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23andMe vs. China's 23Mofang Review: What Do DNA Tests Tell You? - Bloomberg

When my reports came back, 23Mofang’s analysis was much more ambitious than its American peer. Its results gauged how long I will live, diagnosed a high propensity for saggy skin (recommending I use products including Olay and Estee Lauder creams) and gave me — an optimist not prone to mood swings — a higher-than-average risk of developing bipolar disorder. 23andMe doesn’t assess mental illness, which Gil McVean, a geneticist at Oxford University, says is highly influenced by both environmental and genetic factors.

The Price of Insulin Has Soared. Biohackers Want to Fix It | Time

Ultimately, it’s not clear that the Open Insulin Project’s real goal is to facilitate insulin minilabs across the U.S. The group intends to put the plan for their designer insulin-­producing yeast online as soon as it’s done, but only for “research purposes,” says Di Franco. And without brewing facilities or the ability to check and purify the hormone, the plans themselves are a long way—scientifically and legally—from the point where anyone will be injecting homegrown insulin. Di Franco has offered up his own body as a proving ground once the lawyers sign off: “I’d be thrilled to be the first person to take the insulin,” he says.

Patient charity settles allegations it helped MS drug makers pay kickbacks

The Assistance Fund, based in Orlando, says its mission is to help patients manage copays, coinsurance, deductibles, and other expenses related to their disease or chronic condition. But the government alleges that it conspired with Teva, Biogen (BIIB), and Novartis (NVS) to funnel money donated by the drug makers to MS patients to ensure the patients took their drugs, not their competitors’, regardless of price.

The medium is the medicine: a novel history

Before 1900, “many people thought of medicine as an inferior profession, or at least a career with inferior prospects,” according to Starr. The average American doctor earned less than “an ordinary mechanic,” riding miles each day on horseback to see just a handful of patients. The status of doctors changed dramatically in the first decade of the 20th century, when cars, telephones and urbanization made practicing medicine more efficient and therefore more lucrative.

Urgent Need to Improve PAP Management: The Devil Is in Two (Fixable) Details

Several high-profile, large prospective sleep apnea therapy trials have failed to meet expected outcomes: Apnea Positive Pressure Long-term Efficacy Study (APPLES) (cognition),1 the Treatment of Predominant Central Sleep Apnoea by Adaptive Servo Ventilation in Patients With Heart Failure (SERVE-HF) trial (heart failure),2 the Canadian Positive Airway Pressure Trial (CANPAP), the Sleep Apnea cardioVascular Endpoints (SAVE) study (general cardiovascular),3 and the Heart Bio-marker Evaluation in Apnea Treatment (HeartBEAT) (metabolic/hemodynamic).4 Each theoretically had the power to positively influence practice, but instead have cast doubt on the staple of our field: positive airway pressure. Struggling to navigate these findings, experts have invoked explanations ranging from inadequate use, too-short duration of therapy, overwhelming disease pathophysiology, treatment initiated too late in evolution of disease, and unknown pathophysiological constructs.

The absurdly high cost of insulin, explained - Vox

But not all insulins are patent-protected. For example, none of Eli Lilly’s insulins are, according to the drugmaker. In those cases, Luo said, potential manufacturers may be deterred by secondary patents on non-active ingredients in insulins or on associated devices (such as insulin delivery pens).

Protective Effect of Hand-Washing and Good Hygienic Habits Against Seasonal Influenza

Compared with the poorest hand-washing score of 0 to 3, odds ratios of influenza infection decreased progressively from 0.26 to 0.029 as hand-washing score increased from 4 to the maximum of 9 (P < 0.001). Compared with the poorest hygienic habit score of 0 to 2, odds ratios of influenza infection decreased from 0.10 to 0.015 with improving score of hygienic habits (P < 0.001). Independent protective factors against influenza infection included good hygienic habits, higher hand-washing score, providing soap or hand cleaner beside the hand-washing basin, and receiving influenza vaccine.

Using science to sell apps: Evaluation of mental health app store quality claims | npj Digital Medicine

Seventy-three apps were coded, and the majority (64%) claimed effectiveness at diagnosing a mental health condition, or improving symptoms, mood or self-management. Scientific language was most frequently used to support these effectiveness claims (44%), although this included techniques not validated by literature searches (8/24 = 33%). Two apps described low-quality, primary evidence to support the use of the app. Only one app included a citation to published literature. A minority of apps (14%) described design or development involving lived experience, and none referenced certification or accreditation processes such as app libraries.

Period-Tracking Apps Say You May Have a Disorder. What if They’re Wrong? - The New York Times

“It’s certainly become confusing as a consumer if you go onto these app marketplaces and these apps are making claims about helping you learn about mental health, PCOS, heart disease, diabetes,” said Dr. John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston, one of the authors of the Nature study. “Do we know this helps or it doesn’t help?”

Efficacy and safety of anti-inflammatory agents for the treatment of major depressive disorder: a systematic review and meta-analysis of randomised controlled trials | Journal of Neurology, Neurosurgery & Psychiatry

Thirty RCTs with 1610 participants were included in the quantitative analysis. The overall analysis pooling from 26 of the RCTs suggested that anti-inflammatory agents reduced depressive symptoms (SMD −0.55, 95% CI −0.75 to −0.35, I2=71%) compared with placebo. Higher response (RR 1.52, 95% CI 1.30 to 1.79, I2=29%) and remission rates (RR 1.79, 95% CI 1.29 to 2.49, I2=41%) were seen in the group receiving anti-inflammatory agents than in those receiving placebo.

Transient and long-term disruption of gut microbes after antibiotics - ScienceBlog.com

In contrast, the triple-antibiotics individuals showed a significant increase of new strains that persisted as long as six months after treatment, as compared to the single antibiotic and the control individuals. Furthermore, the fraction of transient strains was also significantly higher in the multiple antibiotics individuals. This suggested a long-term change to an alternative stable microbiome state, Morrow says. These changes were not due to a difference in growth rates. “Given the importance of the microbiome in human health, we think our results with these data sets can be used to help evaluate microbiome stability under different conditions,” Morrow said. “For example, we can now provide guidance to clinical investigators to judge the impact of certain treatments for diseases, such as cancer or diabetes, on the gut microbial community that could be significant for evaluation of outcomes. Furthermore, this approach could be applied to a patient’s pre- and post-hospitalization to identify individuals who may need further management of their microbiomes.”

Light works, Prozac ties placebo

A total of 122 patients were randomized (light monotherapy, 32; fluoxetine monotherapy, 31; combination therapy, 29; placebo, 30). The mean (SD) changes in MADRS score for the light, fluoxetine, combination, and placebo groups were 13.4 (7.5), 8.8 (9.9), 16.9 (9.2), and 6.5 (9.6), respectively. The combination (effect size [d] = 1.11; 95% CI, 0.54 to 1.64) and light monotherapy (d = 0.80; 95% CI, 0.28 to 1.31) were significantly superior to placebo in the MADRS change score, but fluoxetine monotherapy (d = 0.24; 95% CI, −0.27 to 0.74) was not superior to placebo.

Fake doctor saved thousands of infants and changed medical history

But for all his showbiz, Couney was in the lifesaving business, and he took it seriously. The exhibit was immaculate. When new children arrived, dropped off by panicked parents who knew Couney could help them where hospitals could not, they were immediately bathed, rubbed with alcohol and swaddled tight, then “placed in an incubator kept at 96 or so degrees, depending on the patient. Every two hours, those who could suckle were carried upstairs on a tiny elevator and fed by breast by wet nurses who lived in the building. The rest [were fed by] a funneled spoon.”

NEJM Journal Watch: Summaries of and commentary on original medical and scientific articles from key medical journals

Rivaroxaban (Xarelto) and apixaban (Eliquis) are the most commonly prescribed direct-acting oral anticoagulants (DOACs) in the U.S., but no head-to-head comparisons are available to guide physicians' choices between these drugs. In this study, researchers used a large U.S. claims database to compare the effectiveness and safety of rivaroxaban and apixaban in patients with newly diagnosed venous thromboembolism (VTE). About 3000 apixaban users were compared with about 12,000 propensity-score-matched rivaroxaban users. During average follow-up of about 3 months, recurrent VTE occurred significantly less often in apixaban users than in rivaroxaban users (3 vs. 7 events per 100 person-years). Major bleeding also occurred significantly less often with apixaban (3 vs. 6 events per 100 person-years). These findings were consistent across various subgroups.

Pattern Analysis of Oxygen Saturation Variability in Healthy Individuals: Entropy of Pulse Oximetry Signals Carries Information about Mean Oxygen Saturation

Pulse oximetry is routinely used for monitoring patients' oxygen saturation levels with little regard to the variability of this physiological variable. There are few published studies on oxygen saturation variability (OSV), with none describing the variability and its pattern in a healthy adult population.

Debunking a study by citing zero studies

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: “It is well-established that it often takes a while for patients to feel the full benefits of modern antidepressants and that they work best when taken for significant periods of time, which is one reason why doctors will often review patients after several weeks of use and then prescribe a fairly long course of the drugs, if they appear to be beneficial.”

Medicine as a turtle

In medicine, good ideas still take an appallingly long time to trickle down. Recently, the American Academy of Neurology and the American Headache Society released new guidelines for migraine-headache-treatment. They recommended treating severe migraine sufferers—who have more than six attacks a month—with preventive medications and listed several drugs that markedly reduce the occurrence of attacks. The authors noted, however, that previous guidelines going back more than a decade had recommended such remedies, and doctors were still not providing them to more than two-thirds of patients. One study examined how long it took several major discoveries, such as the finding that the use of beta-blockers after a heart attack improves survival, to reach even half of Americans. The answer was, on average, more than fifteen years.

The Heroism of Incremental Care | The New Yorker

In the United Kingdom, where family physicians are paid to practice in deprived areas, a ten-per-cent increase in the primary-care supply was shown to improve people’s health so much that you could add ten years to everyone’s life and still not match the benefit.

The Heroism of Incremental Care | The New Yorker

We have a certain heroic expectation of how medicine works. Following the Second World War, penicillin and then a raft of other antibiotics cured the scourge of bacterial diseases that it had been thought only God could touch. New vaccines routed polio, diphtheria, rubella, and measles. Surgeons opened the heart, transplanted organs, and removed once inoperable tumors. Heart attacks could be stopped; cancers could be cured. A single generation experienced a transformation in the treatment of human illness as no generation had before. It was like discovering that water could put out fire. We built our health-care system, accordingly, to deploy firefighters. Doctors became saviors. “Let me preface my remarks by saying that the chain is a lot longer than it looks.” But the model wasn’t quite right. If an illness is a fire, many of them require months or years to extinguish, or can be reduced only to a low-level smolder. The treatments may have side effects and complications that require yet more attention. Chronic illness has become commonplace, and we have been poorly prepared to deal with it. Much of what ails us requires a more patient kind of skill.

Popular mobile games can be used to detect signs of cognitive decline -- ScienceDaily

Their research put 21 healthy participants through standard paper-based cognitive assessment tests, followed by 10-minute sessions of playing Tetris, Candy Crush Saga and Fruit Ninja over two separate periods, a fortnight apart. The three games selected were chosen because they are easy to learn, engaging for most players and involve intensive interactions using multiple gestures. Using the sensors built into the mobile phones to collect data, the team showed how users interacted with the games and illustrated a clear link between the subjects' touch gestures, or taps and swipes, their rotational gestures and their levels of cognitive performance. The study revealed the participants' ability to perform visuo-spatial and visual search tasks, as well as testing their memory, mental flexibility and attention span.

Pragmatic trials revisited: applicability is about individualization - Journal of Clinical Epidemiology

Classically, clinical research has centered on studying groups of individuals to extrapolate the findings to the general population. It is time to walk back from the population (the average patient) to the individual patient, understanding that population-oriented research is actually exploratory and individual-oriented research is confirmatory [24].

Pragmatic trials revisited: applicability is about individualization - Journal of Clinical Epidemiology

These designs represent an important step toward stratified therapy, but N-of-1 trials [14] are the purest form of pragmatic patient-centered design [15]. N-of-1 trials are multiple-period, crossover experiments comparing two or more treatments within individual patients. They are the optimal design to estimate individual treatment effects directly and to identify the best treatment for each individual patient in each specific setting. The Journal of Clinical Epidemiology has recently published a number of articles reviewing the main features and applications of N-of-1 trials [16].

Cancer drugs don't always work as intended, researchers warn -- ScienceDaily

In a new paper recently published in the journal Science Translational Medicine, a team of researchers led by Sheltzer and researchers Ann Lin and Chris Giuliano, detail how the "mechanism of action" of the 10 drugs were mischaracterized, just like MELK. "The idea for many of these drugs is that they block the function of a certain protein in cancer cells. And what we showed is that most of these drugs don't work by blocking the function of the protein that they were reported to block," Sheltzer explained. "So that's what I mean when I talk about mechanism of action." All 10 of the drugs are currently being tested in clinical trials and involve about 1000 human cancer patients. And while they do appear capable of killing cancer cells, it's just not in the way researchers had thought. So how can this be? "In some sense, this is a story of this generation's technology," Sheltzer said.

Survey shows many primary care doctors are unprepared to help patients avoid diabetes -- ScienceDaily

The researchers received 298 completed surveys, or 34% of the 888 ultimately found eligible for inclusion in the study. "Our results revealed that there are substantial gaps in the knowledge that PCPs have in all three categories we tested," Tseng says. For instance: - On average, respondents selected just 10 out of 15 correct risk factors for prediabetes, most often missing that African Americans and Native Americans are two groups at high risk. - Only 42% of respondents chose the correct values of the fasting glucose and Hb1Ac tests that would identify prediabetes. - Only 8% knew that a 7% weight loss is the minimum recommended by the American Diabetes Association as part of a diabetes prevention lifestyle change program. "Our results also suggests that 25% of PCPs may be identifying people as having prediabetes when they actually have diabetes, which could lead to delays in getting those patients proper diabetes care and management," Maruthur says.

Educate Your Patients…or They Will Take Medical Advice From Their Hairdresser |

“One of the bigger distractions in sports medicine practices is that patients often focus on what we do with professional athletes…everyone wants to try what worked for Kobe Bryant. But I tell them that is an n of 1, and what they should truly be basing their decision on is the result of a large prospective study where you are looking at efficacy of a specific dosage and formulary, for their particular type of orthopaedic problem. And this is our job to present that data in a fair fashion, particularly because of the appearance of conflict involved in these cash-based procedures that are rarely covered by insurance.  “Because medicine has become a consumer field we must focus on public education. If we were to poll the physicians who are performing most of these treatments, they will likely agree that the evidence is still pending but looking promising, and furthermore that the patients are asking for it.” I spend a good amount of time in my clinic talking to these patients about the current evidence (and lack of such) behind these treatments, and some still do choose to move forward with this option.

Persistence of Contradicted Claims in the Literature | Dementia and Cognitive Impairment | JAMA | JAMA Network

For the 2 vitamin E epidemiological studies, even in 2005, 50% of citing articles remained favorable. A favorable stance was independently less likely in more recent articles, specifically in articles that also cited the HOPE trial (odds ratio for 2001, 0.05 [95% confidence interval, 0.01-0.19; P < .001] and the odds ratio for 2005, 0.06 [95% confidence interval, 0.02-0.24; P < .001], as compared with 1997), and in general/internal medicine vs specialty journals. Among articles citing the HOPE trial in 2005, 41.4% were unfavorable. In 2006, 62.5% of articles referencing the highly cited article that had proposed beta-carotene and 61.7% of those referencing the highly cited article on estrogen effectiveness were still favorable; 100% and 96%, respectively, of the citations appeared in specialty journals; and citations were significantly less favorable (P = .001 and P = .009, respectively) when the major contradicting trials were also mentioned. Counterarguments defending vitamin E or estrogen included diverse selection and information biases and genuine differences across studies in participants, interventions, cointerventions, and outcomes. Favorable citations to beta-carotene, long after evidence contradicted its effectiveness, did not consider the contradicting evidence.