Thursday, February 14, 2013

Sex Diseases Cost $16 Billion a Year to Treat, CDC Says - Bloomberg

Sexually transmitted diseases cost $16 billion each year to treat in the U.S., with 19.7 million infections diagnosed annually, the nation's health agency found.
People ages 15 to 24 account for half of the annual cases, according to reports released yesterday by the Centers for Disease Control and Prevention. There are about 110 million total infections among U.S. men and women of all ages, the agency said, with the most common infection human papillomavirus, a virus linked to cancer.
Young people have borne a disproportionate burden of sexually transmitted diseases for as long as the Atlanta-based CDC has kept records, said Catherine Satterwhite, an author of one of the reports and a CDC epidemiologist. They often don't have good insurance or difficulties accessing care, she said.
"We've seen a disproportionate burden for quite a while," Satterwhite said in a telephone interview. "Young women in particular are at greater risk."
The CDC reported data on eight sexually transmitted infections, including HIV, syphilis, gonorrhea, hepatitis B, chlamydia, trichomoniasis, herpes and HPV.
Drug-resistant gonorrhea is a growing threat, the agency said in a separate study published today in the Morbidity and Mortality Weekly Report. There aren't enough antibiotics in development and more experimental therapies are needed immediately, according to the report. For now, to minimize the spread of resistant strains, more people should be screened and treated, the agency said.

Trends Persist

The sexually transmitted diseases study released yesterday, which uses data from 2008, the most recent comprehensive information available, isn't directly comparable with previous studies because of changes in the reporting methods, the CDC said. However, some trends, including that of younger patients, have persisted.
All sexually transmitted diseases are preventable, many are curable and all are treatable, Satterwhite said. Getting more people tested effectively, such as making sure more young women are screened for chlamydia and all sexually active adults are tested for HIV at least once, would help, she said.
The costliest STDs are HIV, which requires lifelong care, and HPV, which causes throat, anal, penile, and cervical tumors. Use of vaccines that can prevent HPV, made by Merck & Co. andGlaxoSmithKline Plc, have remained low as rates of HPV-related cancers have risen, according to a study last month in the Journal of the National Cancer Institute.
Curable sexually transmitted diseases cost $742 million, with chlamydia as the most common and the most expensive.
Prevention strategies for STDs include abstaining from sex, condom use, and mutually monogamous relationships, Satterwhite said. The HPV vaccine made by Merck called Gardasil is recommended for boys and girls to help prevent cancers.
The two reports on sexually transmitted infections' prevalence and cost, were published in the journal Sexually Transmitted Diseases.

U.S. Approves First Method to Give the Blind Limited Vision -







"Without the system, I wouldn't be able to see anything at all, and if you were in front of me and you moved left and right, I'm not going to realize any of this," said Elias Konstantopolous, 74, a retired electrician in Baltimore, one of about 50 Americans and Europeans who have been using the device in clinical trials for several years. He said it helps him differentiate curbs from asphalt roads, and detect contours, but not details, of cars, trees and people. "When you don't have nothing, this is something. It's a lot."



About 100,000 Americans have retinitis pigmentosa, but initially between 10,000 and 15,000 will likely qualify for the Argus II, according to the company. The F.D.A. says that up to 4,000 people a year can be treated with the device. That number represents people who are older than 25, who once had useful vision, have evidence of an intact inner retinal layer, have at best very limited light perception in the retina, and are so visually impaired that the device would prove an improvement. Second Sight will begin making Argus II available later this year.

But experts said the technology holds promise for other people who are blind, especially those with advanced age-related macular degeneration, the major cause of vision loss in older people, affecting about two million Americans. About 50,000 of them are currently severely impaired enough that the artificial retina would be helpful, said Dr. Robert Greenberg, Second Sight's president and chief executive.

In Europe, Argus II received approval in 2011 to treat a broader group of people, those with severe blindness caused by any type of outer retinal degeneration, not just retinitis pigmentosa, although it is currently only marketed in Europe for that condition. In the U.S., additional clinical trials need to be completed before the company can seek broader FDA approval.

Eventually, Dr. Greenberg said, the plan is to implant electrodes not in the eye, but directly into the brain's visual cortex. "That would allow us to address blindness from all causes," he said.





The Argus II has had relatively few safety problems, mostly post-surgical infections and occasional erosions of a thin layer in the eye that covered the implant. Those problems have been addressed, Dr. Greenberg said, and only two people needed to have the implant removed. An F.D.A. advisory panel voted unanimously last September to recommend approval, finding that benefits outweighed the risks.

Some patients experience more improvement than others, for reasons the company has not been able to determine. Kathy Blake of Fountain Valley, Calif., said she has had success with a Second Sight exercise to see if patients can identify large numbers or letters on a computer screen.



Stephen Rose, the chief research officer for the Foundation Fighting Blindness, which supported Dr. Humayun's very early work but has not financed it since, said the artificial retina would eventually be only one of the options to help blind people.

"I think there are tremendous possibilities," he said. "I'm not downplaying the retinal prosthesis, don't get me wrong. It's huge for some individuals, and it's here now."

Barbara Campbell, 59, relishes how the device helps her navigate Manhattan streets, locate her Upper East Side bus stop, and spot her apartment building's foyer light while riding in a taxi.


At a performance by Rod Stewart, "I could definitely see his hair," she said, which was white-blond under the lights. At a concert by Diana Ross, even though Ms. Campbell sat far away from the stage, she said Ms. Ross "was wearing a sparkly outfit, and I could see her."

No such luck at a performance by James Taylor, though. His low-key clothing created no contrast for the artificial retina to register. Alas, Ms. Campbell said, "He wasn't so sparkly." 

Tuesday, February 12, 2013

Price for a New Hip? Many Hospitals Are Stumped -

"Transparency is all the rage these days in government and business, but there has been little push for pricing transparency in health care, and there's virtually no information," said Dr. Peter Cram, an associate professor of internal medicine at the University of Iowa, who wrote the paper with Ms. Rosenthal. He added: "I can get the price for a car, for a can of oil, for a gallon of milk. But health care? That's not so easy."
"We've been trying to help patients get good value, but it is really hard to get price commitments from hospitals - we see this all the time," said Jeff Rice, the chief executive of Healthcare Blue Book, a company that collects data on medical procedures, doctors visits and tests. "And even if they say $20,000, it often turns out $40,000 or 60,000."
There are many caveats to the study. Most patients - or insurers - never pay the full sticker price of surgery, because insurance companies bargain with hospitals and doctors for discounted rates. When Ms. Rosenthal balked at initial high estimates, some hospitals produced lower rates for a person without insurance.
In an accompanying commentary, Andrew Steinmetz and Ezekiel J. Emanuel of the University of Pennsylvania acknowledged that there was "no justification" for the inability to provide estimates or for the wide range of prices. But they said that more rigorous data on quality - like infection rates and unexpected deaths - were required to know when high prices were worth it.
But, broadly, researchers emphasized that studies had found little consistent correlation between higher prices and better quality in American health care. Dr. Cram said there was no data that "Mercedes" hip implants were better than cheaper options, for example.
Jamie Court, the president of the California-based Consumer Watchdog, said: "If one hospital can put in a hip for $12,000, then every hospital should be able to do it. When there's 100 percent variation in sticker price, then there is no real price. It's about profit."
Dr. Cram said the study did contain some good news: some of the country's top-ranked hospitals came up with "bargain basement prices" in response to repeated calls. "If you're a good consumer and shop around, you can get a good price - you don't have to pay $120,000 for a Honda," he said.
But that shopping can be arduous in a market not set up to respond to consumers. To get a total price, Ms. Rosenthal often had to call the hospital to get its estimate for on-site care, and a separate quote from doctors. And many were simply perplexed when she asked for a price upfront, Ms. Rosenthal said, adding, "The people who answered didn't know what to do with the question."

Health Testing on Mice Is Found Misleading in Some Cases -


The study's findings do not mean that mice are useless models for all human diseases. But, its authors said, they do raise troubling questions about diseases like the ones in the study that involve the immune system, including cancer and heart disease.





"It's amazing," said Dr. Richard Wenzel, a former chairman at the department of internal medicine at Virginia Commonwealth University and a former editor of The New England Journal of Medicine. "They are absolutely right on."

Potentially deadly immune responses occur when a person's immune system overreacts to what it perceives as danger signals, including toxic molecules from bacteria, viruses, fungi, or proteins released from cells damaged by trauma or burns, said Dr. Clifford S. Deutschman, who directs sepsis research at the University of Pennsylvania and was not part of the study.

The ramped-up immune system releases its own proteins in such overwhelming amounts that capillaries begin to leak. The leak becomes excessive, and serum seeps out of the tiny blood vessels.Blood pressure falls, and vital organs do not get enough blood. Despite efforts, doctors and nurses in an intensive-care unit or an emergency room may be unable to keep up with the leaks, stop the infection or halt the tissue damage. Vital organs eventually fail.

The new study, which took 10 years and involved 39 researchers from across the country, began by studying white blood cells from hundreds of patients with severe burns, trauma or sepsis to see what genes were being used by white blood cells when responding to these danger signals.



"They were so used to doing mouse studies that they thought that was how you validate things," he said. "They are so ingrained in trying to cure mice that they forget we are trying to cure humans."

"That started us thinking," he continued. "Is it the same in the mouse or not?"


"We were kind of blown away," Dr. Davis said.

The drug failures became clear. For example, often in mice, a gene would be used, while in humans, the comparable gene would be suppressed. A drug that worked in mice by disabling that gene could make the response even more deadly in humans.

Even more surprising, Dr. Warren said, was that different conditions in mice — burns, trauma, sepsis — did not fit the same pattern. Each condition used different groups of genes. In humans, though, similar genes were used in all three conditions. That means, Dr. Warren said, that if researchers can find a drug that works for one of those conditions in people, it might work for all three.



Still, Dr. Davis said, reviewers did not point out scientific errors. Instead, he said, "the most common response was, 'It has to be wrong. I don't know why it is wrong, but it has to be wrong.' "

The investigators turned to Proceedings of the National Academy of Sciences. As a member of the academy, Dr. Davis could suggest reviewers for his paper, and he proposed researchers who he thought would give the work a fair hearing. "If they don't like it, I want to know why," he said. They recommended publication, and the editorial board of the journal, which independently assesses papers, agreed.


"When I read the paper, I was stunned by just how bad the mouse data are," Dr. Fink said. "It's really amazing — no correlation at all. These data are so persuasive and so robust that I think funding agencies are going to take note." Until now, he said, "to get funding, you had to propose experiments using the mouse model."


"Mice can eat garbage and food that is lying around and is rotten," Dr. Davis said. "Humans can't do that. We are too sensitive."


"This is a very important paper," said Dr. Richard Hotchkiss, a sepsis researcher at Washington University who was not involved in the study. "It argues strongly — go to the patients. Get their cells. Get their tissues whenever you can. Get cells from airways."

"To understand sepsis, you have to go to the patients," he said.

Sunday, February 10, 2013

Unexpected Letter From ER Doctor May Make You Tear Up

True love and compassion aren't easy to ignore.

This week, a 24-year-old Redditor shared a letter received just after the death of his mother. The event, despite being difficult, brought an unexpected source of condolence -- a personal note from a physician who had never contacted a patient's family before.

"The letter was written for my father," he told The Huffington Post on Friday. "He stayed by her side until the very end."

The letter reads:

Dear Mr. (removed),



I am sorry for your loss and I hope you can find comfort in the memory of your wife's great spirit and of your loving bond. My heartfelt condolences go out to you and your family.

(removed), MD

According to the Redditor, his mother had breast cancer. A month ago, breathing difficulties landed her in the hospital, and 16 hours later, she passed away.

Surprisingly, the doctor who wrote the letter had never met or treated his mother until that day.

"If my mother were alive to see this, she would want readers to reflect on the power of showing compassion towards a total stranger," he told HuffPost.


2013-02-08 Spike activity « Mind Hacks

Quick links from the past week in mind and brain news:


The dodgy practice of psychologists trying to patenttherapeutic techniques is covered by Neuroskeptic.


Forensic psychology nerds: In The News covers the latest in the debate on theaccuracy of violence risk assessments.

The Bangkok Post on the bizarre Thai government announcement that calculators, phones "and even karaoke machines" could damage memory, lead to Alzheimer's disease. Bryan Adams covers, screaming fits. 80s hair metal, unfortunately lycra incidents.

People without an amygdala can experience fearNeurophilosophy covers an intriguing new study.





After a nonsense article on 'girls and the science gap' two neuroscientists write a stirling reply on why pseudoscience and stereotyping won't solve the problem inNotes and Queries.

News - Beware of neuro-bunk

Can a cheese sandwich or chocolate help you make better decisions? Can a brain scan cure mental illness?  Or are these just two examples of neuro-bunk, where neuroscience is being overly simplified and distorted to sell products and newspapers?
In a recent TED talk, neuroscientist and Gates Cambridge Alumna Molly Crockett [2006] talks about how to spot when neuroscience has been simplified to support unrealistic claims.
She talks about an experiment she conducted which involved people drinking a horrible-tasting concoction which depleted the amino acid tryptophan. She found that depleting tryptophan made people more likely to take revenge when they were treated unfairly.
The headlines that emerged from the study suggested cheese sandwiches and chocolate, which contain tryptophan, could help people make better decisions.
Does this oversimplification matter, asks Molly. After the reports were published, she was approached by marketeers and others interested in getting her to endorse their products. She says neuroscience is being increasingly used to sell products without any evidence to back up the claims made on their packaging.
In the TED talk, she shows how putting a picture of a brain on something makes people more likely to believe in the product. "Brains sell," she says.
Molly, who did a PhD in Experimental Psychology, says there is some very exciting neuroscience taking place, but a lot of the deductions made by non-scientists about neuroscientific research are neuro-bunk.
One report, for instance, claimed that brain scans show that people love their iPhones because they show that a part of the brain linked to love is active when people look at pictures of iphones. However, that part of the brain - the insula - is also involved in other emotions, such as pain and anger, says Molly.  Another study claims the hormone oxytocin is the 'moral molecule' because it is involved in trust and empathy, but other studies suggest it is also linked to envy and bias towards one's own group. Boosting it could therefore lead to a decrease in co-operation. It could just as easily be called the 'immoral molecule', says Molly.
She adds that clinics in the US are making millions by offering brain scans to people, including children, claiming they can identify and prevent mental illness and help overcome marital conflicts.
"The broad consensus in neuroscience is that you cannot yet diagnose mental illness from a single brain scan," says Molly, who is currently working with support from the four-year Sir Henry Wellcome Postdoctoral Fellowship studying human altruism in laboratories worldwide.
She says there is tremendous potential for neuroscience, but it is too early to make overblown claims about its abilities.
"Real science is playing a much longer game," she says. In the meantime, people should question any claims on products which say they are backed by neuroscience and they should expect the answers not to be simple, because the science is not simple.
She states: "[Neuroscientists] haven't found a 'buy' button inside the brain, we can't tell whether someone is lying or in love just by looking at their brain scans, and we can't turn sinners into saints with hormones."

TED Talk:
