Tuesday, November 14, 2017

First Digital Pill Approved to Worries About Biomedical ‘Big Brother’ - The New York Times

For the first time, the Food and Drug Administration has approved a digital pill — a medication embedded with a sensor that can tell doctors whether, and when, patients take their medicine.

The approval, announced late on Monday, marks a significant advance in the growing field of digital devices designed to monitor medicine-taking and to address the expensive, longstanding problem that millions of patients do not take drugs as prescribed.

Experts estimate that so-called nonadherence or noncompliance to medication costs about $100 billion a year, much of it because patients get sicker and need additional treatment or hospitalization.

"When patients don't adhere to lifestyle or medications that are prescribed for them, there are really substantive consequences that are bad for the patient and very costly," said Dr. William Shrank, chief medical officer of the health plan division at the University of Pittsburgh Medical Center.

Ameet Sarpatwari, an instructor in medicine at Harvard Medical School, said the digital pill "has the potential to improve public health," especially for patients who want to take their medication but forget.

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https://www.nytimes.com/2017/11/13/health/digital-pill-fda.html?

Under New Guidelines, Millions More Americans Will Need to Lower Blood Pressure - The New York Times

The nation's leading heart experts on Monday issued new guidelines for high blood pressure that mean tens of millions more Americans will meet the criteria for the condition, and will need to change their lifestyles or take medicines to treat it.

Under the guidelines, formulated by the American Heart Association and the American College of Cardiology, the number of men under age 45 with a diagnosis of high blood pressure will triple, and the prevalence among women under age 45 will double.

"Those numbers are scary," said Dr. Robert M. Carey, professor of medicine at the University of Virginia and co-chair of the committee that wrote the new guidelines.

The number of adults with high blood pressure, or hypertension, will rise to 103 million from 72 million under the previous standard. But the number of people who are new candidates for drug treatment will rise only by an estimated 4.2 million people, he said. To reach the goals others may have to take more drugs or increase the dosages.

Few risk factors are as important to health. High blood pressure is second only to smoking as a preventable cause of heart attacks and strokes, and heart disease remains the leading killer of Americans.

If Americans act on the guidelines and lower their blood pressure by exercising more and eating a healthier diet, or with drug therapy, they could drive an already falling death rate from heart attacks and stroke even lower, experts said.

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https://www.nytimes.com/2017/11/13/health/blood-pressure-treatment-guidelines.html?

Tuesday, November 7, 2017

“No Fatties”: When Health Care Hurts - Longreads

Kasey Smith began gaining weight as a teenager. The numbers on the scale started increasing overnight, and no matter how few calories she consumed, they continued to go up. "It will even out," she thought, crediting the change to puberty and hormones. But it didn't, and her hair and skin began changing as well. "Something was definitely wrong."

Each medical appointment, and there were many, concluded with doctors telling her to go on a diet. Smith (not her real name) remembers telling the endocrinologist about her frustrations with burning off the 900 calories she consumed each day and still gaining weight. "He looked at me and said, 'Maybe you can cut back your McDonald's to twice a week.' I was stunned silent, and I went into the bathroom and broke down. 'He doesn't believe me. He thinks I'm just fucking with him.'"

As Smith's weight went up, her food intake went down. Her mother signed her up for Nutrisystem, and her diet hung on the fridge for everyone in her family to see. Shame and humiliation narrowed her life down to three questions: what to eat, what not to eat, and how to burn more calories. She began to form dangerous habits, sometimes eating little more than lettuce.

Smith ultimately received a diagnosis of polycystic ovary syndrome, a hormonal disorder that can lead to excess male hormones, irregular menstrual cycles, and weight gain. She was prescribed Metformin and quickly began to lose weight, but the damage had been done. The 18-year-old developed anorexia, leaving for college at 130 pounds and coming back four months later and 30 pounds lighter, her hair falling out in clumps.

No one thought anything was wrong.

"I would go to the doctor, and there were no red flags. It was 'You look fantastic!' Not 'This is alarming.'" Smith continued starving herself for another year until she ended up in the hospital, undergoing a colectomy to remove a foot and a half of her intestines, which had twisted as a result of her severe calorie restriction.

One year after the surgery, her worst nightmare returned: She was gaining weight. Celiac disease was the cause this time, but it wasn't diagnosed until after Smith was in the habit of purging the little food she ate every day. She would regularly run in the park and pass out afterward. "I would starve all day, then I'd eat something at night, then I would purge it. In my head, I'm thinking, 'I'm literally not consuming anything. The weight has to fall off.'"

She realized she needed professional help, and Smith found a therapist who specialized in eating disorders and began treatment at The Renfrew Center, a residential facility in Pennsylvania. She continues to struggle with discussing her weight at medical appointments. After she told her endocrinologist about her treatment at Renfrew, his reply was "I see you need to lose some weight."

More …

https://longreads.com/2017/10/26/no-fatties-when-healthcare-hurts/

Sunday, November 5, 2017

How to Feign an Illness - The New York Times

"Research your symptoms," says Eve Muller, a Los Angeles-based actress who has been working in medical schools as a simulated patient since 1990. Bodies manifest ailments in recognizable patterns that medical professionals are trained to observe and diagnose. It is not enough to say your belly hurts; exactly where and how does it hurt? Stomach pain could be food poisoning, an ectopic pregnancy, pelvic inflammatory disease, appendicitis, twisted ovarian tubes or something else entirely. Know your malady's pathology and describe it with specificity. "You need to know anatomy," Muller says.

Before she interacts with students, a medical school gives Muller a detailed case study outlining the pretend patient's medical history, biography, symptoms and sometimes even scripted lines. Be similarly thorough in your preparation. If the condition requires a repeated physical action, like a limp or the trembling associated with Parkinson's disease, watch videos of real patients online and mimic their behavior in front of a mirror or on video. Use makeup, hair and clothing to help tell your story. "Look the part," says Muller, who paints bruises and rashes onto her body. She drinks yogurt smoothies to sound phlegmy if she's portraying someone with congestion. Sometimes she wears business attire; for other characters she jams dirt under her fingernails and rubs oil in her hair.

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https://www.nytimes.com/2017/11/03/magazine/how-to-feign-an-illness.html?

Sunday, October 29, 2017

The Symptoms of Protracted Dying - NYTimes.com

Geraldine was warmly opinionated and, along with her husband, she'd raised her four daughters to be the same.

When work settled and time allowed, she melted into the couch next to any of her children who were home and turned on the Hallmark channel. If a movie showed people who couldn't care for themselves, she would remark, "I don't want to live like that," or "if that's me, don't bother doing all that."

On May 25, a clot blocked a blood vessel in Geraldine's heart. Her husband performed CPR. She was whisked to the hospital, where her heart survived, but lack of oxygen launched her brain into uncontrollable seizures. At age 56, her melodic Irish accent was silenced.

Her lips sagged around a breathing tube when I met her three weeks later. Her limbs lay wherever we put them. Kinked gray hair stood in all directions from her scalp, pushed aside by electrodes that recorded brain activity.

In the small conference room in our neuro intensive care unit, we discussed Geraldine's prognosis with her family.

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https://www.nytimes.com/2017/10/24/well/live/the-symptoms-of-protracted-dying.html

Why opioids are such an American problem - BBC News

For every one million Americans, almost 50,000 doses of opioids are taken every day. That's four times the rate in the UK.

There are often good reasons for taking opioids. Cancer patients use them for pain relief, as do patients recovering from surgery (codeine and morphine are opioids, for example).

But take too many and you have a problem. And America certainly has a problem.

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http://www.bbc.com/news/world-us-canada-41701718

Drug Companies Make Eyedrops Too Big — And You Pay for… — ProPublica

If you've ever put in an eyedrop, some of it has almost certainly spilled onto your eyelid or cheek.

The good news is the mess doesn't necessarily mean you missed. The bad news is that medicine you wiped off your face is wasted by design — and it's well-known to the drug companies that make the drops.

Eyedrops overflow our eyes because drug companies make the typical drop — from pricey glaucoma drugs to a cheap bottle of Visine — larger than a human eye can hold. Some are so large that if they were pills, every time you swallowed one, you'd toss another in the garbage.

The waste frustrates glaucoma experts like Dr. Alan Robin, whose patients struggle to make pricey bottles of drops last. He has urged drug companies to move to smaller drops — to no avail.

"They had no interest in people, their pocketbooks or what the cost of drugs meant," said Robin, a Baltimore ophthalmologist, researcher and adjunct professor at the University of Michigan Medical School.

ProPublica has been documenting the many ways health care dollars are being wasted. We've shown how hospitals throw out brand new supplies, nursing homes flush tons of unexpired medication and drug companies concoct costly combinations of cheap medication. Recently we described how arbitrary drug expiration dates cause us to toss safe and potent medicine.

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https://www.propublica.org/article/drug-companies-make-eyedrops-too-big-and-you-pay-for-the-waste?

Wednesday, October 25, 2017

The Rules of the Doctor’s Heart - The New York Times

Every medical case, to paraphrase the writer Viet Thanh Nguyen, is lived twice: once in the wards and once in memory. Some of what follows is still intensely vivid, as if it were shot in high-def video. Other parts are blurry — in part because I must have subconsciously deleted or altered the memories. I was 33 then and a senior resident at a hospital in Boston. I had been assigned to the Cardiac Care Unit, a quasi I.C.U. where some of the most acutely ill patients were hospitalized.

In mid-September — it had been a moody, rain-drenched month, as I recall — I admitted a 52-year-old man to the unit. I'll call him by the first letter of his given name, M. As medical interns, we were forewarned by the senior residents not to identify too closely with patients. "A weeping doctor is a useless doctor," a senior once told me. Or: "You cannot do an eye exam if your own eyes are clouded." But M.'s case made it particularly hard. He was a doctor and a scientist — an M.D., a Ph.D., like me. He must have been about 15 years ahead of me in his schooling; I could imagine him returning to my class in med school to teach us "Patient-Doctor," in which students are taught how to deal with real-life patients. He'd trained as a medical resident and then as a fellow in cardiology at another hospital across town. He was now an assistant professor — it seemed like such a victory to have that title — and ran a small laboratory. I knew a student who once worked with him. Six degrees of separation? There was barely one.

More …

https://www.nytimes.com/2017/10/24/magazine/the-rules-of-the-doctors-heart.html?

Thursday, October 19, 2017

Dry eye, other vision problems, affect women more than men - The Washington Post

At first, it felt like something was in her eye. Then her eyes turned red, watery and irritated. Her vision became blurry, and she found it difficult to read. It was painful to fly, and to be in air conditioning. Ilene Gipson, a scientist who studies eye disorders, didn't need a specialist to tell her what she had. "I knew what it was," she says.

Gipson had dry eye disease, an ailment that occurs when the eye does not produce enough tears, or when the tears evaporate too quickly. It is the most common eye problem that older women experience, and it disproportionately affects women: more than 3 million women vs. about 1.7 million men, according to the American Academy of Ophthalmology.

And it's not the only one. Many eye disorders — some of them quite serious — seem to favor women over men.

"Women make up two-thirds of the people who are visually impaired or blind in the world," says Janine Clayton, an ophthalmologist who heads the office of research on women's health at the National Institutes of Health. "Most people would say, 'That can't be the case in the United States.' But it is. Unfortunately, we don't know why."

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https://www.washingtonpost.com/national/health-science/vision-problems--dry-eye-among-them--affect-more-women-than-men/2017/10/13/02c121d6-a79f-11e7-850e-2bdd1236be5d_story.html?

Monday, October 16, 2017

Health care prices are the problem - Vox

On September 28, 2016, a 3-year-old girl named Elodie Fowler slid into an MRI machine at Lucile Packard Children's Hospital in Palo Alto, California. Doctors wanted to better understand a rare genetic condition that was causing swelling along the right side of her body and problems processing regular food.

The scan took about 30 minutes. The hospital's doctors used the results to start Elodie on an experimental new drug regimen.

Fowler's parents knew the scan might cost them a few thousand dollars, based on their research into typical pediatric MRI scans. Even though they had one of the most generous Obamacare exchange plans available in California, they decided to go out of network to a clinic that specialized in their daughter's rare genetic condition. That meant their plan would cover half of a "fair price" MRI.

They were shocked a few months later when a bill arrived with a startling price tag: $25,000. The bill included $4,016 for the anesthesia, $2,703 for a recovery room, and $16,632 for the scan itself plus doctor fees. The insurance picked up only $1,547.23, leaving the family responsible for the difference: $23,795.47.

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https://www.vox.com/policy-and-politics/2017/10/16/16357790/health-care-prices-problem