who have a genetic condition called G6PD deficiency. The drug can damage red cells in people with this condition, leading to anemia. Many people aren’t aware they have G6PD deficiency until they start a treatment like primaquine.
The CDC has attributed the recent infections to increased international travel brought on by the summer. Hurricane season may have also contributed to these infections as more standing water gives mosquitoes more opportunity to breed.
Speaking on the potential for widespread transmission, Adams said a bigger concern is that these malaria infection could indicate the spread of other mosquito-borne diseases like dengue, the Zika virus, West Nile virus and the Chikungunya virus.
West Nile virus has already been detected in several states as summer sets in. Louisiana has seen an earlier than usual onset of cases this year.
Malaria can be combated with helicopters and airplanes spraying insecticides to kill adult mosquitoes and larva. Adams noted every county in Florida has a mosquito abatement district, a program tasked with controlling mosquito populations and preventing disease.
To reduce the chance of becoming infected, individuals can buy clothing that already contains a synthetic repellent and insecticide called permethrin as well as spray themselves with standard mosquito repellent.
The CDC has advised clinicians to consider malaria when treating patients with fever of unknown origin, regardless of whether they’ve recently traveled international. Clinicians should also obtain a travel history of their patients.
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. | Epidemics & Outbreaks |
30 years and a continent separated Catherine Conteh, her daughter Regina, and a nurse named Aly who was visiting their home in Sierra Leone and saved her life by funding an emergency surgery.
Regina wasn’t born on the day of that fateful meeting, technically, because Catherine was dying after four days in labor. Unable to afford a Caesarean section, that might have been the end if not for Aly Hogarth-Hall, then in her 20s, who was visiting the hospital from a nearby charity.
She managed to acquire the £70 cost for the surgery in 1993 and formed a close bond with Catherine and her new baby Regina, but lost touch.
Then 18 months ago, as Catherine and Regina prepared to go to work aboard a charity called Mercy Ships, which operates a hospital ship on the coast of Sierra Leone, they got to see Aly—now 52—as she climbed aboard for a stint of volunteer work.
“To see Catherine again, it’s very surreal really,” said Aly, who is working in the dining room with her while Regina is on nursing duties. “It’s not something I ever expected until we made contact again, 18 months ago or so, so it was overwhelming.”
“We just sobbed. We cried and cried,” Catherine quickly added.
Mercy Ships operates hospital ships that deliver free surgeries and other healthcare services to those with little access to safe medical care, and it’s where she had originally met Catherine all those years before.
MORE HEARTWARMING REUNIONS: Rapper’s Insistence on Featuring Homeless People in Music Video Results in Family Reunion
“The nurse told me that she would die, and the baby would die,” Aly recalls.
Aly informed a colleague, a British anaesthetist Dr. Keith Thomson who was part of her tour group, who paid for the surgery.
“Then the nurses came up to me and explained, ‘Look, these strangers who came in are going to pay for your Caesarean section,'” recalls Catherine.
OTHER HUMAN INTEREST STORIES: NICU Nurse Adopts 14-Year-Old Teen Patient with Triplets, to Keep Their Family Together
Whilst visiting Catherine in the hospital was easy enough, they lost touch when Aly returned home to New Zealand and Regina gained asylum in Australia.
Catherine followed Regina there and they both became nurses, inspired by Aly.
They stayed in Perth, Australia, but Catherine regularly returns to Sierra Leone to serve her local community—even fundraising to found her own school.
The pair will spend the next month volunteering aboard the Mercy Ship while the ship’s crew carry out surgeries and train more than 200 Sierra Leonean healthcare professionals. Their bond remains as strong as ever, and this time they have no plans to lose touch ever again.
WATCH them reunited below from SWNS…
SHARE This Heartwarming Meeting And Tear-Jerking Reunion… | Global Health |
As artificial intelligence gains an ever-widening role in the medical field, the Mayo Clinic has recently appointed a new executive to lead the health system’s efforts in that area.
Radiologist Bhavik Patel, M.D., has been named chief artificial intelligence officer (CAIO) for Mayo Clinic Arizona. Before joining the clinic in 2021, Patel practiced at Duke University Medical Center and Stanford University Medical Center.
Dr. Richard Gray, CEO of Mayo Clinic Arizona, announced the hire on LinkedIn, noting the organization has only "begun to scratch the surface of AI's potential in medicine."
In his new role, Patel will lead Mayo Clinic’s Advanced AI and Innovation Hub.
He'll focus on expanding AI-based solutions throughout the organization, according to a press release.
A growing number of health care organizations are hiring individuals in high-level AI roles, said Dr. Harvey Castro, a Dallas, Texas-based emergency medicine physician and AI expert — but it could be a challenge to fill them.
"We will likely see a huge increase in these roles, but may not have enough AI doctors to fill this space," Castro told Fox News Digital.
Approximately 5,000 U.S. doctors have AI and data science knowledge after undergoing formal training in these fields, he estimated.
Why is the chief AI officer role important?
In an interview with Fox News Digital, Patel described AI as a "transformative force that has the potential to revolutionize health care delivery, research and operations."
Given AI’s sweeping impact and fast growth, Mayo Clinic’s new CAIO said there is a need for a dedicated leadership position to ensure "clear direction and alignment with broader organizational goals."
The chief AI officer is also responsible for balancing the technology’s risks and benefits, Patel noted.
"The chief AI officer is not just a technocrat, but a visionary leader."
"While AI brings forth myriad benefits, it also carries inherent risks," he said. "A CAIO provides the necessary oversight to ensure that the implementation of AI is ethical, responsible and in line with regulatory guidelines."
A chief AI officer also "bridges the knowledge gap," he said, helping teams understand and harness the technology’s power.
The role is also important in terms of maximizing the use of resources, fostering collaboration across departments and keeping up with future health tech trends, Patel added.
"Their expertise is critical in ensuring that the organization remains on the cutting edge of technological advancements while safeguarding patient welfare," he said.
"In essence, the chief AI officer is not just a technocrat, but a visionary leader, ensuring that the organization navigates the AI-driven paradigm shift in health care with agility, responsibility and a patient-centric approach."
Castro agreed that the importance of this role is evident as AI becomes a pivotal part of health care.
"A chief AI officer can oversee the use and development of AI technologies, ensuring that they are leveraged effectively for patient care, data management and other applications," he said.
Daily functions of a chief AI officer
A chief AI officer has several core functions, according to Castro.
Educating the health care community is one focus.
"This person should ensure that staff and stakeholders are informed about AI technologies and their applications," he said.
Developing and implementing the algorithms used in the AI solutions is also a key part of the job, said Castro.
The CAIO must understand and analyze data derived from AI to inform decision-making and strategy.
"This role also entails managing the use of AI across the organization, ensuring that it aligns with regulatory standards and organizational goals," Castro said.
Strategy development is also inherent to the chief AI officer’s job.
"This involves formulating strategies for the implementation and utilization of AI in various health care aspects, such as patient care, data analysis and operational efficiency," said Castro.
In Patel’s case, he said the heart of his new role is to "ensure that our AI direction seamlessly integrates with and reinforces our organizational values."
Some of Patel’s day-to-day functions include:
- Overseeing the identification, vetting and integration of AI solutions for various clinical and administrative functions
- Using AI to improve diagnostic accuracy, optimize treatment paths and enhance the patient experience
- Engaging with stakeholders to gather insights, feedback and expertise
- Ensuring that all AI algorithms are transparent, free from biases, and designed in the best interests of patients and their communities
- Facilitating training sessions, workshops and awareness campaigns to ensure that everyone is up-to-date and empowered to harness AI's potential
"In essence, my role as chief AI officer is both strategic and operational," Patel told Fox News Digital.
"It's about setting a vision rooted in our values while ensuring the tactical execution of AI projects that drive value to our patients."
One of the tech team’s biggest recent contributions is an AI model that proactively assesses a person's risk of a heart attack, Patel noted.
"This model uses data from chest CT exams — often conducted for unrelated health issues, such as COVID or lung nodules — and identifies future heart disease risk, which unfortunately even expert physicians can't discern from the scan," he said.
"The model helps cardiologists prevent potential heart attacks rather than treating them reactively."
Mayo Clinic has also developed AI models that predict the prognosis of patients with diseases such as colon cancer, detect risks of future cancers using existing medical records, and predict 30-day hospital readmission or hospital-acquired infections, Patel said.
"AI can pinpoint details that make a significant difference in diagnosis and treatment."
"Our focus is not only to develop these AI models, but to ensure that the benefits of these models reach patients swiftly," he added.
Key benefits of AI in health care
Patel said he views AI as a "powerful instrument" that helps magnify physicians’ capabilities rather than replacing them.
"One of AI's primary strengths is its ability to recognize patterns that might escape the human eye," he said.
"Whether it's intricate anomalies in medical imaging or subtle patterns in patient histories, AI can pinpoint details that make a significant difference in diagnosis and treatment."
The technology also helps providers by sifting through and analyzing vast volumes of information, far more than what would be humanly possible, Patel said.
It also automates mundane and routine tasks, allowing health care professionals to redirect their focus to the patient, he noted.
Early risk detection is another key benefit.
"AI tools can predict potential health risks by analyzing a combination of genetic, behavioral and environmental factors, facilitating early interventions and potentially saving lives," Patel said.
As well, AI can help enable the delivery of personalized medicine and proactive preventative care, he noted.
"By analyzing individual genetic makeup combined with lifestyle and environmental factors, treatments can be tailored to the unique needs of each patient," Patel said.
"And by predicting potential health issues before they manifest, we can guide patients on preventive measures, fundamentally changing our approach from cure to prevention."
Potential risks and limitations
AI in health care also presents challenges and limitations, Patel acknowledged.
Because AI is a branch of science, it requires rigorous evaluation before it can be applied by doctors, he said.
"This ensures that we're not just implementing technology for the sake of innovation, but are truly enhancing patient care in a tangible, evidence-based manner."
AI models also run the risk of bias, he warned.
"By recognizing AI’s limitations and actively working to address them, we can harness AI's potential while safeguarding the core values of our health care system."
"AI models are, by nature, a reflection of the data they're trained on," he said. "If this data contains biases — whether racial, gender-based or from other sources — the models may perpetuate these biases."
There is the additional risk that humans will become overly reliant on AI, leading to a phenomenon called "automation bias."
"Essentially, this means giving undue weight to AI-generated results without adequate human scrutiny," Patel said.
"In health care, understanding the ‘why’ behind a diagnosis or recommendation is as crucial as the result," he said. "As providers, we must always contextualize AI outputs within the broader patient picture, leveraging our clinical judgment and experience."
It’s important to protect data privacy and security as well, Patel noted, due to the large amounts of information that must be fed to AI models.
While AI's capabilities are "immense and ever-growing," Patel emphasized that AI’s role is to be an ally.
"Humans caring for humans is the bedrock of health care — AI strengthens that foundation, but doesn’t replace it," he said.
"AI can offer insights and assist in decision-making, but human touch, intuition and empathy cannot be replicated by algorithms."
While AI promises a "new frontier" in health care — Patel calls for a balance of "enthusiasm and caution."
"By recognizing AI’s limitations and actively working to address them, we can harness AI's potential while safeguarding the core values of our health care system." | Medical Innovations |
Nitashia Johnson/KFF Health News
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Reesha Ahmed of Venus, Texas, was billed nearly $2,400 for standard blood tests following her first prenatal checkup.
Nitashia Johnson/KFF Health News
Reesha Ahmed was on cloud nine.
It was January and Ahmed was at an OB-GYN's office near her home in Venus, Texas, for her first prenatal checkup. After an ultrasound, getting anti-nausea medication, and discussing her pregnancy care plan, she said, a nurse made a convenient suggestion: Head to the lab just down the hall for a standard panel of tests.
The lab was inside Texas Health Hospital Mansfield, which opened in December 2020 in a Dallas-Fort Worth suburb. Ahmed, just eight weeks pregnant, said the doctor told her everything about the visit was routine. "Nothing really stood out," Ahmed said. "And, of course, there's just a lot of excitement, and so I really didn't think twice about anything."
Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
Her blood tests checked for multiple sexually transmitted infections, her blood type, and various hormones. Within days, Ahmed began bleeding and her excitement turned to fear. A repeat ultrasound in early February showed no fetus.
"My heart kind of fell apart at that moment because I knew exactly what that meant," she said.
She would have a miscarriage.
Then the bills came.
The patient: Reesha Ahmed, 32, has an Anthem Blue Cross and Blue Shield policy through her employer.
Medical services: An analysis of Pap smear results and several blood tests in tandem with Ahmed's initial prenatal visit, including complete blood count, blood type, and testing for STIs such as hepatitis B, syphilis, and HIV.
Service provider: Ahmed got her tests at Texas Health Mansfield, a tax-exempt hospital jointly operated by Texas Health Resources, a faith-based nonprofit health system, and AdventHealth, another religious nonprofit.
Total bill: The hospital charged $9,520.02 for the blood tests and pathology services. The insurer negotiated that down to $6,700.50 and then paid $4,310.38, leaving Ahmed with a lab bill of $2,390.12.
What gives: Ahmed's situation reveals how hospital-based labs often charge high prices for tests. Even when providers are in network, a patient can be on the hook for thousands of dollars for common blood tests that are far cheaper in other settings. Research shows hospitals typically charge much more than physician's offices or independent commercial labs for the same tests.
The situation was particularly difficult for Ahmed because she had lost the pregnancy.
"To come to terms with it mentally, emotionally, physically — dealing with the ramifications of the miscarriage — and then having to muster up the fighting strength to then start calling your insurance, and the billing department, the provider's office, trying to fight back a bill that you don't feel like you were correctly sent? It's just, it's a lot," she said.
In Texas, the same lab tests were at least six times as expensive in a hospital as in a doctor's office, according to research from the Health Care Cost Institute, a nonprofit that examines health spending.
The markup can be even higher depending on the test. HCCI data, based on 2019 prices, shows the median price for a complete blood count in Texas was $6.34 at an independent lab and $58.22 at a hospital. Texas Health charged Ahmed $206.69 for that test alone.
"It is convenient to get your lab done right in the same building," said Jessica Chang, a senior researcher at HCCI, but "many patients are not thinking about how highly marked up these lab tests are." Chang said she suspects many hospitals tack on their overhead costs when they bill insurance.
Anthem also charged Ahmed for at least four tests that most insurance plans would consider preventive care and therefore covered at no cost to patients under the Affordable Care Act's requirements for covering preventive care, which includes aspects of prenatal care. Her EOBs, or "explanation of benefits" notices, show she paid out-of-pocket for a test identifying her Rh factor — which detects a protein on the surface of red blood cells — as well as for tests for hepatitis B, hepatitis C, and syphilis.
Asked to review Ahmed's tests, Anthem spokesperson Emily Snooks wrote in an email to KFF Health News that the claims "were submitted as diagnostic — not preventive — and were paid according to the benefits in the member's health plan."
There "definitely shouldn't be" out-of-pocket costs for those screenings, said Sabrina Corlette, co-director of Georgetown University's Center on Health Insurance Reforms.
The Centers for Disease Control and Prevention recommends screening pregnant patients for several infectious diseases that pose major risks during pregnancy. Ina Park, a professor of family community medicine at the University of California-San Francisco and an expert on STIs, said the tests Ahmed received didn't raise red flags from a clinical perspective. "It's really more what the actual lab charged based on what the tests actually cost," Park said. "This is a really exorbitant price."
For example, Ahmed paid $71.86 in coinsurance for a hepatitis B test for which the hospital charged $418.55. The hospital charged $295.52 to screen for syphilis; her out-of-pocket cost was $50.74.
"You just wonder, is the insurance company really negotiating with this provider as aggressively as they should to keep the reimbursement to a reasonable amount?" Corlette said.
The resolution: Ahmed refused to pay the bills and Texas Health sent the debt to collections. When she tried to get answers about the costs, she said she was bounced between the doctor's office and the hospital billing department. Ahmed submitted a complaint to the Texas attorney general's office, which passed it to the Texas Health and Human Services Commission. She never heard back.
According to Ahmed, a hospital representative suggested her bloodwork might have been coded incorrectly and agreed the charges "were really unusually high," but she was told there was nothing the hospital could do to change it. The hospital did not comment on the reason behind the high charge. And in a March 7 email, an AdventHealth employee told Ahmed the doctor's office had "no control" over the hospital's billing.
Ahmed filed an appeal with Anthem, but it was denied. The insurance company stated the claims were processed correctly under her benefits, which cover 80% of what the insurer agrees to pay for in-network lab services after she meets her deductible. Ahmed has a $1,400 deductible and a $4,600 out-of-pocket maximum for in-network providers.
"We depend on health care providers to submit accurate billing information regarding what medical care was needed and delivered," Snooks said. Asked about reimbursements to the Texas Health lab, she added, "The claim was reimbursed based on the laboratory's contract with the health plan."
After a KFF Health News reporter contacted Texas Health on Oct. 9, the hospital called Ahmed on Oct. 10 and said it would zero out her bills and remove the charges from collections. Ahmed was relieved, "like a giant burden's just been lifted off my shoulders."
"It's just been fighting this for 10 months now, and it's finally gone," she said.
Texas Health Resources and AdventHealth declined to respond to detailed questions about Ahmed's charges and the tests she was directed to obtain.
"We are sorry Ms. Ahmed did not get clarity on her care with us. Our top priority is to provide our patients with safe, effective and medically appropriate care," Laura Shea, a spokesperson for the hospital, said in an emailed statement.
The takeaway: Ahmed's problem demonstrates the pitfalls of using a hospital lab for routine testing.
For standard bloodwork "it's really hard to argue that there's a quality difference" between independent labs and hospitals that would warrant higher prices, Chang said. That holds true for other services, too, like imaging. "There's nothing special about the machines that hospitals use for a CT or MRI scan. It's the same machine."
Broadly, state and federal lawmakers are paying attention to this issue. Congress is considering legislation that would equalize payments for certain services regardless of whether they are provided in a hospital outpatient department or a doctor's office, although not lab services. Hospitals have tried to fend off such a policy, known as "site-neutral payments."
For example, the Lower Costs, More Transparency Act would require the same prices under Medicare for physician-administered drugs regardless of whether they're given in a doctor's office or an off-campus hospital outpatient department. That bill also would require labs to make public the prices they charge Medicare for tests. Another bill, the Bipartisan Primary Care and Health Workforce Act, would ban hospitals from charging commercial health plans some facility fees — which they use to cover operating or administrative expenses.
According to the National Conference of State Legislatures, Colorado, Connecticut, Ohio, New York, and Texas have limited providers' ability to charge privately insured patients facility fees for certain services. Colorado, Connecticut, Maryland, and New York require health facilities to disclose facility fees to patients before providing care; Florida instituted similar requirements for free-standing emergency departments.
Patients should keep copies of itemized bills and insurance statements. While not the only evidence, those documents can help patients avoid out-of-pocket costs for recommended preventive screenings.
For now, patients can proactively avoid such extreme bills: When your doctor says you need blood tests, ask that the requisition be sent to a commercial lab like Labcorp or Quest Diagnostics that is in your network and have the tests done there. If they can't do it electronically, ask for a paper requisition.
"Don't always just go to the lab that your doctor recommends to you," Corlette said.
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.
Emmarie Huetteman of KFF Health News edited the digital story, and Taunya English of KFF Health News edited the audio story. NPR's Will Stone edited the audio and digital story. | Health Policy |
This story is part of The Dallas Morning News monthlong series on how fentanyl has affected our community.
AUSTIN — Gov. Greg Abbott signed a handful of bills into law in June that aim to fight the fentanyl crisis in Texas.
One law allows prosecutors to pursue murder charges for some fentanyl deaths; another allows for the distribution of the opioid overdose-reversing drug naloxone on college campuses; and two more are meant to increase awareness on the dangers of the drug that killed five Texans a day last year.
Not included in the legislative package this year, however, was a bill decriminalizing fentanyl test strips, which research has shown to be highly effective at detecting the powerful opioid. A proposal to legalize the strips passed the Texas House with overwhelming bipartisan support in May but died in the Senate.
Families and medical professionals across the country — and Texas — say the test strips are one of the most effective and cost-efficient tools at tackling the fentanyl crisis and saving lives. Most strips on the market in 2021 ranged between 96% and 100% accuracy.
Abbott has not said if he will ask the Legislature to decriminalize the strips in an upcoming special or regular session.
The strips cost a few dollars each. In states where they’re legal, they are available in vending machines, convenience stores and community health centers — sometimes for free. They can be bought on websites such as DanceSafe, BunkPolice and Amazon, according to the Partnership to End Addiction.
Without a clear path for legalization in Texas, some families are frustrated.
“I’m just upset because we need what’s available to our children,” said Adolph Alvarez, a Tarrant County father whose 18-year-old daughter, Abigil Chagoya Alvarez, died from a fentanyl overdose in 2022. “I’m really enough about talking about it, let’s just do it.”
Texas is one of the few states where test strips are illegal. State after state has decriminalized them since 2018, according to the Network for Public Health Law, which tracks state laws for testing drugs. Since January 2022, at least 16 states have passed laws. More states joined the list this year. Close to 40 states have legalized the strips so far.
The strips are thin and made of paper. To use them, the Centers for Disease Control and Prevention says to mix a small amount of drugs with water and then dip the strip in the solution for about 15 seconds. Next, place the strip on a flat surface and read the results: a single pink line on the left-hand side indicates positive, two pink lines mean negative.
The strips detect fentanyl only in the tested portion of the drugs. It’s possible to test a portion that does not contain fentanyl while the rest contains a potentially lethal amount. It’s commonly called the “chocolate chip cookie effect” and it’s why public health experts warn the tests are not foolproof.
Their illegality dates back to a model law from the 1970s by the Drug Enforcement Administration, which classified as illegal anything linked to taking or making banned substances, said John Woodruff, an attorney with the Legislative Analysis and Public Policy Association.
Supporters of the Texas test strip bill — including families who have lost loved ones to fentanyl overdoses — were disappointed when it didn’t pass in the Senate.
The bill died in the Texas Senate because some lawmakers believed legalizing the strips would give people more confidence to abuse drugs. It did not have the votes to make it out of a Senate panel, Sen. John Whitmire, D-Houston, told The Dallas Morning News in April.
Ju Park, an assistant professor of medicine and epidemiology at Brown University, said fentanyl test strips are important because “people right now have really no idea where and when fentanyl is appearing in the drug supply.”
“So you hear of young people ordering drugs like Adderall or counterfeit molly or whatever they are experimenting with and inadvertently overdosing on fentanyl because it really only takes a very small amount.”
Research shows test strips may help lower the risk of fentanyl overdose among young adults.
“People make more informed decisions when they have access to those tools,” said Megan Reed, a research assistant professor at Thomas Jefferson University. “They might choose not to use the drug, they may choose to use in a different way, so to use less.”
There has not been conclusive research showing if decriminalizing the strips lowers the number of overdoses, according to Park and Reed.
Woodruff, the attorney, said he’s unaware of people being prosecuted for having test strips.
“Sometimes, I think, harm reduction organizations run into problems where they can’t get funding for buying [test strips] because somewhere along the line someone goes, ‘Isn’t that drug paraphernalia?’ And so there’s sort of a chilling effect.”
Lucas Hill, a clinical associate professor at the University of Texas at Austin College of Pharmacy, said language in the paraphernalia law has led to some confusion about the legality of the test strips.
Around 2017 and 2018, Hill said, some rehab programs in Texas were purchasing the test strips with state funds. But the attention drawn to the strips in the past few years has caused a dilemma.
“Advocacy to explicitly legalize fentanyl test strips has unintentionally led to the widespread view that they currently are illegal,” he said.
“This is something that I think a lot of us are still trying to work through.”
In July, a group of bipartisan senators in Congress, including GOP Sen. John Cornyn of Texas, filed legislation to remove the test strips from federal drug paraphernalia statute. U.S. Reps. Jasmine Crockett, D-Dallas, and Lance Gooden, R-Terrell, filed a similar bill in the House of Representatives. If either bill becomes federal law, Texas would not have to pass its own.
Alvarez, the Tarrant County father, wants to see Texas lawmakers take action now.
“If we pass out a million fentanyl test strips, if we save one person,” he said, “it was worth it.”
Staff writer Adithi Ramakrishnan contributed to this story.
CORRECTION, Sept. 21 at 2:52 p.m.: A previous version of this story misspelled Abigil Chagoya Alvarez’s name. | Drug Discoveries |
A devastated mum was diagnosed with cancer after her doctor mansplained and "bet his mortgage" that she was too young to have the disease.
Beth Doherty, 28, could potentially be left infertile after her symptoms were dismissed for six months.
The mum spent less than five minutes with her male GP during which time he insisted that her symptoms were normal "birth complications".
She is now in remission from Stage Four Hodgkin's Lymphoma, a cancer of the immune system and white blood cells.
Beth underwent 12 gruelling rounds of chemotherapy which left her almost suffering from a collapsed spine.
The performing arts lecturer, from the West Midlands, started experiencing extreme back pain four months after giving birth to her daughter, now aged two, in 2020.
Beth visited her GP in early 2021, who told her that she had sciatica from childbirth, told her to rest and sent her home.
By March, the pain was so severe that Beth's 12-year-old sister had to bathe her because she couldn't lift her arms and she could barely move or even hold her daughter.
Beth's father died of Leiomyosarcoma, a soft tissue cancer, when she was a child so she was very aware of what the changes in her body could mean.
But once again, her male GP dismissed her concerns as typical post-birth symptoms.
She said: "My GP told me he would 'bet his mortgage on the fact that this was nothing serious' because people my age 'don't get cancer'.
"He just brushed it off very quickly, suggesting it was sciatica caused from trapping a nerve during childbirth or possibly related to my epidural, but he didn't give much more information or guidance than that.
"He was extremely passive, almost unwilling to listen to me or my symptoms. I almost felt like I was wasting his time.
"I would come out of every appointment feeling deflated or upset from the tone he had used to speak to me."
It was only when Beth spoke to a female on-call doctor that she was taken seriously and sent for an MRI.
The GP who had refused to take her seriously called her the same day as her MRI and told her to come into the surgery with a chaperone.
At that appointment, he told her that the MRI was showing signs of cancer and an urgent PET scan revealed the full extent of the disease.
She had cancerous spots throughout her body, particularly in her spine, which was under so much strain that medics were afraid of it collapsing.
Beth was eventually diagnosed with Stage 4 Classical Hodgkin's Lymphoma, a cancer of the immune system and white blood cells – six months after her first doctor's appointment.
Her chemotherapy had to be started quickly but Beth contracted Covid-19 before her treatment, meaning it had to be delayed.
This ultimately meant that she could not have egg-freezing treatment, meaning that there is a chance that Beth and her partner Sean, 29, will be unable to have any more children.
The brave mum went through 12 rounds of ABVD Chemotherapy and has now been in remission for almost a year, but the damage caused by her doctor's negligence will last for a lifetime.
"I feel like I have missed out on getting to do all the special things that mums and babies should get to do, especially as she may have been our only chance," Beth said.
"Even if we were fortunate to be able to get pregnant again in the future, we just don't know how my body and spine would handle the pressure and physical demands of another pregnancy."
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Beth is one of many women who have spoken out in recent years about the difficulties women face when dealing with male doctors, who often dismiss their symptoms as "normal" things women just have to deal with.
She is determined to empower other people to advocate for themselves and their bodies, sharing her story on her Instagram, @b.andthebig.c.
Beth said: "I remember sitting at home with my partner googling different symptoms, and before I had been diagnosed I kept being drawn to the NHS page for lymphoma.
"I knew before the professionals, which is why I always stress the importance of knowing your own body on my Instagram page.
"He never apologised to me, not even when he had to sit me down and tell me the MRI results. And he hasn't acknowledged the fact he was wrong."
Beth remained remarkably positive during her treatment and was supported by her partner and her closest family and friends, whom she says were "wonderful."
She said: "I ended up losing my hair, which was particularly difficult for me."
"Though I did end up having fun experimenting with new styles and wigs and being able to take the wig off at the end of a long day became almost a satisfying feeling!
"It was the hardest thing that any new, young parents should have to go through, but it has made me and my partner so much closer and the appreciation we have for each other is so much more evident.
"Similarly, it only brought me closer to my family. I spent so much time with them during treatment and diagnosis while they supported my partner in physically caring for me and my daughter.
"I'm still getting used to my new body, physically and mentally. I look and feel very different to how I did before my diagnosis.
"I have continuing mobility issues, and fatigue issues, and I struggle with a severely weakened immune system.
"As a result, I still get very nervous going out into large crowds.
Despite the long-term battle she faces, Beth has already saved lives with her advocacy.
"Since starting my Instagram page in September 2021, I have had five other women come forward to say they have gone and been checked by their GP for symptoms they recognised as a result of my page," she said.
"And so many friends and family members have registered to national and global stem cell registers to help save the lives of others like me, including a close family member who is currently preparing to donate his stem cells after testing as a positive match for someone." | Disease Research |
Six children were hospitalized in Florida after they ate candy containing cannabis at the Lauderhill Boys & Girls Club on Wednesday.
Police officers were dispatched to the location in Broward County three times that afternoon, according to a local report from NBC 6 South Florida.
A total of eight children ranging from 6 to 8 years of age consumed the gummies. Six of the children were transported to Broward Health and Florida Medical Center, according to Lauderhill Fire Rescue officials.
All of the children now have been released and are "returning to their normal activities," said the Boys & Girls Clubs of Broward County in an official statement provided to Fox News Digital.
It is believed that one of the children brought a package of cannabis-infused gummy candies into the club after school and shared the candies with the other members, the statement said.
"The safety and protection of the young people we serve is always our absolute highest priority, and we take any situation that might impact their well-being very seriously," the club added.
A spokesperson for the club told Fox News Digital on Friday that the source of the gummies is still under investigation.
Dangers of cannabis for kids
Edible products are often packaged in ways that are very similar to name-brand candy and snack products that are familiar to children, according to Kelly Johnson-Arbor, M.D., a medical toxicologist and co-medical director at the National Capital Poison Center in Washington, D.C.
"Children are often not able to differentiate between these snack products and their cannabis lookalike varieties — and this can result in unintentional consumption," she told Fox News Digital.
These products can also contain large amounts of cannabis, with doses intended for adults.
Stacia Woodcock, PharmD, pharmacy editor at GoodRx in New York City, said it’s possible for cannabis edibles to be dangerous for children, but it depends on exactly what cannabinoids the edibles contain and how much the children consume.
"In most cases, if a child consumes a cannabis edible by mistake, they’ll just feel extra sleepy or loopy until it wears off," she said.
"It is very important to keep all cannabis edible products far away and out of reach of children."
"Agitation, red eyes and a fast heart rate are also possible," she added.
"More severe side effects, like seizures or breathing issues, are rare but still possible — especially with large amounts of THC."
The risk of a life-threatening issue is higher with illicit or unregulated cannabis edibles, said Woodcock, as these are more likely to contain heavy metals, pesticides or other substances — such as fentanyl — that could be dangerous for children to consume.
Children are more likely than adults to experience severe signs of symptoms, Johnson noted, which is why it’s important to seek medical attention.
"The degree of monitoring and treatment needed after cannabis ingestion in children depends on multiple factors, including the dose consumed, the child's age and any underlying medical issues," she went on.
"In some cases, specialized treatments, including intravenous medications and respiratory support, may be required," said Johnson.
The signs and symptoms of cannabis poisoning in children may last for several hours, Johnson said — and in some cases, children may require hospitalization for several days.
Although cannabis possession is legal in some states, it remains illegal on a federal level, Johnson said.
"This means that for cannabis edibles, there are no federal regulations for childproofing or use of packaging that is not attractive to children," she said.
"Because of this, it is very important to keep all cannabis edible products far away and out of reach of children."
What to do if a child consumes cannabis
In the event of an accidental consumption, the first step is to gather the facts, said Woodcock.
"The packaging of the edible will tell you what kind of edible they ate and the THC level or other cannabinoid content, such as CBD or CBN," she said.
Regardless of whether the child has symptoms, Woodcock said it’s important to reach out to a medical professional.
"Call 911 if they’re having severe symptoms, like trouble breathing or changes in behavior," she said.
"It’s important to keep in mind that the effects of cannabis edibles can take an hour or two to appear," she noted. "So just because your child seems fine at first doesn’t mean they’ll stay that way."
If you don’t notice any changes, you should still contact Poison Control, either online at www.poison.org or by phone at 1-800-222-1222, to receive "free, personalized, and evidence-based medical guidance for monitoring and treatment," said Johnson.
How to reduce the risk
If you keep cannabis in your home, Woodcock said to treat it like a prescription medication and keep it in a secure location that’s out of reach of children — ideally a lockbox.
"Make sure everyone in your home knows the difference between a cannabis edible and a regular food item," she said.
"Keep cannabis products in their original packaging, and make sure it’s clearly marked to avoid any confusion."
"Since there’s not much information on the long-term effects of a cannabis overdose in children, prevention is truly key to protecting your child’s safety," Woodcock also said. | Epidemics & Outbreaks |
The NHS is creating hundreds of diversity and inclusion roles despite being told to crack down on “waste and wokery”.
Officials at NHS England have drawn up plans for three new departments called “Equality, Diversity and Inclusion”, “People and Culture” and “People and Communities”, with 244 posts across the teams.
The Health Secretary is understood to be “frustrated” by the move and intends to summon health officials to demand explanations for the creation of large departments enforcing “woke doctrines”.
Ministers have repeatedly promised to crack down on bureaucracy, with NHS England ordered to cut its total workforce by up to 40 per cent.
Earlier this year, Steve Barclay, the Health Secretary, ordered NHS England to get rid of specific diversity and inclusion roles, as part of efforts to “ensure good value for money”.
The latest move has emerged ahead of the first joint strikes by junior doctors and consultants which NHS bosses have warned will cancel almost all appointments.
NHS waiting lists in England are also at a record high, with 7.7 million people – around one in seven of the population – waiting for treatment.
Plans seen by The Telegraph show the units have a staffing budget of almost £14 million, including 18 senior officials on six-figure salaries.
The departments fall under the auspices of workforce chief Dr Navina Evans, who is on a salary of more than £200,000.
In March, Mr Barclay wrote to the heads of 10 arms-length bodies, saying he believed that diversity and inclusion was “everyone’s responsibility and should be picked up through normal management processes and as a part of everyone’s role rather than through the use of external providers or discrete dedicated roles within organisations”.
It followed promises from predecessor Sajid Javid to stamp out “waste and wokery” in the health service.
However, proposals for the NHS’s new structure, to take effect from April 2024, show that it is seeking to create new directorates covering diversity, communities and culture.
Between them, the three departments will employ 244 people, including 177 staff earning at least £50,000 each.
Despite Mr Barclay’s instructions to get rid of specific roles for diversity and inclusion, the units include a dedicated Equality Diversity and Inclusion (EDI) department, with 50 employees, and staffing costs of £3 million.
The plans say the national EDI team will focus on establishing “policy, knowledge and expertise in areas other than race and disability”.
The other new departments, “People and Culture” and “People and Communities”, are set to include scores more roles dedicated to inclusion, voice and culture and LGBT health and inequalities.
The £13.8 million in total salaries across the three units does not include on-call, overtime and London-weighting allowances, which could significantly inflate salaries.
Backroom bureaucracy
A source close to Mr Barclay said: “Taxpayers will be deeply concerned that NHS time and money is once again being wasted on rejigging backroom bureaucracy rather than frontline patient care.
“The Health Secretary has been clear that equality and diversity should be dealt with through normal management processes and by all staff recognising their responsibility for these matters rather than for dedicated teams enforcing woke doctrines.”
On Sunday night Mr Javid said: “The NHS should be focused on the urgent need to tackle the backlogs and deliver long term fundamental reform, not creating roles solely focused on diversity and inclusion.
“Patients want delivery on their priorities. That means using taxpayers’ money to drive improvements in care through ambitious reform. I’m sceptical these dedicated roles will do anything like that.”
Mr Barclay has cut one in six civil servant roles from the Department of Health since October, reducing the workforce by around 600 employees, and plans to shut 10 of its 21 offices.
NHS England is undergoing a restructure following its merger with NHS Digital and Health Education England, which will cut the total number of staff by around 40 per cent, to around 15,000.
In 2022/23 NHS England’s running costs came to £3.2 billion. The NHS’s overall budget is £153 billion.
It previously had an “Equality and Inclusion” department which had 72 staff and a budget of £5 million.
Frank Young, research and communications director at the Civitas think tank, said: “Most ordinary people will be aghast to yet again see money being spent on equalities advisers that could be spent treating sick people in hospitals.
“We’re constantly told that the NHS is underfunded while budgets are then made available for NHS managers fretting over diversity targets instead of medical care.”
He added: “Given the sizeable budgets being proposed, it is likely to come at the expense of genuine delivery of healthcare to patients. The NHS is creating a rod for its own back in misdirecting resources away from where they are best needed.
“NHS managers need to get a grip and push this money to hospitals to help make sick people better, not on re-organising the HR department to meet diversity targets.”
Dr Sean Phillips, head of health and social care at Policy Exchange, urged ministers to make good on previous commitments to get rid of dedicated diversity and inclusion roles.
He said: “The Health Secretary should demand an immediate moratorium on recruitment, including internal transfer, into Equality, Diversity and Inclusion roles and direct that NHS England carry out a sharp review into how to dramatically reduce expenditure in this area. Who’s in charge here: elected ministers, or NHS managers?”
Joint strike action
Consultants in England will walk out for 48 hours from Tuesday, and will be joined by their junior colleagues on Wednesday. Junior doctors, who are demanding a 35 per cent pay rise, will then continue their strike on Thursday and Friday.
Both consultants and junior doctors will then strike together on October 2, 3 and 4 – coinciding with the Conservative Party annual conference in Manchester.
Prof Sir Stephen Powis, the NHS’s national medical director, warned that the health service had “never seen this kind of industrial action in its history”.
He added: “This week’s first ever joint action means almost all planned care will come to a stop and hundreds of thousands of appointments will be postponed, which is incredibly difficult for patients and their families, and poses an enormous challenge for colleagues across the NHS.”
An NHS spokesman said: “While there are legal duties on equality the NHS has to meet, and they have an important contribution to make in retaining and recruiting the hundreds of thousands of NHS staff needed to care for patients now and in the future, the number of EDI roles in NHS England has actually reduced by more than a third over the last year as part of our efforts to ensure an even greater proportion of NHS funding reaches the front line.” | Health Policy |
The level of illness among the UK population is costing lives and harming the economy, a report has warned - after the number of people off work due to long-term sickness hit another record high.
More than 2.6 million people now do not have jobs because of their health, according to latest employment data from the Office for National Statistics (ONS).
The all-time high comes after an additional 491,433 adults were added to the official total in the three months from May to July, figures released on Tuesday revealed.
The Institute for Public Policy Research (IPPR) said in a report on Wednesday that the issue had become a "serious fiscal threat" to the UK - and to individuals' health.
The think tank blamed long NHS waiting lists and other problems faced by the public in accessing treatment, and said reform was urgently needed to avert "killer" costs while also ending second-rate care.
It comes after the number of patients in England waiting to start routine hospital treatment topped a record high of 7.6 million.
People aged between 16 and 64 who are not in employment due to long-term sickness are officially classed as "economically inactive", rather than unemployed, because they are either not looking for a job or are unable to work.
Overall economic inactivity - including students in the age range and those not seeking employment for other reasons - rose by 0.1 percentage points during the period to 21.1%, according to the official figures.
The ONS said that while the rate had generally been falling in recent decades, it increased during COVID and is currently still above pre-pandemic levels.
The IPPR pointed the finger at what it said was a decline in the quality of health care - and said the UK was increasingly "spending more to get less".
Read more
Call for more help to get millions of long-term sick back into employment
One in five adults in England will be living with major diseases by 2040
"The number of deaths that could have been avoided with timely healthcare or public health interventions is much higher in the UK than in all other comparable European nations," the report said.
"We estimate that if the UK had an avoidable mortality rate similar to those in comparable European countries, around 240,000 fewer people would have died in the decade from 2010."
It added: "On the post-pandemic trajectory, new modelling commissioned for this report finds government healthcare spending in England is on course to rise from 9% of GDP [gross domestic product] to 11.2% of GDP by 2033/34.
"This is much faster than the rate at which we expect the economy to grow, suggesting cuts for other public services or rationing of health and social care services."
The think tank said reforms, such as better integrated services in neighbourhood "health hubs" and improvements to social care, along with better pay and rights for healthcare workers, could save taxpayers up to £205bn over a decade.
Lord Bethell, former health minister and commissioner, said: "Sick Britain is costing us our lives, our livelihoods and harming the UK economy."
He added: "We must start taking action to reduce demand and need for healthcare, through prevention."
Downing Street acknowledged on Tuesday that improvements were needed in tackling long-term sickness.
The prime minister's official spokesman told reporters: "We recognise there is more to do to help get people back into work or into the workforce more generally."
He added: "We are introducing a package of measures worth £3.5bn to remove barriers to the labour market, to support people who would like to work including those with disabilities or health conditions."
But Nicola Smith, head of economics and rights at the TUC, said: "This is yet another example to add to the government's catalogue of economic failures with rapidly rising unemployment alongside record numbers of people unable to find work because of ill health."
The government recently unveiled proposals to shake up disability benefit assessments as part of efforts to encourage economically inactive people to enter the workforce.
But concerns have been raised that the reforms could force people into jobs when they are not well enough and make them more ill.
Hannah Slaughter, a senior economist at the Resolution Foundation, described the rising number of people who are too sick to work as a "worrying trend".
She added: "Addressing this issue will require more than just reforms to benefit assessments, it will need to mean more support for those in work too." | Health Policy |
Babies would have survived if hospital executives had acted earlier on concerns about the nurse Lucy Letby, a senior doctor who raised the alarm has said.
In an exclusive Guardian interview, Dr Stephen Brearey accused the Countess of Chester hospital trust of being “negligent” and failing to properly address concerns he and other doctors raised about Letby as she carried out her killings.
Brearey was the first to alert a hospital executive to the fact that Letby was present at unusual deaths and collapses of babies in June 2015.
The paediatrician and his consultant colleagues raised concerns multiple times over months before Letby, then 26, was finally removed from the neonatal unit in July 2016. The police were contacted almost a year later, in May 2017.
Speaking publicly for the first time, Brearey told the Guardian that executives should have contacted the police in February 2016 when he escalated concerns about Letby and asked for an urgent meeting.
Instead, he said, nothing was done other than to arrange another meeting three months later. “Discussing with police at that stage would seem to be a sensible action to take. If that had happened, it’s reasonable to conclude that [two] triplets, Child O and Child P, would be alive today,” he said.
Brearey was the lead clinician in the Chester hospital’s neonatal unit, where Letby murdered seven babies and attempted to murder another six in the year to June 2016, a court found.
She was found not guilty of two attempted murder counts. The jury could not reach verdicts on six further counts of attempted murder, relating to five babies.
Having given evidence several times in Letby’s trial, Brearey is now free to talk about the case for the first time.
Brearey, who still works on the neonatal unit, said executives were too quick to blame “failures outside the hospital” for the deaths of babies and should have launched a forensic review by February 2016 at the latest. That month he also requested an urgent meeting with executives, which did not happen until three months later.
By that time, five infants had died in unusual circumstances and Letby was known to be the only staff member who was present at every incident.
Letby was removed from the neonatal unit in early July 2016 when senior doctors demanded she be redeployed after the sudden and unexplained deaths of two triplet brothers within 24 hours of each other.
“You could argue all the events from May 2016 onwards were avoidable if they had acted appropriately,” Brearey said of executives at the trust. “If they had responded appropriately to the urgent meeting request in February 2016, then the same would be true from February 2016.”
Brearey said “things would have been different from October 2015” if the hospital had taken a “proactive” approach to the concerns.
Consultants raised concerns in October 2015 after the death of a four-week-old girl whom Letby murdered on her fourth attempt.
The infant was the fifth Letby killed in five months. She would go on to murder another two babies – two triplet brothers – and attempt to kill three more before she was eventually removed from the unit in early July 2016.
Brearey accused executives of “bullying” and “intimidating” senior doctors who raised concerns about the nurse and that it felt as if they were “treating us with as much suspicion as Lucy Letby”.
Brearey claimed there was an “anti-doctor agenda” among the trust’s senior leaders, most of whom had a nursing background. He said this partly led bosses to side with Letby instead of the consultants when they raised concerns from October 2015, because they treated it as “a case of doctors picking on a nurse”, Brearey said. “It just astonished me that attitude, which I think was shared with some [or] most of the execs.”
Executives commissioned two reviews into the neonatal unit in late 2016, one by the Royal College of Paediatrics and Child Health and another by an external independent neonatologist. However, neither was tasked with forensically examining potential causes of the rise in deaths or the suspected association with Letby.
The consultants were briefed on the results of these reviews at a “confrontational” board meeting in January 2017, when executives presented what was considered to be proof of Letby’s innocence.
One senior nurse read a statement from Letby in which she described how distressing the allegations had been. Brearey and his colleagues were ordered to apologise to the nurse and enter a mediation process with her, even though they felt their concerns about her harming babies had not been addressed.
He said: “We were all stunned. It’s still etched in everybody’s minds. It’s just the most horrific meeting I’m ever likely to attend really. We didn’t get into any sort of meaningful discussion with them, because it probably would have ended badly anyway. We all felt obviously very intimidated and bullied into agreeing to their demands.”
A second consultant paediatrician on the unit, Dr John Gibbs, told the Guardian that the hospital could have taken “more definitive action” by February 2016 at the latest.
Gibbs, who has now retired, said: “I think senior managers have to explain what they did and why they did it. Maybe they can justify it. I don’t know all the information they were receiving and how strongly they were being told that we consultants had it completely wrong.
“But in the end consultants are quite experienced. We are meant to be senior members in charge of patient care. We have ultimate responsibility for patient care, as well as the management, so if you’re not going to listen to the consultants, you’re in big trouble.”
Gibbs, who gave evidence 13 times during Letby’s trial, said he was “shell-shocked” by the January 2017 meeting. “To be told what the reviews showed without having seen them at all was a bit surprising, and then to be told we were to draw a line under the matter and that was it, and then to be instructed to send a letter of apology to Lucy Letby was just flabbergasting.”
Brearey said he was speaking publicly for the first time out of a “duty of candour” to the parents of the victims and the public.
He said some of the executives involved should be stripped of their “fat salaries” and “fat pensions” because of their “incompetence” in handling the matter. Senior executives at the hospital were earning salaries of more than £200,000 in 2018, according to public filings.
He added: “I’ll always look back on this and think: could I have done something sooner? Could I have pushed harder with the execs? Could I have gone knocking their door down to talk about these sort of things earlier in the year? And I suppose I have to live with those thoughts.
“But at the end of the day, I was doing what I felt was reasonable at the time. I thought some of their actions were a little neglectful – in fact, actually quite neglectful – in that time period, certainly in the six months from February [2016] onwards.”
The Countess of Chester hospital trust said it was committed to ensuring lessons were learned. Its executive medical director, Dr Nigel Scawn, said: “Since Lucy Letby worked at our hospital, we have made significant changes to our services. I want to provide reassurance that every patient who accesses our services can have confidence in the care they will receive.
“And, most importantly, our thoughts are with all the families and loved ones at this very difficult time.” | Epidemics & Outbreaks |
âYou would have looked at my sons and never known,â says Bonnie Milas, MD.
Sheâs speaking about the accidental opioid overdoses that killed her two adult sons in 2018 and 2019. She and other doctors say there's something that could spare many other families from going through the same tragedy.Â
Itâs naloxone, a medication that can reverse an opioid overdose and is available without a prescription, or "over the counter," as Narcan nasal spray. It wonât hurt someone. And you donât need special medical training or certification to use it.
Naloxone should be in all first aid kits, Milas says, because you never know who might be at risk.Â
Her sons were both athletes who excelled in school and showed no signs of addiction. Milas asked WebMD not to publish her sonsâ names for privacy reasons.
âPeople have in their minds what a drug user looks like,â Milas says. âThey picture someone who's out on the street. We need to recognize that it's not just certain people who become addicted. It's all of us. There are some very highly functional individuals who are using and itâs kept secret.â
âNot Enough Timeâ
Milas administers opioid medications to her patients every day as part of their medical care. Sheâs also had to use naloxone to save her younger son twice in the 48 hours after he was discharged from an inpatient treatment facility.Â
The first time, she found him on the kitchen floor. He was unconscious, his lips blue. She called for her father-in-law to call an ambulance as she grabbed the naloxone.Â
The next day, she found her same son locked inside the bathroom. His body was slumped against the door. She got the naloxone, took the bathroom door off its hinges, and revived her son again.
âNo one should have to go through that,â Milas says. âItâs a very hard thing to watch and experience as a parent, as a family member, as a friend.âÂ
An accidental overdose of fentanyl, a synthetic opioid, later took her youngest sonâs life. (Milas doesnât speak publicly about her older sonâs death.) As a prescription medication, fentanyl is approved to treat patients with severe pain, especially after surgery. But itâs also widely abused and illegally made. At 50 to 100 times stronger than morphine, fentanyl is part of a national epidemic of opioid-related deaths that killed more than 564,000 people in the U.S. from 1999 to 2020, CDC data show.
It can happen very quickly.Â
âTaken orally, fentanyl can render the person unconscious in minutes, and if injected or smoked, as little as 90 seconds,â Milas says. âThere is simply not enough time to wait for paramedics to arrive. Itâs a potentially terrifying situation to be in if you are first on the scene and not prepared. Having naloxone on hand and basic life support skills is training to be a lifesaver.â
How Naloxone Works
Within 2 to 3 minutes, naloxone reverses an opioid overdose. It works in the brain, binding to certain receptors and displacing the opioid. That allows normal breathing and consciousness to come back.Â
Naloxoneâs effects can last up to 90 minutes. Someone may need multiple doses if they have fentanyl in their system.
When given quickly after an opioid overdose, it can save a personâs life. If theyâve overdosed on something else, naloxone wonât harm them.Â
Itâs especially important to have naloxone if you or someone you know has opioid use disorder. In fact, the CDC likens carrying naloxone to carrying an epinephrine auto-injector (like an Epi-Pen) if you have allergies.
Always call 911 if someone has overdosed. Stay with them until emergency medical care professionals arrive, since the person needs at least 4 hours of monitoring and medical attention to make sure their breathing is back to normal.
In February, Milas testified before an FDA committee in favor of making naloxone available over the counter. (The FDA approved over-the-counter Narcan nasal spray in March 2023.)Â
âNow that you can pull naloxone off the shelf right next to the Tylenol, it removes the stigma and makes it mainstream,â Milas says. âSo the soccer mom is going to go pick it up because she wants to be a responsible mom, a responsible citizen.â
Since the FDA approved over-the-counter naloxone nasal spray, the American Medical Association has called for health insurers to cover naloxone at no cost or a low cost and for it to be prominently placed on store shelves. The average cost for a box of generic naloxone spray (with two bottles in the box) is about $73, not including discounts or insurance.Â
Saving Lives Outside the Home
While Milas had to use naloxone on her son at home, overdoses can happen anywhere.Â
It was in a public space â a bathroom in a Boston-area shelter for unhoused people â where Avik Chatterjee, MD, MPH, first administered naloxone. His patient was a woman who had become unconscious after using and had turned blue.Â
Chatterjee used naloxone on her. Soon after, he recalls, she was breathing on her own, sitting up, and even talking.Â
âIt's kind of this miraculous thing,â Chatterjee says of naloxone. âYou don't have anything in medicine that works so effectively, so dramatically, and in such a high percentage of the time as you do naloxone for drug overdoses.â He calls naloxone âvery safe and lifesaving.â
Chatterjee, a Boston University assistant professor and primary care and addiction medicine physician, provides addiction medicine care at several shelter-based clinics through the Boston Health Care for the Homeless Program. He says many of his patients donât have a home with a medicine cabinet to turn to for naloxone, so efforts to make naloxone widely available is critical.Â
âEven the best-meaning person in long-term sobriety or recovery can relapse,â Chatterjee says.
Breaking Through the Stigma
âIâve lost a lot of patients and physicians to overdoses, and Iâve had a couple of really, really scary overdoses myself,â says Peter Grinspoon, MD, a Harvard Medical School instructor and primary care physician at Massachusetts General Hospital.
Grinspoon struggled with addiction at the start of his medical career. Heâs been in recovery for more than 15 years. Heâs written about it in books including Free Refills: A Doctor Confronts His Addiction.
âNaloxone is to help make sure that people donât die, plain and simple,â says Grinspoon. âItâs easy enough to carry it. You just put it in your pocket.â
Itâs crucial, Grinspoon says, to recognize addiction as a complex medical condition, deserving of compassion and understanding.Â
Chatterjee agrees. He calls harm reduction practices, such as making naloxone available, âa philosophy based in love because itâs the act of caring for another personâs well-being.â
For Milas, working to make naloxone widely available is part of her sonsâ legacy.  She leads REVIVEme, an initiative of the American Society of Anesthesiologists that provides resources such as downloadable infographics and tutorials on how to use naloxone.
âI think that my sons would have been proud to see me represent a group of individuals â mothers, fathers, family members â who has suffered this loss,â Milas says. âEveryone deserves the right to be saved, to have a chance at recovery. Naloxone gives them another chance.â | Drug Discoveries |
The NHS, it is claimed, is facing an exodus of doctors. It is one of the reasons put forward to support their claims for more pay as strike action continues.
But an analysis of data by the BBC suggests this is not the case - yet.
The proportion of the medical workforce leaving the NHS has hardly changed for a decade, while figures on those seeking a move overseas do not, overall, show a clear upwards trend.
There are, however, some worrying signs - with increasing numbers of junior doctors taking a break in their training, and some evidence that aggressive marketing by authorities in Australia on social media and billboards is turning the heads of more UK medics.
Doctors not leaving NHS in greater numbers
Every year thousands of doctors leave the NHS. Some retire, others move into private practice and some head abroad.
But figures from NHS Digital in England show over the past decade the proportion leaving overall has remained pretty constant at about 14-15%.
Meanwhile, the number of new joiners has increased, leading to a rise in the number of doctors in the NHS.
But what about if we just look at junior doctors? This is the group that receives the lowest rates of pay in the profession and is often said to be the most disenchanted.
They make up almost half the hospital doctors in England and include anyone who has finished medical school but has not yet completed their postgraduate training to become a GP, speciality doctor or consultant.
Firstly, most junior doctors do stay. Of those in 2016 who had completed their first two years of foundation training, only 7% had left the profession five years later, according to the General Medical Council (GMC).
But junior medics are taking a break
However, other data from the regulator does show a big jump in the numbers taking a break from their training.
In 2012, two-thirds moved straight on to the third year of their junior doctor training pathway after completing year two.
But by 2020 that figure had fallen to under a third.
Where these doctors are going is unclear. They could be spending time working as a locum - taking well-paid but ad-hoc freelance shifts to cover gaps in rotas - going travelling or seeking opportunities abroad.
Most seem to come back after a pause of a year or two, but the fact there is a clear upwards trend is causing some concern.
Working abroad remains an option
The best data on how many move abroad each year comes from the GMC database on applications for a Certificate of Good Standing, which doctors use to apply for work abroad.
Before the pandemic, there were consistently more than 6,000 certificates a year sent to other medical authorities around the world.
After a drop during the pandemic the number rose to about 7,000 in 2022.
More recent figures for 2023 so far suggest the number will be higher again - although it is unclear if this reflects a long-term rise, as the trend seen over the last 18 months may just be a natural catch-up following the dip during the pandemic.
The most popular countries are Australia, United Arab Emirates, Canada and Ireland, accounting for two-thirds of the certificates.
But applying for one of these certificates does not mean a doctor has definitely left the UK, the GMC says, rather it shows an intention to work abroad in the future. Data from previous years suggests half of doctors who apply for a certificate remain working in the UK.
Australia an attractive destination
The BBC has also approached the medical authorities directly in Australia and New Zealand about the number of doctors trained in the UK emigrating.
New Zealand has the most up-to-date figures, which show about 500 doctors a year trained in the UK and Ireland left to work there before the pandemic. The data available for the first three-quarters of 2022-23 suggests a similar level.
The figures for Australia only go up to 2021, and show a total of 6,621 UK-trained doctors arriving to work that year. There has been a gradual upwards trend over the past five years with the figures more than a quarter higher than they were in 2016.
And the British Medical Association (BMA) is convinced this will get worse.
Dr Robert Laurenson and Dr Vivek Trivedi, who jointly chair the BMA junior doctors' committee, said: "You cannot ignore the evidence that if the government won't pay doctors what they are worth, they are going to continue to leave for countries that will."
But as doctors leave the UK, it is also worth noting medics come in from abroad.
Last year more than 12,000 doctors who were trained abroad joined the register. The number of newly-qualified homegrown doctors who joined was 8,000.
It is a two-way street. | Health Policy |
Gabby Bachner, a pharmacy student at the University of Georgia in Athens, found out she had eczema soon after she went to college. The specific type she has, called contact dermatitis, happens when her body touches something that causes an allergic reaction. Bachner, who works in a pharmacy, found that her scrubs and certain lotions triggered her eczema flare-ups.
Â
Eczema and Mental Health
Your skin is your largest organ, so problems with the way it looks can have a psychological impact.
Lower self-confidence can take a toll on your mental health. âWith eczema both in children and adults, we do know that there's a higher rate of depression, ADHD, anxiety, and also a lot of sleep disturbances,â says Mamta Jhaveri, MD, assistant professor of dermatology at Johns Hopkins University in Baltimore.
People with eczema have a higher chance of getting depression and anxiety than those without it. The odds are even higher if you have severe eczema. This can lead to a frustrating cycle. âStress makes eczema worse and eczema makes stress worse,â Jhaveri says.
There are three main ways eczema can affect your mental health:
- Chronic itch. Eczema often causes an itch you canât control. When youâre in public, it can be hard to hide your scratching. This could lead to stress, anxiety, and worries about what others think.
- Inflammation. Chronic conditions like eczema result from inflammation. Jhaveri says it can zap your energy levels and make it hard for you to focus.
- Visible symptoms. Eczema often affects places that are hard to cover up, like your face, eyes, hands, or limbs. These areas might get swollen, scaly, cracked, or bloody, any if which could lower your self-image.
Bachner says past vacations with eczema were never stress-free. Before a trip, she would often get a pedicure. Lotions used during the treatment led to eczema flares on her legs. And since many eczema therapies donât work right away, she couldnât get the outbreak under control before she left. That made it difficult to feel confident in a bathing suit. She was afraid people would mistake her condition for an infection.
The combination of lower self-confidence, itch, and fatigue can make it hard to be around others during a flare. People with eczema often crave a comfortable and private setting. You may need to stay home and take care of your skin.
âIt does lead to a lot of missed work, missed school, and people sometimes opt out of social interactions,â Jhaveri says. âEczema can also impact intimacy. ... If it impacts the face or any intimate parts, it can impact relationships.â
How to Feel More Confident
When Jhaveri treats someone with eczema, she also uses anxiety and depression rating scales to gauge how their skin condition affects their mental health.
But the first line of treatment is always to control the eczema. âSometimes that in itself will help the mental side effects,â she says. If skin symptoms donât go away, Jhaveri will help people find more assistance.
The path to building confidence is slightly different for children than it is for adults. There are some things parents can do to help build their childâs self-image:
- Ask about their peers. Itâs important for parents of a child with eczema to ask about their school and social life. If you think your childâs peers are bullying them because of their condition, address it as soon as possible.
- Work on sleep. You and your childâs doctor can help solve your childâs eczema-related sleep problems. They may suggest your child take melatonin supplements or use anti-itch medication to help them sleep at night. Good sleep is directly linked to a childâs self-image. With more sleep, theyâll feel more confident and focused on school, which will boost their self-image.
These steps can help adults improve their mental health and body image:
- Get professional help. If eczema is taking a toll on your confidence, talk to a therapist or psychiatrist. They can help you regain self-assurance and provide tips on how to deal with the mental aspect of a skin condition.
- Join online support groups. Jhaveri often suggests that people with eczema join support groups on Facebook or get involved with the National Eczema Association. These outlets help you connect with others and share tips for gaining confidence.
- Talk to your family. If youâre comfortable doing so, it can help to tell your close family how eczema affects you emotionally. This way youâll have someone to talk to or lean on when your self-image isnât at its highest.
- Practice mindful meditation. Stress relief can play a big role in your body image and confidence. Jhaveri suggests meditation or another relaxation technique, like yoga, tai chi, or music therapy. All those things can help you reconnect with your inner self, she says. That can help you see the impact eczema has on your self-image.
- Write it down. Jhaveri says it may help to write a story or journal about how your skin condition affects you. Sharing it with someone youâre close to can help you release bottled up emotions and may help to you accept your feelings.
- Take a step back. Bachner says that one of the best things she does to regain her confidence is to think logically. Itâs easy to feel like everyone is focused on your eczema, she says. But most people wonât even notice your flares unless you point them out. Itâs important to remember that self-confidence comes from self-acceptance. âItâs not your fault that you have eczema,â Bachner says. âTry not to let it bog you down. ⦠People arenât paying attention to what you think they are.â | Mental Health Treatments |
Image source, Getty ImagesWeekly flu deaths in Scotland have reached their highest level in more than 20 years, according to official figures.National Records of Scotland reports that there were 121 deaths last week where flu was mentioned on the death certificate, up from 91 the previous week.There has also been an increase in deaths where Covid was a cause.The total last week was 101, with 84 deaths the previous week.The number of deaths in Scotland from all causes last week was 2020, which NRS said was 29% more than the five-year average.Pete Whitehouse, director of statistical services at NRS, said: "Deaths involving influenza have risen in recent weeks. "There were 121 deaths where influenza was mentioned on the death certificate, up from 91 in the previous week."This is the highest weekly number of flu deaths registered in over 20 years."Unprecedented pressuresJillian Evans, head of health intelligence at NHS Grampian, told BBC Radio Scotland's Lunchtime Live programme the flu figure was "sobering" but added that flu was now at a moderate level in Scotland."The highest number of deaths in over 20 years - a lot of that will be because we've seen so much flu," she said. "It's a small percentage but a very high number of people who were affected with flu."It's on the back of an extraordinary surge of flu incidents in the December period. "Thankfully incidents of flu have come down. It's now at moderate levels in Scotland which is very welcome. But we are seeing the effect of that surge translate now into deaths. "Every one of those could have been considered to be an avoidable death."Ms Evans said the Covid figures were also the result of an earlier surge."We know that there's a lag," she told the programme. "The numbers are high - and higher than last week - but we should start to see a stabilisation in deaths."But also, thankfully, incidents of Covid in the community are starting to come down too."She said the number of people being vaccinated against flu and Covid had slowed down considerably and reminded people it was never too late to get a flu vaccination."I think vaccination is something we can all do," she said. "Let's not forget the deaths from Covid [at the beginning of the pandemic] and how vaccination has made such an impact on that."She added: "All the respiratory illness that we're seeing and people that are still in hospital just adds another layer to very busy hospitals."We're not out of the woods as far is winter is concerned and I suspect we'll not be out of the woods for several weeks yet."The figures come 10 days after First Minister Nicola Sturgeon said Scottish hospitals were almost full as she acknowledged that the NHS was facing unprecedented pressures.She said the increase in winter viruses, including flu, had played a part, along with backlogs caused by the Covid pandemic and Brexit-related staff shortages.Meanwhile, chairman of the British Medical Association (BMA) in Scotland, Dr Iain Kennedy has warned that the NHS in Scotland is "broken" and cannot survive in its current form. He called for a "national conversation" on the future of the health service.Related Internet LinksThe BBC is not responsible for the content of external sites. | Epidemics & Outbreaks |
People with a history of heavy cigarette smoking should be checked regularly for lung cancer even if it's been many years since they quit, the American Cancer Society (ACS) now recommends.
This new recommendation, released Wednesday (Nov. 1) in CA: A Cancer Journal for Clinicians, is a departure from the ACS' previous advice, which said former smokers no longer needed annual screening once they went 15 years without smoking.
"Lung cancer is a disease of the elderly, and so, basically, your risk starts becoming greatest once you're in your 60s, which was probably during this time period when people were stopping to be screened," Dr. William Dahut, chief scientific officer for the ACS, told CNN.
"People developed a false sense of security," which may have contributed to the "abysmally low" rates of screening, Dahut added in an interview with NBC.
Rates of annual lung cancer screening vary among states, but the national average suggests that only about 10% of eligible people get checked, Robert Smith, senior vice president for early cancer detection science at the ACS and lead author of the guideline, told The Washington Post. Screening involves low-dose computed tomography (low-dose CT), a scan that combines a series of X-rays into a detailed image of the inside of the body.
The small percentage of people who do get screened often fail to get their next scan the following year, Smith said. "I don't think they fully appreciate it is not one-and-done."
In addition to eliminating the years-since-quitting clause, the ACS broadened its guidelines in several other important ways. It used to recommend annual screening to current and former smokers ages 55 to 74 who had at least a 30 "pack-year" smoking history and had quit less than 15 years ago. (Thirty pack-years is the equivalent of smoking one pack of cigarettes per day for 30 years, or two packs a day for 15 years, and so on.)
Now, the ACS recommends that current and former smokers ages 50 to 80 with a 20 pack-year smoking history be screened annually, regardless of whether or when they quit. These changes mean that about 19.3 million people in the U.S. should now be eligible for screening, compared with 14.3 million under the previous guidelines, NBC reported.
The ACS' new guidelines mostly align with recommendations from the U.S. Preventive Services Task Force (USPSTF), a panel of volunteer experts in primary care and prevention. The USPSTF recommends yearly screening to adults 50 to 80 years old with a 20 pack-year smoking history, but it still says people can stop getting screened if it's been more than 15 years since they quit.
"The new guidelines from the American Cancer Society, I think, are reflective of newer modeling evidence," Dr. Matthew Triplette, a pulmonologist and cancer prevention researcher at the Fred Hutchinson Cancer Center in Seattle who wasn't involved with either set of guidelines, told CNN.
The new evidence suggests that the risk of lung cancer continues to rise as people age, even among those who have quit smoking for 15 or more years.
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Nicoletta Lanese is the health channel editor at Live Science and was previously a news editor and staff writer at the site. She holds a graduate certificate in science communication from UC Santa Cruz and degrees in neuroscience and dance from the University of Florida. Her work has appeared in The Scientist, Science News, the Mercury News, Mongabay and Stanford Medicine Magazine, among other outlets. Based in NYC, she also remains heavily involved in dance and performs in local choreographers' work. | Disease Research |
People in the beautiful Cornish town of Lostwithiel have turned to song in a desperate effort to recruit a new doctor.
More than 500 people, young and old (some musically gifted, others not) have appeared in a pop video urging a GP to join a local practice.
Despite the town’s beauty and history – it is an ancient capital of Kernow – the town has had a difficult time enticing a new GP.
So a wide range of townsfolk, from butchers to firefighters, schoolchildren to pharmacists, danced along to the local choir singing, rather plaintively, lines such as: “We’ve folks with asthma and young new mothers / We’ve limping fathers and snot-filled others.”
The song and film highlight some of the town’s attractions, including the River Fowey, a castle, a fine fish and chip shop, and a mainline railway station. It concludes pithily: “You can negotiate your terms / If you keep us free from germs.”
Emma Mansfield, a spokesperson for Really Lovely Projects, the arts-led community interest company that made the video, said: “Our local GP contacted us and said he’d been trying to recruit for a new doctor but was having no luck and felt he had to do something quite radical.
“Everywhere is finding it hard to find GPs at the moment, and we want an outstanding doctor who’s going to really stay here for 20 years. Everybody came out and took part. It’s all locally made, a local musician did the backing track and the local choir sang it.”
The song – set loosely to the tune of Nina Simone’s Ain’t Got No, I Got Life – and video are part of the Lostwithiel Needs a Doctor campaign, which was launched by Dr Justin Hendriksz, the remaining practice partner at the surgery.
He said: “Despite the beauty of rural Cornwall and the lively, positive community of Lostwithiel, as a medical practice we have struggled to recruit new GPs through the usual route of adverts in the medical publications.
“We’re all very aware of the alarming number of GPs leaving the sector, so we know we’re not the only practice to be finding it such a challenge to find the right incoming doctors. Of course I’m biased, but there really is nowhere better to be a GP.”
He said local people had embraced the chance to do some recruiting via the power of song. “The whole community has got behind this idea and I sincerely hope the campaign pop song and video reaches the right people to come and find their ultimate job and home right here in Lostwithiel.” | Health Policy |
In Continued Defense Of Effective Altruism
"All you do is cause boardroom drama, and maybe some other things I’m forgetting..."
I.
Search “effective altruism” on social media right now, and it’s pretty grim.
Socialists think we’re sociopathic Randroid money-obsessed Silicon Valley hypercapitalists.
But Silicon Valley thinks we’re all overregulation-loving authoritarian communist bureaucrats.
The right thinks we’re all woke SJW extremists.
But the left thinks we’re all fascist white supremacists.
The anti-AI people think we’re the PR arm of AI companies, helping hype their products by saying they’re superintelligent at this very moment.
But the pro-AI people think we want to ban all AI research forever and nationalize all tech companies.
The hippies think we’re a totalizing ideology so hyper-obsessed with ethics that we never have fun or live normal human lives.
But the zealots think we’re a grift who only pretend to care about about charity, while we really spend all of our time feasting in castles.
The bigshots think we’re naive children who fall apart at our first contact with real-world politics.
But the journalists think we’re a sinister conspiracy that has “taken over Washington” and have the whole Democratic Party in our pocket.
The only thing everyone agrees on is that the only two things EAs ever did were “endorse SBF” and “bungle the recent OpenAI corporate coup.”
In other words, there’s never been a better time to become an effective altruist! Get in now, while it’s still unpopular! The times when everyone fawns over us are boring and undignified. It’s only when you’re fighting off the entire world that you feel truly alive.
And I do think the movement is worth fighting for. Here’s a short, very incomplete list of things effective altruism has accomplished in its ~10 years of existence. I’m counting it as an EA accomplishment if EA either provided the funding or did the work, further explanations in the footnotes. I’m also slightly conflating EA, rationalism, and AI doomerism rather than doing the hard work of teasing them apart:
Global Health And Development
Saved about 200,000 lives total, mostly from malaria1
Treated 25 million cases of chronic parasite infection.2
Given 5 million people access to clean drinking water.3
Supported clinical trials for both the RTS.S malaria vaccine (currently approved!) and the R21/Matrix malaria vaccine (on track for approval)4
Supported additional research into vaccines for syphilis, malaria, helminths, and hepatitis C and E.5
Supported teams giving development economics advice in Ethiopia, India, Rwanda, and around the world.6
Animal Welfare:
Convinced farms to switch 400 million chickens from caged to cage-free.7
Freed 500,000 pigs from tiny crates where they weren’t able to move around8
Gotten 3,000 companies including Pepsi, Kelloggs, CVS, and Whole Foods to commit to selling low-cruelty meat.
AI:
Founded the field of AI safety, and incubated it from nothing up to the point where Geoffrey Hinton, Yoshua Bengio, Demis Hassabis, Sam Altman, Bill Gates, and hundreds of others have endorsed it and urged policymakers to take it seriously.11
Helped convince OpenAI to dedicate 20% of company resources to a team working on aligning future superintelligences.
Gotten major AI companies including OpenAI to work with ARC Evals and evaluate their models for dangerous behavior before releasing them.
Got two seats on the board of OpenAI, held majority control of OpenAI for one wild weekend, and still apparently might have some seats on the board of OpenAI, somehow?12
Become so influential in AI-related legislation that Politico accuses effective altruists of having “[taken] over Washington” and “largely dominating the UK’s efforts to regulate advanced AI”.
Helped (probably, I have no secret knowledge) the Biden administration pass what they called "the strongest set of actions any government in the world has ever taken on AI safety, security, and trust.”
Helped the British government create its Frontier AI Taskforce.
Won the PR war: a recent poll shows that 70% of US voters believe that mitigating extinction risk from AI should be a “global priority”.
Other:
Provided a significant fraction of all funding for DC groups trying to lower the risk of nuclear war.15
Donated tens of millions of dollars to pandemic preparedness causes years before COVID, and positively influenced some countries’ COVID policies.
Played a big part in creating the YIMBY movement - I’m as surprised by this one as you are, but see footnote for evidence17.
I think other people are probably thinking of this as par for the course - all of these seem like the sort of thing a big movement should be able to do. But I remember when EA was three philosophers and few weird Bay Area nerds with a blog. It clawed its way up into the kind of movement that could do these sorts of things by having all the virtues it claims to have: dedication, rationality, and (I think) genuine desire to make the world a better place.
II.
Still not impressed? Recently, in the US alone, effective altruists have:
ended all gun violence, including mass shootings and police shootings
cured AIDS and melanoma
prevented a 9-11 scale terrorist attack
Okay. Fine. EA hasn’t, technically, done any of these things.
But it has saved the same number of lives that doing all those things would have.
About 20,000 Americans die yearly of gun violence, 8,000 of melanoma, 13,000 from AIDS, and 3,000 people in 9/11. So doing all of these things would save 44,000 lives per year. That matches the ~50,000 lives that effective altruist charities save yearly18.
People aren’t acting like EA has ended gun violence and cured AIDS and so on. all those things. Probably this is because those are exciting popular causes in the news, and saving people in developing countries isn’t. Most people care so little about saving lives in developing countries that effective altruists can save 200,000 of them and people will just not notice. “Oh, all your movement ever does is cause corporate boardroom drama, and maybe other things I’m forgetting right now.”
In a world where people thought saving 200,000 lives mattered as much as whether you caused boardroom drama, we wouldn’t need effective altruism. These skewed priorities are the exact problem that effective altruism exists to solve - or the exact inefficiency that effective altruism exists to exploit, if you prefer that framing. Nobody cares about preventing pandemics, everyone cares about whether SBF was in a polycule or not. Effective altruists will only intersect with the parts of the world that other people care about when we screw up; therefore, everyone will think of us as “those guys who are constantly screwing up, and maybe do other things I’m forgetting right now”.
And I think the screwups are comparatively minor. Allying with a crypto billionaire who turned out to be a scammer. Being part of a board who fired a CEO, then backpedaled after he threatened to destroy the company. These are bad, but I’m not sure they cancel out the effect of saving one life, let alone 200,000.
(Somebody’s going to accuse me of downplaying the FTX disaster here. I agree FTX was genuinely bad, and I feel awful for the people who lost money. But I think this proves my point: in a year of nonstop commentary about how effective altruism sucked and never accomplished anything and should be judged entirely on the FTX scandal, nobody ever accused those people of downplaying the 200,000 lives saved. The discourse sure does have its priorities.)
Doing things is hard. The more things you do, the more chance that one of your agents goes rogue and you have a scandal. The Democratic Party, the Republican Party, every big company, all major religions, some would say even Sam Altman - they all have past deeds they’re not proud of, or plans that went belly-up. I think EA’s track record of accomplishments vs. scandals is as good as any of them, maybe better. It’s just that in our case, the accomplishments are things nobody except us notices or cares about. Like saving 200,000 lives. Or ending the torture of hundreds of millions of animals. Or preventing future pandemics. Or preparing for superintelligent AI.
But if any of these things do matter to you, you can’t help thinking that all those people on Twitter saying EA has never done anything except lurch from scandal to scandal are morally insane. That’s where I am right now. Effective altruism feels like a tiny precious cluster of people who actually care about whether anyone else lives or dies, in a way unmediated by which newspaper headlines go viral or not. My first, second, and so on to hundredth priorities are protecting this tiny cluster and helping it grow. After that I will grudgingly admit that it sometimes screws up - screws up in a way that is nowhere near as bad as it’s good to end gun violence and cure AIDS and so - and try to figure out ways to screw up less. But not if it has any risk of killing the goose that lays the golden eggs, or interferes with priorities 1 - 100.
III.
Am I cheating by bringing up the 200,000 lives too many times?
People like to say things like “effective altruism is just a bunch of speculative ideas about animal rights and the far future, the stuff about global health is just a distraction”.
If you really believe that, you should be doubly amazed! We managed to cure AIDS and prevent 9/11 and so on as a distraction, when it wasn’t even the main thing we wanted to be doing! We said “on the way to doing the other things we really care about, let’s stop for a second to cure AIDS and prevent 9/11, it won’t take too much time or resources away from the important stuff”. Why haven’t any of you distraction-free people managed that?
I don’t think any of this is a distraction. The Democratic Party is anti-gun and pro-choice. The gun control isn’t a ruse to trick pro-life people into joining the party, and the abortion rights aren’t a smokescreen to deflect opposition from gun owners. Movements are coalitions. Sometimes this means different people with different priorities choose to work together. But other times it means the same people tend to share both priorities. People who are pro-choice are usually also anti-gun, and vice versa.
And I notice that the tiny handful of people capable of caring about 200,000 people dying of neglected tropical diseases are the same tiny handful of people capable of caring about the next pandemic, or superintelligence, or human extinction. I think the common skill is trying to analyze what causes are important logically. Surprisingly, this comes up with different results than the usual strategy of caring about whatever is trending on Twitter today! Some of those results are broadly popular, like saving 200,000 lives. Other results are broadly unpopular, like worrying about AI risk. But both sets of results come from the same process, and the people who get them are natural allies in a world where most people can’t bring themselves to care about anything that isn’t current front-page news.
I don’t want the takeaway from this post to be “Sure, you may hate EA because it does a lot of work on AI - but come on, it also does a lot of work on global health and poverty!” I’m proud of all of it. I believe - just like Geoff Hinton, Bill Gates, Sam Altman, Daniel Dennett, etc - that there’s a pretty serious risk of human extinction from AI over the next few decades. I can’t imagine believing this and not thinking it’s important to prepare for. EA has done a great job working on this (see list of accomplishments above), and I think the AI and x-risk people have just as much to be proud of as the global health and animal welfare people.
So my recommendation is that you look carefully into the research on what causes can most benefit the world - near-term, long-term, whatever seems most important to you after some honest study - and try to come up with some way to help them. If you want, take the Giving What We Can pledge to donate 10% of your income, or look at 80,000 Hours to see how you can get an altruistic career.
And whatever you do, do it quick, before the metronome swings back and all of this becomes popular again.
Source: AMF says 185,000 deaths prevented here; GiveWell’s evaluation makes this number sound credible. AMF reports revenue of $100M/year and GiveWell reports giving them about $90M/year, so I think GiveWell is most of their funding and it makes sense to think of them as primarily an EA project. GiveWell estimates that Malaria Consortium can prevent one death for $5,000, and EA has donated $100M/year for (AFAICT) several years, so 20,000 lives/year times some number of years. I have rounded these two sources combined off to 200,000. As a sanity check, malaria death toll declined from about 1,000,000 to 600,000 between 2000 and 2015 mostly because of bednet programs like these, meaning EA-funded donations in their biggest year were responsible for about 10% of the yearly decline. This doesn’t seem crazy to me given the scale of EA funding compared against all malaria funding.
Source: this page says about $1 to deworm a child. There are about $50 million worth of grants recorded here, and I’m arbitrarily subtracting half for overhead. As a sanity check, Unlimit Health, a major charity in this field, says it dewormed 39 million people last year (though not necessarily all with EA funding). I think the number I gave above is probably an underestimate. The exact effects of deworming are controversial, see this link for more. Most of the money above went to deworming for schistosomiasis, which might work differently than other parasites. See GiveWell’s analysis here.
Source: this page. See “Evidence Action says Dispensers for Safe Water is currently reaching four million people in Kenya, Malawi, and Uganda, and this grant will allow them to expand that to 9.5 million.” Cf the charity’s website, which says it costs $1.50 per person/year. GiveWell’s grant is for $64 million, which would check out if the dispensers were expected to last ~10 years.
Estimate for number of chickens here. Their numbers add up to 800 million but I am giving EA half-credit because not all organizations involved were EA-affiliated. I’m counting groups like Humane League, Compassion In World Farming, Mercy For Animals, etc as broadly EA-affiliated, and I think it’s generally agreed they’ve been the leaders in these sorts of campaigns.
The original RLHF paper was written by OpenAI’s safety team. At least two of the six authors, including lead author Paul Christiano, are self-identified effective altruists (maybe more, I’m not sure), and the original human feedbackers were random volunteers Paul got from the rationalist and effective altruist communities.
I recognize at least eight of the authors of the RLAIF paper as EAs, and four members of the interpretability team, including team lead Chris Olah. Overall I think Anthropic’s safety team is pretty EA focused.
Open Philanthropy Project originally got one seat on the OpenAI board by supporting them when they were still a nonprofit; that later went to Helen Toner. I’m not sure how Tasha McCauley got her seat. Currently the provisional board is Bret Taylor, Adam D’Angelo, and Larry Summers. Summers says he “believe[s] in effective altruism” but doesn’t seem AI-risk-pilled. Adam D’Angelo has never explicitly identified with EA or the AI risk movement but seems to have sided with the EAs in the recent fight so I’m not sure how to count him.
The founders of Anthropic included several EAs (I can’t tell if CEO Dario Amodei is an EA or not). The original investors included Dustin Moskowitz, Sam Bankman-Fried, Jaan Tallinn, and various EA organizations. Its Wikipedia article says that “Journalists often connect Anthropic with the effective altruism movement”. Anthropic is controlled by a board of trustees, most of whose members are effective altruists.
Total private funding for nuclear strategy is $40 million. Longview Philanthropy has a nuclear policy fund with two managers, which suggests they must be doing enough granting to justify their salaries, probably something in the seven digits. Council on Strategic Risks says Longview gave them a $1.6 million grant, which backs up “somewhere in the seven digits”. Seven digits would mean somewhere between 2.5% and 25% of all nuclear policy funding.
I admit this one is a wild guess. I know about 5 EAs who have donated a kidney, but I don’t know anywhere close to all EAs. Dylan Matthews says his article inspired between a dozen and a few dozen donations. The staff at the hospital where I donated my kidney seemed well aware of EA and not surprised to hear it was among my reasons for donating, which suggests they get EA donors regularly. There were about 400 nondirected kidney donations in the US per year in 2019, but that number is growing rapidly. Since EA was founded in the early 2010s, there have probably been a total of ~5000. I think it’s reasonable to guess EAs have been between 5 - 10% of those, leading to my estimate of hundreds.
Open Philanthropy’s Wikipedia page says it was “the first institutional funder for the YIMBY movement”. The Inside Philanthropy website says that “on the national level, Open Philanthropy is one of the few major grantmakers that has offered the YIMBY movement full-throated support.” Open Phil started giving money to YIMBY causes in 2015, and has donated about $5 million, a significant fraction of its total funding.
Above I say about 200,000 lives total, but that’s heavily skewed towards recently since the movement has been growing. I got the 50,000 lives number by GiveWell’s total money moved for last year divided by cost-effectiveness, but I think it matches well with the 200,000 number above. | Global Health |
A Stanford Medicine-led trial of identical twins comparing vegan and omnivore diets found that a vegan diet improves overall cardiovascular health.
November 30, 2023 - By Emily Moskal
In a study with 22 pairs of identical twins, Stanford Medicine researchers and their colleagues have found that a vegan diet improves cardiovascular health in as little as eight weeks.
Although it’s well-known that eating less meat improves cardiovascular health, diet studies are often hampered by factors such as genetic differences, upbringing and lifestyle choices. By studying identical twins, however, the researchers were able to control for genetics and limit the other factors, as the twins grew up in the same households and reported similar lifestyles.
“Not only did this study provide a groundbreaking way to assert that a vegan diet is healthier than the conventional omnivore diet, but the twins were also a riot to work with,” said Christopher Gardner, PhD, the Rehnborg Farquhar Professor and a professor of medicine. “They dressed the same, they talked the same and they had a banter between them that you could have only if you spent an inordinate amount of time together.”
The study published Nov. 30 in JAMA Network Open. Gardner is the senior author. The study was co-first authored by Matthew Landry, PhD, a former Stanford Prevention Research Center postdoctoral scholar, now at the University of California, Irvine, and Catherine Ward, PhD, a post-doctoral scholar at the center.
Twin participants
The trial, conducted from May to July 2022, consisted of 22 pairs of identical twins for a total of 44 participants. The study authors selected healthy participants without cardiovascular disease from the Stanford Twin Registry — a database of fraternal and identical twins who have agreed to participate in research studies — and matched one twin from each pair with either a vegan or omnivore diet.
Both diets were healthy, replete with vegetables, legumes, fruits and whole grains and void of sugars and refined starches. The vegan diet was entirely plant-based, included no meat or animal products such as eggs or milk. The omnivore diet included chicken, fish, eggs, cheese, dairy and other animal-sourced foods.
During the first four weeks, a meal service delivered 21 meals per week — seven breakfasts, lunches and dinners. For the remaining four weeks, the participants prepared their own meals.
A registered dietitian, or “diet whisperer,” according to Gardner, was on call to offer suggestions and answer questions regarding the diets during the duration of the study. The participants were interviewed about their dietary intake and kept a log of the food they ate.
Forty-three participants completed the study which, Gardner said, demonstrates how feasible it is to learn how to a prepare a healthy diet in four weeks.
“Our study used a generalizable diet that is accessible to anyone, because 21 out of the 22 vegans followed through with the diet,” said Gardner, who is a professor in the Stanford Prevention Research Center. “This suggests that anyone who chooses a vegan diet can improve their long-term health in two months, with the most change seen in the first month.”
Improving health
The authors found the most improvement over the first four weeks of the diet change. The participants with a vegan diet had significantly lower low-density lipoprotein cholesterol (LDL-C) levels, insulin and body weight — all of which are associated with improved cardiovascular health — than the omnivore participants.
At three time points — at the beginning of the trial, at four weeks and at eight weeks — researchers weighed the participants and drew their blood. The average baseline LDL-C level for the vegans was 110.7 mg/dL and 118.5 mg/dL for the omnivore participants; it dropped to 95.5 for vegans and 116.1 for omnivores at the end of the study. The optimal healthy LDL-C level is less than 100.
Because the participants already had healthy LDL-C levels, there was less room for improvement, Gardner said, speculating that participants who had higher baseline levels would show greater change.
The vegan participants also showed about a 20% drop in fasting insulin — higher insulin level is a risk factor for developing diabetes. The vegans also lost an average of 4.2 more pounds than the omnivores.
“Based on these results and thinking about longevity, most of us would benefit from going to a more plant-based diet,” Gardner said.
The vegan participants (and the omnivores to some extent) did the three most important things to improve cardiovascular health, according to Gardner: They cut back on saturated fats, increased dietary fiber and lost weight.
A global flair
Gardner emphasizes that although most people will probably not go vegan, a nudge in the plant-based direction could improve health. “A vegan diet can confer additional benefits such as increased gut bacteria and the reduction of telomere loss, which slows aging in the body,” Gardner said.
“What’s more important than going strictly vegan is including more plant-based foods into your diet,” said Gardner, who has been “mostly vegan” for the last 40 years. “Luckily, having fun with vegan multicultural foods like Indian masala, Asian stir-fry and African lentil-based dishes can be a great first step.”
The study was funded by the Vogt Foundation; the Stanford Clinical and Translational Science Award; and the National Heart, Lung and Blood Institute.
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. | Nutrition Research |
Some patients can have vivid and detailed sexual hallucinations during anesthesia with sedative-hypnotic drugs like propofol, midazolam, diazepam and nitrous oxide. Some make suggestive or sexual comments or act out, such as grabbing or kissing medical professionals or touching themselves in a sexual way. Others awaken erroneously believing they were sexually assaulted. Why does this happen?
Doctors have long known that sedative-hypnotic drugs, which slow down brain activity to induce calm or sleep, can affect a patient’s perception of reality. A 1984 review of the drugs midazolam, ketamine and thiopental found that 18% of patients receiving anesthesia for a dental or medical procedure had a hard time distinguishing reality from fantasy during and shortly after administration. Similarly, a 1980 study found that around 14% of patients report some sexual dreaming or arousal while under anesthesia. It’s no surprise that together these two features of anesthesia could sometimes manifest in sexual hallucinations.
There have been rare cases in which medical professionals used a patient’s unconscious state to commit sexual assault. For instance, in 1991, a health professional sexually assaulted a university student under anesthesia. Although the case was initially dismissed on the grounds that the patient could have had a drug-induced sexual hallucination, genetic evidence the health professional left behind later led to his conviction. It cannot be assumed that all cases of reported sexual assault under anesthesia are due to a sexual hallucination.
We are pharmacology researchers who recently reviewed the medical literature on sexual assault or sexual fantasy during anesthesia from the earliest documented case to February 2023, finding 87 reported cases from 17 published papers. Better understanding what triggers unpleasant or sexual dreams under anesthesia could help researchers figure out how to reduce the risk of hallucinations to keep both patients and providers safe.
Reports of sexual hallucinations
Sixteen of the individual cases we found in our review involved patients reporting sexually amorous behavior or perceived sexual assault. In these cases, observers like health professionals or family members were also present during the procedure, reducing the chance that the sexual behavior actually occurred versus being hallucinated.
We also found a striking match between the anatomic location of the procedure and where the patient perceived inappropriate sexual contact. Procedures involving the mouth were perceived as oral sex, squeezing a ball to make a vein more accessible as squeezing a penis, chest procedures as breast fondling and groin procedures as vaginal penetration.
This may explain why one assessment of 200 patients found no cases of sexual hallucination for those undergoing gallbladder or appendix procedures involving the abdomen, but around 12% of those undergoing vaginal procedures noted amorous or sexually disinhibited behavior.
Trauma for both patients and providers
These anesthesia effects can have major real-world impacts on patients and providers that last long after the surgery.
The emotional turmoil a patient undergoes is likely the same whether actually experiencing sexual assault under anesthesia or having vivid hallucinations of the event. And practitioners too can experience distress: Some medical professionals accused of real or perceived sexual assault have been brought before regulatory boards or the courts and lose their license to practice.
It is possible that if patients knew a hallucination of sexual assault is a rare but possible adverse effect of anesthesia before they receive it, and were aware of the steps medical providers are taking to reduce that risk, they would be less likely to believe their sexual hallucinations were real. But this would not lessen the trauma of the hallucination. In one case, an anesthesiology student volunteered in a study where she experienced sexual hallucination after taking sedative-hypnotics. Although she knew her vivid memories of the sexual assault weren’t real, the distress she felt over them led her to withdraw from the study.
In our review of the literature, we found 71 individual cases in which the medical professional was alone with the patient at the time of the alleged sexual assault or sexual behavior. For the safety and well-being of both patients and medical professionals, having witnesses in the room or recording devices during dental or medical procedures could help prevent an opportunity for sexual assault and reassure patients that the hallucinations they may experience are not real.
However, the health care system needs to go further to protect patients. Patients struggling with the trauma of hallucinated sexual assault, even if there is evidence that it did not occur in reality, should be referred to counseling and supported just like someone who was physically harmed during a medical or dental procedure.
Many unknowns remain
What makes some people more likely to recall their dreams while under anesthesia is unclear. A 2009 study of 97 patients receiving propofol reported that those who frequently remember their dreams after anesthesia received higher doses of anesthetics, were younger than 50 years old and took longer to recover from anesthesia. A 2013 study of 200 patients receiving propofol found that men were more likely to remember dreams after anesthesia but women were more likely to remember unpleasant dreams. While dreaming and hallucinations are related experiences, people experiencing hallucinations believe they could plausibly be real.
While we reviewed all published cases of sexual hallucinations in the medical literature, the actual incidence of anesthesia-induced sexual hallucinations remains unknown. Given the decades that have passed since the first reported cases, more work needs to be done. Data from a very large sample size of patients will be required to understand the prevalence of sexual hallucinations under anesthesia. However, drug companies are reluctant to spend money on research that may show that their drugs cause adverse side effects.
Finally, though we limited our review to reports of sexual hallucinations during anesthesia, millions of Americans use other prescription sedative-hypnotic drugs. Benzodiazepines like alprazolam (Xanax) and temazepam (Restoril) are used to treat anxiety and induce sleep. Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta) as well as suvorexant (Belsomra) and sodium oxybate (Xyrem) are also used to induce sleep. Opioids like morphine and oxycodone and gabapentinoids like gabapentin (Neurontin) and pregabalin (Lyrica) are used to treat pain. Muscle relaxers like carisoprodol (Soma) and cyclobenzaprine (Flexeril) are used for muscle spasms. All of these drugs have had reported cases of patients experiencing hallucinations while taking them.
In a review of the FDA Adverse Events Reporting System, which public health officials and researchers use to monitor drug safety, 30,728 cases of “abnormal dreaming” were reported from 1974 through 2022. Most involved sedative-hypnotic drugs treating insomnia, anxiety, pain and muscle spasms. The reports do not specify the nature of these dreams, or how they affected the patient’s own perceived well-being.
It is important for patients to be aware that abnormal dreaming is a possibility when starting a sedative-hypnotic medication, and to inform their health professional if they experience hallucinations. These symptoms could indicate that the drug is not the right choice for you or that the dose may be too high. | Drug Discoveries |
A new ‘super melanin’ skin cream developed by scientists at Northwestern University shows the ability to continuously heal sun damage and chemical burns.
The synthetic, biomimetic melanin cream demonstrated the potential to heal damage occurring throughout the day when skin is exposed to sunlight or environmental toxins.
It mimicks the natural melanin in human skin, and can be applied topically to injured skin, where it accelerates wound healing. These effects occur both in the skin itself and systemically in the body.
A study published this week in Nature Regenerative Medicine showed that when applied in a cream, the synthetic melanin can protect skin from sun exposure and heal skin injured by sun damage or chemical burns. The technology works by scavenging free radicals, which are produced by injured skin such as a sunburn. Left unchecked, free radical activity damages cells and ultimately may result in skin aging and skin cancer.
Melanin in humans and animals provides pigmentation to the skin, eyes and hair. The substance protects your cells from sun damage with increased pigmentation whenever the sun is ‘tanning’. That same pigment in your skin also naturally scavenges free radicals in response to damaging environmental pollution from industry smokestacks and car exhaust fumes.
“People don’t think of their everyday life as an injury to their skin,” said co-corresponding author Dr. Kurt Lu, who teaches dermatology and practices at Northwestern University School of Medicine. “If you walk barefaced every day in the sun, you suffer a low-grade, constant bombardment of ultraviolet light. This is worsened during peak mid-day hours and the summer season.”
The skin, which doesn’t age when protected by clothing, always does age due to getting older and external environmental factors, including air pollution.
“All those insults to the skin lead to free radicals which cause inflammation and break down the collagen,” Lu said. “That’s one of the reasons older skin looks very different from younger skin.”
When the scientists created the synthetic melanin engineered nanoparticles, they modified the melanin structure to have higher free-radical scavenging capacity.
“The synthetic melanin is capable of scavenging more radicals per gram compared to human melanin,” said co-corresponding author Nathan Gianneschi, a professor of chemistry and pharmacology at Northwestern. “It’s like super melanin. It’s biocompatible, degradable, nontoxic and clear when rubbed onto the skin. In our studies, it acts as an efficient sponge, removing damaging factors and protecting the skin.”
The sunscreen booster stays on the surface and quiets immune system
Once applied to the skin, the melanin sits on the surface and is not absorbed into the layers below.
“The synthetic melanin stabilizes and sets the skin on a healing pathway, which we see in both the top layers and throughout the body,” Gianneschi said.
The scientists, who have been studying melanin for nearly 10 years, first tested their synthetic melanin as a sunscreen—and it was successful.
“Next, we wondered if the synthetic melanin, which functions primarily to soak up radicals, could be applied topically after a skin injury and have a healing effect on the skin?” Gianneschi said. “It turns out to work exactly that way.”
“You are protecting the skin and repairing it simultaneously,” Lu said. It’s continuous repair, as shown in the team’s video below…
The cream could also potentially be used for blisters and open sores, while quieting the immune system.
The stratum corneum, the outer layer of mature skin cells, communicates with the epidermis below. It is the surface layer, receiving signals from the body and from the outside world. By calming the destructive inflammation at that surface, the body can begin healing instead of becoming even more inflamed.
“This means that stabilizing those upper layers can lead to a process of active healing,” Lu said.
In a lab, the scientists used a chemical to create a blistering reaction to a human skin tissue sample in a dish. The blistering appeared as a separation of the upper layers of the skin from each other—highly inflamed, like a poison ivy reaction.
They waited a few hours, then applied their topical melanin cream to the injured skin. Within the first few days, the cream facilitated an immune response by initially helping the skin’s own radical scavenging enzymes to recover, then by halting the production of inflammatory proteins. This initiated a cascade of responses in which they observed greatly increased rates of healing. This included the preservation of healthy skin layers underneath. In samples that did not have the melanin cream treatment, the blistering persisted.
“The treatment has the effect of setting the skin on a cycle of healing and repair, orchestrated by the immune system,” Lu said.
Melanin could protect from toxins including nerve gas—and the team’s research on melanin is partly funded by the U.S. Department of Defense and the National Institutes of Health. They showed they could dye a military uniform black with the melanin, and that would absorb the nerve gas. Additionally, their observation that melanin protects biologic tissue from high energy radiation, shows it may be an effective treatment for skin burns from radiation exposure.
Melanin also absorbs heavy metals and toxins. “Although it can act this way naturally, we have engineered it to optimize absorption of these toxic molecules with our synthetic version,” Gianneschi said.
The scientists recently completed a human trial showing that the synthetic melanins are non-irritating to human skin—and the promising work may well provide treatment options for cancer patients undergoing radiation therapy in the future.
SHARE the Derm-errific Research With Sun-Worshipers on Social Media… | Medical Innovations |
Cough syrup or codeine linctus could no longer be available over the counter because of concerns it is addictive and can lead to serious health problems.
Rising numbers of reports of drug abuse and dependence to codeine medicines are being made to the UK medicines safety regulator.
It now wants views on reclassifying it as a prescription-only medicine because of fears of misuse.
Pharmacists also say they are worried about the overdose risk.
Codeine linctus is an oral solution or syrup containing the ingredient codeine phosphate, which is sold as a cough remedy in pharmacies.
But some people are also using it for its opioid effects - to feed an addiction to pain-relieving medication - and the Medicines and Healthcare products Regulatory Agency (MHRA) says the rules around how people get hold of it should be tightened.
"Codeine linctus is an effective medicine, but as it is an opioid, its misuse and abuse can have major health consequences," said Dr Alison Cave, chief safety officer of the MHRA.
The problem has been getting noticeably worse in the last five years, with increasing numbers of reports of misuse and criminal activity linked to codeine, often promoted through social media.
The MHRA says it has received 116 reports of recreational drug abuse, dependence and/or withdrawal to codeine medicines, including codeine linctus, since 2018.
There were 277 serious and fatal adverse reactions to medicines containing codeine in 2021 and 243 in 2022, and there have already been 95 this year.
As a result, the regulator has launched a consultation to gather views from health professionals and members of the public on making the medicine available only when prescribed by a GP.
Pharmacists welcomed the move, saying there was "insufficient robust evidence" for the benefits of codeine linctus for treating coughs safely.
"We also have significant concerns about its misuse and addictive potential, as well as the risk of overdose," said Prof Claire Anderson, president of the Royal Pharmaceutical Society.
She said there were many non-codeine based products which people could use for a dry cough, which would probably go away on its own anyway.
Up to 60% of people worldwide may be prone to opioid dependence, studies suggest.
Cough syrups have also been in the news for a different reason in India, where some Indian-made cough syrups were linked to deaths in The Gambia and Uzbekistan.
The Indian government has made it compulsory for cough syrup makers to get samples tested before exporting their products.
What happens to codeine in the body?
- Codeine is a painkiller that is part of a group of medicines called opiates
- It works in the central nervous system and the brain to block pain signals to the rest of the body
- It also reduces the anxiety and stress caused by pain
- It can be used when other painkillers have not worked
- It is possible to become addicted to codeine, so if you need to take it for more than a few weeks, your doctor will tell you how and when to stop taking it
- Children under 12 should not be given codeine unless advised otherwise
The consultation on codeine linctus runs until 15 August 2023. | Drug Discoveries |
Parents setting bedtime rules can be “protective” of their teenage children’s health and wellbeing, helping them to establish good sleep routines as young adults and in the future, say Flinders University researchers.
Using feedback from 2500 students aged from 12 to 14 between 2019-2020, the national study found adolescents whose parents set bedtimes had at least 20 minutes more sleep on average which can make “all the difference” to next-day performance – including reaching the recommended 8-10 hours of sleep a night.
The adolescent sleep researchers at Flinders University are now seeking 30 participants for a new study in Adelaide to record their self-monitored sleep overnight, using electronic devices and other factors to find out more about teen sleep habits.
“Most young people tend to stay up later and have less sleep when they are left to set their own bedtimes, but qualitative research is finding that adolescents are open to parental guidance to improve their sleep patterns,” says psychology researcher Dr Serena Bauducco, a visiting scholar from Sweden.
“In our national study we also found some adolescents were happy to have parent reintroduce bedtime setting after a period of having no bedtime rules,” adds Ms Bauducco, who says holding on to bedtime rules seems to slow down the natural trend towards later bedtimes and shorter sleep duration seen throughout adolescence.
The study, published in the Journal of Sleep Research, supports a growing body of research supporting the positive impact of parent-set bedtimes on adolescents’ sleep. Teenagers need between 8 and 10 hours of sleep per night.
It not only shows sleep interventions help to maintain positive sleep routines but also can reintroduce bedtimes rules in mid-adolescence, paving the way for sleep gains in teenagers at an age when school-based sleep education and other awareness programs are seeking to improve sleep health.
“We therefore encourage public health recommendations to highlight the beneficial effects of maintaining bedtime rules into adolescence.”
Flinders University sleep researchers are inviting 16-18 year old females, with a friend, to take part in an overnight stay in the Flinders University Sleep and Psychology Lab at Bedford Park. The new study will examine their evening routine and sleep habits with and without mobile phone, television and other factors. Meals and a gift voucher will be offered. Contact email: [email protected]
The study will look at the use of mobile phones and other technology in the evening, and teenagers’ understanding of the need for the recommended 8-9 hours sleep for cognitive function, physical health and mental wellbeing.
“The idea is to look at teenagers’ bedtimes when parents are not around,” says Dr Bauducco. “They will come to the lab with a friend and have access to a TV both nights and to a smartphone one night.”
The latest article, It’s past your bedtime, but does it matter anymore? How longitudinal changes in bedtime rules relate to adolescents’ sleep (2023) by SV Bauducco, LA Gardner, K Champion, N Newton and M Gradisar, has been published in the Journal of Sleep Research DOI: 10.1111/jsr.13940.
This study used data from the Health4Life study, a large cluster randomised controlled trial evaluating the effectiveness of an eHealth intervention to improve lifestyle risk factors among Australian secondary school students. Participants were Year 7 students from 71 participating schools across New South Wales, Queensland and Western Australia. The analytical sample of the current study consisted of 2509 adolescents with data on parent-set bedtimes at both time points.
Funding: The Health4Life study was funded by the Paul Ramsay Foundation and the Australian National Health and Medical Research Council grants to University of Sydney co-authors. | Stress and Wellness |
Anti-abortion campaigners have revealed their plans to launch a sickening attack on a sexual health clinic in Glasgow.
Members of extremist fringe group Scottish Family Party (SFP) took to Facebook to discuss their mission to “brick up” the Sandyford clinic in Glasgow. The Sandyford clinic has been repeatedly targeted by pro-life protestors and women attending for treatment have been harassed and even filmed when accessing abortion services.
In a live video on the platform on Tuesday night, party leader and former UKIP member Richard Lucas spoke to SFP member Niall Fraser about the disturbing details of their plan.
Fraser said: “On March 11 at 11am we are going to be protesting this horrific building. The plan is to brick it up. How do we stop kids entering the building? We have to block the entrance. We are going to impede people getting in to the building.”
Lucas then responds: “There are some valid forms of healthcare at Sandyford, but an awful lot of it is not - and we are going to make our feelings known.”
Fraser continues: “We need people of the resistance - a symbol that we are not going to take it anymore.
“I’m willing to do time for it. I won’t have Scottish kids, on an industrial scale pumped full of hormones, confused and ultimately abandoned after they go through this process. It is such a sick, disturbing situation.”
Fraser then adds that he is willing to “do time” for his actions if police attempt to block his protest.
He said: “I am willing to do time for it if the police think that bricking the building up is a step too far.”
The Scottish Family Party, founded in 2017, states in its core policies it opposes both abortion and “transgender ideology”. Their broadcast rallying troops to attack Sandyford comes amidst calls for legislation to introduce ‘buffer zones’ laws at abortion facilities to protect pregnant people from intimidation.
If granted, the legislation would make it illegal for pro-life activists to stage demonstrations within a 100m vicinity of any abortion clinic. The bid was brought forward by Scottish Greens health spokesperson Gillian Mackay, who blasted the Scottish Family Party footage as “disgusting”.
She told the Record: “This is a disgraceful and disgusting new low from an increasingly extreme group that masquerades as a political party. It has no place in a kind, caring and progressive Scotland.
“They are showing a total contempt for the safety, rights and wellbeing of service users and staff. It is intimidation and harassment, and it needs to be stopped. I am going to contact Police Scotland and ask them to urgently investigate.
“It also underlines exactly why we need to introduce buffer zones, to ensure that everyone can access reproductive healthcare without fear of obstruction.”
A spokesperson for pro-choice campaign group Back Off Scotland added: “These comments are shocking - they’re inflammatory and incite violence. Sandyford Services are used throughout the weekend and protests outside are a barrier to those seeking medical care.
“The quicker buffer zones are implemented the better. There is no place for this behaviour at healthcare sites.”
Gemma Clark, pro-choice campaigner, said: “It is chilling to see these threats against the Sandyford clinic. This clinic provides a range of essential services including counselling and sexual health tests for women and girls who have been subjected to rape and sexual assault.”
The Daily Record has reported on a worrying rise of extremist anti-abortion activity outside Scotland’s sexual health clinics. In June last year we told how religious activists were seen ‘filming patients’ outside Sandyford before being chased away by counter demonstrators.
The two men targeted the clinic three times in the same month. One of the ‘preachers’ was quoting Bible passages and chanting through a loudspeaker system while wearing a small black body camera on his chest.
His pal held sickening signs which read “babies are murdered here” and “abortion is murder - thou shalt not murder”.
Last week we reported on Texas based religious group 40 Days for Life staging a “prayer vigil” outside the maternity ward at the Queen Elizabeth University hospital in Glasgow for the second year running. The group, who held up banners which read: ‘Don’t be coerced into abortion’ with images of foetuses, was led by Bishopbriggs woman Rose Docherty.
Rose previously told the Record she was recruited by 40 Days ‘through the pro-life grapevine’ and claims she aims to ‘help’ women who may be ‘coerced’ into abortion. A furious NHS consultant was forced to confronted the protesters in a bid to protect patients.
Dr Greg Irwin, who works in paediatric radiology, told them: “You are upsetting my patients and you are upsetting my staff. What you are doing is very unkind and I would like you to stop what you are doing.
“You need to stop coming to my hospital, this is not fair.”
He went on to tell the Record: “These people are bullying our patients. Abortion is legal in our country and these women are doing nothing wrong. Women who may be experiencing the very worst day of their lives are having to deal with these people.
“Their protest is aimed directly at women and is the very definition of misogyny. It is spiteful, there is no other word for it.
An NHS Greater Glasgow and Clyde spokesperson said: “NHSGGC provides a wide range of healthcare services and patients should be able to access these services without fear of intimidation or harassment. At all times, our healthcare teams treat service users with respect, compassion and professionalism and we would expect that others will respect these values.”
A Police Scotland spokesperson said: “We are aware of a planned protest on Saturday, March 11 on Sandyford Place, Glasgow. It will be policed appropriately.”
The Record has approached The Scottish Family Party for comment.
Don't miss the latest news from around Scotland and beyond - Sign up to our daily newsletter here. | Women’s Health |
Taking a nap during the day can leave you feeling refreshed, recharged and ready to take on the world. Now new research suggests it could be good for your brain too.
A study which analysed data from people aged 40 to 69 has shown daytime napping could slow the rate at which the brain shrinks as we age.
The average difference in brain volume between habitual nappers and those who were not was equivalent to 2.6 to 6.5 years of ageing, researchers found.
They said they hope their findings into the health benefits of sleeping during the day will reduce any stigma that still exists around daytime napping.
Senior author Dr Victoria Garfield, from the MRC Unit for Lifelong Health & Ageing at UCL, said: "Our findings suggest that, for some people, short daytime naps may be a part of the puzzle that could help preserve the health of the brain as we get older."
Previous research has suggested people who have had a short nap perform better in cognitive tests in the hours afterwards than those who did not take forty winks.
The new study, published in the journal Sleep Health, looked at whether there was a causal relationship between daytime napping and brain health.
Researchers looked at 97 snippets of DNA thought to determine people's likelihood of habitual napping.
They compared measures of brain health and cognition of people who are more genetically programmed to nap with people who did not have these changes in DNA, using data from 378,932 people from the UK Biobank study.
They found that, overall, people predetermined to nap had a larger total brain volume.
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The genetic variants - DNA changes - influencing the likelihood of someone to nap were identified in an earlier study looking at data from 452,633 UK Biobank participants.
But the researchers did not find a difference in how well those programmed to be habitual nappers performed on three other measures of brain health and cognitive function.
Lead author and PhD candidate Valentina Paz, from the University of the Republic (Uruguay) and MRC Unit for Lifelong Health & Ageing at UCL, said: "This is the first study to attempt to untangle the causal relationship between habitual daytime napping and cognitive and structural brain outcomes.
"By looking at genes set at birth, Mendelian randomisation avoids confounding factors occurring throughout life that may influence associations between napping and health outcomes.
"Our study points to a causal link between habitual napping and larger total brain volume."
Dr Garfield added: "I hope studies such as this one showing the health benefits of short naps can help to reduce any stigma that still exists around daytime napping." | Longevity |
Two poultry workers in England have tested positive for bird flu, although there are no signs of human-to-human transmission, the UK Health and Security Agency (UKHSA) has said.
Both people were known to have recently worked on an infected poultry farm and have since tested negative.
Neither worker experienced symptoms of avian influenza, with both cases found during screening.
The risk to the general population remains very low, the UKHSA added.
The UKHSA is running a programme of testing workers who have come into contact with infected birds, but is also running asymptomatic testing.
The first person who tested positive is thought to have inhaled the virus.
The second person is thought to be a more complicated case and it is unclear whether they have suffered a genuine infection or whether they too inhaled the virus while at work.
The UKHSA says precautionary contact tracing has been undertaken for this second individual.
Chief Medical Advisor at the UKHSA Professor Susan Hopkins said that globally there is "no evidence of spread of this strain from person to person, but we know that viruses evolve all the time and we remain vigilant for any evidence of changing risk to the population."
"It remains critical that people avoid touching sick or dead birds, and that they follow the DEFRA advice about reporting," she added.
There are various different types of avian flu that have circulated in the past - the latest one infecting birds is H5.
Although none of these strains easily infect people, and they are not usually spread from person to person, small numbers of people have been infected around the world, leading to a small number of deaths.
There have been very few cases of bird flu transmission to people recorded in the UK. The virus is not that well suited to humans and does not spread as easily as it does between birds.
It usually requires very close contact with an infected bird, which is why experts say the risk to humans is currently considered very low.
These latest cases do not change that assessment. There is no suggestion that the virus has changed to become infectious to us or spread from person to person.
A "mandatory housing order" for England and Wales was lifted on 18 April, meaning poultry and captive birds could be kept outside again.
The measures were introduced during the world's biggest ever bird flu outbreak.
Government guidance on the signs of bird flu and how to report it can be found here. | Epidemics & Outbreaks |
Iranian officials said young girls have been poisoned in about 30 schools across the country, in an apparent effort to stop them from going to school, according to several news reports.
The BBC reported about 700 girls have been affected by toxic gas since November, many of whom have been hospitalized, but none have died. The girls impacted have exhibited symptoms, including nausea and fatigue, the network added.
Schoolgirls have been on the forefront of protests that have rocked the country following the death of 22-year-old Mahsa Amini in morality police custody in September after the young woman was arrested for allegedly not wearing her hijab properly.
The first cases of poisoning were reported in November in the religious city of Qom, which is home to Shiite Muslim clerics and many religious schools.
Students at Qom’s Noor Yazdanshahr Conservatory fell ill both in November and December, according to The Associated Press, but authorities at first failed to recognize a connection between those incidents.
More cases were later reported in other cities, including in the country’s capital Tehran and in Borujerd, suggesting the incidents weren’t isolated.
Most of the poisonings affected schools were young girls were taught, but at least one so far was reported in a boys’ school in Borujerd, the AP added.
About 100 people, including parents, protested the incidents in Qom last month, and some families have already not been taking their children to school.
Both Iran’s prosecutor general and the Intelligence Ministry have launched investigations into the poisonings.
“The poisoning of students of Qom was intentional and caused by available chemical compounds. Some people wanted all schools to be closed, especially girls’ schools,” Younes Panahi, a deputy health minister, said at a press conference Sunday, according to a report by Iranian state broadcaster IRIB, cited by NBC News.
Panahi, who did not identify who is behind the attacks, subsequently said his remarks that implied the targeting of girls’ schools were thought to be premeditated had been misunderstood, as the government has not confirmed that, the BBC reported.
During the news conference, Panahi said those impacted exhibited mild symptoms, including weakness and lethargy, and none of the students suffered complications.
“The poisoned students do not need aggressive treatment and a large percentage of the chemical agents used are treatable,” he said.
Young women opposing the strict Islamist dress code were targeted with acid attacks in 2014 in Isfahan, Iran.
“If operatives of the acid attacks had been identified and punished then, today a group of reactionaries would not have ganged up on our innocent girls in the schools,” Azar Mansoori, a reformist politician, wrote on Twitter, according to Reuters.
Girls’ education in Iran has not been questioned since the 1979 Islamic Revolution, the AP explained, despite the country’s very conservative leadership. Iran has even called on Afghanistan to allow girls to attend schools and universities.
Government critics in Iran, however, have raised the possibility the poisonings could be an act of “revenge” on behalf of the government for girls’ participation in the protests following Amini’s death. There does not appear to be any evidence so far to support those claims. | Epidemics & Outbreaks |
Sean Rayford/Getty Images
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A tornado damaged a Pfizer pharmaceutical plant in Rocky Mount, N.C., in July. The facility makes almost 25% of Pfizer's sterile injectable medicines used in the U.S.
Sean Rayford/Getty Images
A tornado damaged a Pfizer pharmaceutical plant in Rocky Mount, N.C., in July. The facility makes almost 25% of Pfizer's sterile injectable medicines used in the U.S.
Sean Rayford/Getty Images
As a pharmacist, Jason Chou didn't major in international relations. But a few days after the Hamas attack on Israel threw the Middle East into crisis, he and his colleagues started thinking about drug shortages.
"We have to look and say, well, is there production of any kind coming out of Israel?," said Chou, vice president of pharmacy services for Ochsner Health in New Orleans. "It's not just the drug, too. So that's the other thing that I think we've become more sensitive to is that you have the active drug ingredient, but then you have non-active ingredients, you have vials, containers, packaging. So all of that stuff can impact ... drug availability."
So far, Chou is concerned about a handful of items, but nothing has caused a big problem yet.
He and other members of End Drug Shortages Alliance, a consortium of organizations affected by drug shortages, find themselves trying to anticipate drug shortages before they happen. They try to enough product stocked to weather whatever storm comes their way.
And sometimes it is a literal storm. A tornado wiped out a Pfizer warehouse of drugs in July. Many of the drugs were already in short supply.
There were 243 different drug shortages as of Nov. 1, according to the American Society of Health System Pharmacists, which keeps track. The situation is a bit better than it was over the summer when the number of shortages approached a 20-year record high. But the ones that have lingered have been severe, especially for generic injectable drugs.
Critical drugs in short supply
The raw number of shortages doesn't tell the whole story, says Michael Ganio, senior director of Pharmacy Practice and Quality with ASHP. For some pharmacists, this is the worst it's been in their decades-long careers, he says, calling the current situation "alarming" and "heartbreaking."
And the kinds of drugs in short supply worsens the problems.
"Some of them involve oncology drugs, things we use to treat cancer," he says. "And of course, those patients are already going through a personal struggle. But now you layer on top of that the fact that the drug that is preferred to treat their cancer may not be available."
Recent oncology drug shortages have included cisplatin and carboplatin, generic drugs that are workhorses in chemotherapy.
But oncology isn't the only part of the hospital missing crucial medications.
When a patient's heart stops beating or they stop breathing, hospitals call a "code blue." That prompts medical staff to rush with a crash cart to revive the patient. But there have been crucial shortages of drugs needed for crash carts, like painkillers, overdose reversers and even simple saline IV bags.
Those shortages leave patients, doctors and nurses in a difficult position.
"This is when you are moving and shaking to make sure that we can help maintain life," says Aisha Terry, President elect of the American College of Emergency Physicians. "And when we go to that crash cart in the middle of an emergency and can't find the medications that we need, it really is not only a failure of the system, but absolutely a failure to that patient who came to us seeking help with literally sustaining their life."
Sometimes, shortages hit patients who are seeking relief for chronic pain.
Pauline Cass, pharmacy manager at Stoughton Hospital in Stoughton, Wisc., spoke to NPR one afternoon in September about patients awaiting steroid injections for joint pain.
"We have zero vials," Cass says. "And we have six patients scheduled in the next two weeks who need the radiologists to use that injectable when they do joint injections."
So far, the hospital hasn't had to turn anyone away, because the staff has been been able to find the drug eventually. But appointments were delayed.
Ripple effects of shortages
A recent survey by the ECRI Institute found that shortages compromised patient care. Health care workers told the nonprofit they were sometimes unable to give patients the best drug for their condition, administered less effective drugs, delayed care and even made medical errors.
About a quarter of health care workers responding to the survey said they were aware of at least one error in the last six months as a result of a shortage. For example, one patient received half the dose of the anesthesia drug ketamine.
The shortages prompt hospital pharmacy employees to work overtime, hunting down alternative medications. It also strains hospital budgets, especially in places where hospitals are already struggling to stay open.
About half of the hospitals ASHP surveyed in mid-July say they're having to spend 5% to 10% more on overtime thanks to the shortages. And about half say they've had to spend 6% to 15% more on drugs.
That's because hospitals typically have purchasing contracts to get the best prices on the generic drugs they need. When the contracted options dry up, hospitals buy drugs off-contract, a more expensive solution.
"The same drug just made by a different manufacturer can cost us double or triple the amount that we'd be spending if we were buying it on contract," says Chris Laman, Vice President of Strategy for Columbia Memorial Hospital in Astoria, Ore..
A shortage became personal
A hospital pharmacist who works with Laman, Jeffrey Chow, experienced a drug shortage firsthand earlier this year.
When he got a mole on his scalp biopsied, he learned that the regular numbing injection – lidocaine and epinephrine – wasn't in stock. He received only lidocaine.
Normally, the epinephrine constricts blood vessels to reduce bleeding. Without it, Chow bled profusely. Blood trickled down his forehead where he could see it.
"We had to get more gauze," says Chow, the outpatient pharmacy manager at Columbia Memorial Hospital in Astoria, Oregon. "It took a while to get it to stop or slow down enough to where we could bandage it up so that I could leave."
Before that,Chow said he'd grown somewhat numb to the chronic shortages plaguing the health care system. "It was kind of just an eye-opening situation of how much it really can affect customers if they can't get what they need." | Drug Discoveries |
Social media might be addictive, but it turns out quitting is complicated. A study out Wednesday from the UK’s Durham University asked 51 moderate to heavy social media users to stay off the apps for one week. Participants had a decrease in negative emotions and feelings including boredom, but they reported a drop in positive feelings as well. It adds to a growing body of evidence that there may be no easy fix for my specific personal problems.
Social media is often compared to alcohol or other addictive substances, and that’s as true in academic circles as it is in popular culture. Accordingly, the researchers expected that abstinence would come with withdrawal symptoms. That’s not what happened: not only were the emotional changes a mixed bag, but going cold turkey didn’t lead to the cravings you’d expect from other more established chemical or behavioral addictions.
The results could “be consistent with the Goldilocks hypothesis of digital screen use, which posits that a moderate amount of [social media] use may be beneficial to mental well-being,” the authors wrote. If only TikTok was as nourishing as porridge.
The study gathered a group of people aged 18–25 who used social media services for a range of 30 minutes to over 9 hours a day, with a mean of nearly 3-and-a-half hours of daily screen time. After an initial baseline period, the researchers monitored participants as they stayed off social media for six days, and then followed them for another four days when they could use social media freely. People in the study were asked to fill out daily surveys and questionnaires about their mood and experience, and subjected to a number of tests to measure how social media affected their cognitive function.
Except for a few minor relapses, participants didn’t have any trouble cutting out social media. According to daily questionnaires, people saw a dip in generally negative emotions, but there was also about the same drop in generally positive emotions as well. Specific feelings that included boredom and loneliness saw a similar decrease. The various cognitive tests that measured cravings to use social media showed negligible changes after the experiment. In other words, it’s almost like people who took a week-long break from social media just had fewer feelings, in general.
The researchers hypothesized this might be because the effects of social media are nuanced. As the study points out, content on social media can trigger feelings like fear of missing out or comparing yourself to other people who seem to be doing better, but it can also lead to feelings of social approval.
“In sum, the present study indicates that abstaining or reducing [social media] use for one week is not associated with any substantial effects on affective or motivational responses,” the researchers wrote.
As always, the only thing the study can say definitively is we need to do more studies, but one thing is clear: that social media influencer who’s telling you that you need to get off social media may not have all the answers. | Mental Health Treatments |
When 69-year-old Keith Guernsey from Gainesville, GA, first found out he had multiple myeloma, it was a complete shock. Heâd just gotten past prostate cancer surgery and was looking forward to putting cancer behind him. He hadnât noticed any signs of another health problem. But, blood tests his doctor ordered related to the earlier cancer led to the unthinkable: Guernsey was facing a new, and this time treatable but incurable, cancer diagnosis.
âMy wife became my sole caregiver because the rest of my family is scattered,â Guernsey says.
He took advantage of online support groups, where he met people all around the country at all different stages of multiple myeloma. He found special inspiration in a woman in California whose initial diagnosis was stage IV multiple myeloma.
âShe was told to get her affairs in order -- that she had 6 months to live,â Guernsey said. âSheâs been in remission for 20 years. So, she gives me and others a lot of hope. Itâs a very supportive group.â
Finding Resources
While multiple myeloma is a rare cancer, there are lots of resources available to support people who have it. A good place to start is your own care team, says Jason Valent, MD, a myeloma specialist at Cleveland Clinic. In addition to specialists in myeloma, he says care teams include palliative care specialists to help with the pain as well as psychologists and psychiatrists to help you cope with the diagnosis.
âThat's a very important thing for patients to have access to,â Valent says. âThe emotional pain is oftentimes just as bad or even more severe [than the physical pain].â
Michelle OâHare, RN, an oncology nurse who cares for myeloma patients at Memorial Sloan Kettering Cancer Center, says those who need extra support can talk to a social worker, who can connect you with transportation help and other assistance. A case manager can be helpful if youâre in need of nursing care at home. She also recommends support groups, which may be in-person or online.
âI always tell patients that they can google multiple myeloma support groups and get a whole list,â OâHare said. âThat's the beauty of the internet.â
Online organizations that offer help for people with myeloma include:
- Myeloma Crowd by Healthtree
- Multiple Myeloma Research Foundation
- International Myeloma Society
- Leukemia & Lymphoma Society (LLS)
âLLS can provide not only patient resources in terms of support groups, but also financial assistance for copays,â Valent says.
In addition to support groups, some organizations can connect you with a one-on-one mentor or coach. For instance, the coaches at Myeloma Coach by Healthtree are myeloma patients or caregivers who stay in touch with you, listen, and offer guidance on financial aid, online resources, and more.
Finding Your Own Way
When deciding among your many support options, Urvi Shah, MD, a myeloma specialist at Memorial Sloan Kettering Cancer Center, says you should be true to yourself.
âPatients should be careful to pick whatâs right for them,â Shah says. âFor some, support groups are helpful. They want to know what lies ahead and it reduces stress. For others, hearing too much worsens stress and anxiety. Knowing what type of personality you have can help you to decide if you want to reach out and to whom.â
Amy Pappas of Cleveland, OH, found out she had multiple myeloma at age 45, after intense back pain sent her to a spine specialist. It turned out the cancer had cracked her spine. It was also in her ribs, pelvis and skull. For support, instead of online groups, she relied on a close network of friends and family.
âEven though I did feel really sick [at times during treatment], I just kept going,â Pappas says. âThatâs my personality: trying to feel normal as I was getting better. Distractions were huge for me. I could say to my friends, âHey, I feel like crap, but come over and distract me.ââ
She also took advantage once or twice a week of the yoga classes that Cleveland Clinic offers for people with any cancer type. The classes were relaxed and small and included people at all different stages in their cancer journey.
âBeing around those people did feel good,â she says. âIt was a nice outlet and different from being in a regular yoga studio.â
Coming Full Circle
Guernsey is now in his second year of remission. He says heâs feeling as good as heâs felt since he was 28 and still playing hockey. He still has regular Zoom calls with folks he met through an online support group. He also serves as a myeloma coach for others who are going through the same things he has.
âIâm not a doctor, so I donât pretend to be,â Guernsey says. âBut I share my experience and try to let them know what worked for me. It can also work for them.â | Disease Research |
For the past six years, professional dancer Amy Dowden has wowed on Strictly Come Dancing. But before her rise to fame, choreographers and potential dance partners considered her a "risk" to work with for fear her Crohn's disease would impact their careers if she needed to take time out.
"Everyone is used to seeing me on Strictly with all the hair and make-up and the biggest of smiles," she says, but behind the scenes she manages a chronic illness.
Crohn's disease is a lifelong invisible condition which causes parts of the digestive system to become inflamed. For Amy, this can cause swollen eyes, terrible mouth ulcers, constipation, severe pain, sickness and fatigue. She takes eight steroids a day to stay out of hospital.
"It's certainly a rotten illness to live with," she tells the BBC Access All podcast.
Amy was diagnosed aged 11, just as she started to rocket through the junior dance ranks. She hated people asking about her health rather than her dance aspirations, but far worse was the reaction from dancers when she was looking for new partners.
"I'd go for a try-out and then as soon as my dance teacher would say 'you need to tell them about your Crohn's,' I wouldn't hear back from them," she says.
"I had so many rejections because of my Crohn's. If a producer wants to take you on tour, [they question] what happens to them and their insurance when I'm poorly? You're seen as a risk."
It's why she takes every opportunity to speak openly about it now.
Her Bafta-winning documentary Strictly Amy: Crohn's and Me didn't hide the realities of the illness showing her in hospital in agony, her voice rasping.
"People don't want to talk about poo and guts and bowels. They all get embarrassed. So it's about breaking down the stigma," she says.
But it has taken her a long time to reach that confidence.
LISTEN: You can hear more from Amy on the BBC Access All podcast.
And after the government unveiled its plan to reform support for children with special educational needs and disabilities (SEND) in England, parents Tania Tirraoro and Lucy Bartley, see how it shapes up.
Amy did eventually find a dance partner - Ben Jones who she is now married to - but getting past the discrimination within the industry has been difficult.
It's why, when she was selected for Strictly Come Dancing she had decided not to mention her chronic illness.
Although Amy and Ben had become British National Latin Dance Champions that same year, she worried her medical history would eclipse that and the show would drop her.
The live Saturday night show partners professional dancers with a celebrity who has little or no dancing experience, all hoping not to get knocked-out, and to win the final.
"I didn't want a celebrity to go, 'I don't want Amy because she's got Crohn's'. I wanted to prove myself on the show first."
Looking back, she says this was "ridiculous" and her parents convinced her to meet the production team to tell them.
"I can remember sitting in that meeting and saying 'I've got Crohn's'. And they were like 'that's absolutely fine, let us know what we need to do'."
It was the first time she had experienced such positivity.
"The team always ensure that I'm not pushing myself. Sometimes they make me take the afternoon off to rest. They do it for everybody. There's always a contingency plan if people are injured."
Amy has been part of those Strictly seasons which have brought disabled contestants to the fore, often challenging audience perceptions.
Rose Ayling-Ellis won legions of fans and the competition, lifting the glitterball trophy in 2021, when she demonstrated being deaf was no barrier to enjoying music and dance. Ellie Simmonds became the first person with dwarfism to compete alongside her partner Nikita Kuzmin who himself has Type 1 diabetes.
Recently, Amy has partnered CBeebies favourite, George Webster, who has Down's syndrome, as well as TV presenter and Royal Marine veteran, JJ Chalmers, who has a limb difference after he was injured by a bomb in Afghanistan.
Amy says it often leads to a closer understanding between her and her partner as they know what the other is going through.
"I understood pain," she says of being paired with JJ. "It was the perfect partnership. We have our own pain battles to deal with and we could both sit there and just chat about hospital stays."
When working on the choreography there were some adaptations to be made. She knew JJ couldn't complete lifts and arm movement above the shoulder was restricted.
"I would technically explain a movement and then realise ' Oh, it doesn't work, because he's missing that muscle'. And it was my job to learn how to then teach him to get the movement.
"I just adapted and I absolutely love the challenge."
Adaptive dancing is one of Amy's great passions. To fund her dancing career she set-up the Art in Motion dance studio with her husband which specialises in teaching disabled children.
But she says adaptations are just part of dancing.
"I have to adapt myself for every single celebrity. Teaching [comedian] Brian Conley was totally different to teaching [musician] Tom Fletcher. Everybody learns differently, everyone moves differently. So it's just working out what works for you and collaborating."
JJ and Amy did well and reached the quarter-finals. Although they didn't win the competition, the journey held real meaning.
"I'll never forget when JJ said: 'This is better than any rehab'. That will stay with me forever," Amy says.
Crohn's is no longer a barrier to her career and she is no longer considered a "risk", but she continues to speak out to help others.
Amy and the rest of the Strictly professionals are currently on tenterhooks waiting to hear if they'll be part of the Class of 2023.
"Hopefully I'll be going into my seventh year," Amy says. "I'm just taking every year as it comes and being grateful. In years to come, Ben and I would love to start a family, but at the moment I want to make the most of dancing."
You can listen to the podcast and find information and support on the Access All page | Disease Research |
Summary
- 'Science has shown that if someone has not taken an addictive substance by the age of 21 years, the chances of them taking the substance later in their life are reduced.'
Ugandan government plans to increase the alcohol consumption age from 18 to 21 to counter addiction, a Ministry of Health official has revealed.
Speaking at the second National Prefects Conference 2023, an event aimed at crafting measures to fight drug abuse among students in Uganda, the Ministry of Health Commissioner for Mental Health, Alcohol and Substance Abuse, Dr Hafsa Lukwata said “we want to reduce on the number of people who are going to buy. We want to raise the age from 18 to 21.”
According to her, science has shown that if someone has not taken an addictive substance by the age of 21 years, chances of them taking the substance later in their life are reduced.
“It is 88% chances that they will never take this substance. At 18 years of age, the chances are 48 percent,” Dr Lukwata added.
According to her, many industries will approach policy makers, some of which she called drunkards to have this altered.
“Most of the industries will approach some policy makers who also drunkards because they take alcohol to have this altered. They will say, ‘why are you making life difficult.’ No for addictive substance; the age has to be 21 years,’’ she said.
According to the 2023 report released by the global health body, on average, a Ugandan consumes 12.21 litres of pure alcohol annually. Men consume more than women, with an average of 19.93 litres of pure alcohol annually compared to 4.88 litres for women.
Dr Lukwata seemed disturbed by the findings of the research which rated Uganda at the top of the alcohol consumption list on the African continent.
“We will never develop as a country if majority of the people are taking drugs or alcohol for that matter,’’ she said.
Mr Saidi Nsamba, the Commissioner Guidance and Counselling at the Ministry of Education and Sports, said some students had resorted to smoking grey hair, paspalum, and cow dung.
“What was an urban issue has now reached the rural settings,” he said.
Initially he said, men were the ones abusing drugs but females have also engaged in the vice.
SCP Namutebi Hadijah, Ag Chief Political Commissar Uganda Police Force who spoke at the event spelt out penalties against drug use.
According to her, most people rejoiced when the Narcotic Drugs and Psychotropic Substances (Control) Act, 2015 which prohibited the sale and use of several narcotic drugs in the country was annulled thinking narcotics are legalized. This she said was a gap in the law and is being addressed. As they wait for a better legislation, she said the enforcement officers are now using old laws to curb the vice.
A World Health Organisation 2023 report themed "Monitoring health for the SDGs and sustainable development," indicated that on average, a Ugandan consumes 12.21 litres of alcohol annually.
The report further indicated that men in Uganda consume more alcohol compared to women, with each consuming an average of 19.93 litres of pure alcohol compared to 4.88 litres of alcohol consumed by women annually.
The same report indicates that about three million deaths (about 5.3% of all deaths) across the world occur annually as a result of harmful consumption of alcohol.
WHO says harmful consumption of alcohol is the underlying factor in more than 200 diseases and injuries across the world. | Health Policy |
Young people who have been helped by an eating disorder charity run by a former Emmerdale actress have said it has given them hope for the future.
Gemma Oaten, from Hull, developed anorexia when she was nine, prompting her parents to set up the SEED charity to help others with the disease.
Now 38, she helps run the charity's new base at Princes Quay shopping centre.
Sienna, 19, one of those helped by the charity, said: "I can see a future for myself now."
She added: "Last year was when I first started noticing it and I didn't really see a future at the time. Then it got to October and my body started to shut down."
Sienna told the BBC's One Show that when she first got involved with the SEED charity, she was "nervous and anxious", but she was also hopeful because she was getting help.
The charity's centre in Hull, which opened in January, provides therapy, listening services, an advice line and workshops from registered trainee therapists for anyone affected by eating disorders.
It includes two therapy rooms named after Big Brother star Nikki Grahame and teenager Chelsea Mooney.
Nikki, who was 38, and Chelsea, who was 17, died from anorexia within a few days of each other in April 2021.
What is anorexia?
- Anorexia is a mental illness which sees people limit how much they eat and drink and become extremely low-weight
- People with the condition often think they are larger than they are and experience a deep fear of gaining weight
- It can cause severe physical problems, including loss of muscle strength and reduced bone strength
Source: Beat
According to NHS data, more than 1,700 young people with eating disorders are currently awaiting treatment in England.
One mother, Toni, whose 15-year-old daughter is also getting support from SEED, said before coming to the charity it had been "incredibly hard to find help".
She added: "Without SEED I don't even want to think about where we would be."
Meanwhile, Toni's daughter said the charity had given her support and advice.
She said: "There's light at the end of the tunnel and I know I'm going to be OK."
Recalling her own experience, Ms Oaten told The One Show she was aged 10 when she asked her dad whether she was fat. From that point, she said her "brain just switched".
Ms Oaten described how she spent 13 years of her life living with anorexia and she nearly died four times.
The actress said she did not get the help she needed and that was why it was important SEED and similar organisations provided early interventions before people reached "crisis point".
The government said it was investing almost £1bn in community mental health care to support adults by next year.
That was on top of £54m which would be spent on eating disorder support services for young people and children, it added.
If you've been affected by the issues raised in this article, help and support is available via BBC Action Line. | Mental Health Treatments |
A mother who was jailed for illegally taking abortion tablets to end her pregnancy during lockdown will be released from prison after the Court of Appeal reduced her sentence.
Carla Foster, 45, admitted illegally procuring her own abortion when she was between 32 and 34 weeks pregnant.
A judge told her last month she would serve half her 28-month term in custody and the remainder on licence.
But the Court of Appeal reduced the term to 14 months suspended.
Dame Victoria Sharp, sitting with Lord Justice Holroyde and Mrs Justice Lambert at the London court on Tuesday, called it "a very sad case".
"It is a case that calls for compassion, not punishment," Dame Victoria said.
Foster appeared at the hearing via a video link from Foston Hall prison, Derbyshire.
The mother-of-three from Staffordshire was jailed at Stoke-on-Trent Crown Court on 12 June.
The court heard she had moved back in with her ex-partner at the start of lockdown, while carrying another man's baby.
She procured pills by post from the British Pregnancy Advisory Service (BPAS) after providing information that led staff to believe she was seven weeks pregnant.
Although abortion is legal up to 24 weeks, after 10 weeks the procedure is carried out in a clinic.
On 11 May 2020, after she took the abortion pills, emergency services received a call to say she had gone into labour.
The baby was born not breathing during the call and pronounced dead about 45 minutes later.
Foster was initially charged with child destruction, which she denied.
She later pleaded guilty to an alternative charge of section 58 of the Offences Against the Person Act 1861, administering drugs or using instruments to procure abortion, which was accepted by the prosecution.
No communication with children
Dame Victoria told the court there was "no useful purpose" served by detaining Foster in custody, and added her case had "exceptionally strong mitigation".
Foster's barrister Barry White said there had been a lack of "vital reports" into his client's mental health and the pandemic had added to her existing anxiety.
The Court of Appeal also heard the prison had not allowed Foster any communication with her children during her 35-day incarceration, one of whom is autistic.
Mr White highlighted Foster had voluntarily revealed her actions to police, adding: "Had she not done that, it is highly unlikely that she would have ever been prosecuted."
Robert Price, from the Crown Prosecution Service, said the original sentence was not "manifestly excessive" and the judge had "correctly made allowances for mitigating factors in this unusually sensitive case".
As well as the 14-month suspended prison sentence, Foster will also have to complete up to 50 days of activity.
'Cruel, antiquated law'
In response to the verdict, chief executive of the BPAS Clare Murphy said she was "delighted" the mother would be released from prison and called for a change to the law.
"The court of appeal has today recognised that this cruel, antiquated law does not reflect the values of society today," she said.
"Now is the time to reform abortion law so that no more women are unjustly criminalised for taking desperate actions at a desperate time in their lives."
Right to Life UK, however, urged the government to reject legislation changes and called for a "full inquiry" into how BPAS had come to dispatch Foster's abortion pills.
"Campaigners, led by BPAS... are using this tragic case to call for the removal of more abortion safeguards and the introduction of abortion up to birth across the United Kingdom," said spokesperson Catherine Robinson.
"At at least 32 weeks or around eight months' gestation, [the baby] was a fully formed human child. If her mother had been given an in-person appointment by BPAS, she would still be alive," she added.
Stella Creasy MP tweeted decriminalisation was needed in abortion cases and called existing legislation "archaic".
"The relief that this woman can go home to be with her children is tempered by the knowledge there are more cases to come where women in England [are] being prosecuted and investigated," the Labour MP said. | Health Policy |
Prosthetic hands have come a long way, but many are still too unwieldy and impractical for everyday use. Beyond being incapable of a natural hand’s dexterity, most prosthetics can’t offer neurological feedback to the user, thus rendering tactile or kinesthetic sensation impossible. But thanks to a program called DeTOP, a new type of prosthetic is on the horizon: A bionic hand fused to the user’s bone and nervous system, offering unprecedented range and sensation.
DeTOP, short for “dexterous transradial osseointegrated prosthesis,” is a collaboration between research organizations in Sweden, Italy, Switzerland, and the United Kingdom. Since they began working together in 2018, the organizations have sought to create a prosthetic limb that doesn’t just sense texture and pressure but also reproduces the level of dexterity found in a natural hand. DeTOP created its first operational prototype in 2019; shortly after, it began working with a Swedish woman whose lower arm had been dismembered in a farming accident two decades prior. This woman would become DeTOP’s first bionic hand candidate.
The October cover story for Science Robotics details the prototype’s success over the past four years. The woman, identified as Karin, has reportedly been able to use the bionic hand to perform 80% of a natural hand’s functions. It’s a significant improvement over her former circumstances, marked by reduced mobility and near-constant phantom limb pain.
“It felt like I constantly had my hand in a meat grinder, which created a high level of stress, and I had to take high doses of various painkillers,” Karin said in a statement for Scuola Superiore Sant’Anna, an Italian university involved in DeTOP. She added that conventional prosthetics weren’t comfortable or practical enough to be worthwhile. “For me, this research has meant a lot, as it has given me a better life.”
Before she could start using DeTOP’s bionic hand, Karin had to complete a rehabilitation program that helped her forearm bones—the radius and ulna—regain strength. (Bones can weaken following partial amputations, as they’re less frequently used.) She also had to practice commanding her missing hand using virtual reality. Afterward, the bionic hand was fused with Karin’s bones and electrically connected with her nervous system. The electrodes implanted within Karin's forearm and connected to the bionic hand allow her to control each finger and experience pressure and texture.
According to the data published in Science Robotics, Karin’s mobility and overall quality of life have improved after receiving the bionic hand. Her phantom pain, limb pain, and work- and sleep-related complications have decreased significantly.
Though it’s unclear whether DeTOP plans to iterate on its first operational bionic hand, the program’s achievements could easily inspire a new wave of improved prosthetics for amputees. | Medical Innovations |
The Biden White House is refusing to say whether it would support a recommendation that Americans stop at only two beers a week, though White House press secretary Karine Jean-Pierre suggested President Biden might defer to "the experts."
Fox News' Peter Doocy asked White House press secretary Karine Jean-Pierre about the recent reports that President Biden's alcohol czar may recommend Americans to have no more than two beers a week.
Doocy asked Jean-Pierre if Biden wants "to limit Americans to two beers a week," which the press secretary did not answer.
"Where's this coming from? Maybe I didn't miss you so much," Jean-Pierre said. "Where is this? Where is this coming from?"
Doocy rephrased his question to Jean-Pierre, asking her how dropping the recommendation on alcohol consumption "will go over" with the American public.
"Let me tell you what I'm not gonna get involved in: that question," Jean-Pierre responded, which Doocy followed up asking if Biden would be "okay" with Americans being recommended to drink only two beers a week.
But then she said: "I will leave it to the experts," she said. "I'm just not going to comment on that."
Biden, who does not drink himself, encouraged Americans to take part in an Anheuser-Busch promotional giveaway to get COVID-19 vaccination numbers up.
Anheuser-Busch offered of-age Americans a free round of beer if they got the shot.
"Get a shot and have a beer," Biden said in 2021.
Jean-Pierre's comments come after a Thursday Daily Mail interview with National Institute on Alcohol Abuse and Alcoholism (NIAAA) Director George Koob, who said that the U.S. may follow Canada's footsteps on alcohol guidelines.
Currently, American guidelines recommend men limit themselves to two drinks per day while women should only have one drink. The American recommendations are up for review in 2025.
Canada's guidelines recommend only having two drinks per week.
Koob, who said he partakes of a couple of glasses of "buttery Californian Chardonnay" a week, said he was watching the Canadian "big experiment" with interest.
"If there's health benefits, I think people will start to re-evaluate where we're at," Koob said.
Koob said there are "no benefits" to physical health from drinking alcohol and that he was "pretty sure" American alcohol consumption recommendations are "not going to go up."
"So, if [alcohol consumption guidelines] go in any direction, it would be toward Canada," Koob said. | Health Policy |
Two scientists who jointly worked on the ground-breaking technology behind some of the most effective COVID-19 vaccines have been awarded the 2023 Nobel Prize for medicine, one of the most prestigious accolades in the field.
Hungarian American scientist Katalin Kariko and her American colleague, Drew Weissman, began working on so-called “mRNA” technology in the early 1990s at the University of Pennsylvania. Their breakthrough was crucial in developing the Moderna and Pfizer-BioNtech coronavirus vaccines, which have proved among the most effective in tackling COVID-19.
Lifesaving vaccines
The Nobel Prize in Medicine Committee in Sweden said the discovery had helped defeat one of the greatest threats to human health in modern times.
“mRNA vaccines, together with other COVID-19 vaccines, have been administered over 13 billion times. Together, they have saved millions of lives, prevented severe COVID-19, reduced the overall disease burden, and enabled societies to open up again,” Nobel committee member Rickard Sandberg told reporters following the announcement Monday.
“mRNA technologies are now being used to develop vaccines against other infections. The technology may also be used for therapeutic protein delivery and cancer treatment in the hope of further improving human health,” Sandberg said.
World Health Organization Director-General Tedros Adhanom Ghebreyesus congratulated the Nobel Prize winners Monday. “Today is a great day for health, a great day for science and a great day for vaccines,” he told reporters in Geneva.
mRNA Technology
mRNA — or messenger RNA — instructs cells to make proteins that match those found on the surface of pathogens, like the coronavirus. The body sees these as invaders and makes antibodies and T-cells to attack them; thus, training it to deal with a real virus in the future.
Kariko and Weissman first met while lining up to use a photocopier machine at the University of Pennsylvania in the early 1990s.
By 2005, the pair had worked out a way to stop the immune system from attacking RNA made in the laboratory, previously seen as a major hurdle against its use.
Kariko said Monday they made a good team.
“I was the RNA person and Drew was [the] immunologist, and we educated each other. And together we learned [from] each other and developed mRNA,” she told The Associated Press.
Future applications
Weissman said the future potential for mRNA was incredible.
“We've been thinking for years about everything that we could do with RNA, and now it's here,” he told AP.
The coronavirus pandemic accelerated the development of mRNA technology, said Paul Hunter, a professor of medicine at Britain’s University of East Anglia.
“Prior to COVID, people knew that work was being done on mRNA vaccines,” he told VOA. “But I don’t think we were ever close to getting real-world use of the technology. Now that it’s been shown to work — to work probably better than many if not most other vaccine types — I think is a big boost to it, and there are a substantial number of potential uses of this technology.
“Then there is the speed of the development of this technology,” he added. “It’s a lot easier now and a lot quicker to develop new vaccines.”
Cancer hope
The chair of the Nobel Committee for Medicine, Gunilla Karlsson-Hedestam, expressed hope that mRNA technology could one day be used to fight cancer.
“Vaccines that are targeted towards specific kinds of tumors, maybe even to specific individuals or personalized cancers. That will become an area that this platform is really ideally suited for, because of the flexibility,” she told Reuters.
Kariko and Weissman share the prize of $1 million and will receive their medals at a ceremony in Stockholm in December. | Vaccine Development |
Summer’s soaring temps bring the well-known risks of heat exhaustion and heat stroke — but they can also take their toll on people’s moods and mental health, experts say.
Higher temperatures have been linked to an uptick in emergency room visits for mental health conditions and diagnoses, as found in a 2022 study published in JAMA Psychiatry.
The Boston University study looked at nearly 3.5 million adult ER visits between 2010 and 2019.
"Our work showed that emergency department visits to treat mental health increased as ambient temperatures increased, for adults across the U.S. with commercial health insurance, for a wide range of illnesses," lead study author Amruta Nori-Sarma, assistant professor of environmental health at Boston University, told Fox News Digital.
While the researchers didn’t dive into the specifics of how heat impacts the brain, Nori-Sarma identified heat as a stressor that exacerbates people's underlying ill health.
Dr. Joseph Galasso, CEO at Baker Street Behavioral Health in New Jersey, was not involved in the study but said its findings are in line with what he would expect.
"We do know that extreme heat has a significant impact on mood and behavior," he told Fox News Digital. "In particular, we see increases in aggression and mood instability."
He also said, "In terms of our behavior, we see both externalized aggression and hostility toward others, as well as internalized aggression, which can take the form of suicide attempts and self-harm."
How extreme heat affects the brain
When people are uncomfortable, Galasso said, it typically changes their mood and behavior.
"Extreme heat can lower, across the population, our general ability to be resilient and to maintain our psychological defense system, because it is detecting an increase in stress," he explained.
One hypothesis is that exposure to extreme heat may interfere with levels of serotonin, a neurotransmitter that is linked to mood and emotion regulation, though more research is needed to confirm this, Galasso said.
"What we do know is that exposure to extreme heat affects our ‘emotional gatekeepers,’ or the systems that keep our psychological resources and defenses intact," he explained.
One major factor could be that rising temperatures tend to disrupt sleep, the doctor said, which leads people to feel irritable and agitated.
"Further, people report greater difficulty with memory, attention, concentration and reaction time," Galasso said. "When there is pressure on the internal systems that regulate mood and frustration, symptoms occur that make us feel less effective in our daily lives."
"Exposure to extreme heat affects our ‘emotional gatekeepers,’ or the systems that keep our psychological resources and defenses intact."
"For those with preexisting mental health conditions, this can often be the precursor to an increase in pathology," he added.
Those who have mood instability, a history of substance abuse, or a severe or persistent mental illness are most vulnerable, Galasso warned — along with people in lower socioeconomic classes who may not have access to air conditioning and/or temperature-controlled environments.
Additional studies have found that periods of extreme heat also tend to trigger a surge in violent activity.
A 2021 study published in The Lancet found a link between rising temperatures and violent crimes, including homicides, sex offenses and assaults.
One theory is that "hot weather induces interpersonal violence by increasing discomfort, frustration, impulsivity and aggression," wrote the researchers from the School of Public Health and Preventive Medicine at Monash University in Melbourne.
A second theory was that temperature increases led to changes in people's routine activities, which then sparked interpersonal conflicts.
How to keep a cool head in the heat
To prevent heat-induced meltdowns, Galasso emphasized the need for the public — particularly those who are most vulnerable — to have access to cooling centers, water and medical care.
"As mental health providers, we need to provide education to our clients and communities to help mitigate some of the negative effects of extreme heat," he said.
"And it is important for first responders to understand that they may see an increase in violence, domestic violence, aggression and heat-related issues," Galasso added.
People who are taking psychotropic medications also need to know that some types of drugs impair the body's ability to regulate temperature, he said.
Many cities across the U.S. have emergency preparedness programs to help vulnerable people cope with the heat, pointed out study author Nori-Sarma.
The National Center for Healthy Housing’s website lists cooling centers by state.
"One of the best ways we have to cope with heat waves is to rely on our social networks — friends checking in on friends and loved ones, neighbors keeping an eye on neighbors — to make sure that everyone who may be impacted by extreme heat is cared for," Nori-Sarma added. | Mental Health Treatments |
Liquid bleach does not kill off a hospital superbug that can cause fatal infections, researchers have found.
The researchers say new approaches are needed towards disinfection in care settings.
Clostridium difficile, also known as C diff, is a type of bacteria found in the human gut. While it can coexist alongside other bacteria without problem, a disruption to gut flora can allow C diff to flourish, leading to bowel problems including diarrhoea and colitis.
Severe infections can kill, with 1,910 people known to have died within 30 days of an infection in England during financial year 2021-2022.
Those at greater risk of C diff infections include people aged over 65, those who are in hospital, people with a weakened immune system and people taking antibiotics, with some individuals experiencing repeated infections.
According to government guidance, updated in 2019, chlorine-containing cleaning agents with at least 1,000 ppm available chlorine should be used as a disinfectant to tackle C diff.
But researchers say it is unlikely be sufficient, with their experiments suggesting that even at high concentrations, sodium hypochlorite – a common type of bleach – is no better than water at doing the job.
“With antimicrobial resistance increasing, people need to recognise that overuse of biocides can cause tolerance in certain microbes, and we’re seeing that definitely with chlorine and C diff,” said Dr Tina Joshi, co-author of the research, from the University of Plymouth.
While chlorine-based chemicals used to be effective at killing such bacteria, that no longer appears to be the case, she said.
“The UK doesn’t seem to have any written new gold standard for C diff disinfection. And I think that needs to change immediately,” she said.
Writing in the journal Microbiology, Joshi and colleagues report how they exposed spores from three different strains of Clostridium difficile to three different concentrations of sodium hypochlorite bleach – ranging from 1,000 ppm to 10,000 ppm. The spores were left for 10 minutes before the bleach was neutralised.
The researchers then attempted to culture the spores on agar plates, and compared the results with the controls of spores exposed only to water or the neutralising substance.
The results reveal spores from all three strains of C diff survived all three concentrations of bleach, with no significant reduction in their ability to germinate compared with the controls. Indeed, scrutiny of the spores with scanning electron microscopy showed that they underwent no visible damage when exposed to the cleaning agent.
The researchers also applied spores of C diff to squares of fabric cut from new multiuse surgical scrubs and patient gowns and tested whether they would transfer when an agar plate was touched by the fabric.
The team found the spores largely remained on the gowns and scrubs, with exposure of the spores to different concentrations of bleach making no tangible difference.
“It’s very clear that the spores are sticking to the fibres,” said Joshi, noting that that finding suggests such items are reservoirs of transmission.
Joshi said the new work has important implications. “Even if we’re trying to disinfect across different surfaces, the chlorine is not doing its job,” she said. “It’s not the right biocide.” | Disease Research |
Stephanie Colombini/WUSF
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Substitute teacher Crystal Clyburn, 51, doesn't have health insurance. She got her blood pressure checked at a health fair in Sarasota, Fla.
Stephanie Colombini/WUSF
Substitute teacher Crystal Clyburn, 51, doesn't have health insurance. She got her blood pressure checked at a health fair in Sarasota, Fla.
Stephanie Colombini/WUSF
At a health-screening event in Sarasota, Florida, people milled around a parking lot waiting their turn for blood pressure or diabetes checks. The event was held in Sarasota's Newtown neighborhood, a historically Black community.
Local resident Tracy Green, 54, joined the line outside a pink and white bus offering free mammograms.
"It's a blessing, because some people, like me, are not fortunate and so this is what I needed," she said.
Green said she wanted the exam because cancer runs in her family. And there's another health concern: her breasts are large and cause her severe back pain. A doctor once recommended she get reduction surgery, she said, but she's uninsured and can't afford it.
In a recent Gallup poll, 38% of Americans surveyed said they had put off medical treatment last year due to cost, up from 26% in 2021. The new figure is the highest since Gallup started tracking the issue in 2001.
A survey by The Kaiser Family Foundation last summer showed similar results. It found people were most likely to delay dental care, followed by vision services and doctor's office visits. Many didn't take medications as prescribed.
Stephanie Colombini/WUSF
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The health screening event is part of an ongoing effort provide health services to low-income Floridians who are uninsured. Attendees could have their blood pressure checked or receive screenings for diabetes. A bus also delivered mammogram services.
Stephanie Colombini/WUSF
The health screening event is part of an ongoing effort provide health services to low-income Floridians who are uninsured. Attendees could have their blood pressure checked or receive screenings for diabetes. A bus also delivered mammogram services.
Stephanie Colombini/WUSF
The neighborhood screening event in Newtown — organized by the non-profit Multicultural Health Institute in partnership with a local hospital and other health groups — is part of an effort to fill in the coverage gap for low-income people.
Tracy Green explained that her teeth are in bad shape too, but dental care will also have to wait. She doesn't have health insurance or a stable job. When she can, she finds occasional work as a day laborer through a local temp office.
"I only make like $60 or $70-something a day. You know that ain't making no money," said Green. "And some days you go in and they don't have work."
If she lived in another state, Green might have been able to enroll in Medicaid. But Florida is one of eleven remaining states that haven't expanded the program to cover more working-age adults. With rent and other bills to pay, Green says her health is taking a backseat.
"I don't have money to go to the dentist, nothing, it's so expensive," she said. "Now, to get one extraction, one tooth pulled, it's like $200-300 that you don't have. So I don't know what to do. It's like fighting a losing battle right now."
Stephanie Colombini/WUSF
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Tracy Green, 54, joined the line outside a pink and white bus that offered free mammograms. Green said she wanted the exam because cancer runs in her family.
Stephanie Colombini/WUSF
Tracy Green, 54, joined the line outside a pink and white bus that offered free mammograms. Green said she wanted the exam because cancer runs in her family.
Stephanie Colombini/WUSF
In the Kaiser poll, 85 percent of uninsured adults said they found it difficult to pay for health care. Nearly half of insured respondents said they struggled with affordability as well.
The U.S. experienced record high inflation rates last year, and parts of Florida, including the nearby Tampa metro area, often fared even worse.
"We see an increasing desperation," said Dr. Lisa Merritt, executive director of the Multicultural Health Institute.
The Institute, which helps people access low-cost care, is based in Newtown. The neighborhood, inland from Sarasota's lavish beach communities, has many residents who live below the poverty line, lack insurance and face other barriers to consistent and affordable care.
"It's very difficult for people to be concerned about abstract things like getting screenings, getting regular health maintenance, when they're contending with the challenges of basic survival: food, shelter, transportation often," Merritt said.
'Horrible' housing costs put squeeze on health needs
Merritt and her team of volunteers work to build trust with community residents who may not be aware that support is available. They help people apply for low-cost insurance coverage, free medication programs and other resources that can reduce treatment costs.
Volunteer Bonnie Hardy said the people she serves have many financial worries, but one thing tops the list.
"Right now? A place to stay," said Hardy. "Housing is horrible."
High housing costs have started to ease in recent months, but data shows rent in Sarasota has gone up nearly 50 percent since the pandemic began in 2020.
Hardy helps people find housing and connects them with programs that cover costs like utilities and security deposits. The goal is to help people stabilize their day-to-day lives, and that in itself can improve health, she said.
"Because they're more comfortable now," she said. "They feel like, hey the rent is paid, I can let my guard down, maybe I can go get the medical attention I need."
Daylina Miller/WUSF
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Dr. Lisa Merritt and her team of volunteers work to build trust with community residents who are uninsured but may not be aware that support is available.
Daylina Miller/WUSF
Dr. Lisa Merritt and her team of volunteers work to build trust with community residents who are uninsured but may not be aware that support is available.
Daylina Miller/WUSF
Research shows putting off health care can lead to bigger problems.
The Gallup poll found 27% of respondents delayed treatment due to costs even for "very or somewhat serious" conditions.
Another reason people may be holding off on treating medical issues is that they already have health care debt. An investigation from NPR and Kaiser Health News found about 100 million people in America had medical debt. About 1 in 8 owe more than $10,000, according to a KFF poll.
Treating cancers or chronic conditions like diabetes early can not only save lives, it can also be less expensive than treating advanced-stage illnesses, according to the Centers for Disease Control and Prevention.
Doctors at the health screening event in Newtown said it's critical to help residents access preventive care.
At the health fair, substitute teacher Crystal Clyburn, 51, got a mammogram on the pink-and-white mobile bus and had her blood pressure checked. Clyburn doesn't have health insurance and she relies on events like this to stay on top of her health.
"I just try to take advantage of whatever that's out there, whatever that's free," she said. "You have to take care of yourself because you can look healthy and not even know you're sick."
After the cuff came off, a doctor told Clyburn her blood pressure was a little high. But then the doctor kept talking, and she smiled.
Although her pressure was high, it wasn't high enough that she needed to take medication. She thanked him and left, relieved to know that was one expense she wouldn't have to worry about. Not yet, anyway. | Health Policy |
International team of scientists says identifying some foods as addictive could stimulate research, shift attitudes
Fralin Biomedical Research Institute scientist joins colleagues from three continents in calling for a global rethink of food choices
Researchers from the United States, Brazil, and Spain, including scientists with the Fralin Biomedical Research Institute at VTC, published an analysis in a special edition of the British Medical Journal with a timely and controversial recommendation: It’s time for an international shift in the way we think about ultra-processed food.
“There is converging and consistent support for the validity and clinical relevance of food addiction,” said Ashley Gearhardt, the article’s corresponding author and a psychology professor at the University of Michigan. “By acknowledging that certain types of processed foods have the properties of addictive substances, we may be able to help improve global health.”
While people can give up smoking, drinking, or gambling, they can’t stop eating, said co-author Alexandra DiFeliceantonio, assistant professor at the Fralin Biomedical Research Institute. The challenge, and the still open and controversial question, is defining which foods have the most potential for addiction and why.
Their work was published Oct. 10 in Food For Thought, a special edition of the British Medical Journal, a high-impact publication and one of the world’s oldest medical journals.
DiFeliceantonio is also associate director of the Fralin Biomedical Research Institute's Center for Health Behaviors Research and an assistant professor in the Department of Human Nutrition, Foods, and Exercise in the College of Agriculture and Life Sciences at Virginia Tech.
Not all foods have the potential for addiction, the researchers said.
“Most foods that we think of as natural, or minimally processed, provide energy in the form of carbohydrate or fat — but not both,” DiFeliceantonio said.
Researchers gave the example of an apple, salmon, and a chocolate bar. The apple has a carbohydrate to fat ratio of roughly 1-to-0, while the salmon has a ratio of 0-to-1. In contrast, the chocolate bar has a carbohydrate to fat ratio of 1-to-1, which appears to increase a food’s addictive potential.
“Many ultra-processed foods have higher levels of both. That combination has a different effect on the brain,” DiFeliceantonio said. Researchers also called for more study into the role of food additives used in industrial processing. Key takeaways from the analysis include:
- Behaviors around ultra-processed food, which are high in refined carbohydrates and added fats, may meet the criteria for diagnosis of substance use disorder in some people. Those behaviors include less control over intake, intense cravings, symptoms of withdrawal, and continued use despite such consequences as obesity, binge eating disorder, poorer physical and mental health, and lower quality of life.
- This global health challenge needs to consider geographic differences. In a review of 281 studies from 36 different countries, researchers found ultra-processed food addiction is estimated to occur in 14 percent of adults and 12 percent of children. In some countries, ultra-processed foods are a needed source of calories. Even within high-income countries, food deserts and other factors could limit access to minimally processed foods. People facing food insecurity are more reliant on ultra-processed foods, and therefore more likely to demonstrate food addiction, researchers noted.
- Viewing some foods as addictive could lead to novel approaches in the realm of social justice, clinical care, and public policy. Policies implemented in Chile and Mexico — taxes, labelling, and marketing — are associated with decreases in caloric intake and purchases of foods high in sugar, saturated fat, and salt, for example. And in the United Kingdom, a salt-reduction program was associated with a decline in deaths from stroke and coronary artery disease.
The co-authors represent international expertise on food addiction, nutrition physiology, gut-brain reward signaling, food policy, behavioral addiction, and eating disorders. They call for more study and science surrounding ultra-processed foods,
“Given how prevalent these foods are — they make up 58 percent of calories consumed in the United States — there is so much we don’t know.” DiFeliceantonio said.
The researchers call for more study into such areas as: how complex features of ultra-processed foods combine to increase their addictive potential; better defining which foods can be considered addictive; differences among countries and communities, including disadvantaged communities; the value of public-health messaging; and clinical guidelines for preventing, treating, and managing addiction to ultra-processed foods.
In addition to Gearhardt and DiFeliceantonio, authors include Nassib B. Bueno, a professor at Universidade Federal de Alagoas in Brazil; Christina A. Roberto, associate professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania’s Perelman School of Medicine; and Susana Jiménez-Murcia and Fernando Fernandez-Aranda, both professors in the Department of Clinical Psychology at the University Hospital of Bellvitge in Spain.
DiFeliceantonio is not the only Virginia Tech researcher whose work appears in the special edition. Valisa Hedrick, an associate professor with the Department of Human Nutrition, Foods, and Exercise, is also featured. Hedrick’s work highlights nutritional uncertainty and the need for more research into non-sugar sweeteners. | Nutrition Research |
Science Photo Library
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Sand flies carry the protozoan parasites that spread leishmaniasis. It was thought to be a disease of tropical climates, but leishmaniasis-causing parasites have now been found living and circulating in the United States.
Science Photo Library
Sand flies carry the protozoan parasites that spread leishmaniasis. It was thought to be a disease of tropical climates, but leishmaniasis-causing parasites have now been found living and circulating in the United States.
Science Photo Library
Back in 2014, dermatologist Bridget McIlwee saw a 3-year-old patient in central Texas with unusual bumps on his ear.
"They looked a little bit like almost kind of a benign mole that you would see in a child, except that you wouldn't expect something like that to come up quickly and then multiply," she says.
McIlwee sent off a sample for laboratory testing, and the results came back pointing to a surprising culprit: The boy had tested positive for cutaneous leishmaniasis, a neglected tropical disease. The World Health Organization says between 600,000 and 1 million new infections happen worldwide every year, mostly in tropical regions of the Americas, the Mediterranean basin, the Middle East and Central Asia - not in Texas. These illnesses can be disfiguring, even if they are rarely fatal.
"I was shocked, because in medical school, we're taught that this is a tropical disease, something that you see in immigrants, military returning from deployment, people who went on vacation to South America or Asia or Africa," McIlwee says.
But this boy hadn't traveled anywhere, meaning he must have picked up the cutaneous leishmaniasis parasite at home in the United States. That led McIlwee and her colleagues to investigate whether the parasite could be living and spreading in North America. They published their results in 2018, arguing that cutaneous leishmaniasis is, in fact, endemic to the United States.
Now the Centers for Disease Control and Prevention is reinforcing those findings via new research presented in October at the American Society of Tropical Medicine and Hygiene's conference, suggesting that a specific strain of the Leishmania parasite has likely been living in the U.S. for years.
Sand flies spread Leishmania with a nasty bite
Mary Kamb, a medical epidemiologist at the CDC who worked on the new research, says cutaneous leishmaniasis is known to be endemic in almost 90 countries but "wasn't thought to be a problem among people living here in the United States until recently."
This disease is spread by sand flies, which Kamb says are tiny. "They're about a quarter of the size of a mosquito. They live in wooded areas and grassland areas, and they primarily bite at dawn and dusk."
McIlwee says Leishmania parasites are often harbored by rodents. Sand flies bite those rodents, get infected with the parasite and pass the parasites on to people.
Most of the infections reported are in Texas — the only state where health workers are required to report leishmaniasis to health authorities — but Kamb says, "The sand flies which have the capacity to transmit leishmaniasis exist in several U.S. states, primarily southern states." McIlwee adds, "We have data supporting that the disease vectors and reservoirs have been located as far north as Ohio."
Vitaliano Cama, a microbiologist at the CDC also involved in the new research, says we know the parasite associated with locally transmitted leishmaniasis in the U.S. has been here "at least since 2005," when the CDC started testing clinical samples for the Leishmania parasite's DNA. He says there have been roughly 80 cases of infection reported over the last 15 years, although, "of course, not everything gets reported."
The parasite responsible for most infections within the U.S., called Leishmania mexicana, causes only the cutaneous form of leishmaniasis rather than the more severe visceral leishmaniasis (the latter affects internal organs rather than the skin and is generally fatal if not treated). The CDC research shows that these parasites are genetically distinct from ones picked up abroad, making clear that they have made a home for themselves in the United States.
Most people never show symptoms
Many people who get cutaneous leishmaniasis may never develop symptoms, but for those who do, the infection "may start out as just a little pimple," according to Peter Melby, an infectious diseases physician and director of the Center for Tropical Diseases at the University of Texas Medical Branch. "But over time, weeks and months, it can grow into a chronic ulcer-type lesion. It's not life threatening, but it can be disfiguring, especially if it's on the face."
Still, Melby says most people never even know they were infected. That's one of the reasons the number of infections reported is so low. But for those who do show progressively worsening symptoms, treatment can be grueling.
"There are several [treatments], but they tend to be pretty severe and people may have side effects," Kamb says. "And if they need to take treatment by mouth, they tend to have a long treatment period of about 28 days."
Kamb says that there aren't specific medical interventions that people can take to protect themselves from leishmaniasis. "There's no effective vaccine against leishmaniasis, and there aren't any drugs that people can take to prevent it," she says. The only things that help, Kamb says, are wearing clothing that covers arms and legs and using insecticide when in an area with sand flies.
Climate change brings "tropical disease" stateside
The CDC has not yet published the new results, but the team released its preliminary findings to get the word out sooner, particularly to clinicians.
But raising awareness about leishmaniasis means challenging some long-held beliefs about this disease. "Every medical textbook, whether it's Dermatology or Principles and Practice of Infectious Disease, teaches that this is a tropical disease," McIlwee says. "So there's a huge disconnect between the clinical reality and what's being taught in medical schools."
One thing that McIlwee believes needs to change is how leishmaniasis infections are tracked. Providers in states besides Texas aren't required to report cases to health agencies.
Medical providers will need to get familiar with leishmaniasis, say experts, as climate change puts more parts of the world at risk for the disease.
"Research projections suggest that the sand fly vector, which is prevalent throughout the southern U.S., over the next number of decades is likely to be able to move further north with climate change," Melby says.
Climate models estimate that there are some 12 million people in the U.S. who could be locally exposed to leishmaniasis — a number projected to more than double over the next 60 years. These Americans join the approximately 1 billion people worldwide who live in areas with endemic leishmaniasis, causing a million infections a year.
Max Barnhart is a Ph.D. candidate and science journalist studying the evolution of heat-stress resistance in sunflowers at the University of Georgia. | Disease Research |
KFF/Screengrab of Dec. 13, 2022, Mendocino County Board of Supervisors meeting
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At a December 2022 meeting, the Mendocino County Board of Supervisors decided to use $63,000 of opioid settlement funds to help cover a budget shortfall. Since settlement payments will arrive annually till 2038, they plan to use it as an ongoing revenue source.
KFF/Screengrab of Dec. 13, 2022, Mendocino County Board of Supervisors meeting
At a December 2022 meeting, the Mendocino County Board of Supervisors decided to use $63,000 of opioid settlement funds to help cover a budget shortfall. Since settlement payments will arrive annually till 2038, they plan to use it as an ongoing revenue source.
KFF/Screengrab of Dec. 13, 2022, Mendocino County Board of Supervisors meeting
Over the past two years, as state attorneys general agreed to more than $50 billion in legal settlements with companies that made or sold opioids, they vowed the money would be spent on addiction treatment and prevention. They were determined to avoid the misdirection of the tobacco settlement of the 1990s, in which billions of dollars from cigarette companies went to plug budget gaps instead of funding programs to stop or prevent smoking.
But in at least one California county, history is repeating itself. And across the country, there are concerns about the lack of transparency regarding how this money will be used. Many local leaders are finding themselves in difficult positions: choosing between paying bills due today or investing in the fight against an ongoing crisis.
Mendocino County in rural Northern California has reported the highest rate of overdose deaths in the state. Yet, its board of supervisors decided to use more than $63,000 of opioid settlement funds — about 6.5% of all the settlement cash the county has received in the first two years of distribution— to help fill a general budget shortfall of about $6 million.
Specifically, the money has been allotted to cover employee health insurance premiums, wage increases, and cost-of-living adjustments. County officials plan to use that amount as a recurring source of payment, since opioid settlements are scheduled to arrive annually till 2038.
The board also used retirement reserves and delayed repair projects and equipment purchases to plug the gap.
"We have to balance our budget by law," said Glenn McGourty, chair of the board of supervisors. "You find money where you can."
Vice Chair Mo Mulheren added that health insurance deficits were caused, in part, by the overprescribing of opioids and the costs of addiction treatment for county employees or their family members. Now the settlement dollars can make the county "whole again," she said.
Mendocino County Board of Supervisors meeting screengrab via KFF
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At a December 2022 meeting, Mo Mulheren, vice chair of the Mendocino County Board of Supervisors, raised concerns about using opioid settlement funds to cover a budget shortfall. But she later told KFF Health News that the use was appropriate because it made the county "whole again" after years of paying for opioid-related health insurance claims.
Mendocino County Board of Supervisors meeting screengrab via KFF
At a December 2022 meeting, Mo Mulheren, vice chair of the Mendocino County Board of Supervisors, raised concerns about using opioid settlement funds to cover a budget shortfall. But she later told KFF Health News that the use was appropriate because it made the county "whole again" after years of paying for opioid-related health insurance claims.
Mendocino County Board of Supervisors meeting screengrab via KFF
But many people with substance use disorders and their loved ones want the money to be used to make their communities whole again in a different way — by supporting people in recovery and preventing opioid-related deaths. More than 100,000 Americans died of drug overdoses last year.
The settlement funds are the result of thousands of lawsuits filed against a host of health care companies, including Johnson & Johnson, McKesson, CVS Health, and Walmart, for aggressively promoting and distributing painkillers. The money should remediate the effects of that corporate behavior, say attorneys general, treatment providers, and those directly affected by the crisis.
In Mendocino County, McGourty said, "we certainly expend a lot of money on substance abuse." But tourism and tax revenues, which were boosted at the height of the pandemic as Bay Area residents escaped to the rural county, have recently decreased. Meanwhile, costs for the sheriff's office, jail, and behavioral health programs often run over budget, partly due to the opioid epidemic, he said.
The story is all too familiar to Matthew Myers, former president of the Campaign for Tobacco-Free Kids, which monitors how states spend money from the tobacco master settlement agreement of 1998.
Back then, states won more than $240 billion to be distributed over the first 25 years and continued annual payments for as long as the companies are selling cigarettes. In theory, the money was to be used to help people stop smoking, but there were no legal restrictions on how it was spent. In a 2007 report, the Government Accountability Office reported states had allocated $16.8 billion, or 30% of the money they'd received, to health care and $12.8 billion, or 23%, to budget shortfalls.
"Almost from the beginning, a significant number of states used the tobacco settlement money for anything but tobacco," Myers said. "What's most concerning, though, is that over time the track record of the states has gotten worse."
People who made the original agreements left office, budget needs arose — especially during recessions — and oversight from the public and nonprofit organizations waned. Tobacco settlement money flowed to transportation departments to fill potholes, support corporate tax breaks, and even subsidize tobacco farmers. Today, less than 3% of the annual payouts is used for smoking cessation or prevention.
It's a sobering statistic that many attorneys general kept in mind when negotiating the opioid settlements. To avoid the same scenarios, they set restrictions: At least 85% of the money has to be spent on opioid remediation, with a menu of suggested strategies. The balance can be used freely, but to some advocates that's a slippery slope.
Some states are stricter than others. In California, for example, 70% of the settlement funds funnel into an abatement account from which the state doles it out to counties and cities. All money from that account must be spent on future opioid remediation efforts, with at least half for creating treatment infrastructure, diverting people from the criminal justice system, preventing youth addiction, or other activities the state identified as high-impact. The state Department of Health Care Services has issued written guidance, held webinars, and offered customized assistance to local governments to ensure the money is used appropriately.
"We really want to make sure that all of this funding is for opioid remediation," said Marlies Perez, who oversees opioid settlement funding at the department.
If her team finds examples of misspending, they can take local governments to court.
But there's a caveat: The department has authority only over money that comes from the abatement fund and an additional 15% the state receives directly. The final 15% of the state's settlement money goes straight to local governments and can be used for anything the localities define as opioid-related.
That's why Mendocino County was able to use $63,000 to plug its budget hole and plan to spend a chunk of future funds similarly. (It has received roughly $780,000 more through the state abatement fund, which must be spent on opioid remediation.)
Even if that use of funds is legal, some people question whether it is appropriate.
JT Williams
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Jacqueline Williams is executive director of the Ford Street Project, a nonprofit that runs Mendocino County's only adult residential addiction treatment program. "It's disheartening that the need is so great," she says, yet some of the county's opioid settlement money is being spent on a budget shortfall instead of going directly to the crisis.
JT Williams
Jacqueline Williams is executive director of the Ford Street Project, a nonprofit that runs Mendocino County's only adult residential addiction treatment program. "It's disheartening that the need is so great," she says, yet some of the county's opioid settlement money is being spent on a budget shortfall instead of going directly to the crisis.
JT Williams
Jacqueline Williams is executive director of the Ford Street Project, a nonprofit that runs a food bank, homeless shelter, and Mendocino County's only adult residential addiction treatment program. "It's disheartening that the need is so great," she said, yet some of the settlement money is not going directly to the crisis.
She has asked the county for $4 million to build a 24-bed sober living facility, where clients — many of whom are homeless — can stay after completing residential treatment. "The hardest thing is when somebody asks for help if you don't have a bed," said Williams, who hasn't received a final response to her request.
Jenine Miller, Mendocino County's behavioral health director, said the county is using revenue from a local sales tax increase to build a psychiatric hospital, crisis respite facilities, and mobile response teams, but there is still a need for more residential treatment for addiction specifically.
"I can never say I have enough funds to do everything we need to do," she said.
Miller signed off on a report the county is required to file with administrators of the settlement, saying it spent $63,000 on purposes that do not qualify as opioid remediation. She told KFF Health News that she understands the county's need to recuperate costs to its health insurance plan, "but the largest amount of the money needs to be in our community doing prevention, early intervention, and treatment."
Mulheren, the vice chair of the board of supervisors, said if the county has savings in future years, it may be able to put some of the recurring $63,000 toward addiction initiatives. The county recently switched from being self-insured to a group health insurance plan for its roughly 900 employees.
"We're trying to constantly figure out how we can save money, especially when it comes to the health insurance premiums." Mulheren said.
But Myers, of the Campaign for Tobacco-Free Kids, said his experience with the tobacco settlement suggests the first few years of spending set the tone for the future.
"If states don't start spending money for the designated purpose effectively and build it into the DNA of the budget process, the risks down the road only grow," he said.
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. | Health Policy |
Novel algorithm successfully improves microscopy resolution through pixel reassignment
Obtaining high-resolution images in the world of microscopy has long been a challenge. Deconvolution, a method to enhance image clarity, often amplifies noise between the sample and the image. Researchers at Boston University have recently developed a novel deblurring algorithm that avoids these issues, improving the resolution of images with photon intensity conservation and local linearity.
As reported in Advanced Photonics, the innovative deblurring algorithm is adaptable to various fluorescence microscopes, requiring minimal assumptions about the emission point spread function (PSF). It works on both a sequence of raw images and even a single image, enabling temporal analysis of fluctuating fluorophore statistics. Furthermore, the researchers have made this algorithm available as a MATLAB function, making it widely accessible.
The fundamental concept behind this breakthrough is pixel reassignment. By reassigning pixel intensities based on local gradients, images are sharpened without the risk of introducing noise artifacts. The technique standardizes raw images before applying this process, ensuring consistent results.
The resolution of a microscope is traditionally defined by its ability to distinguish two closely spaced point sources. The new method, called "deblurring by pixel reassignment" (DPR), significantly reduces the required separation distance, allowing for enhanced resolution in microscopy.
To demonstrate the effectiveness of DPR, the researchers applied it to a variety of imaging conditions: single-molecule localization, structural imaging of engineered cardiac tissue, and volumetric zebrafish imaging. These real-world applications showcased DPR's potential in improving the clarity of microscopic images.
DPR's unique ability to sharpen images, while preserving larger structures, opens doors to broader applications. It can be used in scenarios where samples contain both small and large structures, making it a versatile tool for researchers. While no deblurring strategy is entirely immune to noise, DPR's advantage lies in the fact that it does not amplify noise. This sets it apart from other deconvolution methods, simplifying its implementation and making it suitable for a wide range of samples with extended features.
A new approach to enhancing the spatial resolution of microscopy images, the DPR technique provides a versatile and user-friendly solution that significantly improves image clarity while avoiding common noise-related issues, making it an invaluable tool for a wide range of scientific applications.
Professor Jerome Mertz, director of the Biomicroscopy Laboratory at Boston University and senior author of the study, says, "Because of its ease of use, speed, and versatility, we believe DPR can be of general utility to the bio-imaging community."
More information: Bingying Zhao et al, Resolution enhancement with deblurring by pixel reassignment, Advanced Photonics (2023). DOI: 10.1117/1.AP.5.6.066004
Journal information: Advanced Photonics
Provided by SPIE | Medical Innovations |
Nine online talking-therapy treatments for anxiety or depression have been given the green light to be used by the NHS in England.
They offered faster access to help but less time with a therapist, which may not suit everyone, the health body recommending them said.
There is huge demand for face-to-face services, with people waiting several weeks to see a therapist.
Psychiatrists said digital therapies were not a long-term solution.
Mental-health charity Sane said they were no substitute for a one-to-one relationship and could leave people feeling even more isolated than before.
Reduce waiting times
One out of every six people in England says they experience a common mental-health problem such as anxiety and depression in any given week.
In 2021-22, more than half a million people were referred to depression and anxiety services - called NHS Talking Therapies - for problems such as body-dysmorphic disorder, panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder and a variety of phobias.
The new digital therapies, delivered via a website or an app using cognitive-behavioural therapy (CBT), provide an alternative way of accessing support, which may be more convenient for some, the National Institute for Health and Care Excellence (NICE) says.
They could also free up resources and help reduce the wait for care.
Its guidance recommends six therapies designed to treat adults with anxiety disorders and three to treat those with depression, including Beating the Blues, Deprexis and Space from Anxiety.
Before treatment starts, there is a formal assessment with a trained clinician or practitioner but after that, clinicians are involved much less:
- During online depression therapy, 90 minutes is spent with a therapist instead of eight hours during standard care
- Online anxiety therapy gives four hours with a clinician, as opposed to 10 hours under normal care
Dr David Rigby, who jointly chairs the Royal College of Psychiatrists' digital group, said digital therapies could make it easier for some vulnerable patients to access vital mental-health support but were not a long-term solution.
"Mental health services are struggling with chronic staff shortages which are making it difficult for them to provide patients with quick and effective treatment," he said.
"The government must tackle the workforce crisis by honouring its commitment to publish a comprehensive NHS workforce plan this year."
'Inner mental pain'
Sane founder and chief executive Marjorie Wallace CBE digital therapy "may be very useful for some" but was "no substitute for a one-to-one relationship with someone who knows their story".
"Our experience with those who contact us is that self-diagnosis and techniques of self-management do not always reach the layers of their inner mental pain and can leave them feeling even more unsafe and alone," she said.
NICE interim director of medical technology and digital evaluation Mark Chapman said: "One of our priorities is to get the best care to people fast while at the same time ensuring value for money for the taxpayer - these digitally enabled therapies do both." But the choice of online therapy "must be the right one for the individual".
While some of the digital therapies are already in use, others require further approvals being they can be rolled out.
NICE will look at the evidence from their use over the next few years to work out how cost-effective they are. | Mental Health Treatments |
A former health secretary has warned reform of England and Wales' youth gender service is "under threat" over concerns that staff involved in past failings will still have key roles.
BBC Newsnight has learned a clinician from the existing gender clinic, due to be closed this year, has been given a training job in the new service.
Sajid Javid said appointment processes should be "urgently reviewed".
NHS England said the new services would offer a new clinical approach.
The Gender Identity and Development Service (Gids) is the only designated NHS gender clinic for children and young people in England and Wales. It provides an assessment service and can refer them for medical treatments such as puberty blockers - or hormones when they are old enough.
Based at London's Tavistock Centre, it was earmarked for closure last July after an interim report raised concerns about the clinic's reliance on "predominantly an affirmative, non-exploratory approach" to young people who identify as trans.
The report by Dr Hilary Cass, part of her independent review of children's gender identity services, detailed the concerns of some medics who believe this approach allowed other issues such as autism and mental health problems to be overlooked in some cases.
NHS England announced plans to replace Gids, which had been rated "inadequate" by the healthcare regulator, with two new regional hubs - one in London, the other in north-west England.
Following criticism of the old service, the BBC has now learned of concerns about two members of staff appointed to train new staff at the regional hubs.
One is a senior clinician at Gids who says they are "devoted" to an affirmative approach to young people presenting with gender difficulties, and that "social justice" underpins all their work.
Another person appointed, who is not employed by Gids or the trust that runs it, has openly questioned Dr Hilary Cass and NHS England's more cautious stance on social transition - the changing of a young person's name, pronouns, and way they dress. Dr Cass and NHS England argued that it is not a neutral act, and that it can have a psychological impact on children.
Meanwhile, some applicants invited for interview for roles at the new services were initially informed that Polly Carmichael, who has been in charge of Gids since 2009, would be on the interviewing panel - a decision the BBC understands was later reversed.
Dr Carmichael communicated to Gids staff not to seek external safeguarding advice, an employment tribunal concluded in 2021. During her tenure, the leadership of Gids was also rated as inadequate by healthcare regulator the Care Quality Commission.
Mr Javid, who was health secretary when the decision to close Gids was made following last year's report by Dr Cass, told Newsnight that staff who had been involved in failings at the clinic should not be involved in training people appointed to its replacement.
In a statement he said: "Individuals who oversaw significant failings at the Tavistock should clearly not be managing the set-up of the new system."
He said the approach at Gids was "overly affirmative" and "bordered on the ideological".
Gids has maintained that being respectful of young people's gender identities did not prevent the service from exploring other issues that may affect them.
Current Health Secretary Steve Barclay told the BBC the government would ensure the new service was run in line with the recommendations of the independent Cass review, which "differ significantly" from the services provided by Gids.
He said: "Any suggestion that the recruitment or training of new service providers are not following these recommendations is very concerning and I will work closely with partners to resolve this."
Great Ormond Street Hospital for Children NHS Foundation Trust, one of the trusts due to run the new service in London, was in charge of the recent recruitment process.
A spokesperson for the trust said it wanted to recruit a wide range of staff to collectively develop training materials in line with the Cass review recommendations.
"While we appreciate they may hold differing views, there will be strong governance processes in place" to ensure the training aligns with the review's recommendations and the latest evidence, the spokesperson said.
Dr Cass and international experts have been invited to join an oversight group to sign off on the curriculum, Great Ormond Street said.
The BBC understands that the trust will be interviewing further external candidates for the education role and that pre-employment checks are under way for candidates who have been offered roles so far.
A sharp rise in the number of young people presenting with gender issues has led to lengthy waiting times for treatment - a time of great uncertainty and stress for the young people and their families.
One couple, David and Diana, whose names have been changed to protect the privacy of their child, told the BBC their child had already been on the Gids waiting list for 18 months.
Speaking about the new services, David said he felt Gids "shouldn't be anywhere near it".
His partner, Diana, said: "There needs to be proper evidence-based care and real accountability and recordkeeping and aftercare - all of that stuff that's been so sorely lacking."
Children questioning their gender and their families have widely varying views about how care should be provided, with some wanting a cautious approach while others believe there should be faster access to medical interventions.
Gendered Intelligence, a trans-led charity, said it was not for them to question NHS England's approach to staffing, but it wanted more support and better communication for those already receiving treatment or on the waiting list.
"What we want to do is advocate for these young people being looked after better," spokesperson Cleo Madeleine said.
NHS England said: "All aspects of the new children and young people's gender service - from the development of both the interim and final service specification, including staff training, to individual patient care - will be guided by the ongoing findings and expert advice from the Cass Review." | Health Policy |
Boy, four, is given an 'accidental vasectomy' during hernia surgery after doctor 'cut the wrong piece of anatomy': Family suing Houston hospital for medical negligenceThe boy, four, was having surgery at Texas Children's Hospital to treat hernia when surgeon accidentally cut tube which carries reproductive semen in itHis family are now suing the hospital and the surgeon for medical negligenceIt is feared the boy will need more surgery to be able to have children in future Published: 10:42 EDT, 14 June 2022 | Updated: 10:46 EDT, 14 June 2022 The family of a four-year-old boy who was accidentally given an 'unintended vasectomy' during surgery in Texas are suing the hospital and a doctor for medical negligence.The boy was having surgery to treat a hernia in the groin area in August 2021 when the surgeon at the Texas Children's Hospital in Houston accidentally cut the tube which carries reproductive semen in it.It is feared that the four-year-old will need more surgery to be able to have children - and even with medical advancements, the boy could always have fertility issues.Randy Sorrels, an attorney in Houston who is representing the boy's family, said the error during surgery could affect the boy 'for the rest of his life'. The boy was having surgery to treat a hernia in the groin area in August 2021 when the surgeon at the Texas Children's Hospital (file image) in Houston accidentally cut the tube which carries reproductive semen in itHe told Fox 4 News: 'You expect things to happen in life, but not necessarily at the hands of a surgeon, who simply cut the wrong piece of anatomy.'The surgeon, we think, cut accidentally the vas deferens, one of the tubes that carries reproductive semen in it. It could affect this young man for the rest of his life.'The vas deferens, or sperm duct, carries sperm from the testicles to the urethra - but once cut, it is unable to carry out this process.Records reveal the surgeon who carried out the procedure does not have a history of malpractice and no issues have been reported before. It is feared that the four-year-old will need more surgery to be able to have children - and even with medical advancements, the boy could always have fertility issues (stock image)Sorrels added: 'It's not a common mistake at all. Before a doctor transects or cuts any part of the anatomy, they are supposed to positively identify what that anatomy is and then cut. 'Here, the doctor failed to accurately identify the anatomy that needed to be cut. Unfortunately, cut his vas deferens. That wasn't found out until it was sent in for pathology.'Sorrels said the family hopes that advancements in medical technology will allow the four-year-old to have children when he is older - but that would require further surgery. 'The family's biggest concern is how this might affect their child physically, on the ability to have children in the future, and emotionally,' said Sorrells.'[Along with] having to explain this to a potential partner who you are going to have children with.' A spokesperson from Texas Children's Hospital said in a statement: 'Texas Children's Hospital's top priority is the health and well-being of our patient. Due to patient privacy requirements, we are unable to comment.' Advertisement | Medical Innovations |
The Wuhan lab leak hypothesis will be front and center during a new House hearing on the coronavirus, with its witnesses featuring prominent voices who have argued COVID-19 likely originated in a Chinese lab.
The Republican-led Select Subcommittee on the Coronavirus Pandemic will be hosting a hearing on “Investigating the Origins of COVID-19” on Wednesday, and it is likely to touch on not just the Wuhan Institute of Virology but also gain-of-function research funded by the National Institutes of Health, the attempted silencing of the lab leak hypothesis by officials like Dr. Anthony Fauci, and Chinese obfuscation and obstruction.
“This investigation must begin with where and how this virus came about so that we can attempt to ‘predict, prepare, protect, or prevent’ it from happening again,” Rep. Brad Wenstrup (R-OH), chairman of the subcommittee, said in a statement to the Washington Examiner. “Government scientists and government funded researchers have so far been less-than-forthcoming in their knowledge and actions, including work with the Wuhan Institute of Virology and potential pandemic pathogens."
The witnesses for the Wednesday hearing include Dr. Robert Redfield, the former director of Centers for Disease Control and Prevention, who has said COVID-19 “clearly” began in a Wuhan lab, as well as Nicholas Wade, the former science and health editor at the New York Times, who has written about the “substantial” evidence of a lab leak.
Also testifying is Jamie Metzl, a former Clinton White House National Security Council member who has long argued a Wuhan lab leak is at minimum plausible and must be investigated.
The hearing comes after FBI Director Christopher Wray confirmed last week that the FBI has long believed COVID-19 originated at a Chinese government lab and after it was recently revealed the Department of Energy now believes with “low confidence” that the coronavirus started at a Wuhan lab.
The assessments in favor of a lab leak are the first movement since the Office of the Director of National Intelligence released an assessment in 2021 stating that one U.S. intelligence agency, the FBI, assessed with "moderate confidence" that COVID-19 most likely emerged from a lab in Wuhan, while four U.S. spy agencies and the National Intelligence Council believed with just "low confidence" that COVID-19 most likely had a natural origin.
The witnesses are sure to speak to those assessments on Wednesday.
Redfield told Fox News last month that the FBI and Energy Department both have “an enormous, powerful, scientific workforce” and “a lot of science depth” at their agencies. The former Trump CDC director added, “I think that clearly the origin of this virus was a leak from the Wuhan lab, and eventually people will come to realize that. … COVID came into man and immediately was enormously transmissible, which in my view meant that it was educated in a laboratory on how to infect human tissue.”
The former CDC director’s comments last month built upon his March 2021 public assessment, which also hinted that COVID-19 was a product of gain-of-function research at the Wuhan lab.
Wade, also a former editor at Science and Nature, penned a lengthy essay for the Bulletin of Atomic Scientists in May 2021, which helped keep the Wuhan lab leak possibility in the spotlight after Fauci and many in the media had attempted to dismiss the hypothesis.
“The available evidence leans more strongly in one direction than the other,” Wade wrote at the time of the lab leak hypothesis. “It seems to me that proponents of lab escape can explain all the available facts about SARS-CoV-2 considerably more easily than can those who favor natural emergence.”
Wade added, “If the case that SARS-CoV-2 originated in a lab is so substantial, why isn’t this more widely known? ... There are many people who have reason not to talk about it. The list is led, of course, by the Chinese authorities. But virologists in the United States and Europe have no great interest in igniting a public debate about the gain-of-function experiments that their community has been pursuing for years.”
Scientists consulting with the U.S. government early in the pandemic in 2020 believed COVID-19 originating from a lab in Wuhan was possible or even likely, but emails indicate Fauci and then-NIH Director Dr. Francis Collins worked to shut the hypothesis down.
Wade wrote for City Journal in January 2022 that “the medical-research establishment in Washington” attempted to dismiss as “conspiracy theorists” anyone who had considered a Wuhan lab leak escape but that the unearthed emails were “making it seem increasingly likely that there was, in fact, a conspiracy, its aim being to suppress the notion that the virus had emerged from research funded by the National Institute of Allergy and Infectious Diseases, headed by Fauci.”
Newly released emails also show Fauci and others "prompted" an influential scientific paper that pushed back on the Wuhan lab leak hypothesis in the early days of the COVID-19 pandemic.
Metzl called it “inexcusable” that there still hasn’t been a full investigation into COVID-19’s origins in a Wall Street Journal piece last month. Metzl wrote the piece with Trump deputy national security adviser Matt Pottinger, who has been saying publicly as early as early 2021 that the evidence for a lab leak “far outweighs” that of natural origin.
“While Chinese obfuscation and misdirection is chiefly to blame for the lack of understanding of how the novel coronavirus swept the globe, the U.S. could do far more to get to the bottom of what happened,” Metzl and Pottinger wrote, emphasizing that “in the early days of the pandemic, a small group of Western virologists came together to consider the pandemic’s origin. Emails that eventually came to light revealed their plan to push the public conversation away from the lab-accident hypothesis.”
Meanwhile, the Chinese government has continued to deflect from the Wuhan lab leak possibility by pushing the baseless conspiracy theory that COVID-19 originated from a U.S. military base, including as recently as this week. | Epidemics & Outbreaks |
Up to 167,000 people may have contracted coronavirus in hospitals in England during the second wave of the pandemic, a study of healthcare-related infections has suggested.
Scientists who assessed COVID infections between June 2020 and March 2021 said their findings show how many cases started in hospitals and why, noting factors such as limited numbers of single rooms.
They concluded that hospitals needed to be better equipped to limit the transmission of future viruses.
Hospital transmission puts vulnerable people at risk, affects healthcare workers and potentially drives transmission in the community.
But despite the obvious risks, there hasn't been much work done to assess the extent of the problem.
A team from Oxford University, led by Professor of Epidemiology, Ben Cooper, have tried to put that right by studying data from 145 English NHS acute hospital trusts, representing a combined 356 hospitals with around 100,000 beds.
They looked at the number of COVID infections, how many staff working days were missed because of the virus and how the likely source of infection was classified at the time.
They found nearly 17,000 (16,950) infections in hospital patients were classed as having definite links to healthcare, and more than 19,000 (19,355) were thought to probably have a healthcare connection.
However, the researchers calculated that only around one in four (26%) of such infections might actually have been recorded, as many patients may have been discharged before testing positive, for example.
Once they factored that into their projections, they estimated that hospital-acquired infections in the period were between 95,000 and 167,000.
In other words, 1 to 2% of all hospital admissions likely resulted in such an infection over the study period.
Professor Cooper's team found geographical variations in the incidence of infections, with the highest rates in northwest regions of England, and the lowest in the South West and London areas.
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They suggested the low availability of single rooms and reduced heating of hospital buildings could play a part.
The vaccination of healthcare workers was another driver of lower infection rates.
Their findings could show hospitals how to reduce transmissions, which in turn could protect vulnerable patients and healthcare workers, as well as reduce community transmission in the future, the authors said.
The COVID-19 public inquiry was told on Tuesday that fewer people might have died if lockdown had started sooner. | Epidemics & Outbreaks |
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