Being a president can knock two years off your life

first_imgPoliticsBeing a president can knock two years off your life “We’re reasonably confident that there is a difference between elected leaders and unelected leaders in terms of mortality,” said Anupam B. Jena, an associate professor at Harvard Medical School, who coauthored the report with Andrew Olenski, a research assistant at the school, and Matthew Abola, a medical student at Case Western Reserve University.So even if Donald Trump’s doctor says he would be “the healthiest individual ever elected to the presidency,” the diagnosis might not sound so rosy after a few years in the White House.advertisement Their findings arrive in the midst of a presidential campaign in which age and health could play an outsized role. Several leading contenders like Hillary Clinton, Donald Trump, and Bernie Sanders are nearing or into their 70s. Some of their rivals, most notably Marco Rubio, are — intentionally or not — using their youth to campaign on a message of bringing “a new generation” to the White House.Voters generally say that a candidate’s health is very important to their ability to do the job. Presenting a clean bill of health “is kind of considered a necessary prerequisite for running for president,” said Carter Eskew, who was a top aide to Al Gore’s 2000 presidential campaign.But as this new research reinforces, while they might be healthy when they check into the White House, they won’t be healthy when they check out. A word of warning to all the little girls and boys who say they want to grow up to be president of the United States: Don’t do it if you want to live as long as you can.And if you’re running for president now, and you’re on the older side, just know that you might be hastening your end.That’s the conclusion of a new study that found leading a nation knocks more than two years off a head-of-state’s life.advertisement Related: Doctor: Trump would be ‘healthiest individual ever’ elected president Related:center_img A voters guide to the health of the presidential candidates Tags Bernie SandersDonald TrumpHillary ClintonpolicyPresidential campaign The idea that political leadership leads to less longevity has been around for a long time. Before-and-after stills of President Obama and George W. Bush, graying and wrinkled after years on the job, have been popular memes in the Internet age. Obama jokes about his gray hair. Bush underwent heart surgery in 2013, and National Journal reported that one the former president’s arteries was 95 percent blocked.But for this analysis, published Monday in The BMJ, a leading medical journal, the authors did something different to quantify a theory that has been widely believed but difficult to prove.Rather than compare a president or prime minister to their country’s general population — whom they are statistically likely to outlive because of their higher socioeconomic status — the researchers pit them against the person they defeated in their elections to their nation’s highest office. The researchers also broadened their scope by looking at presidents and prime ministers in 17 relatively stable Western democracies, rather than limiting the study to the United States.The thinking was that the approach would help increase their confidence that the difference in the political leaders’ lifespans really was because they were running a country, not for other reasons.And indeed, after adjusting as well as they could for things like life expectancy — and screening out the occasional dictator, since the study was supposed to be about elected leaders — the researchers found that heads of state lived 2.7 fewer years than the opponents they beat.The authors openly acknowledged that they couldn’t identify exactly why presidents don’t live as long as their unelected rivals. But there is one obvious culprit: Stress. Its ravages on the human body are one of medical science’s most well-documented facts.Another related but distinct possibility, Jena said, is that the hectic schedule that presidents must keep prevents them from eating as healthy or exercising as much as they otherwise could.“All of those you can think of as mortality costs that come with the job,” he said. President Obama jokes about his graying hair, but the aging of presidents has been a real issue. AP(2) By Dylan Scott Dec. 14, 2015 Reprintslast_img read more

FDA approves injectable drug for anthrax

first_imgHealthFDA approves injectable drug for anthrax About the Author Reprints A sample of billions of anthrax bacteria. Victor R. Caivano/AP Associated Press By Associated Press March 21, 2016 Reprints WASHINGTON — The Food and Drug Administration on Friday approved a new injectable drug to treat patients who have been exposed to the deadly toxin anthrax.The FDA approved the drug called Anthim to treat inhalation anthrax, which can cause serious injury and death, and occurs when anthrax bacterial spores are inhaled. Because anthrax is a potential bioterrorism weapon the US government has been funding the development and production of therapies.Anthim was developed by Elusys Therapeutics of Pine Brook, N.J., with support from the Biomedical Advanced Research and Development Authority. Tags anthraxFDAlast_img read more

Mental boost of brain-training games may be just placebo effect

first_img Tags brainmental healthvideo games APStock By Rebecca Robbins June 20, 2016 Reprints Lumosity to settle deceptive ‘brain training’ health claims Related: Industry under fireThe findings may be seen as another blow to a brain-training industry already under fire. The company behind the most high-profile brand of brain-training games, Lumosity, agreed in January to a $2 million settlement with the Federal Trade Commission for making deceptive claims about the health effects of its games. The money is being doled out as refunds to Lumosity’s customers.“It’s really necessary for researchers to in some way account for this [placebo effect] moving forward because this could contaminate your effects,” said Cyrus Foroughi, a cognitive scientist and the study’s lead author.There are also questions about how long any real cognition benefits might last. And it’s also unclear how much it actually matters: Cognitive improvement on the games is often measured by how well people perform abstract tasks in a university lab, which may not carry over to maintaining complicated skills such as driving a car or remembering a grocery list. The new study, published Monday in the Proceedings of the National Academy of Sciences, flipped the script of most brain-training research. The 50 study participants played the same memory-boosting game, but were recruited in two different ways: either from a flyer blaring the buzzwords “brain training and cognitive enhancement” or one that simply invited them to “participate in a study” without any mention of brain training.Recruitment flyers for the two groups of study volunteers. PNASThe former group of 25 people saw a 5-to-10-point IQ boost after playing the game; the latter showed no cognitive improvement. And that arrangement was not just hypothetical: After conducting their study, the George Mason researchers emailed academics who have published research on cognitive training and found that 17 of the 19 studies surveyed had recruited participants in a way that may have biased their outcome.advertisementcenter_img In the LabMental boost of brain-training games may be just placebo effect Related: The marketers of “brain-training” games have long drummed up sales by pointing to data that show that their products make you smarter or ward off cognitive decline.But a cleverly designed new study from researchers at George Mason University offers the best evidence yet that there’s a serious flaw in much of that research. The problem: People may get a mental boost because they expect to do better, not because the games actually work.“This study seems to strongly support our concerns that brain-training effects might be nothing more than placebo effects,” said Walter Boot, a cognitive psychologist at Florida State University who was not involved in the research.advertisement But it’s the placebo effect in particular that scientists have long suspected of clouding much of what they are seeing in the brain-training field.Adam Gazzaley, a cognitive neuroscientist at the University of California, San Francisco, said the findings about the role of the placebo effect “confirm what a lot of us have always assumed.”But Gazzaley, an adviser to a startup that’s trying to get approval from the Food and Drug Administration for a “prescription” video game based on his prototype, is known for an unusually rigorous approach to game development. And he sees a bright side in the growing evidence that people’s expectations can influence their cognitive performance, so long as researchers measure and account for it in their study design.“We view the fact that people think that they can use a training program to improve themselves as a positive,” he said, “because it increases motivation and depth of engagement in the training.” Inside the push to get doctors to prescribe video games last_img read more

Synthetic human genome project releases its draft timeline

first_img Forget the sci-fi horror stories. Here’s what we could learn from a synthetic genome The project was also rebranded from the “Human Genome Project-Write,” which implied an emphasis on creating human genomes from scratch, to the “Genome Project-Write,” which clarifies that participants will look at synthesizing all sorts of large genomes, not just human ones. This was the intention of the project from the beginning, said attorney and white paper coauthor Nancy Kelley, but it got lost in the media conversation. Mario Tama/Getty By Ike Swetlitz Oct. 28, 2016 Reprints Please enter a valid email address. Privacy Policy The research group behind an effort to synthesize a human genome this week released more information about its plans, including a draft white paper with a timeline of how the research might go.It’s the latest step in the ambitious project, originally named “Human Genome Project-Write,” which came to light after a May meeting to discuss the building of large genomes from off-the-shelf parts.Within a year, the international group will select one small-scale research project to kick off the effort, and start a “major effort to engage with representative members of the public,” according to the draft road map. By year five, it will “shift into high gear” and start tackling the creation of entire genomes — maybe human or maybe not, depending on feedback.advertisement Kelley said that the white paper is very much a work in progress — “a living document.” She said that in the coming weeks, everyone who attended the May meeting will be invited to provide feedback and potentially sign on as coauthors.advertisementcenter_img Related: But one of those attendees said the project could be doing more to be transparent. Alina Chan, a Harvard postdoc who presented research at the meeting, said she was initially asked if she wanted to contribute to the white paper, and she said yes — but she never was invited to. Chan didn’t know the draft had been posted online until contacted by STAT Friday morning.“The whole thing, in terms of organization, could be better,” Chan said, pointing out that the online paper isn’t labeled as a draft.Regardless, scientists around the world have expressed interest in the project — Kelley has heard from more than 60 researchers in over 13 countries. Their names are not listed on the website but will be in the future, Kelley said.The group has also been posting more information online that sheds light on synthetic biology research that may be a part of this new genome project. Over the summer, videos from the May meeting were added on YouTube, and this week, a summary of the May meeting was posted, including information on possible next steps for research. NewslettersSign up for The Readout Your daily guide to what’s happening in biotech. In the LabSynthetic human genome project releases its draft timeline Leave this field empty if you’re human: Exactly which genomes are going to be built is still to be determined. For now, the group will focus on a pilot project — a smaller-scale undertaking that could provide scientific insight useful to whole-genome synthesis and also advance technology to the point that building an entire genome from scratch is feasible.Some possible pilot projects, detailed in the white paper and also discussed at the May meeting, include building “ultrasafe” human cell lines that are resistant to threats like radiation, cancer, and viruses, and building a human genome that can produce all 20 essential amino acids (currently, humans produce only 11, and need to eat to obtain the other 9). Kelley said that she will also be seeking proposals for pilot projects that relate to non-human genomes.These pilot projects, along with other aspects of GP-Write, will be discussed at meeting that will probably happen in May 2017, Kelley said. Tags geneticssynthetic biologylast_img read more

10 steps the Trump administration can take to make America healthy again

first_img Related: Improving early and pre-kindergarten education across the nation with efforts like this Head Start program in Sullivan County, N.Y., can make a tremendous, potentially intergenerational difference in the health of Americans. John Moore/Getty Images Privacy Policy Tags Donald Trumpopioidspublic health Improve early educationEducation is a fundamental determinant of health. The more education we receive, the healthier we are likely to be, with early education playing a key role. Take, for example, the Brookline Early Education Project. Between 1972 and 1983 it provided health and developmental services to Boston-area children from birth until kindergarten. A 25-year follow-up study showed the program to be associated with a range of positive health outcomes, including lower rates of depression, compared to individuals who did not receive the intervention. Given how profoundly early-life experiences can shape health later on, improving early and pre-kindergarten education nationwide stands to make a tremendous, potentially intergenerational difference in the health of Americans. The players who are set to influence Trump on health care One-fourth of US cancer deaths linked with one thing: smoking @sandrogalea Please enter a valid email address. By Sandro Galea Nov. 16, 2016 Reprints Can Trump kill Obamacare? He’ll have to answer these questions first Control the opioid epidemicDriven in part by greater access to prescription opioids and to heroin, opioid overdose deaths more than doubled between 2000 and 2014. Many attempts have been made to solve the problem of opioid addiction, with little success. That may be changing. Last March, Massachusetts Governor Charlie Baker signed into law an innovative new program designed to tackle the opioid crisis on multiple fronts. Components of the law include limits on opiate prescriptions, a database to monitor these prescriptions, and a variety of strategies to identify those at risk of abuse and to provide them with the necessary support services. A similarly comprehensive approach at the national level could make real headway against the misuse of these deadly drugs.advertisement Leave this field empty if you’re human: Increase support for episodes of special needThere are certain times in everyone’s life — childbearing, unemployment, caregiving for sick family members, and the like — when health is particularly vulnerable. They happen to almost everyone, which is why structures of support should be in place to provide assistance during them. Sadly, the US often lacks this structure. For example, ours is one of the few countries in the world, and the only high-income country, that does not guarantee paid parental leave for its citizens, despite the fact that paid leave benefits the health of both parents and children. Guaranteeing financial help during these episodes is good for all Americans.Prevent violenceThe effects of violence — be it physical, sexual, psychological, or deprivation-based — can touch anyone, regardless of gender or age, often with lifelong repercussions. The Adverse Childhood Experiences Study and others have demonstrated an association between childhood abuse and poor health later in life. Intimate partner violence is another dimension of this problem. An estimated 8.8 percent of women and 0.5 percent of men have experienced intimate partner rape over their lifetimes, while lifetime experiences of other sexual violence perpetrated by an intimate partner has been estimated at 15.8 percent among women and 9.5 percent among men. It is possible to mitigate this cycle of violence with strategies such as those developed for the Centers for Disease Control and Prevention’s DELTA FOCUS Program, which promotes “healthy, respectful, nonviolent relationships” and works to mobilize communities against intimate partner violence. A nationwide rollout of similar programs could extend the reach of these critical interventions. Create health impact assessmentsThe World Health Organization defines health impact assessments (HIA) as “a combination of procedures, methods, and tools used to evaluate the potential health effects of a policy, programme or project.” HIAs reflect data gathered through various methods to provide recommendations to stakeholders across economic and political sectors. These stakeholders can then apply this information toward better health interventions. For example, city officials looking to promote urban fitness through a bicycle sharing program could conduct their own HIA using an assessment of Barcelona’s program as a template. Data-driven policy planning that is informed by a broader adoption of HIAs stands to be more efficient and, ultimately, more effective. Related: Do more to control tobacco useSuccess in the fight against tobacco is one of the preeminent public health achievements of the 20th century. However, not all populations have benefitted from overall reductions in cigarette use. People who are uninsured are more likely to smoke, as are those living below the poverty line, those on Medicaid, and those without a college degree. We must use proven strategies — like better access to smoking cessation materials, and an expansion of tobacco taxation — to level the health playing field for those groups in danger of being left behind.Put earned income tax credits to workPoverty is unquestionably bad for health. The earned income tax credit is a cash-transfer benefit for the working poor, ranging from $500 a year to $6,200, a sum large enough to make a measurable difference in the lives of those who need it. This tax credit has been shown to mitigate the effects of poverty through reductions in maternal smoking during pregnancy, low birthweight, childhood behavior problems, and improvements in term birth, breastfeeding, and maternal health. Given the positive difference it has already made, extending the coverage of the earned income tax credit would do much to improve the health of families in poverty.Reform the criminal justice systemThe US has the highest incarceration rate in the world, a rate that has risen dramatically since the mid-1970s. The health effects of mass incarceration are varied and destructive. Compared to the general population, prisoners tend to have poorer mental and physical health, and are at risk of infectious diseases like HIV and tuberculosis. Mass incarceration also damages communities, with ripple effects extending to families that suffer from the lack of a caregiver or spouse. Worst of all, perhaps, are the racial disparities reflected by incarceration rates. Black Americans are about five times likelier to be incarcerated than whites. Eliminating mandatory minimum sentencing and reducing drug-related prison terms would go far toward addressing the problem of mass incarceration, as would greater attention to race-based unfairness in our justice system. First Opinion10 steps the Trump administration can take to make America healthy again America’s poor health helped elect Donald Trump.The United States has the worst health indicators among its peer nations, even though it spends far more money on health than any of those countries. Much of this health burden is borne by the same marginalized groups that found hope in the message of the president-elect.The new administration should seize the opportunity to be bold and inventive and to take steps that can actually make a difference in the lives and the health of the people who elevated Trump to power. My own work, and that of others, suggests 10 key ways to accomplish such change.advertisement Limit alcohol misuse through taxationThe misuse of alcohol has been linked to a range of health hazards, including liver disease, cancer, and poisoning, as well as mental health challenges like depression and suicidality. Taxing alcoholic beverages, though underutilized in the US, is a well-established tool to improve public health. A 2010 analysis estimated that doubling the alcohol tax would reduce alcohol-related deaths in the US by 35 percent, traffic deaths by 11 percent, sexually transmitted disease by 6 percent, and violence by 2 percent.Hands off the Affordable Care ActI leave this for last because I realize that the new administration is determined to change Obamacare. But the ACA clearly represents an enormous triumph of social legislation, improving health care access for millions. The most recent numbers show that 17.6 million previously uninsured Americans gained coverage since October 2013, when the ACA took effect, and about 10.5 million more Americans are currently eligible for marketplace coverage in the upcoming enrollment. Meddling with the ACA will once again leave millions of Americans underinsured or without health insurance altogether. That would be a disaster.We as a nation are about to turn the page on a challenging and, in many ways, unprecedented election year. Many difficulties, political and otherwise, stand in the way of progress on health and health care issues. With the historical winds at its back, will the Trump administration have the courage to think big, seize the moment, and implement commonsense solutions that will improve the health of all? We can only hope so.Sandro Galea, MD, is the dean of the Boston University School of Public Health. About the Author Reprints Sandro Galea Related: Newsletters Sign up for First Opinion A weekly digest of our opinion column, with insight from industry experts.last_img read more

A lesson on life’s end: How one college class is rethinking doctor training

first_imgIn a wood-paneled classroom at Columbia’s Morningside campus, a group of undergraduates fill the air with chatter. They’re young: fresh-faced 20- and 22-year-olds gossiping in groups of twos and threes.Once the class begins, the room matures. Suddenly, they are potential doctors, not college students, and they’re grappling with the heaviest questions medicine can ask.Today, their guest is Craig Blinderman, the director of the Adult Palliative Medicine Service at Columbia University Medical Center. Rather than lecture, Blinderman opens the room to discussion. The conversation veers from the medical to the philosophical.“How do I understand the suffering of my patients with dementia?” Sophie McAllister, a 21-year-old pre-med student, asks. “Is the loss of self a kind of pain?”Another student asks how doctors can fairly divide their time with busy schedules. “If there’s very little time and two patients, one is nonverbal, one is communicative, won’t doctors always choose the one who is verbal?” she worries. “Are we prioritizing the pain of verbal patients?”“My patient likes to share food with me, but I’m not comfortable with that,” one student says. Another asks, “Do you need to channel your own suffering to be a good caregiver, or does doing that inhibit your abilities?”Blinderman goes to the chalkboard, drawing a symbol of a doctor with a patient’s needs floating around it, like planets orbiting the sun. If the doctor becomes depleted, smaller, the patient’s needs don’t get smaller too, he says. It’s important for doctors to take care of themselves, or patients will feel the effects. He recommends meditation and mindfulness, and the ability to be present in each moment and then walk away; leave it behind. By Shayla Love Dec. 7, 2016 Reprints Columbia University pre-med student Sophie McAllister talks with Donna Martin, who can’t see but who loves beading, about which beading supplies she’d like McAllister to bring.  It was Halloween day, and McAllister arrived for her weekly four-hour block with patients at TCC. She entered the room of Kathleen Kelly and Donna Martin, roommates in the dialysis wing who’ve lived together for about six years.Martin was propped up in her bed, with a headscarf and blankets pulled up to her waist; she is bedbound and blind from diabetes. Kelly was perched on the foot of an adjacent, neatly made bed. They immediately jumped into conversation. Did they dress up? Did they go to a costume party? How are they feeling today?McAllister sat down on a chair between the two of them, where a curtain can be closed for privacy, but usually remains open. Kelly showed McAllister all the beaded necklaces Martin had made her: long strings of neon plastic beads.McAllister reached into her backpack and pulled out a gift for Martin: a large Ziploc bag of beads in a splash of different colors. Taking the ball of string from Martin’s bedside, she began cutting a handful of necklace-length strands for the next jewelry-making session. “Can you bring bells next time?” Martin asked. Yes, McAllister says, she will find her bells. Martin likes to be able to hear people coming and going.As McAllister measured out the string, the talk ebbed and flowed, from shallow topics like what had changed in the vending machine, to suddenly plunging into the deep end. Martin told McAllister about her sons who died young of Duchenne muscular dystrophy around this time of year.“I stood by the bed and he died in my arms,” Martin said. “I got him on the floor, and I started CPR, and I brought him back. That was on my birthday, the 27th of October. Then on Dec. 13, 2007, he passed away. My other son, Vinnie, died on Feb. 7, 2008. My mother died April 10, 2010. They went: boom, boom, boom.”McAllister didn’t shy away from Martin talking about her sons or their deaths. She asked about their childhoods. Did they like Halloween? Did they believe in Santa?Over the summer, McAllister and Martin had recreated another of the woman’s memories: sitting in Central Park with her brother, listening to music and eating pretzels. It was the first time Martin had been outside in a long while.“It was burning,” McAllister said. “We came back and we were drenched in sweat. I was scared you didn’t like it.”“No, I loved it!” Martin said, smiling. “I’m from St. Thomas, Virgin Islands. It’s hot there, you never get any cold breezes.”They remembered how good the pretzels were, dipped in salt, and McAllister promised they would go again once it was warmer.“I loved that mustard,” Martin said. Tags dementiaend of life Sophie McAllister looks at a prayer card with Angela Declemente, who has dementia.  The Columbia class is the brainchild of Robert Pollack, a biology professor, and Dr. Anthony Lechich, the medical director at TCC. In 2005, they started to place one or two students per summer in an internship at the facility. Six years in, one of their interns was pre-med student Ashley Shaw, who saw in her own experience something that flagged up a shortcoming in medical education more widely.“Medical students and trainees enter medicine thinking that medicine is an exact science,” Shaw said. “There are the signs and symptoms of a condition, and this is the treatment, and this is what the evidence is, and all you have to do is learn that. [But] a large percentage of this endeavor is dealing with uncertainty. You’re in deep trouble if you’re unprepared to handle that.”In 2012 Shaw worked with Pollack and Lechich to expand the internship to a volunteer program that ran year-round, and last year, another volunteer and pre-med student, Tess Cersonsky, advocated to turn the program into a credit-earning course. After pitching the class to various programs at Columbia, she and Pollack found a home for it in the American studies department. At the moment, it does not count as pre-med credit; the students have to take it as a non-technical elective. Eventually, Cersonsky and others would like to see it part of the pre-med curriculum.The initiative is in keeping with a cultural shift that has begun to open up more space to talk about dying. But medical training, as well as the practice of medicine, has been slower to adapt.Atul Gawande, in his book “Being Mortal,” reveals how dramatically death has changed in the midst of technical advancements that keep people alive. Most of us now die hooked up to machines, he says, and doctors resort to more aggressive treatment options instead of facing reality.But sometimes there is no cure. At a certain point in everyone’s life, medicine will reach its limit. How are we preparing our doctors to care for us in those moments?“I don’t think we teach them in med school ‘do not feel, do not have emotions,’” said Dr. Danielle Ofri, a physician at Bellevue Hospital and associate professor of medicine at New York University. “We just don’t talk about it. And it gets pushed to the side.”She worries that alongside heavy workloads, such emotional strain is contributing to the high depression and suicide rates among medical students.Some hospitals are doing more to encourage emotional reflection. Harborview Medical Center in Seattle began a program called Death Rounds in 2000. The medical staff gathers each week to discuss patient deaths. Doctors are encouraged to share their remembrances of patients who’ve died, and how they felt about their deaths. The ICU was the first department to do so, and since then the neurology and surgical units have begun Death Rounds as well.“We’re talking about death,” said Dr. Sandeep Khot, a neurologist at Harborview. “If you’re involved in this field, if you’re involved in medicine, this is going to happen — and this is part of caring for patients who are going to die.” A new class at Columbia University envisions something different. The class, called Life at the End of Life, places students with medical aspirations — before they even apply to medical school — with patients at the Terence Cardinal Cooke Health Care Center (TCC), a nursing home in Harlem. The students enter the doors of the clinic knowing that their patients will not get better, and likely never leave.In an increasingly tech-enabled medical profession, where death is postponed as long as possible, the class challenges pre-med students to confront that ultimate reality, and to learn how to guide patients and their families through it. And along the way it’s challenging their field’s hidebound distinction between medicine and palliative care — between doing everything to keep someone alive, and helping them die with dignity. McAllister listens to Kathleen Kelly in the room she shares with Donna Martin.  In July, McAllister sat at the bedside of a dying elderly woman — her first deathbed visit. The woman’s family wouldn’t be arriving until later, and the TCC staff didn’t want her to be alone.“For awhile, it was just me and her,” McAllister said. “It was kind of terrifying. It was unsettling to see someone like that. It seemed like all her energy was going toward breathing.”McAllister searched her mind for ways to offer comfort in those final moments. She rubbed the pillow around the woman’s head, smoothing out the wrinkles. She touched her hand softly, and remained physically close. She knew that the woman was Catholic, so she Googled “soothing Catholic music” on her iPhone, settling on “Ave Maria” to play.“You don’t really know what’s going on inside her head,” McAllister said. “So I did what I could. And I just sat with her.” Terence Cardinal Cooke Health Care Center resident Angela DeClemente holds her purse. center_img NEW YORK — A person’s breath is usually invisible. It’s quiet and automatic, unseen and unheard. It can be so silent that anxious parents hold mirrors next to their newborns’ faces, trying to catch a glimpse of it.But in the days before death, the nature of breath changes.Instead of passing through the body unnoticed, it calls for attention. It becomes noisy, hollowed, labored. Clinicians even have a name for it: the death rattle. It’s not something most people have heard, unless they’ve sat at a dying person’s side. Doctors in training, who go through years of coursework learning to keep people alive, might never experience it. And when they do, it can be overwhelming.advertisement Sophie McAllister looks with Angela Declemente at a card from Declemente’s niece, Jamie.  When McAllister walks into Angela Declemente’s room, she finds her surrounded by family photos.McAllister discovered the photos several months ago, shoved away in a drawer, and they now go through them often. McAllister points out Jamie, Declemente’s favorite niece. Declemente, a small, frail woman with white hair, yells Jamie’s name in delight each time McAllister points her out.When McAllister first met Declemente, she wasn’t sure how much of “her” was still there. Declemente suffers from dementia. McAllister would talk to her, and she often didn’t respond, or she repeated phrases that didn’t make much sense.Then, McAllister realized that the woman wasn’t ignoring her, and she wasn’t incapable of understanding — she simply couldn’t hear. McAllister began to write notes to her on paper; later, after finding a whiteboard and dry-erase marker, their relationship blossomed.Now, McAllister knows what Declemente’s odd statements mean. When she says she made “God in the corner,” she means an altar, like the one her mother made at her home in Rhode Island. When Declemente says she “went to heaven,” that means she went to church. The only way to decipher these phrases was to spend time with her, McAllister said. Now that she knows them, conversation flows easily. Sometimes they sit and color, or go through family photos. And sometimes, they can go to heaven together.“Your smile is beautiful,” McAllister writes on the whiteboard.“Isn’t that nice,” Declemente says, and shows McAllister a picture of a baby. “She’s cute!”McAllister writes on the board: “You look like a movie star” — one of Declemente’s favorite messages to get.“Isn’t that nice!” Declemente lights up. “That’s great.” HealthA lesson on life’s end: How one college class is rethinking doctor training Photos by Alice Proujansky for STAT On an unusually warm Thursday in late October, the class came back from their break to two yellow Post-its on each of their desks.Cersonsky, now a senior and the TA of the class, opened the lecture: “I want you to share on these Post-its two thoughts that you have had while volunteering that you wouldn’t feel comfortable saying directly.”When they finished writing, Cersonsky stuck them on the walls of the room, from corner to corner. Then, she told the students to spend some time reading them. It was completely silent as the students walked along the wall of notes.“I can’t understand my long term companion and I’m worried I’m missing important things she’s trying to tell me,” one said.“Should I feel bad about spending most of my shifts with residents that are pleasant to interact with?” another asked.“It makes me sad to think about one day losing the right to make my own decisions.”There wasn’t a single question about the technical side of medicine. And yet, Cersonsky said, it got to the root of medical care. “It feels like this is something that all pre-meds should be doing,” she said. “It’s the only way that we’ve been able to process what it’s like to be around illness in a really intense way.” advertisementlast_img read more

Were women foolish to follow Angelina Jolie into BRCA cancer gene testing?

first_imgGut CheckWere women foolish to follow Angelina Jolie into BRCA cancer gene testing? As revenue falls, a pioneer of cancer gene testing slams rivals with overblown claims Tags cancergeneticswomen’s health About the Author Reprints Sharon Begley For one thing, the conclusion that a large majority of the Angelina-effect women tested negative (and should never have undergone testing in the first place) is an inference based on the lower rates of mastectomy. The researchers “do not know how many of these women tested positive” for a cancer-causing mutation, Mary Freivogel, a genetic counselor in Denver and president of the National Society of Genetic Counselors, told STAT. It’s therefore quite a leap to infer that BRCA testing was unnecessary.Critics have also argued that 60 days is too short a period to count the number of mastectomies resulting from BRCA tests.Writer Suzanne Zuppello was found to have a cancer-causing BRCA1 mutation in March 2015; she had a double mastectomy that October. That lag isn’t unusual. It takes two weeks to get test results, at least a week to see a breast surgeon and gynecologic oncologist, weeks to decide between surveillance (frequent breast imaging) and surgery (both of which are equally valid options for BRCA-positive women), weeks to schedule the required pre-mastectomy mammogram or MRI, time to think long and hard about surgery, and at least a week to get on a surgeon’s schedule, Zuppello wrote in Medium. All that mitigates against a quick post-BRCA mastectomy.Another odd thing about concluding that “Angelina effect” women weren’t in the high-risk group for whom BRCA testing is recommended is that it’s not easy to get insurers to cover the $3,000 test. They almost never do unless a woman has a strong family history of breast or ovarian cancer (as Jolie did). Since the Harvard researchers analyzed insurance claims, experts said, the test was probably covered because the women were suitable candidates for it — not women who were blindly, or in a panic, emulating a celeb.“We do not know how many met standard guidelines for BRCA testing,” said Freivogel, but the insurance claims “tell me that most of these women probably did meet criteria for testing.” Angelina Jolie announced in May 2013 that she underwent a double mastectomy based on a positive BRCA test. Jason Merritt/Getty Images Leave this field empty if you’re human: Moreover, many women who learn they have a BRCA mutation opt for surveillance instead of mastectomy, in part because they fear undergoing such life-changing surgery. Women tested before Jolie’s announcement might have differed in a key way from those tested before: They might well have met the family history or other criteria for testing, but have been afraid to have it until Jolie’s brave announcement. That same fear and tendency to postpone life-changing decisions could account for why 10 percent of women tested before Jolie’s announcement had mastectomies within 60 days of their test compared to only 7 percent of those tested after.Harvard’s Jena said his critics “are exactly right: 60 days may very well be too short for many women.” Although the drop in mastectomies within 60 days of BRCA testing was their main finding, he added, mastectomy rates within 90 and 180 days were also lower after Jolie’s announcement than before. Since the likelihood of mastectomy within 180 days “is quite high,” Jena said, “the vast majority of women who underwent BRCA testing as a result of Jolie’s editorial did not end up receiving preventive mastectomy, most likely because the additional tests obtained were negative.”The verdict:That’s a long chain of inference — no mastectomy within six months of BRCA testing implies no mastectomy, period; no mastectomy implies a negative BRCA result; a negative BRCA result implies the woman shouldn’t have undergone testing — and it makes for a shaky conclusion. [email protected] Privacy Policy Really?Genetic counselors, physicians, and BRCA-positive women have lit up social media attacking the study.advertisement Senior Writer, Science and Discovery (1956-2021) Sharon covered science and discovery. Please enter a valid email address. By Sharon Begley Jan. 5, 2017 Reprints Gut Check looks at health claims made by studies, newsmakers, or conventional wisdom. We ask: Should you believe this?The claim:Swayed by the power of celebrity, many women needlessly rushed to get genetic testing for the cancer-causing BRCA mutations right after actress Angelina Jolie announced in May 2013 that she underwent a double mastectomy based on a positive BRCA test, concluded a study in the BMJ last month.Tell me more:Other studies, too, have reported an uptick in BRCA testing after Jolie’s announcement — the “Angelina effect” — but this one went further. Although insurance claims for nearly 10 million women aged 18 to 64 showed that BRCA testing rose 64 percent in the 15 days after Jolie described her BRCA result and surgery, that wasn’t followed by additional mastectomies.One would expect an uptick in BRCA testing to be followed by an uptick in mastectomies, reasoned health economist Dr. Anupam Jena and graduate student Sunita Desai of Harvard Medical School: When women learn they carry a cancer-causing BRCA mutation, more undergo mastectomy than if they had remained in the dark. But the rate of mastectomy within 60 days of a BRCA test fell, they found, from 10 percent of tested women in the four months before Jolie’s announcement to 7 percent in the eight months after (through the end of 2013). That suggests most women who underwent BRCA testing because of Jolie’s announcement had a lower probability of a BRCA mutation than women tested before her announcement, the researchers concluded.advertisement Related: BRCA testing is recommended for women with a family history of breast or ovarian cancer or other risk factors, but the authors said their finding suggests that most of the women who got tested didn’t have an elevated risk of cancer and provides a cautionary tale about the unintended consequences of celebrity endorsements of medical tests and procedures. They calculated that the extra testing cost as much as $13.5 million. @sxbegle Newsletters Sign up for Cancer Briefing A weekly look at the latest in cancer research, treatment, and patient care.last_img read more

Grassley probes insurer over ‘penalties’ charged for brand-name drugs

first_imgPharmalot Grassley probes insurer over ‘penalties’ charged for brand-name drugs By Ed Silverman April 18, 2017 Reprints Pharmalot Columnist, Senior Writer Ed covers the pharmaceutical industry. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr. After months of targeting drug makers over their pricing, Senator Chuck Grassley is now probing one of the biggest insurers in the mid-Atlantic region, opening what may become another front in the battle over the cost of prescription medicines.The lawmaker has asked CareFirst BlueCross BlueShield to explain a complicated policy that he suspects may force patients to overpay for brand-name medications that doctors have specified must be dispensed. Grassley is also concerned that some people may instead feel they have no choice but to opt for lower-cost generic drugs that, in such situations, may not be as effective. Senator Chuck Grassley Drew Angerer/Getty Images What’s included? Log In | Learn More Unlock this article by subscribing to STAT+ and enjoy your first 30 days free! GET STARTEDcenter_img STAT+ is STAT’s premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. GET STARTED About the Author Reprints Tags drug pricingpharmaceuticalsSTAT+ What is it? @Pharmalot Ed Silverman [email protected] last_img read more

In mega-shelter for Harvey evacuees, telemedicine plans to help doctors keep up

first_img Getting thousands of Houston-area families to shelters has been a massive humanitarian effort. But the aid doesn’t end there: Many of the displaced have chronic medical conditions like asthma or injuries from recent days that need medical attention.Providers of telemedicine are hoping technology can help step into the breach. At Kay Bailey Hutchison Convention Center in Dallas, which has begun to take residents displaced by flooding in Houston, emergency-room doctors at Children’s Health, a pediatric hospital based in Dallas, are seeing young patients remotely.“For every adult that comes in, there will be about three children,” explained Scott Summerall, spokesperson for Children’s Health. “We have doctors for adults available at the shelter 24 hours a day, but we don’t have as many pediatric specialists, especially at night.”advertisement Trending Now: She added that flood conditions, like mold in flooded homes, can exacerbate conditions such as asthma. In addition, floodwater may carry viruses and bacteria from dead animals, chemicals, and other contaminants that could cause serious health problems in children if they swallowed it.“There’s also behavioral health issues,” Williams added. “Children are susceptible to anxiety and depression, especially in a time like this. ”And the Dallas shelter will eventually house a pharmacy, which should enable parents to fill their kids prescriptions on-site.Dr. Maeve Sheehan, a pediatrician at Children’s Health, is another of the physicians on-site at the convention center. Telemedicine has helped both the medical and nonmedical workers at the site, Sheehan said.“We have a lot of volunteers here, and people, especially kids, get sick at night. This way they can be in touch with emergency room doctors whenever they need help.”That, Sheehan said, is a notable improvement over disaster response teams she’s worked on in the past. “We didn’t have telemedicine for Katrina,” she said. “I was on [call] all night. This time, I don’t have to be. Telemedicine makes a big difference.” HealthIn mega-shelter for Harvey evacuees, telemedicine plans to help doctors keep up In preparation for that, Children’s Health has set up a telemedicine station from which ER physicians at the hospital can remotely see children at the shelter, via a computer monitor and specially designed equipment for measuring vital signs. The telemedicine station has been in use since Monday.“We expect to see a lot of rashes and infections,” said Dr. Stormee Williams, who oversees telemedicine at Children’s Health, and who is working on-site at the shelter. Houston’s George R. Brown Convention Center has largely filled up, prompting officials to open the Dallas convention center to flood victims. Joe Raedle/Getty Images Houston hospitals may not be back to normal for a month Williams said she’s seen an outpouring of support from fellow physicians in the days since the storm hit.“We have doctors around the country calling in and saying, ‘I use telemedicine. How can I help?’ But because they are laws and rules about who can practice where, unless they have a license in Texas, they can’t do it,” she said.Still Williams hopes that the Harvey response efforts will be the beginning of telemedicine as a regular part of disaster recovery.“I’m really excited that we’re doing this,” said Williams. “This is an example of how telemedicine can be used in the most extreme situations, when health care is most needed.” Comparing the Covid-19 vaccines developed by Pfizer, Moderna, and Johnson & Johnson And it’s thanks to a recently passed law that it’s even possible: In May, Texas became the last U.S. state to allow physicians to see patients by telemedicine without an initial in-person visit.Children’s Health has set up a telemedicine station at a mega-shelter in Dallas from which ER physicians at the hospital can remotely see children. Children’s Health System of TexasAt the Dallas convention center, patients are slowly trickling in, many of them delayed by still-flooded roads. Plans for the “mega-shelter,” however, indicate that could house up to 5,000 people in coming days and weeks.advertisement Tags patients Related: By Leah Samuel Aug. 31, 2017 Reprintslast_img read more

Marijuana-based drug gets positive review from FDA

first_img Trending Now: Conry and other researchers say it’s not yet clear why CBD reduces seizures in some patients.GW Pharmaceuticals makes its drug from cannabis plants that are specially bred to contain high levels of CBD. It’s seeking approval for two rare forms of childhood epilepsy — Dravet and Lennox-Gastaut syndromes.Common side effects included diarrhea, vomiting, fatigue, and sleep problems. FDA reviewers flagged a more serious issue with potential liver injury, but said doctors could manage the risk by monitoring patients’ enzyme levels.— Matthew Perrone Associated Press WASHINGTON — A closely watched medicine made from the marijuana plant reduces seizures in children with severe forms of epilepsy and warrants approval in the United States, health officials said Tuesday.British drug maker GW Pharmaceuticals is seeking permission to sell its purified form of an ingredient found in cannabis — one that doesn’t get users high — as a medication for rare, hard-to-treat seizures in children. If successful, the company’s liquid formula would be the first government-approved drug derived from the cannabis plant in the U.S.The Food and Drug Administration’s approval would technically limit the treatment to a small group of epilepsy patients. But doctors would have the option to prescribe it for other uses and it could spur new pharmaceutical research and interest into other cannabis-based products. Man-made versions of a different marijuana ingredient have previously been approved for other purposes.advertisement About the Author Reprints By Associated Press April 17, 2018 Reprints HealthMarijuana-based drug gets positive review from FDA DEA decision keeps major restrictions in place on marijuana research Comparing the Covid-19 vaccines developed by Pfizer, Moderna, and Johnson & Johnson Related:center_img Related: Epidiolex is essentially a pharmaceutical-grade version of cannabidiol, or CBD oil, which some parents have used for years to treat children with epilepsy. CBD is one of more than 100 chemicals found in the cannabis plant and it doesn’t contain THC, the ingredient that gives marijuana its mind-altering effect.CBD oil is currently sold online and in specialty shops across the U.S., though its legal status remains murky. Most producers say their oil is made from hemp, a plant in the cannabis family that contains little THC and can be legally farmed in a number of states for clothing, food and other uses.A doctor who treats children with epilepsy says it’s important to have an FDA-approved version of CBD.“I think it needs to be approved because everyone is using it across the internet without knowing the safety … and no one is watching the interactions with other drugs,” said Dr. Joan Conry, of Children’s National Health System in Washington, who was not involved in the studies. FDA The FDA posted its review of the experimental medication Epidiolex ahead of a public meeting Thursday when a panel of outside experts will vote on the medicine’s safety and effectiveness. It’s a non-binding recommendation that the FDA will consider in its final decision by late June. In a first, scientists show a marijuana component reduces seizures for some with epilepsy Patients taking the treatment had fewer seizures, according to the FDA’s internal review posted online. Scientists concluded that GW Pharmaceuticals’ submission “appears to support approval” despite some potential side effects including risks of liver injury.advertisement More than two dozen states allow marijuana use for a variety of ailments, but the FDA has not approved it for any medical use. In 2016, the agency recommended against easing federal restrictions on marijuana. The U.S. continues to classify marijuana as a high-risk substance with no medical use, alongside other illicit drugs like heroin and LSD.For years, desperate patients and parents have pushed for wider access to medical marijuana products for a host of conditions including pain, post-traumatic stress disorder and epilepsy, with only anecdotal stories and limited studies on their side.But studies conducted by GW Pharmaceuticals have begun to change that picture.Across three studies involving more than 500 patients, Epidiolex generally cut the number of monthly seizures by about 40 percent, compared with reductions between 15 and 20 percent for patients taking a dummy medicine.Most patients in the study were already taking at least three other medications to try and control their seizures. Tags pharmaceuticalspolicylast_img read more