Recent quotes:

Why Exercise May Be the Best Fix for Depression - Scientific American

Despite the mounting evidence that exercise can remedy some forms of depression, skepticism persists in academia and health care, Trivedi notes. “There is this general bias that exercise is not a bona fide treatment—it's just something you should do in addition to treatment, like trying to sleep and eat well,” he says. “Even though recognition of exercise as a treatment is increasing,” only some health insurance companies pay for gym time, he explains, and when they do, they often offer small temporary discounts. “I can prescribe a drug that costs $200 and insurance will pay, but they won't give $40 to open a gym membership.”

FDA study -- stimulant triggered psychosis, violence sometimes doesn't resolve

FDA Review ADHD Drugs Induce-Psychosis, Mania, Homicide, Suicide http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4210B-Index.htm DATE: March 3, 2006 TO: Thomas Laughren, M.D., Director Division of Psychiatric Products (DPP), FDAOffice of Counter-Terrorism and Pediatric Drug Development (OCTAP) Memorandum. FROM: Kate Gelperin, M.D., M.P.H., Medical Epidemiologist Kate Phelan, R.Ph., Safety Evaluator The DDRE ADHD Psychiatric Review Team Office of Drug Safety (ODS) 1 EXECUTIVE SUMMARY / INTRODUCTION A BPCA (Best Pharmaceuticals for Children Act) review of methylphenidate products, prompted by Concerta pediatric exclusivity requirements, identified psychiatric adverse events as a possible concern. The review found some psychiatric adverse events mentioned in labeling, but a need for improved clarity was identified. The Pediatric Advisory Committee1 agreed at the June 2005 meeting at which the methylphenidate reviews were discussed, that the issue of psychiatric adverse events with all drugs indicated to treat ADHD should be examined with the goal of better characterizing these events so that drug labeling could be updated and made consistent between products. Thus, DDRE embarked on reviews of postmarketing and clinical trial reports of psychiatric adverse events associated with drugs used to treat ADHD. This document presents the results of the review of postmarketing reports. A companion document2, from Dr. Andrew Mosholder, presents the results of the review of clinical trial reports.  Information pertaining to selected psychiatric adverse event reports received since January 1, 2000 was requested from the manufacturers of products approved or with pending applications for the treatment of ADHD. Sponsors were asked to provide information regarding four broad categories of psychiatric adverse events: 1) signs and/or symptoms of psychosis or mania; 2) suicidal ideation and behavior; 3) aggression and violent behavior; and, 4) miscellaneous serious adverse psychiatric events. In addition, searches of the FDA AERS safety database were conducted covering the same time period, and the identified cases were assessed by a DDRE Review Team. Duplicates, and reports which were considered to be of poor quality or highly unlikely to be related to the drug of interest were excluded from this analysis.  Cases received from Sponsors, as well as those identified from the FDA AERS safety database, were systematically reviewed and analyzed to assess the probability of adverse drug reactions and to describe characteristics or risk factors observed in these reports. This review focuses on postmarketing safety data from the first three search categories. The miscellaneous category was considered to be beyond the scope of this current analysis due to the large volume of data for review. The most important finding of this review is that signs and symptoms of psychosis or mania, particularly hallucinations, can occur in some patients with no identifiable risk factors, at usual doses of any of the drugs currently used to treat ADHD. Current approved labeling for drug treatments of ADHD does not clearly address the risk of drug induced signs or symptoms of psychosis or mania (such as hallucinations) in patients without identifiable risk factors, and occurring at usual dosages. In addition, current labeling does not clearly state the importance of stopping drug therapy in any patient who develops hallucinations, or other signs or symptoms of psychosis or mania, during drug treatment of ADHD. We recommend that these issues be addressed.  A substantial proportion of psychosis-related cases were reported to occur in children age ten years or less, a population in which hallucinations are not common. The occurrence of such symptoms in young children may be particularly traumatic and undesirable, both to the child and the parents. The predominance in young children of hallucinations, both visual and tactile, involving insects, snakes and worms is striking, and deserves further evaluation. Positive rechallenge (i.e., recurrence of symptoms when drug is re-introduced) is considered a hallmark for causality assessment of adverse events. Cases of psychosisrelated events which included a positive rechallenge were identified in this review for each of the drugs included in this analysis.  In many patients, the events resolved after stopping the drug. In the FDA AERS review, resolution of the events after stopping the drug was reported in 58% of amphetamine /dextroamphetamine cases, 60% of modafinil cases, 33% of atomoxetine cases, and 48% of methylphenidate cases. (Note: Outcome of the psychiatric adverse events was not reported in 21% of amphetamine / dextroamphetamine cases, 9% of modafinil cases, 41% of atomoxetine cases, and 30% of methylphenidate cases.) For drugs currently approved for ADHD treatment, no risk factors were identified which could account for the majority of reports of psychosis-related events. For instance, drug abuse was reported in fewer than 3% of overall cases from the FDA AERS analysis of psychosis-related events. Also of note, in the overwhelming majority of cases (roughly 90% overall), the patient had no prior history of a similar condition. Numerous postmarketing reports of aggression or violent behavior during drug therapy of ADHD have been received, most of which were classified as non-serious, although approximately 20% of cases overall were considered life-threatening or required hospital admission.

Doctors overestimate their omnipotence

Now a new study in JAMA Internal Medicine authored by two Australians points out that when it comes to unsound medicine, there is another element at play. It turns out that when prescribing a drug or ordering a procedure doctors are actually quite bad at estimating the benefit and harm associated with it. In a systematic review of 48 studies performed in 17 countries and involving more than 13,000 clinicians, they found that doctors rarely had accurate expectations of benefits or harms. The inaccuracies were in both directions but more often, harm was underestimated and benefit overestimated. Advertisement Paid for by omglane com Final Photo: What Happens Next Is Tragic And Heartbreaking People typically forget how lucky they are to be alive after viewing these 26 images See More No group of doctors fared well. As a result, children with acute ear infections may be overprescribed antibiotics and women with troublesome postmenopausal symptoms may be deprived of hormone replacement therapy. Obstetricians and neurologists underestimated the risk of birth defects from antiepileptic drugs and GPs overestimated the benefit of prostate cancer screening and underestimated the benefit of warfarin for atrial fibrillation, a common heart condition. Transplant surgeons were biased towards an inaccurately low estimate of graft failure and all types of doctors were unaware of the risk of radiation exposure from imaging.

What patients say and what doctors document: Comparison of medical record to self-report of eye symptoms shows wide variation -- ScienceDaily

Symptom reporting drove the inconsistencies between surveys and medical records, the study found. The top discordant issue: glare. Of patients reporting concern about glare on their surveys, 91 percent didn't have it on their medical record. Eye redness was second-most common (80 percent had no medical record mention), followed by eye pain (74.4 percent). Blurry vision was only the symptom to tilt the scales -- with more instances of inclusion in medical records than in questionnaires.

Why Men Don’t Want the Jobs Done Mostly by Women - The New York Times

“Traditional masculinity is standing in the way of working-class men’s employment, and I think it’s a problem,” said Andrew Cherlin, a sociologist and public policy professor at Johns Hopkins and author of “Labor’s Love Lost: The Rise and Fall of the Working-Class Family in America.” “We have a cultural lag where our views of masculinity have not caught up to the change in the job market,” he said.

Instagram photos reveal predictive markers of depression

Using Instagram data from 166 individuals, we applied machine learning tools to successfully identify markers of depression. Statistical features were computationally extracted from 43,950 participant Instagram photos, using color analysis, metadata components, and algorithmic face detection. Resulting models outperformed general practitioners' average diagnostic success rate for depression. These results held even when the analysis was restricted to posts made before depressed individuals were first diagnosed. Photos posted by depressed individuals were more likely to be bluer, grayer, and darker. Human ratings of photo attributes (happy, sad, etc.) were weaker predictors of depression, and were uncorrelated with computationally-generated features. These findings suggest new avenues for early screening and detection of mental illness.

Cold and flu tablets can SHRINK the brain and slow down thinking | Daily Mail Online

Dr Shannon Risacher, the university’s assistant professor of radiology and imaging sciences, said: ‘These findings provide us with a much better understanding of how this class of drugs may act upon the brain in ways that might raise the risk of cognitive impairment and dementia,’ ‘Given all the research evidence, physicians might want to consider alternatives to anticholinergic medications if available when working with their older patients. ‘The impact of these drugs have been know about for over a decade, with a 2013 study finding drugs with a strong anticholinergic effect cause cognitive problems when taken continuously for as few as 60 days. Drugs with a weaker effect could cause impairment within 90 days.’

Paper tape can help prevent foot blisters, study shows

In 2014, Lipman and his colleagues recruited 128 runners participating in the 155-mile, six-stage RacingThePlanet ultramarathon event that crosses deserts around the globe, including the Gobi Desert and deserts in Jordan and Madagascar. Paper tape was applied to just one of each of the runners' feet. The untaped areas of the same foot served as a control. (Which foot got the tape and which didn't was chosen at random). The tape was applied by trained medical assistants to either the participants' blister-prone areas or, if they had no blister history, to randomly selected locations on the foot. The paper tape was applied in a smooth, single layer before the race and at subsequent stages of the race, Lipman said. The medical assistants followed the runners for 155 miles over seven days. For 98 of the 128 runners, no blisters formed where the tape had been applied, whereas 81 of the 128 got blisters in untaped areas. "It's kind of a ridiculously cheap, easy method of blister prevention," Lipman said. "You can get it anywhere. A little roll coasts about 69 cents, and that should last a year or two." He added, "The best way to make it to the finish line is by taking care of your feet."

A turn in the road

In the waiting room, the family across from me has brought in food for dinner. They are just opening their Styrofoam containers when a woman approaches, bends to speak with the father, a hand on his shoulder. The daughter leans in, and the son, and the two others I realize must be their partners. Suddenly, the room is spinning. The food drops to the floor. The father just sits there, hands to his face, shaking his head, but the children are weeping, then wailing. Someone stands, staggers, drops to the floor. They all rush out, food wrappers and bags abandoned. It can happen that swiftly, the end of life as we know it. Then, too, time can creep so slowly, even a minute seems endless.

Why your muscles get less sore as you stick with your gym routine: Unexpected immune system cells may help repair muscles -- ScienceDaily

"T-cells, up until recently, were not thought to enter healthy skeletal muscle," said lead author and grad student Michael Deyhle. "We hadn't planned on measuring them because there's no evidence that T-cells play a role in infiltrating damaged muscle tissue. It's very exciting." The presence of the T-cells suggests that muscles become more effective at recruiting immune cells following a second bout of exercise and that these cells may facilitate accelerated repair. In other words, the muscle seems to remember the damaging insult and reacts similarly to when the immune system responds to antigens--toxins, bacteria or viruses. The group was also surprised to find inflammation actually increased after the second round of exercise. Hyldahl, his students and many physiologists have long thought inflammation goes down after the second bout of exercise, contributing to that "less sore" effect. Instead, the slightly enhanced inflammatory response suggests inflammation itself probably does not worsen exercise-induced muscle damage. "Many people think inflammation is a bad thing," Deyhle said. "But our data suggest when inflammation is properly regulated it is a normal and healthy process the body uses to heal itself." Adds Hyldahl: "Some people take anti-inflammatory drugs such as Ibuprofen and Aspirin after a workout, but our study shows it may not actually be effective. The inflammation may not be directly causing the pain, since we see that muscle soreness is reduced concurrent with increases in inflammation."

Clearing the Body's Retired Cells Slows Aging and Extends Life

In 2011, the team developed a way of singling out and removing those cells. Senescent cells are characterized by a protein called p16. Baker and van Deursen genetically engineered their fast-aging mice so that they would destroy all their p16-bearing cells when they received a specific drug. The results were dramatic: The senescent cells disappeared, and though the rodents still died earlier, they were bigger, fitter, and healthier when they did. Even old mice, whose bodies had started to decline, showed improvements.

Hungarian doctors ask public support for improvements to healthcare – Hungarian Spectrum

Between 2003 and 2011, 12% of Hungarian doctors left the country, most of them after 2010. Sixteen percent of MDs simply abandon their profession and work in the pharmaceutical industry or in fields completely unrelated to medicine. According to some calculations, if the salaries of doctors were raised by 40-50%, the outflow of Hungarian doctors could be stopped.

Round worms change immune system, reduce rejection of foreign bodies (like baby)

Infection with roundworm (Ascaris lumbricoides) is associated with earlier first births and shortened interbirth intervals, whereas infection with hookworm is associated with delayed first pregnancy and extended interbirth intervals. Thus, helminths may have important effects on human fertility that reflect physiological and immunological consequences of infection.

Music not just good for the soul, it's also good for the body - Yahoo News

To assess the impact of music on surgical outcomes, Vetter and colleagues analyzed data from 47 studies, including 26 that looked at the effect of music before procedures, 25 looking at music in the operating room, and 25 looking at music during recovery. Overall, music was linked to about 31 percent less pain, 29 percent lower odds of using pain medication, and 34 percent less anxiety. In addition, music was tied to 40 percent lower blood pressure and 27 percent lower heart rate. When patients choose their own tunes, the benefits sometimes increased, the researchers report in the Annals of Surgery. For example, self-selected music was linked to 35 percent lower pain levels than no music, while music chosen by study personnel was linked to a 26 reduction in pain levels.

Frances Oldham Kelsey, F.D.A. Stickler Who Saved U.S. Babies From Thalidomide, Dies at 101 - The New York Times

Merrell stood to make millions and was anxious to get moving. It had tons of Kevadon in warehouses, ready for marketing, and 1,000 American doctors had already been given samples for “investigational” research. The company supplied more data, but also mounted a campaign to pressure Dr. Kelsey. Letters, calls and visits from Merrell executives ensued. She was called a fussy, stubborn, unreasonable bureaucrat.

The pressure to ignore end of life preferences

Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.