Experts urge Biden to expand access to therapies, patient genetics in cancer ‘moonshot’

first_imgAt Dana-Farber Cancer Institute, DNA from every patient’s tumor undergoes multigene panel testing as part of our Profile project. Using a technology known as next generation sequencing, we check for the presence of mutations in more than 300 genes. Other major cancer centers also use multigene panel testing for many of their patients. The results have uncovered amazing things about cancer, some of which have led to new treatments. A presidential cancer moonshot (again)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 Link EmbedCopiedLive00:0001:1001:10  Presidents have been promising to cure cancer for 45 years, but cancer is still very much with us. Alex Hogan/STAT Most of this sequencing is being paid for by philanthropy and institutional dollars. That isn’t sustainable. The time is right for insurers to start paying for it. We recommended that the vice president ask the Centers for Medicare and Medicaid Services to consider reimbursing multigene panel sequencing for cancer. This would vastly increase the number of cancer patients who have their tumors sequenced.The AACR got the attention of the vice president’s staff in part because of the association’s Project GENIE. Seven institutions are pooling their clinical sequencing data and all of the clinical data associated with it. Projects analyzing these data are already underway. But the AACR doesn’t have the money or the resources to do this on a national scale. The vice president and his office could influence the Office of the National Coordinator for Health Information Technology or other entity to build a repository for sequencing data from all around the country. This would rapidly move the needle in understanding cancer and treating it more effectively.Today, detailed genomic information about cancer is available only from comprehensive cancer centers or from individuals who have the money to pay for sequencing their tumors. We need to democratize genomic information as it applies to cancer by expanding the number of cancer patients who have their tumor genes sequenced. The benefits of this kind of testing are already so manifest that it should be made available to everyone with cancer.Barrett J. Rollins, MD, is the chief scientific officer at the Dana-Farber Cancer Institute and the Linde Family Professor of Medicine at Harvard Medical School.Otis Brawley: Cancer has been with us for thousands of years. It will not be cured in a year’s time but will take concerted, long-term, sustained effort. That said, there are several things the vice president could do in the short term to improve cancer treatment and survival.Gathering and analyzing data about large numbers of cancer patients could provide quick and important advances. The vice president could help overcome privacy laws that do relatively little to protect privacy but a lot to keep researchers from collecting meaningful data. HIPPA and other laws — or incorrect interpretations of them — prevent researchers from sharing genetic and other data. For example, a project called CancerLinQ, organized by the American Society of Clinical Oncology, aims to improve cancer care by gathering data from around the country. But real or perceived privacy issues, along with difficulties connecting disparate electronic health records, may scuttle it.Logistic issues and less-than-optimal care account for far too many early deaths from cancer. In Atlanta, 7 percent of black women and 2 percent of white women diagnosed with early, low-stage breast cancer don’t get treated within one year of their diagnoses. The delays, which can affect survival, are often due to problems like inability to get to a treatment center, not being able to take time off of work, and other logistic issues. Twenty percent of women with breast cancer get less-than-optimal treatment; the percentages are even higher for other cancers.“Moonshot” may be an appropriate description for the vice president’s initiative. When John F. Kennedy announced he wanted to put a man on the moon by the end of the decade, much of the engineering to do that already existed. What was needed was someone to put together all the pieces of the puzzle. Applying the science and discoveries that we already have to the American population could go a long way to preventing deaths from cancer.Finally, it would be wonderful to see the vice president continue to be a champion for good science and clinical work after he leaves office. As someone who is liked and respected by both Democrats and Republicans, he has the opportunity and standing to provide American medicine and American science with guidance that is sorely needed.Otis Brawley, MD, is the chief medical and scientific officer for the American Cancer Society and professor at Emory University.By Gary Gilliland: It’s fantastic that the vice president has decided to launch a concerted effort to fight cancer. The timing is excellent, since we are at an inflection point in the way we think about cancer treatment.This is a very different time than when President Nixon declared his war on cancer in 1971. We couldn’t see the light at the end of the tunnel then. Now we can.Four or five years ago, there was little we could do for cancers like metastatic melanoma and metastatic lung cancer. Today, we are telling many patients that we can cure these diseases. This change was brought about largely because we have learned to harness the power of the immune system to attack cancer, just as it attacks foreign invaders like bacteria and viruses.Drugs like pembrolizumab (Keytruda) — which was used to treat former President Jimmy Carter’s advanced melanoma — take the brakes off the immune system and let it go after tumors with relatively few side effects.When I think about what the vice president could do in a relatively short time to fight cancer, it’s not about tumor sequencing or data sharing. There’s no question that these are really important and will lead to new insights, but they will take some time to pay off. Instead, I think a “moonshot” should aim to make the new, potentially curative therapies available to everyone with cancer, not just to those being treated at designated comprehensive cancer centers. We have these therapies; let’s get them out there.With something as potentially devastating as cancer, which affects so many individuals and so many families, you don’t want to overpromise and underdeliver. But I truly believe that we have the opportunity to move forward quickly and have a more dramatic impact on cancer outcomes in the next few years than we have had in the last 50.Gary Gilliland, MD, is the president and director of the Fred Hutchinson Cancer Research Center in Seattle.By Austin Frakt: I would urge the vice president to invest in data infrastructure and access.Researchers spend a shockingly large amount of time accessing, or trying to access, data they need to do their work. It can take many steps to obtain clinical or administrative data, sometimes even data that has been collected specifically for researchers to use. Having to take many steps to access data, or having to overcome barriers to do it, slows research. Beefing up data availability and data infrastructure and removing regulatory and other obstacles would speed up research. Because they would accelerate a wide range of work, these are useful steps even when specific research areas haven’t yet been defined. They would give researchers and research organizations more time to efficiently and effectively do actual research instead of dealing with red tape.Some red tape provides important functions. For example, it’s essential that clinical trial or administrative data be handled carefully, especially when it contains personal information. But the requirements often go too far and the hurdles can take too long to clear, bringing research to a crawl.For example, the Centers for Medicare and Medicaid Services recently began removing from the data they provide to researchers all records for patients with substance use disorder diagnoses. This makes it difficult to study the opioid crisis, the spread and treatment of hepatitis C (which disproportionately affects substance users), and a wide range of mental health care. This new barrier to data, which had been previously available, has derailed productive researchers who now must figure out new ways to conduct their work.In my world, such data infrastructure issues are common. I’d be surprised if they aren’t just as common in cancer research as well.Austin Frakt, PhD (@afrakt), is a health economist in the US Department of Veteran Affairs and associate professor at Boston University’s School of Medicine and School of Public Health. He is also an editor-in-chief of The Incidental Economist.This story has been updated to include comments from Gary Gilliland. Patrick Skerrett @PJSkerrett By Patrick Skerrett Jan. 13, 2016 Reprints Barrett Rollins: Share data from cancer patientsOtis Brawley: Use influence even after leaving officeGary Gilliland: Make existing potentially curative treatments available to allAustin Frakt: Invest in data infrastructure and accessBy Barrett Rollins: I had the honor to be part of the contingent from the American Association for Cancer Research (AACR) that met last week with Vice President Biden’s staff. We proposed two efforts that could be accomplished in the near term and that could provide substantial advances against cancer. Both revolved around sharing data from cancer patients.advertisement Tags cancerJoe Bidenmoonshot About the Author Reprintscenter_img First OpinionExperts urge Biden to expand access to therapies, patient genetics in cancer ‘moonshot’ Vice President Joe Biden could use some advice on his “moonshot” to improve the diagnosis and treatment of cancer. Win McNamee/Getty Images Editor, First Opinion Patrick Skerrett is the editor of First Opinion, STAT’s platform for perspective and opinion on the life sciences writ large, and the host of the First Opinion Podcast. Vice President Joe Biden unveiled his “moonshot” initiative against cancer Tuesday following a shout-out from President Obama during the State of the Union address. Biden said it’s time to “accelerate our efforts to progress towards a cure, and to unleash new discoveries and breakthroughs for other deadly diseases.”Biden’s aides have already held a series of closed-door meetings with cancer researchers.Read more: Biden lays out road map for his ‘moonshot’ against cancerSTAT asked experts inside and outside the cancer world what advice they would offer the vice president to help move his project forward.advertisement [email protected] last_img read more

Dispatch from Tahiti: Scientists on remote island unravel Zika’s mysteries

first_img Link between Zika, birth defect getting stronger Van Mai Cao-Lormeau, a senior scientist in virology at the Institut Louis Malardé in Papeete, Tahiti, is leading much of the small research center’s work to understand a recent Zika outbreak in French Polynesia. Karim Mahdjouba for STAT Related: French Polynesia also saw an increase in fetuses with neurological problems, including microcephaly, a birth defect that has been linked to the outbreak in Brazil, leading the United States government and World Health Organization to discourage pregnant women from traveling to Zika-affected areas.While a connection to Guillain-Barré was immediately obvious in Polynesia, because the uptick in patients coincided with the start of the outbreak, the rise in babies with the telltale small heads of microcephaly was noticed only in recent weeks, when researchers at a Papeete hospital went back to look at the medical records of women who were pregnant during the outbreak.They found that 12 women had been told their fetuses had such neurological defects, said Cao-Lormeau, who is leading much of the research. Nine of the 12 women had abortions, and the other three gave birth to babies with significant problems, she said.In previous years, at most only two Polynesian babies a year had such birth defects, which cause intellectual disability and lifelong health problems and have no treatment or cure. Tags infectious diseasepublic healthvirologyZika Virus “We are trying to document as much as possible what happened in these people,” Van Mai Cao-Lormeau, a senior scientist in virology at the institute, told STAT Monday. “This will be very useful in the kind of investigation now being conducted in Latin America.” Dengue could be the surprise culprit making Zika worse, researchers say HealthDispatch from Tahiti: Scientists on remote island unravel Zika’s mysteries Zika isn’t the only mosquito-borne virus that should worry us Scientists from the US Centers for Disease Control and Prevention, France’s Institut Pasteur, and University of Oxford in the UK have communicated with the Polynesian team in recent weeks to learn all they can about Zika. The mosquito-borne virus likely spread from here to Brazil in 2014 and is now circulating in two dozen countries in South and Central America and the Caribbean.advertisement PAPEETE, Tahiti — As scientists around the world race to understand the threat posed by the Zika virus, they are turning to this remote and relaxed Pacific island, which recently experienced an outbreak.Zika roared through here between October 2013 and May 2014, sending more than 30,000 residents — 10 percent of the population — to doctors and hospitals for treatment. The Polynesian archipelago was the first place of any size where the virus had emerged, and a team of top scientists at a small research institute watched the outbreak unfold in real time.The Institut Louis Malardé — whose open-air central courtyard was draped this week by a bright red bougainvillea in full flower — tracked Zika’s spread, aided by machinery that rapidly sequences the DNA of viruses and patient records from the main hospital and clinics. Now its five PhD scientists and physicians are hurriedly drafting journal articles to report their latest findings.advertisement About the Author Reprints ‘I can’t move’: In Colombia, families cope with creeping paralysis tied to Zika Karen Weintraub Isolated island chains such as French Polynesia are a perfect laboratory for studying infectious diseases, in part because it is clear when outbreaks begin, said Adam Kucharski, a lecturer in infectious disease epidemiology at the London School of Hygiene and Tropical Medicine.In Brazil and other parts of the Americas where Zika is now raging, there are other mosquito-borne viruses, making it difficult to determine which disease is causing which effects.Tahiti experienced an outbreak of chikungunya, another mosquito-borne virus, last year, and a small number of dengue cases crop up every few months. But it’s easier, Kucharski said, to pin the blame on one disease when scientists have a clear idea when the disease arrived and how it spread.Cao-Lormeau said it was very clear that the outbreak in French Polynesia began around October 2013, when a small group of people on Tahiti came down with the telltale itchy rash, blood-red eyes, and fever. No one in that first group could have brought the virus, because they hadn’t traveled off the island in preceding weeks.But Cao-Lormeau, who came down with Zika herself, and her colleagues have been tracking the viruses infecting Polynesian residents since 2012, so they are certain that there was no Zika before late 2013. Are you at risk of contracting Zika virus?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 Link EmbedCopiedLive00:0001:3301:33  Are you at risk for contracting Zika virus? Your level of risk depends in part on your living conditions. Alex Hogan/STAT Rumors around Tahiti suggest that the virus arrived with an African beach soccer team that came to play in an international tournament around the same time. Cao-Lormeau’s genetic analysis shows that cannot be the case, however; the Zika in Polynesia came from Asia, and is very similar to a strain that sickened about 7,000 people in the Yap Islands of Micronesia in 2007. That was the first known outbreak of the virus, which had been discovered and named in Uganda in 1947. Only 14 individual cases had been reported previously. Related: By Karen Weintraub Feb. 17, 2016 Reprints Related: In a paper slated for publication soon, the Polynesian researchers will examine the intriguing possibility that the dozens of Zika patients here who came down with Guillain-Barré syndrome, an automimmune condition that can cause temporary paralysis, had previously been infected with dengue, a virus in the same family as Zika.An immune system that recently fought off dengue, which is endemic in the tropics, might overreact to Zika, triggering Guillain-Barré, the researchers speculate.Cao-Lormeau (right) and Dr. Tu-Xuan Nhan, assistant director of the Diagnosis Laboratory, at the Institut Louis Malardé, where they are studying a recent Zika virus outbreak. Karim Mahdjouba for STATThey declined to detail their evidence ahead of publication, but at least some of the GBS patients treated at a rehabilitation clinic in the hills outside Papeete were infected with dengue shortly before they came down with Zika, Stéphane Milon, director of care at the Te Tiare clinic, said Monday.The possible link between Zika and Guillain-Barré was first established here, with 42 people diagnosed during the outbreak, after just a handful the entire year before.While infectious diseases like dengue and chikungunya are known to cause GBS too, the number of cases linked to those viruses is typically much lower than was seen in French Polynesia.Since Zika arrived in Latin America, countries such as Brazil, Colombia, Venezuela, and El Salvador have similarly reported upticks in Guillain-Barré cases. Researchers there are likewise studying whether Zika alone can increase the risk of GBS, or if other factors, such as a previous dengue infection, are needed. What is Guillain-Barré syndrome?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 Link EmbedCopiedLive00:0001:4001:40  The disease, known for triggering temporary paralysis, has been linked to Zika virus infections. Hyacinth Empinado/STAT Related: Karen Weintraub is an independenthealth/sciencejournalist, journalism teacher, and bookauthor. @kweintraub Scientists don’t know whether the virus became more dangerous as it crossed the South Pacific, or whether its possible connection to Guillain-Barré and microcephaly went unnoticed in the Yap outbreak because it was relatively small and in an area that lacked close scientific surveillance.About 20 percent of those infected with Zika show any symptoms, scientists estimate, so they assume that well over half the population of French Polynesia caught the mosquito-borne virus before it died out.“We are trying to document as much as possible what happened” during the recent Zika outbreak, says Cao-Lormeau. Karim Mahdjouba for STATGenetically tracking the virus is trickier than it was, say, with West Africa’s Ebola epidemic, Cao-Lormeau said. There, epidemiologists and genetic researchers were able to track the evolution of the Ebola virus as it migrated from a 2-year-old child in Guinea to two midwives in nearby Sierra Leone and then across the border into Liberia.Because Zika is transmitted by mosquitoes, the virus is evolving in the bugs, not people. Also, people clear the Zika virus very quickly from their bloodstream, Cao-Lormeau said, making it difficult to obtain samples.The breed of mosquito that commonly transmits Zika, Aedes aegypti, is present in French Polynesia, Cao-Lormeau said, alongside an indigenous mosquito that was also able to spread the virus once it arrived.Zika arrived in French Polynesia via Tahiti, its most populous island, and then spread to the other 66 inhabited islands of the archipelago, she said, although there are different types of habitats — from the lush forested hillsides rising above urban Papeete to rural islands composed of coral and volcanic rock.As with most island outbreaks, Zika left French Polynesia as quickly as it came, once everyone who was susceptible became infected and the virus ran out of new victims. By early May 2014, there were no more reports of Zika in Tahiti, though the virus continued its march eastward.last_img read more

The patient called me ‘colored girl.’ The senior doctor training me said nothing

first_img Molly Ferguson for STAT @JenniferAdaeze First OpinionThe patient called me ‘colored girl.’ The senior doctor training me said nothing Please enter a valid email address. Teaching medical students to challenge ‘unscientific’ racial categories Related: By Jennifer Adaeze Okwerekwu April 11, 2016 Reprints Again and again during my four years of training, I encountered racism and ignorance, directed either at patients or at me and other students of color. Yet it was very hard for me to speak up, even politely, because as a student, I felt I had no authority — and didn’t want to seem confrontational to senior physicians who would be writing my evaluations.advertisement Medicine struggles with a chronic disease: racism.Medical schools try to combat this disease with diversity initiatives and training in unconscious bias and cultural sensitivity. I’m about to graduate from the University of Virginia School of Medicine, so I’ve been through such programs.They’re not enough.advertisement An urgent call for diversity in medicine, ‘the profession I love’ To be truly inclusive, communities must be places where everyone feels they have equal worth and where people can have honest conversations without judgement. There’s not enough of that spirit in medical school, or in the medical profession.One more example among many: During my obstetrics and gynecology rotation, I helped perform a prenatal ultrasound on a woman wearing a Confederate flag shirt. Her husband and son watched. Both were wearing Confederate flag hats and belts.The optics of the encounter were jarring. I wondered if my patients hated me. Again, the attending physician did not address the racially charged awkwardness of the encounter.Although this physician was otherwise kind to me, his silence left me with a lasting impression. And too many toxic questions.As the Brazilian educator Paulo Freire writes, “Sometimes a simple, almost insignificant gesture on the part of a teacher can have a profound formative effect on the life of a student.” All these years later, I still wonder if these physicians — my teachers — respected me. It was difficult to reconcile the compassion they showed their patients with their apathy towards me.I needed to know if my experiences were anomalies, so I checked in with two well-respected black physicians who focus on diversity in academia. Dr. Marcus Martin, a vice president at the University of Virginia, and Dr. Eve Higginbotham, a vice dean at the University of Pennsylvania, both assured me that I wasn’t alone. In fact, they said such experiences were all too common.“It really is over the lifetime of one’s career that you ultimately understand how to actually deal with these very difficult situations,” Higginbotham said. Privacy Policy [email protected] Related: Leave this field empty if you’re human: A few hours later, when it was finally time to see this patient, the attending physician told me I had the pleasure of conducting my very first patient interview on “Amadou Diallo.”That was not his name. The only similarity between Amadou Diallo, the young man who was shot and killed by four New York City police officers in 1999, and this elderly Haitian gentleman was their skin color. My skin color.“That’s not his name,” I said, instinctively but respectfully.I was pointed in the direction of the patient and clinic, and proceeded as usual.center_img A few weeks later when I received my clinical evaluations, I perceived some of the feedback as unkind. I couldn’t tell if the comments actually reflected my performance or if I, too, was being punished for speaking out, or maybe even for being black. It was terrifying not knowing the difference.As my clinical training progressed, I had several opportunities to point out intolerance and injustice. I always chose amicability over advocacy. I didn’t want to jeopardize my grades and evaluations by calling attention to intolerance, so I stayed silent instead of voicing the values I believed in.During my internal medicine rotation a few months later, a patient called me a “colored girl” three times in front of the attending physician. The doctor did not correct the patient, nor did she address the incident with me privately.Despite all the other positive interactions I had with this teacher, her silence in this circumstance diminished my presence. I wondered if she thought of me as a “colored girl” too.Looking back, I don’t regret my timidity. It’s what I felt I needed to do to survive. But I feel angry and frustrated that my mentors in the medical profession didn’t raise these issues themselves. Diversity and inclusion initiatives challenge bias in the abstract. Checking bias in real-time, with real people, is much more challenging.Maybe they didn’t notice the bias. Maybe they didn’t feel it was important enough to talk about. Maybe they didn’t know how to talk about it.They should have. Jennifer Adaeze Okwerekwu Harvard Medical School students decry lack of diversity Related: These situations made me worry for our future: How can medical professionals address the needs of a rapidly diversifying population, when we cannot address prejudice within our own community?I did try, once, to speak up, but it didn’t end well. My first clinical rotation was in the ear, nose, and throat clinic. On my first day, I overheard the attending physician grumbling about accommodating an elderly Haitian man with limited English who had misunderstood his appointment time. “We’ll stick the med student on him,” he said. I was excited to test my skills, but I couldn’t help but feel that my seeing this patient was intended as a punishment for him — and that made me uncomfortable. Related: A patient threatened to shoot me. Could I then give him good care? About the Author Reprints Columnist, Off the Charts Jennifer Adaeze Okwerekwu is a psychiatrist and a columnist for STAT. Medical school often erodes aspiring doctors’ empathy, compassion, and idealism. As Harvard Medical School professor Dr. Richard Schwartzstein writes: “Typically, students enter medical school idealistic, eager to improve the human condition, and excited about becoming doctors. And then we do various things to change them.”This is most often the byproduct of the intense pressures of academic and clinical work. As a medical student, however, I fear my heart was hardened by an extra burden, of my educators being blind to my worth as a woman of color. As I advance in the training hierarchy and acquire students of my own, I will certainly do my best to foster inclusion. While my experience as a black medical student has made me hyperaware of racism in medicine, I know because I am human, that I have blind spots of my own.I will work to stay aware of tense moments. And I will always stand up for my students. I also hope I can cultivate a community where my students feel comfortable calling me out.Until we all commit to taking action every day to foster a true spirit of inclusion, we’ll risk perpetuating racial harms and undermining the true spirit of medical professionalism. I know race relations in medicine will not change overnight, but learning to see what is hidden in plain sight will be a crucial first step. Every one of us needs to own the principles that protect us and our patients from racism and bias. That means learning to see prejudice and speaking up against it. But that is far, far easier said than done. Newsletters Sign up for Morning Rounds Your daily dose of news in health and medicine. Tags Health Disparitiesmedical schoolphysicianracelast_img read more

‘Inception’ in the lab: Scientists are trying to implant false visions in people

first_imgIn the Lab‘Inception’ in the lab: Scientists are trying to implant false visions in people Groggy after a night in a hotel? Blame the left side of your brain APStock Brain scans strongly predict return of consciousness in vegetative patients The most intriguing version, developed by Takeo Watanabe of Brown University and partners at the Advanced Telecommunications Research Institute in Japan, is called Associative Decoded fMRI Neurofeedback. The technique uses brain scanning with an fMRI machine to teach a skill or association — but without the person being aware of what they’re learning. In the movie “Inception,” Leonardo DiCaprio’s character interferes with others’ dreams to implant new ideas in their minds.It’s a trippy plot premise. It’s also not entirely science fiction.In the last few years, researchers have developed a way to “incept” in real life, a technique they hope could eventually help people with disorders from depression to autism. And a new study indicates we could do “inception” without the subject even being aware of what’s being learned.advertisement By Anna Vlasits June 30, 2016 Reprints Related: In Watanabe’s latest work, published in Current Biology on Thursday, subjects learned to see the color red while looking at a picture of black and white stripes — and they had no idea they were being trained to do this.Fairly innocuous, then, but the idea is somewhat spooky — a kind of subliminal messaging, Watanabe said, “in the simplest form.”Power of the mindThe idea for neurofeedback technique grew out of research from the 1960s showing that a person could regulate his heart rate or temperature just by thinking about it. Our brains regulate temperature and heart rate. Watanabe wanted to see if we could regulate other aspects of brain activity.The process of getting incepted takes multiple days. First, the subjects have to have their brains scanned as a baseline so the software knows what kind of brain activity to look for. Then, the subjects undergo three days of serious neurofeedback training. While they’re lying in the brain scanner, the scientist running the experiment tells them to look at the center of the screen. When black vertical stripes come on the screen, they’re told to “try to somehow regulate your brain activity.” After the vertical stripes go away, the subjects are given a score of how well they did. They’re paid more money if they score high.The subjects aren’t told to think about colors, or try to “see” anything in their minds. They’re told to try to regulate their brain activity, just that. Each person did this exercise over 500 times.In fact, subjects scored highly when they managed to make their brains light up with “red” brain activity, even though they were looking at black and white vertical stripes. The goal of the neurofeedback training was to strengthen the connection in the subjects’ brains between seeing vertical stripes and seeing the color red.After the experiment, the researchers asked the subjects what they were thinking about when they got high scores. Their answers were as different as could be.“I imagined a zebra,” said one participant.“I imagined a gymnastics match in which I performed well,” “I imagined a situation where I behaved violently,” others reported.None of them mentioned colors. But the next day, when the researchers showed the subjects vertical stripes, the subjects were more likely to think something was tinted red than people who hadn’t done the neurofeedback training. For neurofeedback subjects, vertical stripes that were in reality greenish looked slightly reddish to them.Subjects aren’t hallucinating the color red, Watanabe says. They’re experiencing something more akin to synesthesia, a condition in which people perceive colors when they look at printed numbers and letters.And when the researchers tested the subjects again several months later, they were still biased toward red.center_img In an earlier study, Watanabe used the same technique to make people get better at seeing specific orientations of stripes flashed on a screen for just a short amount of time. There again, the subjects had no idea what they were learning.Such a use of fMRI is “very novel and very clever,” said Thomas Naselaris, a psychology professor at the Medical University of South Carolina who was not involved in the study.A treatment for autism?Watanabe thinks neurofeedback could eventually be used to treat neurological and psychiatric disorders, such as depression or autism.The idea would be a similar one. In the case of depression, people would get high scores when their brain activity looked less depressed. For autism, the therapy could theoretically help people deactivate areas associated with autism symptoms.The latter is something Watanabe is actively studying. Based on a study this spring that looked at differences in the brain connections of normal and autistic people, he has begun testing neurofeedback therapy on people with Asperger’s syndrome. The therapy trains them to enhance the “normal” connections and weaken the autism-related connections in their brains. Right now, however, Watanabe says the therapy isn’t really working.Dr. Charles Gilbert, a vision researcher at the Rockefeller University said in an email that “to extend it as a technique for autism therapy is quite a stretch.”Naselaris is more optimistic. “I have no idea if it will work, but on the basis of this result I think it’s worth developing an application for this. This seems potentially very powerful,” he said.Tricking the brainOther scientists have used neurofeedback without the subliminal twist, using electroencephalogram to give people feedback about the speed of their brain waves. A person with anxiety, therefore, would be told to use the meter to try to consciously calm themselves, for instance. (Though some of the benefit may be placebo effect.) Related: Magic mushroom ingredient offers hope for treating depression Related: The basic idea is this: Human subjects lie down in a functional magnetic resonance imaging, or fMRI, machine and play a game. During the game, they have their brains scanned, and the game gives them feedback. Afterward, they have developed new brain connections.This process is called neurofeedback, which uses the data from the fMRI machine to tell someone what is going on in their brain. It’s similar to using your heart rate to set your pace while running (which then changes your heart rate), but instead, you’re controlling your own brain activity.advertisement But for most conditions, the subliminal kind of neurofeedback would probably be needed. The brain activity related to psychiatric conditions is complex and mysterious. Instructing someone to activate a specific brain connection or turn down a certain collection of brain regions would be confusing.“It gets a little tricky, because with depression for example there’s a tendency to recall negative memories, and it actually might even worsen symptoms if you try to recall positive memories,” said Steve Ramirez, a researcher at Harvard University who studies depression in mice.So you can’t just tell someone to “think happy,” you need to trick them out of negative brain states.But that endeavor is contingent on scientists finding the precise brain signatures for different psychiatric conditions — no small task. Neurofeedback, for the time being, can make you see colors — but it may be some time before it can change your brain’s tint on the world. Tags braininceptionneurosciencelast_img read more

Trying to find adequate elder care is a bureaucratic and personal nightmare

first_imgI quickly learned that my research had vastly underestimated the complications of long-distance caregiving. Problems emerge often, whether you are readily available or not, and they tend to demand immediate attention. Nor had I fully comprehended the extent of the vigilance required to protect against insufficient, low-quality services, whether by home health agencies, nursing homes, assisted living facilities, or hospitals. First OpinionTrying to find adequate elder care is a bureaucratic and personal nightmare Related: Laura Katz Olson $75 for reminders to eat: Alzheimer’s patients face flurry of fees while waiting for specialized care Nursing homes fade even as baby boomers age @lauralee111 Sebastien Bozon/AFP/Getty Images I’ve been studying elder care for more than 40 years. My special interest is how social welfare policies affect long-term care. But what I have learned during my career didn’t fully prepare me when I was suddenly thrust into a grueling long-distance caregiving role for my mother, Dottie.Mom had been a healthy athlete her entire life. In her older years, she won medals in the Florida Senior Olympic Games for swimming, basketball, and even bicycle racing. After my mom retired, she managed to get by on her small Social Security pension but didn’t have much of a cushion in savings or other assets. She lived contentedly alone for decades in a public housing apartment.At age 83, my mom became steadily incapacitated by Parkinson’s disease and a gradual loss of vision. Finding care for her was a challenge, especially from 1,200 miles away.advertisement Related: My mother, who needed significant assistance, got the maximum of in-home care available under Florida’s Medicaid plan — 10 hours per week. She was entitled to roughly the same amount of help when she moved to Pennsylvania, where I live. Adult children, mostly daughters like me, are counted on to fill in the remaining huge gaps, with devastating effects on their financial, physical, and emotional well-being. Unlike what I learned through research, I now felt the full weight of these burdens.Despite my long familiarity with long-term care issues, I often felt helpless trying to surmount the countless and unwarranted hurdles that prevented my mother from acquiring vital services in a timely manner. The social welfare system is set up to be punitive and stingy — to discourage people from applying and keeping benefits, even when they are poor, aged, and disabled like Dottie. We had to prove over and over again that she was truly eligible for every single service she required.Through my academic work, I was familiar with the general failings of nursing homes. But it shook me to personally witness the negligent and appalling treatment that my mom received in two Florida facilities for post-acute care. Nothing could have prepared me for the indifference to her physical and cognitive needs, the unpalatable meals, the disdain for government regulations, and the generally slapdash approach to patient care. [email protected] About the Author Reprints I initially thought about finding ways for my mother to stay in her apartment. Like many others studying elder care, I assumed that the recent national movement away from placing people in nursing homes would, under the Medicaid program, offer clear-cut advantages for older people and their families. I was wrong. Not only are there long waiting lists for government-supported services in Florida (and most other states), but there isn’t sufficient help for those with low incomes and multiple chronic conditions.advertisement In 2012, a bad fall landed my mom in a nursing home for rehabilitation. The goal was for her to go home. However, the care in the facility was so negligent and the therapy so limited that she never regained her ability to walk and so couldn’t return to her apartment. She currently lives in a county nursing home near me, in Pennsylvania, where she is receiving relatively decent care. Mom, of course, needs an on-site advocate to protect her; I visit nearly every day.Overseeing my mother’s care inspired me to reexamine a question that I had wanted answers to in the 1970s: Why is there such a stark disconnect between the billions of dollars in government funding for the aged (via Medicare, Medicaid, the Older Americans Act, and other programs) and what older people actually receive? I’ve learned that the swelling budgets feed private financial interests, along with the medical industrial complex and service sector, at the expense of elderly individuals in need. Nursing homes, for instance, siphon off a considerable percentage of federal and state taxpayer money allocated for long-term care.My mother’s experience prompted me to examine the financial profiles of the commercial entities that had served her so poorly. As is the case for many nursing homes and home health agencies, they are owned by either private equity firms or multi-chain conglomerates trading on public exchanges. Despite their extensive dependence on federal funds from Medicare and Medicaid for revenue, I found it tricky to penetrate their inner workings or lay bare the dizzying layers of control and spread of earnings flowing among them. What became obvious is that their main goal — ever-increasing profits — is patently at odds with the essential requirements of their frail clients.Being thrown into caregiving taught me things that only on-the-ground experiences can convey. My elder care journey revealed the unreasonableness of our bureaucratic welfare system and exposed its stinginess and ongoing assaults on human dignity, things I never fully grasped in my academic work and, even more important, things that no older American or his or her family should ever be forced to live with.Laura Katz Olson is a professor of political science at Lehigh University. Her latest book, “Elder Care Journey: A View from the Front Lines,” was published in June by SUNY Press. By Laura Katz Olson July 27, 2016 Reprints Tags agingelder carenursing homeslast_img read more

The kids are all right: Children with 3-way DNA are healthy

first_img Both DNA-mixing procedures involve the mitochondria; the one that recently produced the baby was aimed at replacing a mother’s defective mitochondria. Cohen’s procedure injected a bit of mitochondria-containing cytoplasm into the mother’s egg.Genes in the mitochondrial DNA don’t affect traits like eye and hair color but are important for keeping cells healthy throughout the body.Cohen’s hospital performed the infertility treatment between 1996 and 2001 on 33 couples who failed to conceive after roughly five tries at in vitro fertilization.“We felt that there was something wrong with the cytoplasm” and that injecting a small amount of it from a healthy egg donor might aid embryo development, Cohen said.Fourteen of the 33 patients became pregnant, and 13 ultimately gave birth to 18 babies, including two sets of twins and one of quadruplets. (One of the 18 babies was a twin from a standard egg donation; doctors also included data on that child in the follow-up study.)Cohen and colleagues presented their findings Wednesday in the journal Reproductive BioMedicine Online.The parents of the quadruplets refused multiple requests for follow-up information; doctors know only that all four are alive and in high school.In detailed surveys, parents of the 14 other children all reported their kids in good health. One has chronic migraines, two have mild asthma, one is obese, seven have allergies, and one has attention deficit disorder. None of those rates are unusual for that number of children, doctors said. One boy was diagnosed with a borderline developmental disorder at 18 months but not when he was older, and he has an A average in school. More than 15 years ago, 17 babies were born after an experimental infertility treatment that gave them DNA from three people: Mom, Dad and an egg donor.Now researchers have checked up on how the babies are doing as teenagers. The preliminary verdict: The kids are all right.With no sign of unusual health problems and excellent grades in school at ages 13 to 18, these children are “doing well,” said embryologist Jacques Cohen of the Institute for Reproductive Medicine & Science at Saint Barnabas in Livingston, N.J., where the treatment was done.advertisement Privacy Policy Sperm test 2.0: New diagnostics aim to better understand male infertility Emma Foster (far right), is one of a handful of children born about 15 years ago from three sources of DNA. AP Photo/Richard Drew Related: So finding no problem so far from the infertility treatment is helpful and “a good message” for people considering the disease-prevention procedure, Cohen said. But he emphasized that his findings cannot be taken as proof that the newer procedure is safe and should be performed.Cells carry DNA in two places: the nucleus, where the chromosomes are, and to a much smaller degree the mitochondria. Mitochondria are the little powerhouses in the cytoplasm, the liquid part of the egg cell outside the nucleus. Please enter a valid email address. Leave this field empty if you’re human: “These children have done well,” Cohen said. “It’s what we expected or at least had hoped.”At least two other clinics in the United States. and several in other countries tried the technique after Cohen started it, but the US work stopped after the Food and Drug Administration stepped in to regulate it. Cohen said his group tried to comply with the FDA’s requirements for a permit to continue the work but lost funding before it could meet them.It’s not clear why the treatment worked for the 13 couples, Cohen said. One possibility is the infusion of mitochondria, but cytoplasm contains other molecules and structures too, he said.In any case, it was a success for Emma’s parents, Susan and Peter Foster, who had been trying for about seven years to have a baby.When Cohen’s experimental procedure was described to them and they were asked if they were interested, they had no doubts, Peter said.Susan gave birth at 33. Emma was healthy and has continued that way, her parents say.Emma is the only child in the survey to have been told about the procedure. She said she has long known her origins were unusual — her mom keeps a book that shows her as an embryo — but she didn’t know the specifics until recently.“I think it’s really cool,” she said. “It makes me different.” HealthThe kids are all right: Children with 3-way DNA are healthy Associated Press Beyond three-parent babies: New drugs offer hope for mitochondrial disease By Associated Press Oct. 26, 2016 Reprints Related: That includes Emma Foster, 17, of Red Bank, N.J. “I turned out normal,” Foster said in an interview Tuesday. A cheerleader since age 10, she is now looking at colleges and thinking of majoring in engineering.The infertility procedure is no longer performed. But the study of the children is timely because just last month, the first baby was born from a different procedure that also mixed genetic material from three people. That technique is aimed not at infertility but at preventing the child from inheriting harmful genes from the mother. Critics are concerned about its long-term safety.advertisement Newsletters Sign up for Daily Recap A roundup of STAT’s top stories of the day. About the Author Reprints She may no longer carry any trace of the donor. Only two of eight babies tested after birth showed any sign of donor mitochondria, and Emma was one who showed none. Cohen said the tests, which were not as sensitive then as now, might have overlooked some traces.The follow-up study has some limitations. It’s based on a survey of parents, and the accuracy of such second-hand information can be shaky. And it includes just 13 teens, with no comparison group.Still, Dr. James Grifo, director of infertility treatment at New York University, said the results suggest that criticism of research that mixes DNA from three people appears unfounded.“The outcomes looked uniformly good … suggesting that no harm was done,” said Grifo, who did not participate in the new study. The donor cytoplasm “certainly may have played a role in allowing their embryo to develop to a stage that allowed a pregnancy.”In 1999, after years of experiments in mice, Grifo and colleagues made embryos with DNA from three people and transferred them to several patients’ wombs, but no pregnancy resulted. Then the FDA stepped in and stopped the work.“I think it should be allowed,” Grifo said.But Dr. Alan Copperman, director of infertility at Mount Sinai School of Medicine in New York, said the jury is still out on whether using a third party’s genetic material is safe.“I don’t think that we’re yet able to declare victory and that we’ve figured out how to fix an unhealthy egg or embryo,” Copperman said. Most eggs that fail to develop normally, especially with older patients, are because of abnormal chromosomes, so tinkering with the cytoplasm is not likely to be a solution for many people, he said.But it apparently worked for the Fosters.Emma “is a blessing and a miracle,” Susan Foster said, “and medical science made that possible.”— Marilynn Marchione Tags designer babiesinfertilitymitochondrialast_img read more

First Look: Plumbing the mysteries of sweat to help burn patients cool their skin

first_img By Eric Boodman March 1, 2017 Reprints Unlock this article by subscribing to STAT+ and enjoy your first 30 days free! GET STARTED @ericboodman 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. NEW YORK — Among the myriad traits separating humans from the unsophisticated hordes of lesser mammals, perhaps the least celebrated is our ability to sweat from hairy body parts.That neglect, it turns out, is undeserved. Perspiring at the crotch and the armpit might not have led to dominion over the fish in the sea, the birds in the sky, and all creeping things that creepeth upon the Earth — but understanding it could potentially lead to better treatments for those with severe burns. In the Lab What is it? GET STARTED Eric Boodman 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.center_img General Assignment Reporter Eric focuses on narrative features, exploring the startling ways that science and medicine affect people’s lives. Dale de la Rey/AFP/Getty Images Log In | Learn More About the Author Reprints What’s included? [email protected] First Look: Plumbing the mysteries of sweat to help burn patients cool their skin Tags researchSTAT+last_img read more

Accidental effect of fewer Pap screenings: more cases of undiagnosed chlamydia

first_img The Pap smear: groundbreaking, lifesaving — and obsolete? Tags public healthsexual health The CDC recommends that sexually active women under 25 get tested for chlamydia every year. Prior to 2012, this was generally done with a swab test during a woman’s annual Pap screening.advertisement When, a handful of years ago, the U.S. and Canada changed their screening guidelines for cervical cancer, it was an acknowledgment that screenings for young women carried unintended harms.However, a new study shows they also carried unintended benefits. As Pap screenings for women under 24 became less frequent in Ontario in 2012-2014, fewer cases of the bacterial infection chlamydia were caught — putting women at risk of potentially serious consequences.The finding represents the challenge public health officials face in striking a balance between harms and benefits of disease screenings — some of which extend far beyond the condition actually being tested for.advertisement Chlamydia is the most common sexually transmitted infection in the U.S. and worldwide, with over 1.5 million cases reported to the Centers for Disease Control and Prevention in 2015. It can easily be cleared up with antibiotics, but often doesn’t have symptoms. Men with chlamydia rarely have health problems, but women who aren’t treated can develop pelvic inflammatory disease, which damages their reproductive system and can cause infertility. By Catherine Caruso July 10, 2017 Reprints Naimer said unpublished data from their group indeed show more cases in 2015 and 2016. But without data on screening numbers, she cautioned, it’s unclear whether that points to more thorough screening or a real rise in disease spread.Fortunately, there may be a simple fix: Urine testing for chlamydia has become much more reliable in recent years. These days a urine test is as sensitive and specific as swab testing, and doesn’t require a pelvic exam.Still, whether clinicians remember to administer this new type of test is a different question. Naimer thinks including reminders in electronic medical systems could help, as could leaving urine collection containers out in waiting rooms so patients can decide for themselves whether or not they want or need a chlamydia screening.“I think there just needs to be education: public education and education of primary care providers to do things a little bit differently than we’ve done in the past in light of these new guidelines,” she said.Long’s advice for young women who are sexually active is simple: “If your doctor wants to do a chlamydia screening, just say yes. Don’t think about it a lot, just do it.” HealthAccidental effect of fewer Pap screenings: more cases of undiagnosed chlamydia But Pap guidelines in the U.S. and Canada changed in 2012, putting a lower age limit on the test for the first time. The new guidelines in both countries recommend against Pap screenings for women under 21, after research indicated that cervical cancer was extremely rare and slow-growing in young women. The guidelines also reduced the frequency of screenings for women 21 and up to once every three years.But, as a result, chlamydia screening “just kind of dropped off the radar” of clinicians, said Dr. Margaret Long, an OB-GYN at Mayo Clinic.To quantify that impact, researchers used two databases of health information of Ontario residents: one that determined the total number of chlamydia tests based on billing information, and another that recorded the total number chlamydia cases as reported to the province’s public health department.The researchers found that between 2012 and 2014, chlamydia screening dropped 26 percent for women between 15 and 19, and 18 percent for 20-to-24-year-old women. Meanwhile, cases of the infection decreased by 17 percent in the younger group and 14 percent in the older group — which was not necessarily a good thing.“It’s not that the actual incidence has gone down, it’s just you’re not identifying them,” said Dr. Michelle Naimer, a family physician at Mount Sinai Hospital and an associate professor at the University of Toronto who co-led the study published Monday in Annals of Family Medicine. “And then the risk of that is that down the road, it will just spread more and you will have more cases in the future.” Comparing the Covid-19 vaccines developed by Pfizer, Moderna, and Johnson & Johnson Trending Now: Related: APStocklast_img read more

6 in 10 doctors report abusive remarks from patients, and many get little help coping with the wounds

first_img “Anybody who says they’re not bruised by these encounters, we’re sort of kidding ourselves.” “Patients making advances at me is degrading to say the least.” This story was produced in collaboration with WebMD and Medscape.Most doctors have absorbed racist, sexist, and other bigoted verbal remarks from patients under their care, according to a new national survey. And in interviews, physicians say these ugly incidents, while not frequent, can leave lasting scars.African-American doctors told STAT they had been called racial epithets and been asked to relinquish care for white patients by family members — and even colleagues. Asian-American physicians reported being demeaned with longstanding cultural and racist stereotypes, and female doctors being sexually harassed by patients during physical exams.advertisement The most extreme examples of patient bias, Choo said, involve people who refuse to be treated by anyone but a white doctor. “It’s not uncommon, but it’s not every day,” she said.For her, the bias is expressed in a multitude of ways. “It’s questions like, ‘Do you feel like you can practice western as well as eastern medicine?’ Or, ‘Where are you from? Because we definitely hate Chinese doctors, but, oh, thank God you’re not Chinese.’ I just happen not to be. Or they’ll say Oriental instead of Asian, or say other stereotypes about Asians they’ll joke about or talk about in this weird way.”Her experiences with patient bias started as soon as she began her medical education, she said. The patient called me ‘colored girl.’ The senior doctor training me said nothing The family soon objected to Patterson’s care because he is black, and they met with his attending physician — a white woman who later approached Patterson with a compromise: He could enter the patient’s room as long as he was accompanied by a white colleague.“It was a little disappointing that someone who was supposedly a mentor and a teacher would think that solution would work. We both refused to do it. And I don’t know if our attending ever really got it.”Patterson was eventually named as the director of the medical school’s teaching program, where, at one point, a patient refused care from a team of trainees because they all were African-Americans.“So we go down to the emergency room to greet this patient and she … says, ‘Well, I want to talk to the person who’s in charge of the teaching program.’ And I said ‘You’re looking at him,’” Patterson said.But by the end of her hospitalization, Patterson added, “she came to me and said, ‘I really apologize. I started off on the wrong foot. These young women took phenomenal care of me.’” Related: Your email address “It’s like running a race that’s super hard. But one person’s carrying an invisible heavy boulder on their back.” Faiz, who is 27, moved to Boston from the Bronx earlier this year to begin her residency as an emergency physician. Patients’ sexist behavior has challenged her throughout her training.“Patients making advances at me is degrading to say the least. Especially after all I’ve been through to get to this point. … A lot of the patients I’ve worked with are very marginalized and disenfranchised — so it’s not coming necessarily from a place of malice. They’re sick. So I cope with this by not considering it a personal offense. But still, as with any sexist remarks, I walk away from those situations feeling totally unclean, even if I didn’t do anything, and it was done to me.“You’re wearing professional clothes and you have the knowledge, and you’re still being put in situation where people are asking about your personal life and asking completely inappropriate questions. I’m trying to work at it, and take time and reflect and step back, so I don’t get disenchanted with the patients I’m serving and feel resentment toward them.” Have you experienced bias from a patient? Share your story below. “One patient’s son pushed [a doctor] against the wall and called him a [homophobic slur] and asked him where he parked his camel.” Related: Your name Dr. Brian McGillen, director of hospital medicine at Penn State Health Milton S. Hershey Medical Center McGillen said patient discrimination against some of his staff members persuaded him to survey doctors at his hospital more broadly.“I was not close to expecting the huge response I received: sexual orientation, ethnicity, suspected religion, female residents on the basis of gender. …“One patient’s son pushed [a doctor] against the wall and called him a [homophobic slur] and asked him where he parked his camel.”Penn State Health convened a workshop on the topic, which helped convince hospital administrators to revise the patients’ rights and responsibilities statement. That statement now explicitly prohibits patients from requesting a change of doctors on the basis of the physician’s ethnicity, or religious or sexual identity. Women may still request a female doctor. And doctors who receive discriminatory complaints can switch the patient to another provider if they wish.”In this day and age when people walk into hospitals and open fire, we need to be sure our workforce feels protected,” he said. “We all want to honor this notion of patient experience — and improving that is certainly a goal, but you can swing the pendulum too far, and at the risk of damaging your staff, who you really need to be healthy and not be burned out by this stuff.” Tags hospitalspatientsphysicians Patient Prejudice What happened when I talked about what others ignore — racism in medicine Penn State Health Milton S. Hershey Medical Center is further along. Responding to an in-house study of discriminatory behavior by patients, it recently revised its “patients rights and responsibilities” policy to cover situations in which patients direct discriminatory behavior toward staff. The hospital now won’t honor requests for a new physician based on patient prejudices.The stakes are high, said Dr. Brian McGillen, Penn State Health’s director of hospital medicine. “You come here and pour your blood, sweat, and tears for your patients, and then to have that stuff come up, absolutely it’ll lead to burnout,” he said. “There’s no doubt in my mind.”Below, eight physicians who have felt the sting of discrimination recount their experiences, and how they coped. A wide-ranging survey of more than 800 U.S. physicians, conducted by WebMD and Medscape in collaboration with STAT, found that 59 percent had heard offensive remarks about a personal characteristic in the past five years — chiefly about a doctor’s youthfulness, gender, race, or ethnicity. As a result, 47 percent had a patient request a different doctor, or ask to be referred to a clinician other than the one their physician selected.Fourteen percent said they had experienced situations in which the patient complained, in writing, about the doctor’s personal characteristics.African-American and Asian-American physicians were more likely to face such attacks, and female doctors were more often the victims of bias than males. But patients found targets in every imaginable corner: 12 percent of physicians, for instance, endured offensive remarks about their weight.advertisement Like Saha, Whitgob has helped spearhead the study of patient bias toward physicians. She, too, has experienced such behaviors during her training.“I remember being in a situation with male patients, in a surgical clinic at the VA, and I had to do general exams, and they made jokes asking whether am I enjoying it. People almost laughed it off, like ‘Well, now I experienced it too.’ I didn’t stop to think, ‘Am I being threatened?’”Whitgob said her VA rotation was done in a month, “but if, day-in and day-out, that’s what you have to deal with, or you’re a nurse who deals with this every day, there’s no escaping it.”Trainees, she said, have the option of declining to care for patients who direct abusive behavior at them. But supervisors must understand the importance of properly communicating the trainee’s decision to patients.If the supervisor tells a patient that the trainee has been removed, she said, “the patient who didn’t want the trainee in the room is getting what they want. That wouldn’t be the intention, but that would be the effect.”Whitgob said most hospitals support their medical staffs when it comes to biased patients, but they only do so in a “reactive” way, and not proactively state their policies in the manner of Penn State’s new initiative.“Ideally if every hospital system could adopt this policy, patients would say, ‘I expect my doctor to respect me,’ and doctors would say the same.“We need to keep better records of this, because it’s happening more than we know, and once people start talking about it, they bring up stories from 10, 15 years ago that they never thought they could talk about.”Update: WebMD and Medscape have provided a more detailed description of the survey’s methodology. Privacy Policy Dr. Beth A. Lown, associate professor of medicine at Harvard Medical School and medical director at The Schwartz Center for Compassionate Healthcare “Our job is to be caretakers, but it’s also to care for each other.” Related:center_img Dr. Emily Whitgob, fellow in Stanford Medicine’s division of developmental-behavioral pediatrics PhoneThis field is for validation purposes and should be left unchanged. “There was no one to talk to about it. No one talks about this stuff.” Talia Bronshtein/STAT WebMD/Medscape survey in collaboration with STAT Amid a heated national conversation about open expressions of prejudice in America, the survey spotlights a facet of the issue that has, so far, received little attention: the biases patients direct toward their doctors in hospitals and exam rooms.“I’ve certainly not read anything like this,” said Dr. Beth A. Lown, associate professor of medicine at Harvard Medical School and medical director of the Schwartz Center for Compassionate Healthcare.To explore issues raised in the survey, STAT interviewed Lown and eight other doctors and researchers around the country who are women or identify as members of minority groups. They described often disturbing encounters with patients.Lown and others noted that patients have been more actively voicing their care preferences in recent years. “Has this changed socially accepted norms about what you can and cannot say to a health care professional?” Lown asked. “Is this … unmasking attitudes that have been there all along and now, in our polarized societies, people feel less constrained in expressing them? Probably.”Patient prejudice: When credentials aren’t enoughHere’s more coverage from our partners:Full results of the survey (WebMD)Credentials don’t shield doctors, nurses from bias (WebMD)Physicians who experience patient prejudice lack resources (Medscape)Slideshow of physician and consumer survey responses (Medscape)What does your medical record say about you? (WebMD)Medical researchers have studied clinicians’ unconscious biases toward patients, said Kerth O’Brien, a social psychologist at Portland State University who studies discrimination in health care. “But much less is known about patients’ biases toward clinicians, and that is why the current study is important.”“Why would patients allow their own irrational biases to get in the way of their health care?” she added. “Clearly we need to learn more.”The online survey of 822 physicians was conducted by Medscape’s research team in July and August and has a margin of error of plus or minus 3.4 percentage points.In the follow-up interviews, some doctors said they understand why patients might express their prejudices.“Often we meet people at their lowest,” said Dr. Nikhil “Sunny” Patel, a psychiatry resident at Cambridge Health Alliance in Massachusetts. “Sometimes we can have primitive responses to stressful situations, and one of them can be targeting of the other when we’re feeling cornered or vulnerable.” Dr. Somnath Saha, professor of medicine and public health and preventive medicine at Portland VA Medical Center and Oregon Health and Science University Mike Reddy for STAT Dr. Nikhil Patel, psychiatry resident at Cambridge Health Alliance Doctors who had a patient request a different clinician based on a personal characteristic (%)0102030405060GenderEthnicity / national originRaceAccentAgeOtherMedical education from outsidethe USReligionSexual orientationPolitical viewsWeightSmokingpercentPersonal characteristicsRequests for different provider based on personal characteristics, % Gender38Ethnicity / national origin32Race22Accent19Age15Other15Medical education from outside the US7Religion7Sexual orientation2Political views2Weight1Smoking1Doctors who had a patient request a different clinician based on a personal characteristic (%) Saha is one of the few who has researched patient bias, and he has also experienced it. “I’m a brown person who works in the VA, so we treat a lot of older white men who have kind of older white men’s attitudes sometimes,” he said.One patient, for instance, asked to change doctors because he hated the smell of curry. “As if I’d come into the office with curry on my breath,” said Saha, who is of Indian descent.He eats curry infrequently, he said, and had not done so before seeing the patient.Saha agreed to transfer the patient to another doctor. “When there is bias expressed by a patient, it’s basically a deal killer, because to have an effective doctor-patient relationship, rapport is everything. And if you’ve got a patient who’s disrespectful or untrusting for any reason, it basically poisons the relationship.” While in medical school at Vanderbilt in the ’80s, Patterson encountered an older gentleman from northern Alabama, who stopped him during their first meeting.“He said, ‘Why are you asking me all these questions?’ I said, ‘Well, sir, you agreed to allow students to interview you, examine you and so forth.’ And he looked at me and said, ‘Yeah, but when I said that, I didn’t know Vanderbilt had [racial slur] in their classes.’”Once people are entrenched in their beliefs, Patterson said, “there’s not a lot you’ll be able to do to change that attitude. So the way I’ve always dealt with it is to just move on. Take it in, try to stay on your feet, stay balanced and keep moving forward.“But anybody who says they’re not bruised by these encounters, we’re sort of kidding ourselves.”The bruising can also come from the thoughtless reactions of colleagues. Patterson recalled that on his first day at George Washington University Hospital, he started an IV line for an older white patient. “I remember being surprised and embarrassed and humiliated as a medical student when people would say these things. … When it happens to you as a trainee, you tend to think it’s your fault on some level. I know that’s weird. You think, ‘Maybe it’s because I’m not competent or maybe I am less smart than a different doctor. Or maybe I shouldn’t be here?’ There’s a lot of shame in being the target of racism, and I think that’s part of it.“It hardly every bothers me anymore. I usually make a joke out of it or deflect it, but the big question is how it’s affecting our trainees and our junior doctors. What is the scope of this problem, and what’s the sequelae?”The questions loom large, she said, for an industry that is trying to grow more diverse.“How do you do that when it’s a really challenging and hard and long path, and on top of that, let’s just tell you you’ll experience racism — this extra burden. It’s like running a race that’s super hard. But one person’s carrying an invisible heavy boulder on their back. They have to work so much harder.” By Bob Tedeschi Oct. 18, 2017 Reprints Dr. Esther Choo, associate professor at Center for Policy and Research in Emergency Medicine at Oregon Health and Science University Dr. David Patterson, associate clinical professor of medicine at George Washington University Hospital Talia Bronshtein/STAT WebMD/Medscape survey in collaboration with STAT More recently, one longtime patient, during an exam, suddenly turned the conversation to Jews, she said: “Like, ‘All they’re interested in is money, and they’re out to cheat you, they’re money grubbers’ — the old stereotypes, and how you have to be on your guard all the time.“I did nothing. And I was very upset with myself that I said nothing. But I didn’t know what to say. I thought, ‘Do you know that I’m Jewish? Are you really saying this to me?’ … I didn’t tell anybody. There was no one to talk to about it. No one talks about this stuff.“You just have to set it aside and compartmentalize it, and pretend somehow, somewhere that it didn’t happen. My job is to be a professional, maintain some compassion and just don’t let it influence your care. And that’s a struggle.” “If you’ve got a patient who’s disrespectful or untrusting for any reason, it basically poisons the relationship.” Talia Bronshtein/STAT WebMD/Medscape survey in collaboration with STAT In one of Saha’s research projects, he studied patients’ comfort with people from other racial backgrounds. Patients who had negative views of other racial groups tended to rate their doctors worse in general.“That might just be a reflection of the fact that people who have negative racial attitudes just have negative attitudes, period. But the white patients who had negative racial attitudes gave particularly low marks to minority doctors.”The discrimination has financial implications, Saha said, because it seeps into physician ratings, which can determine a doctor’s compensation levels. Patel said he was in his first year of residency training when a patient raged at him because the patient believed — evidently based on Patel’s beard and the color of his skin — that Patel was a member of ISIS.“It was like, ‘Go back to where you came from; this is going to be our country again, you [expletive] raghead.’ He decided to just leave the hospital and he stormed out. And I was actually very worried about him.”Patel said the experience shook him.“That was probably the first time I’ve ever felt that othered. That feeling like, ‘Wow, I’ve trained at decent institutions; I thought that would be a protective factor. I thought my clinical acumen would be protective against violent vitriol. I was deluded in that belief. This country I call home — is it home? Then where is home? I thought this country was a country of immigrants.“And things can be less insidious than that. Like ‘Wow, your English is so good.’ Yeah, not to be arrogant, but I went to grad school twice. But that’s not the point. The conceptualization of me, as a bearded brown man, is of the other.”Patel said that he has found support among a group of physicians that discusses such matters, but that the broader medical community should place more emphasis on addressing racism in the hospital.“Our job is to be caretakers, but it’s also to care for each other. To speak up for other health professionals on the team and not be punitive about it, but set the tone that we can’t tolerate a culture where people feel targeted.” Bigoted behavior can essentially paralyze doctors, Lown said. “Because of our sense of professionalism and our code of ethics, we’re committed to letting that stuff roll off our backs, but meanwhile all your emotions are boiling inside, and you’re thinking, ‘Oh, my God, what do I do now? What do I say? How do I behave?’“I’m very petite. I’m like 5 feet tall. So when I first started out, everybody would say, ‘You don’t look old enough to be a doctor.’ All the time. Get me somebody who’s a grown-up was the implication. … It makes you very anxious — which exists in high titers anyway when you’re in medicine.” When the patient is racist, how should the doctor respond? But empathy only goes so far. Doctors who have been on the receiving end of verbal abuse said the medical system has barely acknowledged the issue, much less studied it or developed a response to it, leaving them largely on their own to deal with the psychic wounds.In the survey, the vast majority of physicians said their organizations provided no training, or had no formal policies, on handling patient bias, or they didn’t know about them.The silence of well-intentioned supervisors who have never been trained in how to manage such situations can make matters worse, said Dr. Esther Choo, an associate professor at Oregon Health and Science University.“There are a lot of people who’ve witnessed it, and who want to support their peers and simply don’t know how. And in that void is more hurt,” she said. “If you have a white preceptor and they’re witnessing it and they don’t say anything, the assumption is that they agree with it or they don’t see it, or they see it but think it’s not a problem.”Choo’s Aug. 13 Twitter thread about her experience treating — or attempting to treat — white nationalists, unleashed a torrent of conversation among doctors who had endured similar experiences. In the wake of such dialogue, many researchers and health systems are looking at the issue formally for the first time. Special Report6 in 10 doctors report abusive remarks from patients, and many get little help coping with the wounds Dr. Jessica Faiz, emergency medicine resident at Boston Medical Center “We need to keep better records of this, because it’s happening more than we know.”last_img read more

Doctors: Global warming is taking a toll on people’s health

first_img About the Author Reprints A team of 63 doctors, public health officials and scientists from around the world wrote what they considered the first of a regular monitoring of the health of the planet, similar to having a “finger on the pulse of the patient,” said Dr. Hugh Montgomery, an intensive care specialist and director of the University College of London’s Institute for Health and Performance.Based on 40 indicators, the study said “the human symptoms of climate change are unequivocal and potentially irreversible.”While other disease rates are dropping, cases of dengue fever — a mosquito-borne disease — has doubled every decade since 1990 with 58.4 million cases and 10,000 deaths in 2013. Frumkin, a former environmental health director at the U.S. Centers for Disease Control and Prevention, said climate change, which allows mosquitoes to live in more places and stay active longer with shorter freeze seasons, is part but not all of the reason.The same goes for the increase in tick-borne Lyme disease in the United States, Frumkin said, adding “the ticks do better with warmer weather.”Between 2000 and last year, the number of vulnerable people — those over 65 or with chronic disease — exposed to heat waves increased by about 125 million, the study said. Doctor Vu Minh Dien, left, examines dengue patient Tran Thi Xuyen at the National Hospital of Tropical Diseases in Hanoi, Vietnam, in August 2017. Tran Van Minh/AP It also highlighted the increasing likelihood of food shortages as climate change worsens.Columbia University’s Madeline Thomson, who wasn’t part of the study team, praised the work, saying “climate is a stress multiplier” so it is important to monitor this way.Acting on climate can have side benefits, Frumkin said. Cutting coal takes smog and soot out of the air, while eating less meat and bicycling and walking more to use less electricity means fewer accidents and reduced obesity, he said.— Seth Borenstein “There are some very severe warning signs, but there are some hopeful indicators too,” said co-author Dr. Howard Frumkin, a professor of environmental health at the University of Washington. “Given the right treatment and aggressive efforts to prevent things from getting worse, I think there’s hope.”The report highlighted health problems stemming from more frequent heat waves, disease spread by insects, air pollution and other woes. While the disasters have been costly, deaths haven’t been increasing because society is doing a better but more expensive job adjusting to the changing conditions, the researchers noted.advertisement Related: WASHINGTON — Global warming is hurting people’s health a bit more than previously thought, but there’s hope that the Earth — and populations — can heal if the planet kicks its coal habit, a group of doctors and other experts said.The poor and elderly are most threatened by worsening climate change, but there remains “glimmers of progress” especially after the 2015 Paris agreement to limit heat-trapping carbon dioxide emissions, according to a new big study published Monday in the British medical journal Lancet.Comparing the report to a health checkup, four researchers and several outside experts described Earth’s prognosis as “guarded.”advertisement By Associated Press Oct. 31, 2017 Reprints A ‘perfect storm’ superbug: How an invasive fungus got health officials’ attention Watch: Climate change: It’s the mother of all human health issues Related: HealthDoctors: Global warming is taking a toll on people’s health Associated Presslast_img read more