Doctors use HIV in gene therapy to fix ‘bubble boy’ disease

A study out Wednesday details how scientists turned this enemy virus into a savior, altering it so it couldn't cause disease and then using it to deliver a gene the boys lacked.
Health and Science

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Doctors May Have Found a Way to Reveal Concussion Damage in Living Football Players

Researchers may be closing in on a way to check athletes while they’re alive for signs of a degenerative brain disease that’s been linked to frequent head blows. Experimental scans found higher levels of an abnormal protein tied to the disease in a study of former National Football League players who were having mood and thinking problems.

It’s the first time a major study has tested these scans for detecting chronic traumatic encephalopathy, or CTE, which is only diagnosed now after death, with brain autopsies.

Doctors are searching for a way to tell when players, veterans or others with concussions or other head injuries are at risk for permanent damage. It’s too soon to know if the scans will enable that — so far they only show that these athletes are different as a group; they can’t be used to say a particular player does or does not have CTE.

“We’re not there yet,” said Boston University neuroscientist Robert Stern. “It is not ready to be used for individual diagnosis in the clinic.”

He led the study, published Wednesday by the New England Journal of Medicine.

“It’s an encouraging advance. It looks like they have detected CTE in living players,” said Dr. Gil Rabinovici, a neurologist and imaging expert at the University of California, San Francisco, who is doing other research using the scans.

“It’s hugely important to be able to detect the disease in living people” to know how common it is and to research treatments, he said.

The study was done in Massachusetts and Arizona and involved 26 former NFL players with thinking, mood or behavior problems, and 31 similarly aged men without these symptoms or head injuries.

They were given positron emission tomography, or PET scans, in which a radioactive tracer is injected that binds to various substances and makes them visible on the scans. Several of these tracers are used now to look for a protein called beta amyloid in the brains of people with Alzheimer’s disease. An experimental tracer that doctors are testing binds to another protein, tau, which is the key one that’s been implicated in CTE.

Men in the study had both types of tracers. Tau levels were higher in the players compared to the others, but their amyloid levels were similar, confirming that CTE is a different disease than Alzheimer’s.

Researchers also saw a relationship to years of play.

“The more years of play in tackle football across all levels, the greater the amount of tau detected,” Stern said.

However, there was no relationship between tau levels and the severity of mood and thinking symptoms. Researchers think the study may have been too small to detect a difference or that tau may not be the only factor involved.

“There’s a lot more work to be done to develop a diagnostic” tool using these scans, said Dr. Michael Weiner an imaging expert at UCSF who is involved in other CTE research.

Government grants and Avid Radiopharmaceuticals, which makes the tracers, funded the study. Some authors work or consult for the company.

A larger study of former NFL and college football players is underway; first results are expected early next year.

Mike Adamle, a former running back for the Chicago Bears and sports announcer, has been told he has symptoms consistent with CTE, and has been evaluated by Stern at the Boston research center though he was not part of the current study.

“I had more than a few” concussions, Adamle said. “If you were running, everybody kind of led with their head. Back then, it was a test of your macho man stuff.”

The illness has been devastating, said his wife, Kim. “He couldn’t remember his lunch or he couldn’t remember his lines on the air,” and lost multiple jobs, she said.

If a test could have shown he was at risk and given him a chance to consider quitting play, “I would have definitely taken note,” Mike Adamle said.

Sports – TIME

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Doctors Need To Talk Through Treatment Options Better For Black Men With Prostate Cancer

African-American men have the highest risk of being diagnosed with prostate cancer as well as dying from it compared to any other ethnic group in the U.S. This trend has remained unchanged for over four decades.

Although research has focused on identifying the biological differences that may lead to this difference, there’s growing evidence that distinct racial and ethnic disparities in prostate cancer treatment, and the quality of medical care in African-American men, contribute to this disparity.

African-American men are less likely to receive more aggressive treatments than their counterparts. And, if and when they do receive those treatments, they receive them later than their counterparts. For example, access to early effective survivorship treatments such as androgen deprivation therapies remains a challenge in African-American patients.

Our multidisciplinary research program in cancer population science at the University of Virginia has been examining reasons for poor prostate cancer outcomes, especially in African-American patients. Recent, as yet unpublished research from our group highlights several issues related to medication challenges in elderly prostate cancer survivors. We found there is a clear link between improved use of these treatments and reduced mortality. In addition, both access and use of these life-saving treatments remains low among African-American survivors.

A history of gaps

African-American prostate cancer patients face unique challenges in the treatment decision-making process. These include lower rates of understanding of treatment options, less time and interaction with medical care professionals and, often, poorer quality of medical care. Those challenges particularly affect both their access and compliance to medications, and, in turn, outcomes in these patients.

For example, a 69-year-old African American man whom we interviewed for our research, Mr. Tyler (name changed), along with his wife, Mrs. Tyler, sat in an exam room while his doctor told him he had stage 4 prostate cancer. Stage 4 cancer is cancer that has spread from its original site to distant organs and, in prostate cancer, even the bone.

Mr. Tyler was shocked. He had not noticed any health issues besides getting up in the middle of the night to urinate and some hip pain. He thought that was normal as men age. When he went to the clinic, he thought he had arthritis in his hip and would be prescribed pain medications for that. He could not imagine hearing that he had cancer.

He had not been to see a health care provider in about 12 years. He was always so busy at work and did not really feel comfortable going to a health care provider, having heard stories from family members and friends that other African-Americans are not treated well at the hospital.

The doctor gave Mr. Tyler a few options such as surgery, radiation and androgen deprivation therapy, considering his age, ethnicity, comorbidities and other related factors. But Mr. Tyler and his wife did not know what treatment options to seriously consider.

The health care provider gave a recommendation, but his wife was unsure. They were confused and anxious about making such a big and complex decision. The couple relied on information they received from speaking to friends, church members and relatives and ultimately made a decision, but it was not easy. And, it was not free from some regrets. Ultimately they chose to receive the radiation treatment and start the androgen deprivation treatment, which Mr. Tyler stopped because of discomfort. Mr. Tyler unfortunately died shortly after he discontinued treatment.

Treatment decision process improvements may be paramount

This scenario of confusion and anxiety is not so uncommon. Cancer is a terrifying diagnosis, and making decisions about treatment can be overwhelming.

Studies have suggested that patients with cancer feel more comfortable expressing their concerns with their health care provider when there is a trusting and supportive relationship developed along with adequate time for treatment discussion. This in turn leads to more comfortable treatment decisions, which often works to improve patient outcomes.

Prostate cancer treatment in particular often brings harsh side effects that severely affect a man’s quality of life. These side effects include erectile dysfunction, hot flashes, muscle loss, hair loss and urinary issues such as incontinence. These may be short term, but they can last for years.

The matter is complicated because many of these harsh side effects stem from androgen deprivation therapies, which can improve survival. Because of the complicated nature of assessing the risk of side effects with the potential benefit of survival, the use of androgen deprivation therapies should carefully be considered by the patient and his doctor.

Research has shown that these treatment-related decisions are very different in African-American prostate cancer patients compared to white patients and those residing in urban and rural communities. Therefore, there is a need to study treatment decision-making in both settings to formulate effective educational interventions.

Aids that can help

In one of our recent studies, we found that decision aids may help. Decision aids are electronic or paper tools involving a set of questions and information related to treatments. They are used to assist patients and caregivers in making informed decisions about the types of treatments and procedures, or both, that are more suitable for their particular case.

Decision aids are effective in a shared decision-making process, in which the doctor or nurse navigator sits down with a patient and walks through the process. There is active participation between the patient, caregiver and health care provider.

Decision aids can help patients apply specific health information while actively participating in health-related decision-making. Primarily, decision aids that have been applied to prostate cancer have been focused on knowledge or treatment options only, which patients often complete themselves. These types of decision aids are quite limited and do not allow patients the time and true engagement with health care providers to really understand their disease and the options that are available, and ultimately become satisfied with that decision.

Decision aids are most effective when they are tailored to the individual patient, rather than being generic. For example, researchers have developed an individualized decision support system BreastHealthDecisions.org, which represents a new approach to breast cancer prevention care.

In our study that developed an interactive decision aid for treatment decisions among advanced prostate cancer patients, we found that not only did the decision aid enhance patients’ and their caregivers’ understanding of the options that they had for treatment, but it also built more trust and engagementbetween the patient and the health care provider, which is valuable. The study also revealed that by using the decision aid, patients were more concerned with the quality of their life after treatment than extending the number of years of life.

Developing decision support systems for prostate cancer is paramount as we move towards an era of precision medicine treatments, such as proton therapies, which are used only after decision support system plans are in place for the prostate cancer survivor.

Often, the conversations between health care providers and the patient are focused around the quantity of life. The patients in our study said they felt empowered enough through the use of the decision aid to discuss quality of life, and how that was a critical aspect within their conversations.

There is much work to do to provide optimal health care to patients with cancer, including African-Americans with cancer. Tailored decision aids that focus on the priorities of the patient and their caregivers and that promote trusting relationships with health care providers is key to helping patients feel satisfied with their health care decisions and have less regret.

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California sues Trump administration over rule that stops doctors from discussing abortion

California on Monday filed a lawsuit against the Trump administration over a new Title X rule that bars family-planning clinics from providing abortion services or referrals.
Health and Science

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Insurer skips doctors and sends massive checks to patients, prompting million-dollar lawsuit

A woman received nearly $ 375,000 from Anthem for treatment at a rehab facility, according to a lawsuit. Another woman tells CNN a family member got more than $ 240,000 from Anthem after surgery with an out-of-network doctor. One medical ethicist says insurers paying patients directly, instead of providers, is “insane.”


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Here’s why medical chatbots could help doctors but won’t replace them

Could Sutter Health's new symptom tracker diagnose my bout of food poisoning? I put it to the test.
Health and Science

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FDA Alerts More Doctors Of Rare Cancer With Breast Implants

(AP Photo)

WASHINGTON (AP) — U.S. health officials say doctors should be on the lookout for a rare cancer linked to breast implants after receiving more reports of the disease.

The Food and Drug Administration sent a letter late Wednesday to family doctors, nurses and other health professionals warning about the form of lymphoma in breast implant patients. In suspected cases, the FDA recommends laboratory testing to confirm or rule out of the disease. It’s the first time regulators have issued such a warning to doctors other than plastic surgeons.

The disease is not breast cancer, but usually forms in the scar tissue that forms around implants.

Regulators said they have identified 450 likely cases of the cancer since 2010. That’s a tiny number considering 400,000 U.S. women receive implants annually.

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Less than half of U.S. youth discuss sensitive topics with their doctors

Fewer than half of young people in the United States are having discussions of sensitive topics with their regular healthcare providers, according to a new study. The research suggests that modifying healthcare delivery practices may improve discussions between youth and their healthcare providers.
Teen Health News — ScienceDaily

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Doctors are asking Silicon Valley engineers to spend more time in the hospital before building apps

Doctors have had enough with software that's not useful, so they're inviting entrepreneurs to shadow them.
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Doctors question medical care given to migrant boy who died Christmas Eve

Days after a Guatemalan boy died in US custody on Christmas Eve, infectious disease experts say it appears Felipe Alonzo-Gomez likely had the flu, a potentially deadly illness that can often be treated if caught early enough.


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‘Widespread and dangerous’: Facing medical uncertainty, doctors tell patients it’s all in their heads

When 7-year-old Bailey Sheehan arrived at a hospital in Oregon partially paralyzed, a doctor said the girl was faking her symptoms to get her parents’ attention because she was jealous of her new baby sister.


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Apple now has dozens of doctors on staff, showing it’s serious about health tech

The hires could help Apple win over doctors and suggest it will build applications that can help people with serious medical problems.
Health and Science

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Podcast: KHN’s ‘What The Health?’ Doctors, Guns And Lame Ducks

Election Day was Nov. 6, but results remain undetermined in some races at the state and federal levels. Nonetheless, it is already clear that the election could have major implications for health policy in 2019.

The current Congress is back in Washington for a lame-duck session, and while the budget for the Department of Health and Human Services is set for the fiscal year that began Oct. 1, other health bills, including ones addressing AIDS and bioterrorism, are on the to-do list.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Kimberly Leonard of the Washington Examiner and Alice Ollstein of Politico.

Among the takeaways from this week’s podcast:

  • With the political divide between a Republican Senate and a Democratic House, getting legislation passed in the next Congress may prove hard. But bipartisan support could arise for bills to protect consumers from surprise medical bills and, perhaps, to control some drug prices.
  • The House will likely spend much of its time exercising oversight responsibilities, including possible probes of the Trump administration’s policies on separating immigrant children from their parents, changes in health law rules for contraception coverage, changes in Medicaid and the administration’s decision not to defend the Affordable Care Act in a key court case.
  • Among the issues on state ballots this month was a constitutional amendment in Alabama that makes it state policy to “recognize and support the sanctity of unborn life and the rights of unborn children.” Although abortion opponents hail such “personhood” measures, they have been defeated in other states because they could impinge on infertility treatments, such as in vitro fertilization. It’s not clear whether the Alabama measure will be challenged in court because of that.
  • On the ballot in Oregon and Washington were industry-backed measures that would stop localities from instituting soda taxes. The effort failed in Oregon and passed in Washington.
  • During Congress’ current lame-duck session, members will be looking to pass an appropriations bill for parts of the government. Although HHS already got its appropriations bill, other health measures — such as the renewal of the PEPFAR global HIV initiative, grants for states on bioterrorism and pandemic planning, and changes to Medicare’s doughnut hole funding — could be added.
  • A tweet by the National Rifle Association urging doctors to keep out of the gun control debate and “stay in their lane” has provoked a furor from doctors, who say they must deal with the ramifications of a flawed policy.

Plus, for extra credit, the panelists recommend their favorite health stories of the week they think you should read, too:

Julie Rovner: The New York Times’ “When Hospitals Merge to Save Money, Patients Often Pay More,” by Reed Abelson

Rebecca Adams: The New York Times’ “Something Happened to U.S. Drug Costs in the 1990s,” by Austin Frakt

Kimberly Leonard: Harper’s Magazine’s “Discovery, Interrupted: How World War I Delayed a Treatment For Diabetes and Derailed One Man’s Chance at Immortality,” by Jeffrey Friedman

Alice Ollstein: The Incidental Economist‘s “The Trump Administration Targets the Contraception Mandate,” by Nicholas Bagley

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Kaiser Health News

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Spanking ‘harms kids’: Leading doctors group advises against corporal punishment

New evidence links corporal punishment to an increased risk of negative behavioral, cognitive, psychosocial, and emotional outcomes for children, the AAP said.
ABC News: Health

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http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

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Doctors work to fight gun violence

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http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

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UK doctors will soon prescribe cooking classes to combat loneliness

LONDON — Doctors in England will be able to write prescriptions for cooking classes and walking groups by 2023 as part of the government’s effort to combat loneliness. Prime Minister Theresa May on Monday described loneliness as “one of the greatest public health challenges of our time,” saying it is linked with a range of…
Living | New York Post

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