23 Jun

My first patient died. How I learned to forgive myself

first_img Looming question for medical students: Will they be shut out of advanced training? Sashka and I rolled the woman onto her back in the choreographed motion we’d learned from physicians in the emergency room. I immediately started to do CPR. While I’d practiced this on a mannequin a few years earlier, I’d never done it on a human being whose life might depend on my doing it right, and I was relieved when paramedics arrived and took over.As the ambulance drove away with our patient, I felt a mix of emotions — pride in my ability to remain calm under pressure and recall how to do CPR; excitement about the opportunity to help someone in need; and worry about the woman’s prognosis. But most of all, I felt disbelief. We had cared for someone in dire straits on our own.advertisement Jennifer Adaeze Okwerekwu That day on the track taught me a lesson I couldn’t have learned as a medical student sheltered by the protection of a supervisor. While we set the highest of standards for ourselves, the practice of medicine is imperfect and sometimes unpredictable. When we stop trying to make sense of our catastrophic collisions with loss, forgiveness — rather than failure — becomes the definitive teacher.I returned to my comfortable role as a medical student, following residents and attending physicians around like a duckling follows its mother. When I start my residency this summer, though, I’ll be forced out of the nest and into the real world of medicine where these collisions are all too common. From day one of my training, I will share in the responsibility for patient care and gradually build enough competence to shoulder it on my own.I will also start with an appreciation for “humility that embraces the intention and the effort, in spite of the outcome,” a lesson my medical school dean shared with me. Despite the many achievements I’ve needed to get this far, I am coming to understand that medicine is not always about succeeding, but it is always about trying. Match Day 2016: Where Will Jennifer Match?Volume 90%Press shift question mark to access a list of keyboard shortcutsKeyboard ShortcutsEnabledDisabledPlay/PauseSPACEIncrease Volume↑Decrease Volume↓Seek Forward→Seek Backward←Captions On/OffcFullscreen/Exit FullscreenfMute/UnmutemSeek %0-9 facebook twitter Email Linkhttps://www.statnews.com/2016/03/24/doctor-learns-forgiveness/?jwsource=clCopied EmbedCopiedLive00:0000:4500:45  Jennifer is about to graduate from medical school. The next step in her career: matching with a residency program. STAT was with Jennifer the moment she found out where she matched. Hyacinth Empinado/STAT “We just did all that unsupervised,” I kept repeating to my classmate. There was no experienced professional on the track to guide us and take over if needed, as often happens in medical school. Sashka and I were confident we had done the right thing, yet we also hoped we hadn’t somehow botched her care.Two days later, I learned that the young woman, an undergraduate at the university with her own dreams of becoming a doctor, had died of an aneurysm — a blood vessel in her brain had burst, causing massive bleeding into her brain. The medical school’s deans assured Sashka and me that no one could have saved her life, and that the CPR we did let her fulfill her wish of being an organ donor — nine of her organs went to five people in need.We were commended for our actions, but it was hard to hear congratulations for such a tragic outcome. I wondered, is this what it feels like to be a doctor?As Atul Gawande writes, “You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence. … It comes partly from being helpful to others. But it also comes from being technically skilled and able to solve difficult, intricate problems. Your competence gives you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with a problem you cannot solve.”After a decade of wanting to become a doctor, it was traumatic for me to witness the death of the first patient I cared for on my own. Medical students are trained to fight death, but I was unprepared for the gravity of having my hands on an individual in her last moments. Even knowing there was nothing I could have done to prevent her death, I felt like a failure. Columnist, Off the Charts Jennifer Adaeze Okwerekwu is a psychiatrist and a columnist for STAT. First OpinionMy first patient died. How I learned to forgive myself By Jennifer Adaeze Okwerekwu March 24, 2016 Reprints On Match Day last week, more than 17,000 US medical students were offered their first jobs as doctors. Jennifer Adaeze Anyaegbunam was one of them, matching into her first choice, a psychiatry residency program at Cambridge Health Alliance. She reflects on the transition from medical student to doctor, and what it means to take responsibility for another individual’s health.The first time I felt the full responsibility of being a doctor, I was a fourth-year medical student at the University of Virginia, walking around the outdoor track with a classmate.A young woman ahead of us suddenly collapsed. Other runners and walkers began shouting for a doctor. My friend Sashka and I instinctively responded, recognizing that as fourth-year medical students, we were probably the next best thing. As we sprinted across the track, we realized we were the only thing.I dropped to my knees and rubbed the woman’s back, hoping she would get up, dust off the humiliation of a fall, and continue her evening run. But she didn’t move or respond to our questions. I used my iPhone as a makeshift penlight and looked into her eyes. Her pupils were dilated and didn’t constrict in response to the light, a bad sign. Her lips were turning blue, she began gasping for air, and her pulse faded away.advertisement First wave of undocumented immigrants in medical schools face uncertain future Jennifer Anyaegbunam at her University of Virginia white coat ceremony, 2011. Courtesy Jennifer Adaeze Anyaegbunam @JenniferAdaeze Related: [email protected] About the Author Reprints Related: Tags doctorsmedical schoollast_img read more

23 Jun

Genetically modified mosquitoes are one step closer to being released in Florida

first_img The proposed US trial has two goals, as outlined in the environmental assessment: see if the genetic modification in the engineered mosquitos is passed on to offspring, and determine if the offspring actually die earlier as intended.In the trial, mosquitoes would be released in Key Haven into an experimental zone. The trial would also include a buffer zone and a control zone on the island. The zones would not be physically divided by barriers like nets, but Aedes aegypti only travel in an area encompassing a few hundred meters on average in their lifetime, so they should not migrate from one area to the other, said Oxitec spokesman Matthew Warren. Egg traps in both the experimental and control zones would help compare the mosquito populations.Oxitec’s mosquito is the first genetically engineered animal to be approved by the FDA for use in an open-release field trial, said FDA officials. “I think the pathways that would enable emergency use should be looked at, because the crisis is here and now. It would be an awful shame if in two or three years time we looked back and said why didn’t we do this when we had it in our hands,” he said during a Friday press conference.advertisement Related: By Ike Swetlitz Aug. 5, 2016 Reprints Related: In light of FDA’s findings and increasing numbers of locally acquired cases of Zika infection, Oxitec CEO Haydn Perry urged a state of emergency-type declaration be considered to get the field trial underway quickly, suggesting that should efforts fail in Florida, the company would reluctantly look to other communities for its first US trials. The Keys have the infrastructure needed to do the work, Perry said, and going anywhere else would likely require significant ramp-up. US moves to allow release of genetically modified mosquitoes A public comment period following the preliminary findings yielded more than 2,600 public comments, including those opposing the plan. In November, residents of the Florida Keys will vote in a nonbinding referendum on whether or not to proceed with the field trial.Phil Goodman, chairman of the mosquito board, said the board could vote to allow the field trial, regardless of the outcome of the referendum on the November ballot.“I would vote to move forward” before the referendum, Goodman said.When Oxitec’s genetically engineered Aedes aegypti mate with regular mosquitos in the wild, the offspring die before they are able to reproduce, thus decreasing the total mosquito population and the spread of diseases such as dengue, chikungunya, and possibly Zika. In field trials in Brazil, the Cayman Islands, and Panama, the population of mosquitos in the experimental areas dropped by about 90 percent within six to nine months. And according to Oxitec, in one treated location, incidence of dengue fell by 90 percent while in the nontreated area, incidence fell by about 50 percent. Based on field trial results, work continues in Brazil, Panama and the Cayman Islands. A biologist releases genetically modified mosquitoes in Brazil. Similar efforts are being proposed by Oxitec for the Florida Keys. Victor Moriyama/Getty Images Florida is one step closer to field trials of genetically engineered mosquitoes that could slow the spread of diseases like Zika.The Food and Drug Administration issued its final environmental assessment Friday, finding that a proposed field trial to test the mosquitoes is effectively safe for both humans and the environment.FDA’s decision is not a final approval — Oxitec, the company who created the mosquitoes, now awaits the decision of the Florida Keys Mosquito Control District, which oversees mosquito management. advertisement Florida Keys delays residents’ vote on genetically modified mosquitoes In the LabGenetically modified mosquitoes are one step closer to being released in Florida Tags genetically modified organismsmosquitoesZika Viruslast_img read more

23 Jun

Drug addiction is overwhelming Trump’s America. What’s he going to do?

first_img Tags addictionDonald Trumpopioidspolicy Politics 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 What’s included? By Dylan Scott Nov. 14, 2016 Reprints WASHINGTON — To stop the heroin and painkiller crisis killing thousands of Americans, President-elect Donald Trump has promised to build a wall on the Mexican border and provide more treatment to those who need it.After Trump’s shocking electoral upset, people who work in addiction recovery say they want to believe the new president will take the crisis seriously and hope Republicans in Congress who understand the problem will help guide the new administration. What is it? Donald Trump spoke with community leaders and addiction specialists in New Hampshire in October. Evan Vucci/AP Log In | Learn More 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. Drug addiction is overwhelming Trump’s America. What’s he going to do? Unlock this article by subscribing to STAT+ and enjoy your first 30 days free! GET STARTEDlast_img read more

23 Jun

Why a First Amendment win is good for science

first_imgThe WatchdogsWhy a First Amendment win is good for science The decision, which reverses a ruling from a lower court, doesn’t stop the defamation suit, although it is quite difficult to sue someone whose identity is unknown. But it does uphold a principle we strongly support: Science needs anonymous whistleblowers, and they deserve protection. We hate to contemplate what might have happened had the judges ruled otherwise. Why science would benefit from being self-refereed Some of Donald Trump’s recent comments have bloodied the nose of the First Amendment, but here, at least, is a glimmer of good news: Judges in a Michigan defamation case this week ruled that anonymous scientific critiques are a protected form of speech.The decision, by a three-judge panel on the Michigan Court of Appeals, gives a boost to the nascent but growing practice of online post-publication peer review.The ruling stems from a defamation lawsuit involving Fazlul Sarkar, formerly of Wayne State University. Sarkar is angry because posters to the site PubPeer — which allows people to critique the work of scientists — questioned the integrity of his work. Those comments, he claims, cost him a lucrative job at the University of Mississippi and tarnished his reputation. He has demanded to know the names of the anonymous critics who were calling his findings into question. (Sarkar has now had 18 papers retracted.)advertisement Should researchers publish their findings before peer review? Spencer Platt/Getty Images Related: PubPeer offers a forum for vigorous post-publication review of published research. Critics of the site have argued that it would prove to be a cesspool of vendettas and grudge-bearing. That hasn’t happened. In fact, not only are unfounded accusations quickly moderated from the blog, posters have surfaced evidence there that prompted the retractions of a number of articles and that launched several institutional investigations.advertisement Why is anonymity so important to science? A few reasons. The first: Many people in a position to observe questionable research practices in a lab are underlings — postdocs, students, and others of similarly low station. Like the indentured servants they for all practical purposes are, they’re powerless against lab heads and senior members of the faculty. The shield of anonymity is a crucial protection against retribution.In addition, even peers may not feel comfortable making public allegations or questions about a colleague’s work, for obvious reasons. They may doze through the same department meetings, sit on the same editorial boards, or be active in the same professional societies.We wish humans weren’t so defensive and tribal, really, we do. But until some mad scientist genetically engineers those traits away — which would probably involve a cure that’s worse than the disease — we’re stuck with ourselves. Luckily, we’re also “stuck” with the First Amendment — at least for now. Related: Given the First Amendment stakes, PubPeer had support in the lawsuit from the American Civil Liberties Union, whose attorney, Alex Abdo, praised the decision in a statement: “This ruling is a critical victory for freedom of speech and scientific inquiry,” Abdo said. “Anonymity has a storied history in our country, allowing the nation’s founders to express unpopular views in relative safety. Anonymity is no less important today. Scientists who anonymously review the work of their peers should not have to fear retribution for exposing the anomalies they find, and the court rightly agreed.”Meanwhile, Nicholas Roumel, Sarkar’s attorney, told the Scientist that the ruling “sucked” but was “in line with the trend of these cases all over the country.”Other notable defenses of First Amendment rights in science include the 2015 ruling by a judge in Massachusetts that the journal Diabetes did not defame a scientist in Brazil when it issued an expression of concern about four of his papers. And in another Massachusetts case also last year, a different court ruled that First Amendment rights allowed a journal to retract a paper over an author’s objections.This week’s decision may suck for Sarkar, but it’s good for PubPeer, and, in turn, for science. By Adam Marcus and Ivan Oransky Dec. 9, 2016 Reprints Tags legallast_img read more

23 Jun

In a Byzantine health system, navigators help at-risk patients find their way

first_img Related: @AllisonRBond Allison Bond CHELSEA, Mass. — Ms. P needed a colonoscopy. She’d been losing weight and had noticed blood in her stool; both are red flags for colon cancer. Yet after her doctor delivered that news, she didn’t book the procedure for weeks.Ms. P was a recent immigrant from Venezuela and spoke almost no English. Although her primary care doctor and she had a long discussion with the help of an interpreter, it turned out, she was still confused about the importance and meaning of the test, how to make the appointment, and how to arrange transportation to get there.Even patients who read and speak English fluently face challenges navigating the increasingly Byzantine health care system. But patients who are less well-equipped, whether because of poverty, education level, or cultural barriers, are at a particular disadvantage when it comes to getting the health care they need.advertisement For these patients, seemingly small concerns, such as how and when to make a doctor’s appointment or how to get to the clinic, play an outsize role in their care. For instance, women without the skills to understand and process essential health information — a capacity known as health literacy — are twice as likely to have never received a Pap test and are 50 percent less likely to have had a mammogram in the past two years compared to those with better health literacy.That’s why a new idea is gaining hold: a kind of medical buddy system.advertisement Patient navigators can serve crucial roles in hospitals Transportation shouldn’t be a barrier to health care First OpinionIn a Byzantine health system, navigators help at-risk patients find their way The job is something of a mix of interpreter, community health worker, and social worker. Navigators help patients make and attend appointments, help find resources such as transportation vouchers, and support and advocate for patients in discussions with their doctor or insurer — or even with family members.These positions are often paid for by the hospital itself or by private foundations, rather than via insurance. That’s one big reason many patient navigators to date have been employed in cancer care, where more funding exists.Yet the role is not without detractors, who say that despite good intentions, health navigators could make an already large health care team even bigger and more disconnected.‘A lightbulb went off’I’ve become familiar with the work of patient navigators in my role as a resident of internal medicine at Massachusetts General Hospital. Patient navigator Joanne Toussaint, who works at MGH’s Chelsea HealthCare Center, has a lot of Spanish-speaking patients; her fluency in the language and experience living in and traveling to Spanish-speaking countries have made her especially adept at serving as an intermediary. For example, a patient who is told that a “light” breakfast is permissible the morning of a test might think this small meal could entail a hefty helping of rice and beans, when in actuality that much food could mean the test has to be cancelled. Toussaint has learned to convey that in advance.Toussaint recalls one patient, a Somali man, whose doctor had recommended a colonoscopy. The man initially flatly refused the test, and since he did not know how to read or write, that put the brakes on the doctor’s plan to send him home with pamphlets to hopefully change his mind.Yet sitting alongside the patient and the interpreter, Toussaint saw crucial cultural interpretation in action. The interpreter, searching for an explanation, compared the laxative drink taken to prepare for the test to one commonly imbibed in Somalia. A lightbulb went off, Toussaint said.“Once we started talking about that drink and how it interacted as you drank it, it really gave the gentleman an understanding of preparing for a colonoscopy because he could contextualize it and relate to it,” she said. The interpreter drew pictures to explain when throughout the day the patient should drink the laxative. The patient took those home with him, and pledged to be back for the test later that week.Research has shown that attention to these kinds of details can make a real difference in health outcomes. A recent study looked at patients at Mass. General clinics who were on the fringes of the medical system either because they didn’t speak English, had missed a recent appointment, or were overdue for at least one routine cancer screening. Half of the 1,600 patients were assigned a navigator. At the end of the eight-month trial, those patients were nearly twice as likely to have had a cancer screening test as those without a navigator, the clinicians found.An expensive solutionAs of 2003, more than 200 US cancer care programs had navigators in place; experts estimate that number is now close to 500. And patient navigator programs are required at all 30 medical centers funded by the National Cancer Institute’s Community Cancer Centers Program.Outside of cancer medicine, however, navigators have been slower to catch on, said Sima Kahn, president of the National Association of Healthcare Advocacy Consultants and a former obstetrician-gynecologist who now works as a patient navigator.Kahn sees her new profession as an outgrowth of her old one — with a greater focus on patient advocacy. “Nurses and doctors have been advocating for family members our whole careers, and it was a piece I felt was getting cut out of medical care more and more.”Still, the concept has its critics. For one thing, navigators are expensive. It’s estimated that roughly 1,000 patients would need to be assigned health navigators to save a single life from cancer — and that costs valuable health care dollars.Another concern is that as more specialists and subspecialists join a patient’s medical team, navigators may risk complicating the system rather than simplifying it.For instance, a navigator may be mistaken for a medical professional by patients or family members. In those instances, “the person they ask has to be able to say, ‘I really don’t know the answer to that, but I will do my best to find out for you,’” said Carol Levine, director of the families and health care project at the United Hospital Fund in New York. “It’s about acknowledging that it’s a hard question and that the right person needs to answer it.” About the Author Reprints Related: Tags cancerhospitals By Allison Bond Jan. 4, 2017 Reprints [email protected] Learning to navigateIn many navigator success stories, the end goal is to become obsolete. With time, “patients become empowered and responsible for their own care,” Toussaint said.She remembers one patient who struggled to get radiation treatment for her breast cancer.The patient, who was originally from Honduras, spoke no English. Every week, Toussaint met with her to discuss the crucial logistics of her care, from how she would fit her daily treatments in alongside full-time work, to the best way to get to the cancer clinic.“I went to an appointment or two with her so she felt comfortable with how to get there,” Toussaint said. Together, they took the hospital shuttle from the community clinic to the cancer center, and Toussaint showed her how to find her doctor’s building and floor. Toussaint arranged door-to-door transportation to her appointments, and with a hospital social worker, finagled grocery coupons to offset the cost of travel. When the patient got lost or had questions about the timing of her ride, Toussaint was on the phone with her. Ultimately, the woman finished the full regimen of radiation treatment without missing a single session.Since then, Toussaint said, the patient has done well.“We are there to get them through, and they appreciate our help, but eventually they do not need us anymore.” There are only about 500 so-called patient navigators nationwide, but their visibility is growing. Some come to the job with medical training, but that’s not requisite — just as often the key qualification is a certain language or cultural expertise. Patient navigator Joanne Toussaint talks to a patient at the Chelsea HealthCare Center. Mass General Photo Departmentlast_img read more

23 Jun

NYC calorie rule scrutinized in courts of law, and science

first_imgHealthNYC calorie rule scrutinized in courts of law, and science At least three research analyses have said there’s no definitive proof it leads to lower-calorie orders for diners and eateries in general, though researchers involved note that they may not have captured small effects.Some scientists feel the research shows the policy falls short. Menu labeling “might not be the proper prescription,” Indiana University medical professor Dr. Aaron Campbell wrote in The New York Times in 2015.But some individual studies have found effects. Some Stanford University business professors’ 2010 examination of over 100 million Starbucks purchases found that menu postings trimmed the calories in customers’ orders by an average of 6 percent, from 247 to 232.In another example, a 2013 study in Seattle and surrounding King County found some calorie-cutting, though particularly by women and customers who said they took menu postings into account when ordering.While the overall evidence is mixed, “I think it’s still reasonable to say that among those who see and use the information, it is helpful to them — and why wouldn’t you want to give consumers information?” says University of Washington medical professor Jim Krieger, a co-author of the King County study. He also runs Healthy Food America, a food policy advocacy group. Trending Now: But plenty of opponents to the idea remain, including some who question its effectiveness. Low-calorie sweeteners don’t help with weight loss — and may lead to gained pounds About the Author Reprints Comparing the Covid-19 vaccines developed by Pfizer, Moderna, and Johnson & Johnson “What we haven’t seen so far is any sort of dramatic change in the number of calories purchased at the population level,” says Dr. Brian Elbel, a New York University health policy professor who co-authored a 2014 analysis of 31 studies on the subject, some of them his own. But “some people are definitely seeing and using this information.”The National Association of Convenience Stores cited some of that research when it sued to stop New York City from enforcing a retooled rule expanding the calorie labeling requirements to groceries and other small markets, saying the city was forcing businesses to spend thousands of dollars complying with a local rule when a national one is coming.On Friday, a Manhattan federal judge approved a deal among lawyers on both sides that ensures the city will not enforce the expansion before May. The agreement also ensures that calorie counts won’t disappear from chains that have posted them for years.“This addresses the most basic of needs — providing us with nutrition information to make healthful decisions at the time of decision-making,” spokeswoman Stephanie Buhle said this week.About 1 million New Yorkers see calorie data every day, according to Health Department research, and a 2011 Quinnipiac University poll found 79 percent of city voters found the information useful.But if it’s useful, do people use it? Related: Krieger and others have also done research that suggests some restaurants offer lower-calorie dishes after labeling requirements. And researchers note that calorie counts could have hard-to-measure effects, such as helping gradually shift eating norms and expectations.“It’s unreasonable to say, ‘If this one policy doesn’t reduce obesity, it’s a failure,’ because the chances any one policy will do that are incredibly small,” says Dr. Christina Roberto, a University of Pennsylvania health policy professor who’s worked on several studies on menu calorie counts.“We don’t even have the best data yet. And I think there are a lot of common-sense reasons to do it,” she says.— Jennifer Peltz NEW YORK — As a court fight simmers over New York City’s pioneering requirement for calorie counts on chain restaurant menus, scientists say the jury’s still out on whether giving people the numbers spurs them to eat healthier.The city says that by requiring eateries to tell people that their $4 cheeseburger will also cost them about 540 calories, it’s helping diners make informed choices in an era of rising obesity.New York City’s first-in-the-nation rule took full effect in 2008. It was copied by other cities and counties and a half-dozen states and became part of President Barack Obama’s 2010 health care overhaul. The repeatedly delayed federal regulation, which extends to grocery and convenience store chain menus, is now set to take effect next year.advertisement By Associated Press Aug. 26, 2017 Reprints Calorie counts on menus: Do they work? Related: Studies to date haven’t conclusively shown that restaurant-goers, on the whole, actually order lighter foods when the calorie tally is right there. It appears to influence some people, in some settings, and possibly restaurants’ recipes, researchers say.advertisement Information cards provide calorie counts for food items at a Whole Foods store in New York. Candice Choi/AP Associated Presslast_img read more

23 Jun

‘Right-to-try’ bill rejected by House, in major blow to GOP efforts

first_imgPolitics What is it? [email protected] By Erin Mershon March 13, 2018 Reprints Tags Congresspolicy Unlock this article — plus daily intelligence on Capitol Hill and the life sciences industry — by subscribing to STAT+. First 30 days free. GET STARTED Senior News Editor Log In | Learn More 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. What’s included?center_img ‘Right-to-try’ bill rejected by House, in major blow to GOP efforts 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. About the Author Reprints @eemershon GET STARTED WASHINGTON — In a major blow to the effort to pass a federal “right-to-try” law, House Republicans failed to muster the votes to pass a key compromise measure Tuesday.The legislation was rejected by a vote of 259-140. The bill needed two-thirds majority to pass under suspension of rules. Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee, was one of the main sponsors of “right-to-try” legislation. Chip Somodevilla/Getty Images Erin Mershonlast_img read more

23 Jun

Preventing PTSD: calling Dr. Tetris?

first_img Please enter a valid email address. Comparing the Covid-19 vaccines developed by Pfizer, Moderna, and Johnson & Johnson @shailijainmd By Shaili Jain May 14, 2018 Reprints The team recruited 71 individuals who survived motor vehicle crashes while they were still in the emergency department. Half of them were asked to think about the worst moments of the accident and then were asked to play Tetris for 20 minutes. The other half were asked to write down a log of what they had done since coming to the hospital.advertisement Shaili Jain Newsletters Sign up for First Opinion A weekly digest of our opinion column, with insight from industry experts. Privacy Policy The results, which were published in the journal Molecular Psychiatry, are promising. When compared to the log completers, participants who played Tetris were less likely to report post-trauma intrusive memories and related psychological distress in the week that followed their car accident.For centuries, prevention was an essential part of mental health care. By the mid-1950s, this approach was thriving. But in the ensuing decades, skeptical politicians, the changing role of psychiatrists, and the growing popularity of psychiatric medication pushed preventive psychiatry to the sidelines.This means that today, conversations about PTSD typically focus on treatment: better pills or more powerful talk therapies. Research into the cause of PTSD tends to focus on gene deletions, abnormal brain structures, and neurotransmitters gone awry.But doctors like me who work on the front lines of PTSD are feeling the limitations of that focus. Researchers from the University of Oxford tried to answer that question using an unusual prevention strategy — the computer game Tetris. Engaging in a visually absorbing task soon after surviving trauma could, they hypothesized, distract the brain and prevent it from over-consolidating those early visual memories of trauma. Shift in research funding. Funding agencies need to make a long term commitment to the research and development efforts that will be required to thoroughly test these innovations. Unfortunately, less than 5 percent of American health spending is on prevention. A tangible shift in the way we spend health care dollars will be needed for golden-hour interventions to earn a position on the frontlines of clinical care.Ethical concerns. Most people who experience a traumatic event do not develop PTSD. How, then, would we ethically determine who should receive a golden-hour intervention after trauma? A one-size-fits-all approach would clearly be an overreach. Another conundrum would be how to seek consent for a treatment to prevent a condition that a patient doesn’t yet have. Still, scientists won’t get the chance to engage in these important debates if golden-hour innovations never get to see the light of day. Reassuringly, the Tetris intervention offers a very favorable benefit-risk profile with very little chance of harm but a potentially considerable upside.PTSD is a pressing public health concern. In addition to the potentially devastating human suffering, people living with PTSD miss an average of four days of work per month, resulting in a loss of almost $3 billion dollars per year in productivity in the United States alone.In the end, the toll this condition takes in the United States and around the globe favors the argument that an ounce of PTSD prevention is truly worth more than a pound of cure.Shaili Jain, M.D., is a psychiatrist and PTSD specialist at Stanford University and the author of “Unspeakable: An Intimate Portrait of Posttraumatic Stress” (Harper, 2019).center_img Dom Smith/STAT Leave this field empty if you’re human: At any given moment in the United States, 6.3 million people are living with PTSD. Eighty percent of PTSD sufferers have at least one other psychiatric condition, typically depression, alcoholism, or drug abuse, and all carry a higher risk of death by suicide. Not only is PTSD difficult to live with, it also increases the risk for obesity, cancer, heart disease, and more.We have treatments that work. Symptom improvement has been reported in up to 60 percent of individuals with PTSD who engage in such interventions. Unfortunately, only one-third of people with PTSD receive such treatments. Left untreated for a year or more, their chances of being symptom free are drastically reduced.It’s understandable why the pendulum might be swinging back toward prevention. My fear is that preventive psychiatry’s comeback will fail if we don’t learn from the mistakes of the past. Here are three hurdles we need to overcome to successfully prevent PTSD in the 21st century.Solid evidence. Earlier attempts at prevention relied more on rhetoric and theory than sound evidence. This shaky scientific foundation led to the demise of such efforts. Fortunately, today’s preventive PTSD research is meeting a higher standard. The Oxford study joins a growing body of evidence that has been conducted with a level of scientific precision that was missing from prior preventive efforts. Other golden-hour interventions that show promise include hydrocortisone, delivered as a pill or an intravenous treatment; short-term opioids to aggressively reduce pain after physical trauma; and a modified prolonged exposure (the gold standard in talk therapy for PTSD) intervention for delivery within hours after a trauma. About the Author Reprints First OpinionPreventing PTSD: calling Dr. Tetris? Related: This drug has been used to treat PTSD symptoms. What happens when it fails a trial? Trending Now: Preventive psychiatry, a forgotten chapter in the history of mental health, is trying to make a comeback. One area in which it is being explored is post-traumatic stress disorder. This condition represents an excellent opportunity for prevention because of the so-called golden hours: the period between experiencing a traumatic event and the onset of PTSD. It represents a window of opportunity for medical intervention to set the brain on a path toward recovery.Consolidating memories is an essential function for the human brain. This process involves stabilizing memories and allowing them to ripen and mature. After a traumatic event, the consolidation process can go into overdrive, lending traumatic memories their unforgettable quality and allowing them to invade a survivor’s life, weeks and months later, in an intrusive and highly visual manner.Could disrupting memory consolidation in the golden hours prevent the onset of PTSD?advertisement Tags mental healthlast_img read more

23 Jun

Pfizer wins appeal against record price-gouging fine set by U.K. antitrust watchdog

first_img What is it? @Pharmalot Pfizer wins appeal against record price-gouging fine set by U.K. antitrust watchdog Spencer Platt/Getty Images By Ed Silverman June 8, 2018 Reprints 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. Pharmalot Columnist, Senior Writer Ed covers the pharmaceutical industry. Log In | Learn More 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. Ed Silvermancenter_img Tags drug pricinglegalpharmaceuticalsSTAT+ In a boost for Pfizer (PFE), a U.K. appeals tribunal ruled against an antitrust watchdog that had fined the big drug maker and a small generic company for alleged price gouging in connection with an epilepsy pill. As a result, the case was referred back to the U.K. Competition and Markets Authority for further consideration, although the agency may appeal the decision.Here’s the back story: In late 2016, the CMA had fined Pfizer and Flynn Pharma a record $113 million for deliberately exploiting their dominant market positions by jacking up the price of the epilepsy drug. In explaining the decision, the agency maintained the companies caused the U.K. National Health Service to unnecessarily pay “excessive” prices. Pfizer’s share of the fine was $106 million. Both companies had appealed. What’s included? About the Author Reprints Pharmalot Unlock this article by subscribing to STAT+ and enjoy your first 30 days free! GET STARTED [email protected] GET STARTEDlast_img read more

23 Jun

They’re the next new thing in cancer immunotherapy, but will bispecifics help more patients than CAR-Ts?

first_imgPharma Illustration of a BiTE, Amgen’s bispecific antibodies Amgen Log In | Learn More 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 [email protected] By Sharon Begley Feb. 27, 2019 Reprints About the Author Reprints Unlock this article — plus daily coverage and analysis of the pharma industry — by subscribing to STAT+. First 30 days free. GET STARTED What’s included?center_img What is it? @sxbegle Tags biotechnologycancerdrug developmentSTAT+ They’re the next new thing in cancer immunotherapy, but will bispecifics help more patients than CAR-Ts? Senior Writer, Science and Discovery (1956-2021) Sharon covered science and discovery. 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. In cancer immunotherapy these days, technology is advancing so fast that 2017’s buzzy new treatment may soon be passe: Only 18 months after approval of the first CAR-T, pharmaceutical companies and biotechs are already talking about next-generation cancer therapy.Called bispecific antibodies, they’re being developed by some two dozen companies large and small, with a version cleverly branded as BiTEs already constituting 60 percent of Amgen’s oncology pipeline. The appeal: Bispecifics make the immune system kill tumor cells like first-gen immunotherapy, but, unlike the weeks it takes to laboriously manufacture CAR-Ts, they can start being infused almost as quickly as an oncologist can write a prescription. Sharon Begleylast_img read more