Later On

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Archive for the ‘Medical’ Category

When Women Fail, They Pay a Much Bigger Price Than Men

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Kevin Drum posts at Mother Jones:

Via Harold Pollack, here’s a new study that will probably not surprise you—but should incense you. Heather Sarsons, a graduate student at Harvard, examined Medicare data to determine how doctors referred patients to specialists for surgery. In particular, did they treat male and female surgeons differently?

The answer is pretty simple: oh my, yes. Sarsons used matched panels of surgeons who were equally qualified and had similar records of surgical outcomes. But primary care doctors didn’t treat them the same. If a patient unexpectedly died after surgery, most doctors continued referring patients to male surgeons at about the same rate. But referrals to female surgeons plummeted: . . .

Continue reading.

There’s more, including 3 charts. Depressing, but not surprising.

Written by LeisureGuy

18 November 2017 at 8:47 am

The problem with US healthcare is that it’s too expensive, not that people use too much

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Sarah Kliff of Vox has a (good) email newsletter. This is from the most recent:

Check out the latest episode of What the Health, where I join Julie Rovner of Kaiser Health News, Alice Ollstein of Talking Points Memo, and Joanne Kenen of Politico to talk through this week’s latest health care news.

A quick programming note: VoxCare will be taking a week-long break over the Thanksgiving holiday. We’ll be back in your inboxes on Monday, November 27. Have a fantastic holiday! 

—Sarah

Earlier this week, we learned of the death of famed health economist Uwe Reinhardt. The Princeton professor was 80 years old.

Reinhardt’s influence on American health policy is hard to overstate. Aaron Frakt wrote a wonderful remembrance at the Incidental Economist, and the New York Times also has an obituary that speaks to Reinhardt’s constant curiosity, his personal warmth, and the great joy he always took in trying to understand the maddening, baffling inner-workings of the American health care system.

I wanted to take today’s VoxCare to tell you about a Reinhardt paper I think anyone interested in health policy ought to read. It fundamentally shaped how I think about the biggest problems in American health care — and the right solutions to fix them.

The paper is called “It’s the prices, stupid!” It is co-authored with Gerald Anderson, Peter Hussey, and Varduhi Petrosyan.

The thrust of the argument is this: America does not have an overuse problem when it comes to medicine. We do not go to the doctor more than people in other countries — we actually go to the doctor a little bit less.

The reason that American health care is so expensive is that, each time Americans do go to the doctor, we pay outlandishly high prices. We’re not consuming lots and lots of health care. We’re just paying higher price tags.

This is a fundamental fact about American health care that often gets lost in our debate. We have a lot of discussions about “waste” in American health care or “overuse” in our fee-for-service system.

One poll of 627 doctors, published in JAMA Internal Medicine, found that 42 percent of physicians thought their own patients were receiving too much medical care. “You’re getting too much health care,” a headline in the Atlantic bluntly declared.

Most of the policy interventions we see from Congress or statehouses target the volume of health care in America. They try to tamp down on unnecessary scans, procedures, or prescriptions as a way to ratchet down American health care spending.

But as Reinhardt and his co-authors argue in this paper, those policy interventions don’t get at the fundamental problem of the American health care system: our prices. Reducing the number of MRI scans in the United States, for example, won’t change the fact that an MRI in the United States costs an average of $1,119 — but $503 in Switzerland and $215 in Australia.

Here is how Reinhardt described the situation in a 2013 blog post for the New York Times:

Traditionally, the theory driving discussions on the high cost of health care in the United States has been that there is enormous waste in the system, taking the form of excess utilization of care. From that theory it follows that methods of controlling the growth of health spending should focus on ways to reduce the use of unnecessary or only marginally beneficial health care.

Largely overlooked in these discussions has been the elephant in the room: the extraordinarily high prices Americans pay for health care. However, as a group of us noted in a paper in 2004, “It’s the Prices, Stupid,” it is higher health spending coupled with lower — not higher — use of health services that adds up to much higher prices in the United States than in any other member nation of the Organization for Economic Cooperation and Development. Aside from a few high-tech services, Americans actually use less health care and rely on fewer real health-care resources than do residents of other industrialized countries.

Reinhardt’s relentless focus on American health care prices has shaped my own reporting. It’s made me question the policy interventions that tackle the volume of health care, and how far they can really take the United States to better controlling our health care costs.

What Uwe Reinhardt taught me about American health care is exactly the title of his paper: It’s the prices, stupid. And that has shaped what I decide to report on. It is why I tackle projects that try to bring more transparency to American health care pricing, and the reason I think it’s important to tell the stories of the medical bills my readers send me.

These aren’t one-off, sad stories. These are, as Reinhardt rightfully spent his career arguing, small windows into the systematic way the American health system charges sky-high prices.

I’m so glad I had the chance to interview Reinhardt as a health reporter and learn from his work. This 2004 paper remains just as relevant to explaining American health care now as it was at the time of publication — and I highly recommend taking the time to read it.

Another item in the newsletter suggests that the overcharging is done deliberately:

“Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices”: “Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.” —Chad Terhune, Kaiser Health News

Written by LeisureGuy

17 November 2017 at 3:39 pm

New York Governor Signs Bill Adding PTSD as Qualifying Condition for Medical Marijuana Program

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Sensible step, IMO. The Marijuana Policy Project reports:

A bipartisan bill to add post-traumatic stress disorder (PTSD) as a qualifying condition for New York’s medical marijuana program was signed into law by Gov. Andrew Cuomo during Veterans Day weekend. The Senate passed S 5629 in June (50-13), and the Assembly version, A 7006, received overwhelming approval in May (131-8). New York is the 28th state to allow medical marijuana to be used to treat PTSD.

“Gov. Cuomo should be applauded for helping thousands of New York veterans find relief with medical marijuana,” said Bob Becker, Legislative Director for the New York State Council of Veterans Organizations. “PTSD is a serious problem facing our state, and now we have one more tool available to alleviate suffering.” . . .

Continue reading.

 

Written by LeisureGuy

13 November 2017 at 5:38 pm

Posted in Drug laws, Medical

Against Productivity This Essay Took Four Years to Write

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Quinn Norton writes at Medium:

Four years ago I temporarily moved to Puerto Rico. I went to PR to seek the New American Dream, a dream that had swept through American business culture, launched a billion dollar self-help industry, alienated my generation, and killed uncounted people through its wild pursuit. I went to escape the distractions and social obligations of the mainland and to try to truly capture the elusive quality that rises above all considerations in the contemporary American psyche: I went to Puerto Rico to work on being more productive.

I had a place to stay, and I didn’t speak the language. I went with the idea that I would avoid distractions and get a lot of writing done. I would organize my time, my thoughts, and my notes. I would have to-do lists and subject clouds and create outlines and fill them in, everyday between 9 and 6 or 7. I would have a word count, discrete articles, a body of material. I could pitch them and massage them into house voices as needed on a schedule to woo editors. I’d make habits that let me produce content, on time, regularly, without last minute stress.

I didn’t do any of that. I got a little writing done, and I stared up at the beautiful old ceiling of my apartment a lot.

When I went to Puerto Rico I was, like everyone I knew, not only incredibly busy, but absorbed in trying to figure out how to produce more in my busy time. Even my leisure time had to be productive: Was I having enough fun? Was I sufficiently recharged for my next round of work? Was I getting enough out of the island? I had to be a productive learner as well: was I getting a good picture of PR’s culture? Was I mining my experience of this beautiful place for all it was worth.

I visited with new friends, and tooled around on the net (albeit always at 2G speeds). I watched rain fall. I cooked. I considered the shape of the buildings a lot, and looked after cats periodically. I walked to old forts and lookouts. At one point I took pictures of doors for no reason I could discern. I berated myself for being unproductive, for wasting this precious time I’d set aside to put my professional life together. I spent hours anxious to craft my time to be quantitatively better for writing. Then it all collapsed, and the only habit I fell into was depressive empty afternoons when I was alone with the cats and the rain. But I also, and wholly by accident, thought the thoughts that would take my career and life in a new and unimagined direction.

In the end my trip to Puerto Rico didn’t turn out how I’d hoped. I barely wrote anything. I complained to myself about myself a lot. I took a lot of long walks and so-so pictures. I edited part of a book, but that didn’t take long. I sat around getting both anxious and bored from how little I had gotten done. I had no idea how vital that time was when it was passing.

I have always had a flirtatious interest in the ever morphing American dream, from The Great Gatsby to Fear and Loathing, from the chickens and picket fences of the 50s to the foreign adventures and many attempts to bring democracy to ourselves and others. Every age of America reinvents and transforms the dream and thereby some part of the national soul. But sitting in Old San Juan in a tropical rain, trying to keep mosquitos off my ankles, I began to think no iteration was quite as vile as this one. Despite all the greed and hatred of the past iterations, no version of the dream had been so mechanical — so dehumanizing — as this dream of productivity.

We dream now of making Every Moment Count, of achieving flow and never leaving, creating one project that must be better than the last, of working harder and smarter. We multitask, we update, and we conflate status with long hours worked in no paid overtime systems for the nebulous and fantastic status of being Too Important to have Time to Ourselves, time to waste. But this incarnation of the American dream is all about doing, and nothing about doing anything good, or even thinking about what one was doing beyond how to do more of it more efficiently. It was not even the surrenders to hedonism and debauchery or greed our literary dreams have recorded before. It is a surrender to nothing, to a nothingness of lived accounting.

This moment’s goal of productivity, with its all-consuming practice and unattainable horizon, is perfect for our current corporate world. Productivity never asks what it builds, just how much of it can be piled up before we leave or die. It is irrelevant to pleasure. It’s agnostic about the fate of humanity. It’s not even selfish, because production negates the self. Self can only be a denominator, holding up a dividing bar like a caryatid trying to hold up a stone roof.

I am sure this started with the Industrial Revolution, but what has swept through this generation is more recent. This idea of productivity started in the 1980s, with the lionizing of the hardworking greedy. There’s a critique of late capitalism to be had for sure, but what really devastated my generation was the spiritual malaise inherent in Taylorism’s perfectly mechanized human labor. But Taylor had never seen a robot or a computer perfect his methods of being human. By the 1980s, we had. In the age of robots we reinvented the idea of being robots ourselves. We wanted to program our minds and bodies and have them obey clocks and routines. In this age of the human robot, of the materialist mind, being efficient took the pre-eminent spot, beyond goodness or power or wisdom or even cruel greed.

There’s so many casualties to this view of the mechanical human. Wisdom itself has vanished from the discourse, replaced by mere knowing. I don’t mean that these are less wise times, but that the very idea of wisdom has vanished from the culture. If I hear the word being discussed it’s generally as a game stat. Evidence is everything, but the context that gives it meaning is worthless. The very idea of the liberal education that was once the foundation of our Enlightenment culture is mystifyingly irrelevant, even for the rich rulers it was invented for. How, we collectively ask, does understanding history, philosophy, or art make us more productive? The vibrant life was replaced with mere health. Wonder became a pump for applicable creativity. How shall we get everything done? Despite having more labor-saving technology than anyone in history, we have made it so we have more to get done than any form of society before us. We even created a social obligation to enjoy ourselves with maximal efficiency, and called it a tourism industry.

Productivity, the word, was born at the beginning of the 19th century as the ability to bring forth. . .

Continue reading.

Written by LeisureGuy

11 November 2017 at 11:22 am

Psychology’s power tools

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David A Sbarra, professor of psychology at University of Arizona and director of the Laboratory for Social Connectedness and Health, writes in Aeon:

A few years ago, I was attending a conference in Berlin in Germany, and I went out one evening to catch up with a friend I hadn’t seen in years. James lives in the United States and works in the field of psychology, but Berlin was the first time we’d been together in a good while. It was a beautiful evening and the city felt so alive, but James looked nervous. I knew he had something to tell me.

He started: ‘Brian is Briana.’

‘What?’

‘My son is my daughter. He is really a she.’

I didn’t need any more explanation to know what James was saying. His 18-year-old, formerly Brian, identified as a woman, and he was breaking the news to me.

‘Wow.’

‘I know. I know. He’s going to… I mean, she’s having sex-reassignment surgery in Singapore in December, and we’ve been doing hormone treatments for months. It’s been a wild ride.’

When James used the word ‘we’ to describe the hormone treatments, I knew everything would be OK. The ‘we’ in his sentence was a clue that that their family was not split apart by this news. Learning that your son is really your daughter is, for most people, life-changing news, and the few clients I had worked with in therapy around their gender identity were torn apart by how their families had responded.

James had learned so much in the past year about how to connect with his daughter as a trans-woman. Briana’s brother was turning his back on her, and James and his wife felt alone, as if they were walking on quicksand. Throughout the conversation, though, he kept saying: ‘It is what it is.’ James must have said the phrase 10 times, and it dawned on me that he was getting at something profound. With this aphorism, he could avoid getting sucked into potentially painful emotions and instead be present and available to help his daughter.

When I returned from Berlin, I was primed to hear the phrase everywhere I went. I am convinced I hear it at least once a day, and not only from my clients. I hear it from my wife, my friends, my colleagues, my students and, a few days ago, I heard it from the woman working the register at the gas station. I hear myself and others saying these words, but I hardly ever stop to reflect on their meaning. When it finally dawned on me to ask why everyone keeps using this phrase, the answer appeared quickly and with force: the phrase is a way to psychologically disarm powerful negative emotions. It’s an efficient means of distancing ourselves from difficult experiences, to create mental space and, potentially, to ignore – in a good way – percolating negative emotions. In short, this phrase represents what psychologists call an emotion-regulatory strategy.

Research in clinical psychology suggests that a key aspect of maintaining our emotional health is not deepening our connection to painful thoughts – that is, not getting ‘sucked into’ thoughts about inferiority, impossibility, or seeing the potential for bad outcomes around every corner. ‘It is what it is’ reflects the decision not to go down this road and, when we use it, we’re practising one of the best therapies around. Although there are many routes to emotional equanimity, it is the thoughts in our heads, and the words we choose to express them, that are the gatekeepers of our psychological wellbeing.

This notion is at the heart of cognitive behavioural therapy, or CBT, a proven collection of techniques that help us realign our thoughts so our emotions stay in balance and we successfully navigate life.

Imagine you’re strolling across a lovely college campus on your way to grab lunch with a friend. You’re stopped by two students.

‘Could you spare a minute? We’re running a research study on how people perceive the natural environment. Would you like to participate?’

‘Sure, why not?’

This is when things get a little weird. The researchers have you don a backpack that weighs about 20 per cent as much as you do. Then they ask you to estimate the slant of the hill in front of you from completely flat to a vertical cliff. Can you zip up this hill with your backpack on, or did this small hill just become Mount Everest in your mind? Although I’ve glamorised it a bit, this is a real research study. Developed by the psychologist Dennis Proffitt and his colleagues at the University of Virginia, the ‘hill slant’ study is well-known, and has garnered an impressive set of findings about visual perception. It makes sense that people perceive the hill to be steeper when they are wearing a heavy backpack, relative to when they’re not wearing one (That hill with this backpack? No way!), and that they perceive the hill to be steeper if they’re tired.

A more surprising finding emerged in 2008, when psychologist Simone Schnall, director of the Mind, Body, and Behaviour Laboratory at the University of Cambridge, found that people perceive hills to be less steep when they’re with other people or when they imagine a supportive significant other alongside them. Schnall reasoned that the availability of social resources might keep people from ‘being depleted’ when they donned the heavy backpack. It is hard to overstate the significance of these findings: social support alters how we perceive the demands of the physical world.

In fact, the hill-slant study illustrates one of the most important topics in contemporary psychological science: our evaluations of situations, events and people shape how we perceive, or appraise, the world around us. These psychological evaluations are often referred to as cognitive appraisals. When we’re with others we appraise the slant of the hill differently; we evaluate that mound of dirt as less foreboding.

How do you feel about work or school tomorrow? Smooth sailing or another headache? What about that weird look a colleague gave you this morning? Your kid is talking back and being a total pain. Why does it bother you so much after dinner compared with after breakfast?

These questions capture the essence of the calculus we engage in every second of the day. We’re constantly taking our own psychological temperature and evaluating whether we need to rest or spring into action. Our emotional lives hinge in large part on this appraisal process. Whether we feel happy, engaged and full of energy is derived from the belief that we are in harmony with the world around us.

We maintain this sense of harmony by viewing ourselves, others and the events around us in a relatively benign light: things are fine, we’re safe. When we perceive the slings and arrows of life as non-events – when we can say: ‘It is what it is’ – we can face difficult circumstances and effectively disarm potential emotional landmines.

When anxiety makes our thinking disordered, on the other hand, quite the opposite happens. Hills seem insurmountable, and the world becomes a scary and impossible place. As a brief example of appraisals gone awry, stop for a moment and think about what it would feel like to believe that you are absolutely worthless. You contribute nothing to this planet. Zilch! What if you were as certain of these thoughts as you were of the fact that you need light in order to read this article? Now you have an idea about what it’s like to be depressed.

Most of the time, however, these negative appraisals are distortions; they are misappraisals of the world around us based on automatic habits of thought that have rooted themselves deep inside our minds. CBT was designed to help people break these habits, to learn new ways to evaluate the reality of their appraisals and, in general, to think more flexibly about their lives.

Judith Guest’s novel Ordinary People (1976) is, arguably, one of the richest literary explorations of grief. Guest shows us how reactions to loss can insidiously gnaw at the foundation of our psychological health, and explores how the same events can impact people in different ways. In one of the book’s best exchanges, Conrad Jarrett talks with his psychiatrist, Tyrone Berger, about the massive emotional pain he has kept under wraps since the tragic death by drowning of his oldest brother and his own unsuccessful attempt at suicide. Conrad’s mother, Beth, meanwhile, shuts down completely and is totally disconnected from Conrad’s pain. His father, Cal, tries with all his might to protect his son from the throws of depression, and it’s clear that these efforts are in large part to protect himself from the pain of losing his elder son. The Jarretts were just ordinary people, just trying to make sense of their lives. When tragedy struck, they became ordinary people dealing with an extraordinary set of emotions that set them adrift.

Understanding and improving our mental health often hinges on demystifying emotional experience, and any therapist worth a dime should begin his or her treatments with a review of some basic lessons learned from the research on emotions. For starters, emotions are feelings – the conscious experience of pleasure or pain.We experience our emotions along a continuum from good to bad, at intensities from relatively neutral to downright explosive. Thus, we can sit happily on our couches or jump and scream for joy at our favourite sporting events.

Importantly, emotions communicate information, prepare us for action, and have incredible survival value. Without a signalling system to warn us about potential threats in the natural world – that is, without emotions to provide information – humans and other animals would be toast. Quite often, our emotions become disordered when they are out of proportion to the demands of a given situation. Just think of someone who has a panic attack at the idea of being at Costco on a Saturday; it can be overwhelming for anyone, but it is not an emergency that should elicit an immediate and overwhelming fear response. Given the importance of emotions to our survival and the myriad ways in which they can become disordered, the goal of most psychotherapies is to recalibrate our emotional response system.

Over the course of my career, I have worked with many clients who just wanted to figure out how to eliminate every single one of their emotional reactions. Doc, if you had a pill that would stop me from feeling, I’d take it in a heartbeat. There’s a simple and poignant response for such statements: if we eliminated the experience of physical pain, we’d burn our hands off on a hot stove by dinnertime. The same goes for our emotions. Our goal should never be to eliminate our emotions, but rather to regulate or coexist with them better.

Perhaps no psychologist has contributed more to the study of emotion-regulation than James Gross at Stanford University. In one of his earliest studies, Gross showed research participants three silent videos: one of an abstract shape like you might see on a computer screensaver, one of a burn victim receiving treatment, and one of a close-up amputation of an arm. At any point, participants were allowed to ask that a film be stopped. Gross then evaluated participants’ felt experiences and physiological and behavioural responses under one of three conditions: watching as usual; actively trying to suppress emerging emotions; or using techniques of cognitive reappraisal, in which they were asked to think about what they were seeing objectively and technically, and then reappraise the images in those terms.

The big finding from this study was that reappraisal lead to ‘decreases in both behavioural and subjective signs of emotion’, with no hint of elevations in physiological stress. A particularly interesting aspect of the findings was that seven of the participants in the ‘watch’ and ‘suppress’ groups asked for the upsetting films to be stopped, compared with none in the ‘reappraise’ group, suggesting that asking people to view upsetting material from a more detached perspective does indeed alter the nature of the emotional experience.

This fact is a foundational element of CBT: change how you view your circumstance, and you can change how you feel. Gross’s research provided empirical backbone for the link between our thoughts and our emotions. I have long felt this research captures the essence of what most cognitive behavioural therapists do on a daily basis: we help people come to view the hurdles of life less like perilous threats that will slowly eat them alive and more like challenges to be managed and overcome. . .

Continue reading.

The book Feeling Good: The New Mood Therapy, by David Burns, MD, is based on CBT findings.

Written by LeisureGuy

9 November 2017 at 8:32 am

Unlocking the Secrets of the Microbiome

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Jane Brody reports in the NY Times:

Modern technology is making it possible for medical scientists to analyze inhabitants of our innards that most people probably would rather not know about. But the resulting information could one day save your health or even your life.

I’m referring to the trillions of bacteria, viruses and fungi that inhabit virtually every body part, including those tissues once thought to be sterile. Together, they make up the human microbiome and represent what is perhaps the most promising yet challenging task of modern medicine: Determining the normal microscopic inhabitants of every organ and knowing how to restore the proper balance of organisms when it is disrupted.

Proof of principle, as scientists call it, has already been established for a sometimes devastating intestinal infection by the bacterium Clostridium difficile. This infection, popularly called C. diff, often occurs when potent antibiotics wipe out the normal bacterial inhabitants of the gut that otherwise keep it in check.

When all else fails to clear up a recurrent C. diff infection, the Food and Drug Administration has approved treatment with a fecal transplantfrom a healthy gut presumed to contain bacteria that can suppress C. diff activity. The treatment is highly effective, with a cure rate in excess of 90 percent.

Under the auspices of the National Institutes of Health, a large team of scientists is now engaged in creating a “normal” microbiological road map for the following tissues: gastrointestinal tract, oral cavity, skin, airways, urogenital tract, blood and eye. The effort, called the Human Microbiome Project, takes advantage of new technology that can rapidly analyze large samples of genetic material, making it possible to identify the organisms present in these tissues.

Depending on the body site, anywhere from 20 percent to 60 percent of the organisms that make up the microbiota cannot be cultured and identified with the older, traditional techniques used by microbiologists.

If the institutes’ five-year project succeeds in defining changes in the microbiome that are associated with disease, it has the potential to transform medicine, assuming ways can be found to correct microbial distortions in the affected tissues.

Here are some of the demonstration projects already underway:

Skin: Dr. Martin J. Blaser, microbiologist and director of the human microbiome program at New York University School of Medicine, is directing examination of the organisms on the skin of 75 people with and without psoriasis, checking whether agents used to treat the condition adversely alter the microbiome.

Vagina: Jacques Ravel at the University of Maryland School of Medicine and Larry J. Forney at the University of Idaho are studying 200 women to determine the microbial changes that may result in a common and difficult-to-control infection called bacterial vaginosis, which afflicts more than 20 million American women of childbearing age.

Blood: At Washington University in St. Louis, Dr. Gregory A. Storch, a specialist in pediatric infectious disease, and colleagues are examining the role of viruses and the immune system in the blood and respiratory and gastrointestinal tracts of children who develop serious fevers that result in some 20 million visits a year to hospital emergency rooms.

Gastrointestinal tract: Claire M. Fraser-Liggett, a microbiologist, and Dr. Alan R. Shuldiner, a geneticist, both at the University of Maryland School of Medicine, are exploring how the microbiome affects the body’s use of energy and the development of obesity.

Previous studies have already found differences in the gut microbiota of lean and obese adults. There is also evidence that the typical high-calorie American diet rich in sugar, meats and processed foods may adversely affect the balance of microbes in the gut and foster the extraction and absorption of excess calories from food.

A diet more heavily based on plants — that is, fruits and vegetables — may result in a microbiome containing a wider range of healthful organisms. In studies, mice that had a microbiota preconditioned by the typical American diet did not respond as healthfully to a plant-based diet.

Compared to lean mice, obese mice have a 50 percent reduction in organisms called Bacteroidetes and a proportional increase in Firmicutes, and lean mice get fat when given fecal transplants from obese mice. A similar shift has been observed in people, and the distorted ratio of organisms was shown to reverse in people who lose weight following bariatric surgery.

There is also evidence that microbes residing in the gut can affect distant sites through their influence on a person’s immune responses. This indirect action has been suggested as a possible mechanism behind rheumatoid arthritis. In mice, certain bacteria in the gut have been shown to foster production of antibodies that attack the joints, resulting in the joint destruction typical of rheumatoid arthritis.

Similarly, studies have suggested a role of the gut microbiota in the risk of developing neuropsychiatric illnesses like schizophrenia, obsessive-compulsive disorder, attention deficit hyperactivity disorder, autism and even chronic fatigue syndrome. Researchers have suggested that in genetically susceptible people, altered microbes in the gut may disrupt the blood-brain barrier, leading to the production of antibodies that adversely affect normal brain development.

Among the challenges in elucidating the microbiome’s role in health and disease is determining whether changes found in the microorganisms inhabiting various organs are a cause or an effect. . .

Continue reading.

Written by LeisureGuy

8 November 2017 at 10:06 am

Good news: Over-the-counter painkillers treated painful injuries just as well as opioids in new study

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Melissa Healy reports in the LA Times:

In an opioid epidemic that currently claims an average of 91 lives per day, there have been many paths to addiction. For some, it started with a fall or a sports injury, a trip to a nearby emergency room and a prescription for a narcotic pain reliever that seemed to work well in the ER.
New research underscores how tragically risky — and unnecessary — such prescribing choices have been.

In a new study of patients who showed up to an emergency department with acute pain in their shoulders, arms, hips or legs, researchers found that a cocktail of two non-addictive, over-the-counter drugs relieved pain just as well as — and maybe just a little better than — a trio of opioid pain medications widely prescribed under such circumstances.

The epidemic of opiate addiction, which has left roughly 2 million Americans addicted to narcotic painkillers, has claimed more than 183,000 lives since 1999, according to the Centers for Disease Control and Prevention.

Emergency department prescribing decisions have played a key role in fueling that crisis. One study found that between 2001 and 2010, the share of U.S. emergency department visits that resulted in a prescription for an opioid analgesic rose by nearly 50%, from 21% to 31%.

Not everyone who gets narcotic pain medication will become addicted. But a report released in July by the National Academies of Sciences, Engineering and Medicine found that, among patients prescribed opioid pain relievers, at least 8% develop “opioid use disorder,” and 15% to 26% engage in problematic behaviors that suggest they have become dependent.

And a 2015 study found that, among Colorado ER patients who had never taken opioids but filled such a prescription to treat a short-term pain condition, 17% were still taking a narcotic pain reliever a year later.

The report published Tuesday in the Journal of the American Medical Assn. suggests that much of this misery could have been avoided. . .

Continue reading.

Written by LeisureGuy

7 November 2017 at 2:02 pm

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