Can we ‘cure’ aging? Scientists disagree

first_img In the 1960s, Hayflick found that human cells divide only 40 to 60 times, after which they stop — even when their division is paused and then allowed to resume. This discovery, called the Hayflick Limit, indicates that even if a drug like metformin were effective at suspending aging, the end game stays the same.Aging is normalDr. Jonathan Flacker, an internist in geriatrics at Emory University Hospital in Atlanta, said aging is simply not the same as an illness.“A disease is something not normal that some people get but not everybody gets,” he said. “The implication is that aging is abnormal and something nature didn’t intend.”Flacker is not terribly impressed with age-slowing drugs like metformin, either.“We’ll see,” he said. “The mechanisms that control aging are very fundamental and I think it likely that in trying to modify those pathways there will be some significant unanticipated consequences, but that’s why we have such studies in the first place.” While there is no formal campaign to add aging to the official list of diseases, new medical discoveries have opened the discussion. For instance, after studies showed that metformin, a common diabetes drug, could extend lifespan in rodents, researchers went to the federal Food and Drug Administration in June and won approval for human trials of the drug’s anti-aging properties.But there’s no assurance that the FDA would approve an anti-aging drug, even if the clinical trials are positive. The agency has never allowed such a drug on the market, because aging hasn’t been designated as a condition needing treatment.advertisement Experts interviewed by STAT differ on whether aging should be viewed as a disease, the extent to which it’s treatable — and whether doing so can help people live longer. Here’s what they had to say.Aging is a diseaseBiophysicist Alex Zhavoronkov believes that aging should be considered a disease. His company, Baltimore-based Insilico Medicine, Inc., is working on technologies around drugs to treat age-related illnesses. Zhavoronkov said that describing aging as a disease creates incentives to develop treatments. By Leah Samuel Dec. 29, 2015 Reprints Related: New medical discoveries have opened the discussion about whether aging should be added to the World Health Organization’s official list of diseases. Sebastien Bozon/AFP/Getty Images Hillary Clinton proposes funding surge to help cure Alzheimer’s by 2025 HealthCan we ‘cure’ aging? Scientists disagree Related: A progress report: Fighting the deadliest diseases, one step at a time Related: “It unties the hands of the pharmaceutical industry so that they can begin treating the disease and not just the side effects,” he said.“Right now, [people] think of aging as natural and something you can’t control,” he said. “In academia, people take aging research as just an interest area where they can try to develop interventions. The medical community also takes aging for granted, and can do nothing about it except keep people within a certain health range.”But if aging were recognized as a disease, he said, “it would attract funding and change the way we do health care.”Aging can be curedAubrey de Grey also advocates going after aging itself. He is chief science officer for the SENS Research Foundation, which conducts and funds research on regenerative medicine.“I don’t actually say aging is a disease,” he said. “Aging is bad for you, it’s a medical problem, but that’s just language.”What matters, de Grey added, is understanding that aging is curable.“It was always known that the body accumulates damage,” he said. “The only way to cure aging is to find ways to repair that damage. I think of it as preventive medicine for age-related conditions.”De Grey added that he is intrigued by the skepticism he finds.“It’s a curious thing, ” he said. “If you fix one disease of aging, that’s wonderful. If you fix two diseases, that’s wonderful.”Our lifespan is limitedLeonard Hayflick, a professor of anatomy at the University of California, San Francisco, said the idea that aging can be cured implies the human lifespan can be increased, which some researchers suggest is possible. Hayflick is not among them.“There are many people who recover from cancer, stroke, or cardiovascular disease. But they continue to age, because aging is separate from their disease,” Hayflick said. He added that even if those causes of death were eliminated, life expectancy “would still not go much beyond 92 years.”  Patients aren’t told that death is near until too late. We can do better Aging happens to all of us, and is generally thought of as a natural part of life. It would seem silly to call such a thing a “disease.”On the other hand, scientists are increasingly learning that aging and biological age are two different things, and that the former is a key risk factor for conditions such as heart disease, cancer, arthritis, Alzheimer’s disease, and many more. In that light, aging itself might be seen as something treatable, the way you would treat high blood pressure or a vitamin deficiency.Those two are in the current International Classification of Diseases (ICD), a manual published by the World Heath Organization — but aging is not. The next revision of the manual is due out in 2018.advertisement Tags agingFDAgeriatricslast_img read more

The science behind Steph Curry’s knee injury — and what it means for the NBA Finals

first_imgHealthThe science behind Steph Curry’s knee injury — and what it means for the NBA Finals Please enter a valid email address. More sports teams embrace cryotherapy, freezing players to improve play By Dylan Scott June 2, 2016 Reprints The other factor is not physical, but mental. Petschauer and Landel testified to working with athletes who couldn’t get over the emotional toll of an injury — the fear that their next move could put them back on the trainer’s table.“They have an awareness of their body that we do not have,” Petschauer said.After an MCL injury, when the knee can bend side to side in a way that it wouldn’t when healthy, Landel said: “Patients get a queasy feeling in their stomach when it happens.”“You can imagine if you went up for a jump shot or a layup, you’re thinking, ‘I wonder if I’ll be able to land,’” he said. “You’re not thinking about putting the ball in the bucket.”Adding to the intrigue around Curry’s injury is his decision to get what’s known as platelet-rich plasma treatment to help speed his recovery. It is a treatment that has been tried by other professional athletes eager to get back on the court or field as quickly as they can — even if the science proving its effectiveness is still in its infancy.It involves withdrawing a patient’s own blood and separating out what are called platelets, which are primarily responsible for clotting blood but also contain growth proteins that support healing. A concentrated dose of the platelets is then injected into the injured area.The treatment has been around for a couple decades, but has gained attention in recent years after reports that athletes including Tiger Woods and Rafael Nadal (and now Curry) have turned to it to speed up their recovery. What’s normal for the abnormal? A close look at NBA players’ hearts Related: For a player like Curry, the MCL is a particularly important ligament, and one of the treatments he sought for his injury remains, well, scientifically unproven.(Full disclosure: The author is a Cleveland Cavaliers fan. Other STAT team members root for the Warriors.)advertisement The MCL is one of four ligaments connecting the femur bone to the tibia at the knee. It helps keep the knee stable as it moves from the outside to the inside.So the lateral movements that allow a twitchy dribbler like Curry to get past the guy guarding him and go to the rim or to juke a defender to open up a shot are going to put pressure on the ligament.“His injury was mild on the sprain scale, but, because of what he does, it ends up having a huge impact on what he does and what he can do,” said Rob Landel, a professor of clinical physical therapy at the University of Southern California.Athletic trainers refer to what’s called a “valgus” position — that’s when the knee is turned inward toward the center of the body, and the MCL stretches to keep the joint stable.Most people naturally stand in a slight valgus position, meaning they are putting a little pressure on their MCL without even trying. Playing basketball just adds to that stress, especially during the quick movements that guards like Curry rely on.“That valgus position occurs pretty often in basketball,” said Meredith Petschauer, an exercise and sports science professor at the University of North Carolina at Chapel Hill, “because what you have to do in basketball all the time is plant your foot and turn in a different direction.”You can see it in the abundant clips of Curry dribbling past defenders trying to stay in front of him. As he plants and suddenly swings the ball from one hand to the other, his knee bends accordingly and the MCL flexes.“With a crossover dribble, trying to get a guy to go one way and quickly change direction and go the other way, that kind of lateral move will likely stress it,” Landel said.Many essential parts of playing basketball put demands on the MCL — stuff as simple as jumping and landing.“There’s always a tendency in all of us, when you land from a jump, to put valgus stress on the knee,” said Dr. Lyle Micheli, director of the sports medicine division at Boston Children’s Hospital and an orthopedics professor at Harvard Medical School.Or there’s the basic physical contact that comes with playing tough defense and setting screens — if your feet are planted and somebody pushes you, the MCL is likely to bear the brunt of keeping you steady.“When you’re colliding with other people, you can get pushed into that valgus position as well,” Petschauer said. “It’s the most common position to get pushed into.”center_img Related: When the NBA Finals start Thursday, the pressure will be on, among other things, Steph Curry’s knee.The Golden State Warriors have other great players on their roster, but Curry is the best — the reigning league MVP and the best shooter of his generation. So the only thing that a team that just played the best regular season in NBA history might have to worry about is their point guard’s medial collateral ligament.Curry sprained the MCL in his right knee when he slipped awkwardly in a first-round game against the Houston Rockets. And although he returned to play in the next round, speculation persisted that his MCL might be holding him back. It could be one of the few X factors in the finals outside the Xs and Os when the Warriors face off against LeBron James and the Cleveland Cavaliers.advertisement Stephen Curry sprained the MCL in his right knee during a first-round playoff game against the Houston Rockets. Thearon W. Henderson/Getty Images Tags NBAsports medicineSteph Curry Leave this field empty if you’re human: Science, though, hasn’t definitively demonstrated its usefulness yet, according to the experts.“It’s just in its infancy in terms of scientific validity,” Micheli said. “To really know whether it’s valid, you’ve got to do big, double-blind studies. That kind of research has not been done.”Nonetheless, he said some physicians at his clinic have used the treatment. Because patients don’t appear to experience any negative side effects, the risk is deemed low.At the same time, especially for pro athletes like Curry, the upside of getting back into the game even just a few days sooner “makes all the difference in the world,” as Micheli put it. That potential benefit, paired with their ability to pay for a procedure that an average person’s insurance might consider experimental, likely helps explain its popularity with the pros.“There’s kind of a: ‘Well, why not?’” Landel said. “Athletes are looking for any advantage they could possibly get.” Newsletters Sign up for Daily Recap A roundup of STAT’s top stories of the day. Privacy Policylast_img read more

NIH rejects petition to override patent on pricey prostate cancer drug

first_imgHowever, the NIH denied the petition because there was no information to suggest that Xtandi is or will be in short supply, according to a letter sent on Monday by NIH Director Dr. Francis Collins to Knowledge Ecology International, one of the consumer groups. The agency, which has rarely granted such petitions, noted that the litmus test used in one previous case was whether there were sufficient supplies of the medicine for which a petition was sought. About the Author Reprints NIH Director Dr. Francis Collins Paul Morigi/Getty Images Ed Silverman PharmalotNIH rejects petition to override patent on pricey prostate cancer drug Please enter a valid email address. Leave this field empty if you’re human: At the time, Burwell noted such decisions are made on a case-by-case basis. The NIH previously considered using its march-in authority concerning drug pricing in 2004 and 2013, but determined statutory requirements were not met. Two of those instances involved the Norvir AIDS medicine that was marketed by Abbott Laboratories — now owned by AbbVie — and the Xalatan glaucoma treatment sold by Pfizer.In response, several lawmakers, including presidential aspirant Bernie Sanders, said they would seek a hearing about NIH use of march-in rights, but that never took place. Privacy Policy [email protected] NIH asked to fight price gouging by overriding drug patents Tags cancerdrug pricesNIH After five months of deliberation, the US National Institutes of Health on Monday rejected a request by several consumer groups to override the patent on a prostate cancer drug because the medicine is more expensive in the United States than elsewhere. And one of the consumer groups plans to seek an appeal.Last January, the groups petitioned the NIH to take this step, which is known as a march-in right, to help US patients because federally funded research was used to create Xtandi. The drug is sold by Astellas Pharma and has an average wholesale price in the United States of more than $129,000, about two to four times more than what other high-income countries are paying, according to the consumer groups.Under federal law, a march-in right allows an agency that funds private research to require a drug maker to license its patent to another party in order to “alleviate health and safety needs which are not being reasonably satisfied” or when the benefits of a drug are not available on “reasonable terms.” The drug was developed at the University of California, Los Angeles, with grants from NIH and the US Department of Defense. The school licensed the drug to Medivation, which struck a marketing deal with Astellas.advertisementcenter_img Related: The consumer group plans to submit an appeal to US Secretary of Health and Human Services Sylvia Burwell and said it will base its appeal on the NIH’s “flawed legal rationale” about the use of march-in rights and “its lack of analysis concerning its refusal to use a royalty-free license.” The group added that it plans to refile this case after a new president takes office next year if the HHS declines its appeal.As part of its effort, Knowledge Ecology two months ago solicited Biolyse, a small Canadian drug company, to make Xtandi. The drug maker maintained it could supply a version for $3 per 40-milligram tablet, compared with the $69.41 that Medicare paid in 2014. Biolyse hoped to be able to supply its version in three years. We left word with a company spokesman and will pass along any reply.An Astellas spokesman wrote us to say that the company is “pleased that the NIH has concluded that Xtandi is broadly available to patients, and we are committed to continuing our work with our diverse stakeholders to provide patients with affordable access to our medicines.”The rejection is not a surprise, though.Two months ago, the Obama administration rejected a request from dozens of congressional Democrats, who call themselves the Affordable Drug Pricing Task Force, to develop guidelines that would require drug makers to license their patents and put a lid on “price gouging.” They argued the NIH should be more aggressively granting march-in rights in light of the high price of medicines. @Pharmalot Newsletters Sign up for Pharmalot Your daily update on the drug industry. In a statement, the consumer groups argued the NIH “did not evaluate evidence provided that Astellas charges US residents prices that are far higher than those available to non-US consumers, and that price discrimination against US residents is not consistent with making the product ‘available to the public on reasonable terms,’” as required by federal law.advertisement Related: Pharmalot Columnist, Senior Writer Ed covers the pharmaceutical industry. They also maintained the NIH failed to address evidence that “the unreasonably high price for Xtandi limits patient access, places the drugs on restrictive formularies, causes strain to health care budgets, and requires patients to pay unreasonably high coinsurance and copayments,” all of which justify the use of march-in rights.They added that the NIH ignored its ability to issue a nonexclusive, royalty-free license to allow Xtandi to be manufactured for use by the federal government. Knowledge Ecology legal and policy counselor Andrew Goldman said there is no precondition about supplies and the NIH is wrong to assert that there is no limit on “excessive pricing” in order to grant a march-in right.“This is contrary to the legislative intent of the law, and sends a terrible signal about the government’s willingness to confront the high drug prices through available legal mechanisms,” he said. Supreme Court’s ruling in patent case a blow to drug industry By Ed Silverman June 20, 2016 Reprintslast_img read more

CVS slashes price of substitute EpiPen auto-injectors to $109.99

first_img CVS Health announced Thursday morning that it has cut the price of two-packs of epinephrine auto-injectors to $109.99 — roughly the price that brand-name EpiPen shots were selling for eight years ago, before their escalating price became a hot political issue.A CVS Health spokesperson said that the pharmacies used to sell these products for about $200 a two-pack, and that the price cut was motivated by customers angry with the high price of epinephrine auto-injectors, which are used to quell severe allergic reactions. A press release cites “millions” of individuals who took to social media looking for a solution.The products that CVS Health is selling for such a low price are the authorized generic Adrenaclick auto-injectors. Meanwhile, it is selling the generic EpiPens for $339.99, and the brand EpiPens for $649.99.advertisement This announcement comes the day after President-elect Donald Trump declared at a press conference that drug companies are “getting away with murder” and that the government needs more power to be able to negotiate prices. Related: HealthCVS slashes price of substitute EpiPen auto-injectors to $109.99 By Ike Swetlitz Jan. 12, 2017 Reprints State Medicaid programs and big insurer drop EpiPens in favor of generics center_img Justin Sullivan/Getty Images Tags drug pricingpharmaceuticals Some state Medicaid programs and the large private insurer Cigna have recently changed their policies, making it easier for patients to get generic auto-injectors and harder for them to get the brand-name products.advertisement CVS Health said that the $109.99 price is available to anyone who walks into the pharmacy.Commercially insured patients are eligible to receive $100 off that price via a manufacturer coupon, potentially lowering their cost to $9.99.Mark Donahue, vice president for investor relations and corporate communications at Impax Laboratories, which markets the generic Adrenaclick, said that the arrangement with CVS has been in the works for several weeks. Impax is selling the auto-injectors directly to CVS, without a middleman wholesaler.Donahue said that Impax primarily works with wholesalers, but that it is able to work directly with some large pharmacy chains to sell them certain products like this. He did not comment on whether cutting out the middleman allows Impax to sell the auto-injector for a lower price. He declined to disclose how much they are charging CVS for the auto-injectors, but said that it is “obviously less than the WAC price,” which currently sits around $400.Mylan, which markets the EpiPen and its generic, did not immediately respond to a request for comment.last_img read more

Q&A: Craig Venter’s discounted genome sequencing — now at $7,500

first_img GET STARTED What’s included? 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. 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. [email protected] @megkesh What is it? Biotech Correspondent Meghana covers biotech and contributes to The Readout newsletter. About the Author Reprintscenter_img Unlock this article — plus daily market-moving biopharma analysis — by subscribing to STAT+. First 30 days free. GET STARTED Tags diagnosticsgeneticsSTAT+ Meghana Keshavan By Meghana Keshavan May 11, 2017 Reprints Business Matt Houston/AP J. Craig Venter’s outfit Human Longevity is offering a pared-down version of its signature Health Nucleus program — an extraordinarily in-depth physical exam priced at $25,000.The newer pilot, dubbed Health Nucleus X, will be offered at a discounted $7,500. It offers whole genome sequencing, some lab tests, and a full-body MRI scan — with an add-on microbiome analysis for another $500. Q&A: Craig Venter’s discounted genome sequencing — now at $7,500 last_img read more

VA plans mental care for discharged vets, but at what cost?

first_img VA plans mental care for discharged vets, but at what cost? Log In | Learn More Associated Press About the Author Reprints 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. What’s included? VA Secretary David Shulkin Andrew Harnik/AP GET STARTED By Associated Press May 24, 2017 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. Politics Unlock this article by subscribing to STAT+ and enjoy your first 30 days free! GET STARTED WASHINGTON — Veterans Affairs Secretary David Shulkin touted new efforts Wednesday to expand urgent mental health care to thousands of former service members with less-than-honorable discharges, even while acknowledging his department isn’t seeking additional money to pay for it.Testifying at a House hearing, Shulkin offered new details on his initiative announced in March to stem stubbornly high rates of suicide. Stressing a need at that time for “bold action,” he noted the additional coverage would help former service members who are more likely to have mental health distress. Of the 20 veterans who take their lives each day, about 14 had not been connected to VA care. What is it? Tags Congressmental healthpolicylast_img read more

Rays of hope: light therapy through the ages

first_imgHealthRays of hope: light therapy through the ages The science behind the infrared saunas sweeping Hollywood Smoothing blemished skinDoctors have long used forms of near-infrared, ultraviolet, and laser therapy to treat skin conditions. It’s an easy sell to patients who feel disfigured by conditions like cystic acne, psoriasis, eczema, vitiligo, and skin lesions. To this day, light therapy is marketed as an outpatient treatment for many dermatological woes.Somewhere along the way, though, marketers got the idea that they could sell light as having broader beautifying effects. Beauty Angel, a company based in Germany, boasts that standing inside one of its infrared light machines makes you pretty by building up collagen, reducing fine lines, and softening the skin. Small studies have found some improvements in the skin appearance of healthy patients exposed to various light therapies (including LED lights and infrared diode treatment).But when celebrities claim that relaxing in an infrared sauna can rejuvenate cells and flush out toxins, they’re way overselling the science. The treatment became less common after 1932, when the U.S. began adding vitamin D to milk. Doctors also realized that it actually doesn’t take much sun to get enough vitamin D, as long as there’s some skin exposure.advertisement Strengthening fragile bonesBeginning in the late 1800s, it wasn’t unusual to go to a hospital and see small groups of children and babies, wearing little more than protective goggles, sitting around under or in front of what was essentially a giant sunlamp. The ultraviolet light was meant to treat a condition called rickets, which causes the bones to soften. In the most severe cases, children with rickets develop bowed legs. The condition is caused by a severe vitamin D deficiency; doctors thought high doses of ultraviolet light would help by spurring the children’s bodies to synthesize vitamin D. And there’s some anecdotal evidence that it did make a difference. Improving mental healthIt’s debatable whether light therapy can make you look good, but studies show that it can make you feel good — or better, anyway. Recent studies provide evidence that light therapy can improve symptoms of depression in college students, pregnant women, and other adults. A 2016 study found that even among patients already taking antidepressants, those who added bright light to their regimen found more relief.There’s now a whole market for “light therapy” boxes to treat seasonal affective disorder (depression that surfaces in the low-light seasons of fall and winter). They sell for anywhere from $25 to $300. Comparing the Covid-19 vaccines developed by Pfizer, Moderna, and Johnson & Johnson Trending Now: By Leah Samuel Aug. 3, 2017 Reprints A group of children wearing goggles sits in front of large reflecting lamps at the Institute of Ray Therapy. Fox Photos/Getty Images Tags mental healthwellness It was an arresting image: Four children, wearing black masks to protect their eyes, sitting in front of large lamps. The caption placed them at London’s Institute of Ray Therapy, which opened in 1930.The old photo got us thinking about light therapy, then and now. A hundred years ago, it was all the rage; in addition to the Institute of Ray Therapy, London also boasted a Municipal Sunlight Clinic. The concept seems to be coming back in vogue now; celebrities from Jennifer Aniston to Lady Gaga have been touting the benefits of sweating it out under infrared lights in a steamy sauna.A little digging through old medical journals (and, yes, modern search engines) turned up an array of therapies based on artificial light. Here, some of our favorites uses for the humble lamp:advertisement Related:last_img read more

How bankers and doctors can collaborate to detect ‘early warnings’ of Alzheimer’s

first_imgFirst OpinionHow bankers and doctors can collaborate to detect ‘early warnings’ of Alzheimer’s By Jason Karlawish Dec. 12, 2017 Reprints These age-related financial challenges often coincide with the emergence of troublesome health events, particularly age-related declines in memory and thinking skills. They put older adults at risk of needing long-term care and of being vulnerable to financial fraud, exploitation, or their own financial errors. Once money is lost, a cognitively impaired adult can’t go back to work. Someone else — the family or the state — has to step in to pay. Related: Newsletters Sign up for First Opinion A weekly digest of our opinion column, with insight from industry experts. Banking and medicine have little in common. One is for creating and managing wealth, the other for managing health. Yet together they could help detect and fight the growing burden of Alzheimer’s disease and related dementias. I call this partnership of banking and medicine whealthcare.Thanks to decades-long advances in personal and public health, the average 65-year-old American can expect to live another 19 years. This remarkable progress presents a challenge: Many people might not have enough money to live that long.The monthly pension check has gone the way of the electric typewriter and calculator. Retirement funds, if we have any — half of American families have saved less than $5,000 for retirement — are ours to manage, and we really need that cash to pay for our living expenses and most of our long-term care. Aging Americans are also taking on more debt, such as their children’s and grandchildren’s student loans. Since 1992, the proportion of Americans 75 and older carrying debt has increased from one-third to one-half.advertisement Privacy Policy APStock It’s a problem I see often in the care of my patients.Arthur Packel lost much of his family’s fortune before his wife, Renee, brought him to the Penn Memory Center, where I diagnosed him with Alzheimer’s disease. Joseph Donahue is participating in a study I’m running to test a drug to reduce his risk of developing Alzheimer’s disease. He realized that while he’s actively managing his retirement funds, such as trading equities, he has no system set up to detect an error in these transactions or his other financial transactions.Our day-to-day use of our money provides signals of brain function that can be far more real-world and meaningful than the results of online cognitive tests and brain scans. This is where the banking and financial services industries can help achieve our national “moonshot” goal of preventing Alzheimer’s disease by 2025.In the pencil, paper, and dial-up telephone days, tracking a family’s finances over multiple institutions was a challenge, even for individuals whose brains were healthy. Today, it’s been made easier by volumes of financial data that can be rapidly aggregated and analyzed, along with automated communication of real-time alerts.At the conference, participants discussed how the banking and financial services industries could provide Alzheimer’s “early warnings” using a system that sees older adults’ health as enmeshed in the maintenance of their wealth. Such as system could adopt tried-and-true methods of public health: surveillance, monitoring, and intervention. Related: ‘Type 3 diabetes’: New links emerge between poor glucose metabolism and Alzheimer’s disease “This is a set of circumstances ripe to balloon,” said Patrick Harker, president of the Federal Reserve Bank of Philadelphia, in his opening address at “Aging, Cognition and Financial Health: Building a Robust System for Older Americans,” a two-day conference hosted by the bank in collaboration with the Penn Memory Center, which I co-direct. The problem isn’t just a money problem, he explained, it’s one that affects the health and well-being of older adults and their families.advertisement Please enter a valid email address. Jason Karlawish Leave this field empty if you’re human: Most people spread their funds across multiple institutions. Scammers know this and so adeptly steal a little bit here and a little there. A recurring question was how to get one financial institution to talk to another.Larry Santucci, senior industry specialist at the Federal Reserve Bank of Philadelphia, offered an answer. He closed the conference describing a visionary proposal for a federally operated system that collects alerts from across financial institutions. Bankers, brokers, and doctors like me could use this “eldernet” to identify problems before they spread like a cancer throughout a person’s accounts.That’s the vision of whealthcare.Jason Karlawish, M.D., is a professor of medicine and medical ethics at the University of Pennsylvania and co-director of the Penn Memory Center. In the search for Alzheimer’s drugs, researchers must look beyond beta amyloid @jasonkarlawish A representative from EverSafe, a financial technology company, demonstrated how financial data across accounts can be aggregated and analyzed, and how the company can send out automated alerts when an account has an unusual transaction suggesting fraud or error. With such a system, Renee could have learned about her husband’s problem the first time he forgot to pay a bill. Joseph could continue to manage his accounts knowing that a mistake would be detected and that would be alerted — along with his doctor and other trusted advocates.Casey Greene, a Penn professor and expert in machine learning, showed how we could benefit from studying health and wealth data with the same methods he uses to study genetic and other biological data. Financial information such as credit card purchases and ATM use, as well as voice records from call centers and medical records, could be subjected to methods that learn and predict who’s likely to experience cognitive decline or become a victim of fraud.Technology, of course, is only as good as the people who use it. The financial services industry is built on trust, and trust is about human interactions. The conference discussed how interactions between brokers and their clients are set to undergo a big change in 2018. Just as doctors must ask their patients for the name of an emergency contact and call that person in the event of an emergency, the Financial Industry Regulatory Authority’s rule 4512 mandates that brokers and dealers ask for similar contacts. This requires brokers and dealers to have the kinds of breaking-bad-news and planning-for-the-future conversations that I train medical students and residents to have. [email protected] About the Author Reprints Tags agingdementiafinancemental healthlast_img read more

Doctors like me are at a loss when parents can’t agree on their child’s treatment

first_img Privacy Policy Newsletters Sign up for First Opinion A weekly digest of our opinion column, with insight from industry experts. Christopher Hartnick In Jasper’s case, I knew what the right course of action was: He needed a tracheostomy. So I improvised an approach to counseling Mitch and Kelly. I advised them to switch roles and let Mitch care for Jasper for a few nights, even if that meant taking a few days off work. That way, he could experience what Kathy was experiencing. Finally, I told them that there was no “right” answer here, and they ultimately had to make the best decision they could, and live with the consequences.I don’t know if that exercise made the difference, but they came back to me a week later and told me that they wanted Jasper to have a tracheostomy. I performed the surgery, and Jasper did just fine. Kathy and Mitch took him home, and they suffered through a year of vigilant care. Then, when Jasper had grown out of his laryngomalacia, I removed the plastic tube. Today, he is breathing by himself, and the small scar on his neck is barely visible.I recently asked Kathy and Mitch what my team and I could do to help other parents who disagree with one another in the face of difficult decisions. Kathy’s reply stays with me: “Doctors, please, have patience with us. When we ask the same question over and over, know that it’s not because we haven’t paid attention. It’s because we can’t agree — and are terrified. We are in shock. Help us.”It’s only natural that parents disagree now and then about the treatment for their child’s condition, just like they disagree about discipline, schooling, and screen time. But the stakes are higher. The more tools doctors like me can utilize to help them reach consensus — like if the American Academy of Pediatrics issued mediation guidelines — the better off the children, and their parents, will fare.Christopher Hartnick, M.D., is a professor at Harvard Medical School and director of the Pediatric Otolaryngology Division at Massachusetts Eye and Ear Infirmary. All views represented in this article are those expressly of the author himself. Some details of the case have been changed. Tags hospitalspatientsphysicians Leave this field empty if you’re human: Kathy and Mitch now faced the agonizing choice of whether to have me perform a tracheostomy. Having spoken with other mothers whose children had needed the procedure, Kathy believed that this was best for Jasper. She was exhausted, and she couldn’t take any more nerve-wracking, sleepless nights. “I’m just scared,” she said. “Everything in me tells me something’s wrong.”Mitch vehemently disagreed. “How do we know he won’t get better on his own soon?” he asked. “When he’s not struggling to breathe, he’s just fine.” He nodded at his wife. “She’s catastrophizing!”In Mitch’s defense, during the day, when he spent the most time with Jasper, his son’s breathing did seem slightly better. Mitch wanted to give Jasper more time before having me perform such an invasive surgery. He just couldn’t believe we’d run out of options.Mitch and Kathy had been having this same conversation for days now. As I sat with them, attempting to steer them toward agreement, I didn’t quite know what to say. In my past experience, parents who disagreed at first about their child’s treatment did always reach a consensus. Yes, I’d encountered divorced parents who just couldn’t agree, but on those occasions, I’d left it to our legal department to hash it out. Here, for the first time, I faced a married couple who, despite their best efforts, just couldn’t come to a decision.Medical school didn’t offer any training on mediation, though I did learn early on about the concept of informed consent — how important it is for patients to understand the tests and procedures being performed, and to have a chance to have their questions answered. But in the pediatric arena, the process of informing is muddy. The law requires that only one parent consent to a test or procedure on a minor. When doctors obtain consent, they almost always obtain a single parent’s consent, and assume that his or her partner agrees Please enter a valid email address. First OpinionDoctors like me are at a loss when parents can’t agree on their child’s treatment By Christopher Hartnick April 6, 2018 Reprints Related: Jasper’s condition had worsened, despite two previous attempts at surgical repair. Each night, he struggled to eat. Each bottle feed, which takes 10 minutes at most for a baby who is breathing normally, took 45 minutes. Kathy was staying up all night with her son, terrified that he would stop breathing altogether. Jasper hadn’t gained a pound in two weeks — an ominous sign, what we in the pediatric world call “failure to thrive.” Caring for the caregiver in the emergency department About the Author Reprints Many infants will outgrow laryngomalacia, their breathing improving within the first 18 months of life as their cartilage matures and the strange sounds dissipate. Roughly 5 to 10 percent of infants require surgical repair, since their breathing is so strained that it interferes with their ability to eat. Of these children, a very few don’t respond to the repair. These infants need a tracheostomy, in which a surgeon cuts a hole in their neck and places a small, hollow plastic tube below their voice box so they can safely breathe. Once the airway matures, the surgeon can then remove the tube, and, in most cases, the child can go on to live a normal life.A tracheostomy is a fairly routine surgery in technical terms, requiring only about four or five minutes to complete, but it wreaks havoc on families. Parents have to learn how to care for the plastic tube in their child’s neck. They must suction it, clean it several times a day, and change it every two weeks. If the tube becomes plugged, the child could suffocate and die.advertisement Adobe Kathy sat quietly before me in one of our pediatric exam rooms, dabbing tears from her eyes. Beside her sat her husband, Mitch, his right hand clenched so hard that his fingers had gone white. Jasper, their 3-month old son, lay swaddled in Kathy’s arms, struggling to breathe, the veins on his tiny neck bulging with each desperate inhalation. (The family’s names have been changed for privacy.)The silence between Kathy and Mitch was palpable, and it was obvious that they were somehow at odds.Days after Jasper’s birth, I had diagnosed him with laryngomalacia, a congenital condition in which the structures of the voice box become too soft, flopping over the airway opening and jamming it up. Children with this condition produce a haunting sound when they inhale as the excessively soft cartilage in their voice box collapses.advertisement [email protected] last_img read more

First phage therapy center in the U.S. signals growing acceptance

first_imgIn some ways, the Center for Innovative Phage Applications and Therapeutics simply gives a name — and $1.2 million — to an institute that already exists. After word got out that Strathdee and her husband’s doctors had managed to save his life with a bacteriophage — literally, a bacteria-eater — her inbox filled with pleas for a repeat performance. They came from all over: the U.S., the U.K., Australia, India, China, Albania. In almost every case, there was someone dying because of antibiotic-resistant bacteria. Viruses that had specifically evolved to kill those microbes might be able to help. “Trust me, at the Eliava, we have tried to convince people that phages are a safe and good alternative to antibiotics for many years,” said Mzia Kutateladze, the director of the Eliava Institute. “Finally the people agreed to use it, and we are very happy, of course.” She estimated that Eliava’s phage therapy center gets around 15 to 20 Americans every year.“There really is, thankfully, some momentum building … around these non-traditional therapies,” said Dr. Helen Boucher, an infectious disease specialist at Tufts Medical Center in Boston, who is not involved with the UCSD project. “I would think of this more in a high-risk, high-reward category. This is largely uncharted territory. … At the end of the day, if you have a product that can work against antibiotic-resistant organisms that isn’t antibiotics, that would be huge.”The news that her brainchild had been funded took Strathdee by surprise in late May. She was at a ceremony for UCSD professors with endowed chairs, at which all of them received medals. “The chancellor’s literally putting the medal around my neck, and he said, ‘Hey, I just sent you some money today,’” she recalled.The new center will collaborate with companies such as AmpliPhi Biosciences and Adaptive Phage Therapeutics to treat future patients. Some of them will have cystic fibrosis, which causes mucus in the lungs to be overly sticky, often allowing drug-resistant microbes to proliferate. Others might have long-term infections that are preventing them from getting organ transplants. Yet others will have implanted devices, which sometimes provide the nooks and crannies where bacteria can grow into a slimy film.“The sad thing is that there is going to be no shortage of patients,” said Strathdee. Tags infectious diseasevirology Related: Bacteriophage are viruses that infect bacteria. David Gregory & Debbie Marshall/ Wellcome Collection HealthFirst phage therapy center in the U.S. signals growing acceptance A patient’s legacy: Researchers work to make phage therapy less of a long shot Related: [email protected] Comparing the Covid-19 vaccines developed by Pfizer, Moderna, and Johnson & Johnson To save a young woman besieged by superbugs, scientists hunt a killer virus General Assignment Reporter Eric focuses on narrative features, exploring the startling ways that science and medicine affect people’s lives. The announcement is also symbolic of a wider shift. With the rise of antibiotics in the 1930s and ’40s, phages went out of fashion in the U.S. But the person who had named them, a Canadian microbiologist named Felix d’Herelle, moved to Tbilisi, in the republic of Georgia, continuing his research at an institute that attracted the admiration of Joseph Stalin himself. Even after d’Herelle’s death, the Eliava Institute kept the flame of phage therapy alive.That hardly helped the viruses’ reputation in America during the Cold War. “It was commie science; there was a taint to it,” explained Dr. William Summers, a phage biologist, historian, and professor emeritus at Yale University.Even though phages continued to be an important part of lab science, the researchers who used them thought they were good for just that: research. The idea of using them for therapy was almost a joke.Then, as antibiotic resistance grew into a worldwide crisis — one that kills some 23,000 Americans a year — that joke started sounding more and more appealing. The funding of a center to administer and collect data on phage therapy is a reversal, of sorts: An admission that this long-disparaged idea is worth a million-dollar second glance. Getting phage therapy to a patient can be a bit a puzzle. These viruses are picky about the microbes they feast on, so you often need to take a swab of the patient’s bacteria, nurture it in a dish, and then test which phages are able to kill it off. You need to make sure that the phages in question will explode a bacterial cell, rather than settling comfortably inside like lice on a kindergartener’s scalp. And then you need to purify it before delivery, so there aren’t any bacterial leftovers that might poison the person instead of saving them.There’s also plenty of bureaucracy, because phages have not been approved by the Food and Drug Administration.It’s often a crazy rush to find the right phage with emails and calls and tweets, then getting emergency experimental approval — and that was largely what happened for the five other patients who’ve been treated with phages at UCSD since Strathdee’s husband was revived.“We wanted to make it so it isn’t such a scramble,” said Dr. Robert “Chip” Schooley, an infectious disease specialist at UCSD, who administered the phage to Strathdee’s husband, and who is also co-director of the new center. @ericboodman Sometimes, Strathdee and her network couldn’t act fast enough, and the patient died. But occasionally, it worked out. “I’ve had a second job as a phage-wrangler,” said Strathdee, who is the associate dean of global health sciences at UCSD, and who has been named a co-director of the new center. “When we started to treat patients, each one was like reinventing the wheel all over again: The phone calls at the 11th hour, the paperwork.”advertisement By Eric Boodman June 21, 2018 Reprints When her husband was dying of a drug-resistant infection, Steffanie Strathdee had a last-ditch idea. They could try treating him with a virus that would kill the bacteria colonizing his insides. The method, called phage therapy, was popular in former Soviet republics, but had mostly been abandoned in the U.S. Researchers had to hunt for the right virus in Texas pigsties and sewage treatment plants.That was 2016. Phage therapy is still very much experimental — but it’s come a long way since then. New companies have popped up, hoping to get approval to sell these viruses as drugs. A phage directory has come together, lab by lab, helping doctors figure out who has which virus.Now, the U.S. is getting its first phage therapy center, at the University of California, San Diego. Its mission is to run clinical trials, but also to streamline the mad dash to secure the right phage before a patient dies.advertisement About the Author Reprints Trending Now: Eric Boodmanlast_img read more