Saturday, March 23, 2019

Cystic Fibrosis drug could be made available as early as NEXT MONTH | UK | News |

BREXIT has invaded the cystic fibrosis space, threatening the health of CF patients in the U.K.

A WONDER drug (ORKAMBI)  could dramatically improve the lives of thousands of Cystic Fibrosis patients may be available to use next month if a funding deadlock is broken, it emerged yesterday.

ORKAMBI has been unavailable for three years since the FDA approved its use in the United States of America. VERTEX developed and distributes Orkambi thanks to a generous donation and a partnership with the Cystic Fibrosis Foundation (USA)

Vertex has been a major player in CF treatment. They also developed the following CF therapeutics
generic name: ivacaftor 
class: CFTR potentiators
generic name: ivacaftor/lumacaftor 
class: CFTR combinations
generic name: ivacaftor/tezacaftor 
class: CFTR combinations
All of these drugs have a specific indication for the F508 chromosomal deletion affecting the CFTR protein on cell membranes which is a gatway for chloride transfer.

A description of Cystic Fibrosis was noted in the middle ages.

“Woe is the child who tastes salty from a kiss on the brow, for he is cursed and soon must die”.

Cystic Fibrosis drug could be made available as early as NEXT MONTH | UK | News |

Wednesday, March 20, 2019

Heart Disease Morbidity and Mortality Improve drastically

Apple News

In the US in the 1990s, having a heart attack was basically a death sentence for some 20% of the people who suffered one.
The country’s medical community has spent the last three decades or so working on this problem, and experts widely believe the efforts have paid off. Until now, however, researchers with Yale University say there hasn’t been clear evidence to show that the heart-attack death rate has actually fallen.
Eager to fix that, they set out to analyze data from more than 4.3 million Americans aged 65 or older who had suffered heart attacks. All of them were Medicare fee-for-service patients. The data spans from January 1995 to January 2015 and was pulled from 5,680 US hospitals. The results were published on March 15 in the Journal of the American Medical Association Open Network.

Researchers find heart attacks aren't as frequent or deadly for Americans

The numbers are pretty striking. Back in 1995, 20% of the patients whose cases were included in the study died from their heart attacks. By 2014, that number fell to just 12%. Over the same period, the rate of hospitalization for a first-time heart attack dropped by 38%—from 914 to 566 per 100,000 Medicare beneficiary-years. Because the number of people admitted to the hospital after a heart attack dropped, the healthcare costs attributed to heart attacks has decreased, even though hospital costs overall have increased (pdf) in the US over time.

So what led to these significant declines in costs and fatality rates for heart-attack patients? Much of it has to do with a concerted effort on the parts of three national organizations—the Centers for Medicare & Medicaid Services, the American College of Cardiology, and the American Heart Association—to spearhead changes in treatment.
In the 1990s, the health care community established that aspirin and a class of drugs called beta-blockers (used to reduce blood pressure) were some of the best ways to improve chances of survival after a heart attack. Also over the last 30 years, coronary angioplasty has become more widely available. Physicians use this non-surgical procedure to open arteries that are clogged with a buildup of plaque, thus helping blood flow from the heart. It’s a highly effective way to decrease the risk of mortality, far more so than any medication alone.
The researchers also credit lifestyle changes, such as more healthful dieting, for contributing to the decreases in heart-attack hospitalization and mortality rates.
Not everyone in the US has seen these benefits, however. After analyzing data from thousands of hospitals spread across the US, the researchers uncovered issues of disparity. In places where unemployment is high, the risk of death after suffering a heart attack is higher than in areas with a healthy employment rate. The study didn’t have a clear answer for why that’s the case.
This could be due to more uninsured patients, poor access to hospitals with cardiac excellence centers, and lack of timely emergency transportation, and lack of preventive care. The study did not analyze location parameters.
“This is no time to be complacent,” one of the researchers, Harlan Krumholz, told Consumer Affairs. “We document extraordinary gains—but the effort is far from finished. The goal is to one day relegate heart attacks to the history of medicine.”

Women's Pain Is Different From Men's—the Drugs Could Be Too |


MEN AND WOMEN can’t feel each other’s pain. Literally. We have different biological pathways for chronic pain, which means pain-relieving drugs that work for one sex might fail in the other half of the population.
So why don’t we have pain medicines designed just for men or women? The reason is simple: Because no one has looked for them. Drug development begins with studies on rats and mice, and until three years ago, almost all that research used only male animals. As a result, women in particular may be left with unnecessary pain—but men might be too.
Now a study in the journal Brain reveals differences in the sensory nerves that enter the spinal cords of men and women with neuropathic pain, which is persistent shooting or burning pain. The first such study in humans, it provides the most compelling evidence yet that we need different drugs for men and women.  There’s a huge amount of suffering that’s happening that we could solve," says Ted Price, professor of neuroscience at the University of Texas, Dallas, and an author of the Brainarticle. “As a field, it would be awesome to start having some success stories.”
Modern-day pain control is notoriously dismal. Our go-to medicines—opioids and anti-inflammatories—are just new versions of opium and willow bark, substances we’ve used for thousands of years. Although they are remarkably effective in relieving the sudden pain of a broken bone or pulled tooth, they don’t work as well for people with persistent pain that lasts three months or longer. The failure to include sex differences in the search for better pain relief stems in part from flawed but deep-seated beliefs. “[Medical researchers] made the assumption that men and women were absolutely identical in every respect, except their reproductive biology,” says Marianne Legato, a cardiologist who began sounding an alarm in the 1980s about differences in heart attack symptoms among women. She went on to pioneer a new field of gender-specific medicine.
The physiology of pain is just one of many ways that men and women differ, she says. But she isn’t surprised that no sex-specific medicines have emerged. The medical community—including pharmaceutical companies—didn’t appreciate the variation between men and women, including in their metabolisms, immune systems, and gene expression. "If there were differences in how their drugs worked between men and women, they didn’t want to hear about it," she says. New studies must have separate cohorts for pain studies, rather than aggregating it into one data set. 
What is the legacy of gender-blind research? Mogil once emailed a researcher, asking whether a pain drug worked better in men than women. The researcher didn’t know, and couldn’t pursue the question because the data was controlled by the pharmaceutical company. Mogil was left wondering if drugs that looked promising in male-only animal studies might have failed in clinical trials when the results were blended with those in women, depriving men of a viable treatment.
Medicines that could work best for women wouldn’t make it into the pipeline at all when basic science excluded female animals. Price wonders if unresolved pain among women might have led to their higher levels of chronic pain.  
 Amid the promise of "personalized" medicine, with drugs tailored to patients based on genetic sequencing, developing pain medicines for half the population seems like a no-brainer. "Now there’s a whole new frontier opening up in front of our eyes," Price says. 

Pain physiology is poorly understood. We have difficulty  ranking pain from individual to individual,  let alone along gender classification. The proportionality of pain due to purely neuron transmission to the brain (somatic) vs the second brain (gut) and the role of humoral intermediaries. And lastly the patient's perception of pain is not well measured objectively. Indirectly it can be estimated by changes in vital signs (pulse, blood pressure, respiration, pupillary responses, or involuntary somatic muscle responses.

Basic neurophysiological mechanisms of pain and pain control

Women's Pain Is Different From Men's—the Drugs Could Be Too | WIRED: A new study shows clear differences in the biology of how men and women feel pain, a reminder that sex-specific pain medications might benefit us all.

Friday, March 15, 2019

Dr. Weinstein. A surgeon's struggle with mental health.

Doctors are the healers and the helpers. But what happens when it’s the doctors 
who need the healing and the help?
An estimated 300 to 400 doctors die by suicide each year, a rate of 28 to 40 
per 100,000; more than double that of general population (according to a review 
of 10 years of literature on the subject presented at the American Psychiatry 
Association annual meeting in May 2018).
Doctors who die by suicide often have untreated or undertreated depression or 
other mental illnesses, a fact that underscores the need for early diagnosis 
and treatment.
However, the stigma of a mental illness may be too overwhelming for some 
in the medical community to deal with, and they often mask their pain, rather 
than seek help.  That’s why Dr. Michael Weinstein, a surgeon at Thomas 
Jefferson University Hospital, is so very brave.

When his piece was published, Dr. Weinstein couldn’t anticipate the 
response, but said he received an overwhelming number of affirming
 messages from people from all different walks of life. However, 
perhaps most importantly inthis case, he heard from many colleagues in the 
medical field from across the countryand across the world who saw themselves 
in Dr. Weinstein’s story, and no longer felt alone in their own journeys.
“I realize that, from the outside looking in at me, I’m in potentially a position 
of power, of 
influence.  I’m in a world that could be stereotyped as a world that should be strong 
and courageous and infallible,” he said. “Telling a story from that perspective might
both be able to help folks in similar situations.”
Today, Dr. Weinstein is on a new path of healing. He has embraced Buddhist
 philosophy, and has found the practice of mindfulness meditation to be an 
important part of his recovery. 
Listen to him read excerpts from his inspiring essay “Out of the Straight Jacket” 
and listen to his reflections on his journey to date in this very moving 
OC87 Recovery Diaries video. 
EDITOR IN CHIEF: Gabriel Nathan | EDITOR: Glenn Holsten | 
DESIGN: Leah Alexandra Goldstein | PUBLISHER: Bud Clayman

Wednesday, March 13, 2019

AHRQ launches app to help patients preplan questions for doctors | MobiHealthNews

AHRQ launches app to help patients preplan questions for doctors | MobiHealthNews: The new app, called Question Builder, lets consumers input their health information and then brings up potential questions for them to ask their doctors.

7 Enabling Capabilities To Improve Poor Results From Massive AI

 A survey of over 1,200 executives has just revealed that despite massive and increasing investments in digital transformation and technologies such as artificial intelligence and big data, companies are struggling to turn those investments into real business results.

A survey unveiled today by Deloitte has found that the number of companies investing heavily in digital transformation has almost doubled in the past year.
The accounting and services giant questioned 1,200 executives at organizations of at least 500 people with above $250 million in revenue, finding that 19% planned to invest $20 million or more during 2019. When asked the same question at the start of 2018, 10% gave that answer.
Despite Massive Investments In AI And Digital Transformation, Survey Finds Poor Results And 7 Enabling Capabilities
The term “digital transformation” has come to mean steps that move an organization towards adopting data-driven business models, typically involving artificial intelligence (AI), big data and predictive analytics technology.

The survey also found that budgets dedicated to this transformation at medium to large-sized companies increased from an average of $11 million to $13.5 million this year.
However, it also highlighted the finding that most organizations still report a gap between their investment in this technology and the impact it is having on key performance indicators such as profits, revenues and customer satisfaction.
In an effort to understand this, it identifies 7 “pivots” - capabilities that, when developed, contribute towards a business successfully bringing about positive growth through a technology initiative.
It found that "higher maturity" organizations – those who had progressed their digital transformation to the point where they are driving positive growth - deploy an average of 40 initiatives targeting these pivots capabilities, suggesting they are indeed a contributing factor.
Data mastery is about aggregating, activating and monetizing data that is still often siloed and underutilized in order to generate better products, services and business operations that will drive business success.
“Those are the enabling pivots that allow us to begin thinking about transformation.”
Data mastery involves generating value from data to increase the efficiency and effectiveness of business processes.
“I would say that 90% of the corporate world is not going to capture value through naked monetization of their data assets the way Google or Amazon does. For the most part, they will capture data to increase the efficiency and effectiveness of their company.”
That could mean finding better ways of targeting customers and understanding their behavior and optimizing marketing and retail channels based on the data they collect. In other words, the majority of companies approaching levels of digital maturity where their data becomes a valuable asset is doing so by creating growth for existing, core products and services, rather than creating new ones from their "data exhaust."
The next key pivot – talent – revolves around the way data is used to understand and nurture a business’s most vital asset – it’s employees.
“This is actually the hardest thing to do,” explains Gurumurthy. “One can figure out cloud migration strategies, one can figure out how to collect and store data, and how to run analytics on it, but its harder to manage change around talent.
“If you ask people what their biggest challenges are in digital transformation they will say it is the talent deficit – there's often resistance to cultural change and a deficiency in the kind of talent that's needed.”
This is challenging because of the different mindset which becomes necessary when transitioning to data-driven business models, particularly when human staff are being asked to put their faith in technology like artificial intelligence and advanced analytics which may result in insights and observations which seem counter-intuitive to many of us.
"It's often about retraining the talent – another phrase we use is the ‘digital mindset,'" explains Gurumurthy.
So, what is holding businesses back from unlocking the full potential of digital transformation? Well, aside from the talent deficiency already mentioned (cited by 36% as a barrier), challenges posed by existing, legacy operating models, and a lack of a strategy for clearly prioritizing adoption of transformative technology were cited by 49% and 45% of respondents, respectively.
This makes it clear that whatever industry you’re in, the rewards of driving growth through digital transformation are there for the taking.

Suggested Reading,  
7 Enabling Capabilities To Improve Poor Results From Massive AI:

VA Secretary Robert Wilkie announces precision medicine testing initiative with Sanford Health | FierceHealthcare


Veterans will access the test at their local VA facility, and Sanford Health will process the tests at its South Dakota-based Imagenetics facility—which is overseen by former VA Secretary David Shulkin. (

Up to 250,000 veterans could receive access to no-cost pharmacogenomic testing by 2022 under a new partnership with Sanford Health. The announcement comes just months after the former secretary of the U.S. Department of Veterans Affairs took on the role of chief innovation officer at the Sioux Falls, South Dakota-based health system.

The program will launch at a pilot site in Durham, North Carolina, and will initially enroll cancer survivors, officials said. It will expand to up to 250,000 U.S. veterans at 125 sites by 2022.

PHASeR, or the Pharmacogenomics Action for Cancer Survivorship, is funded by a $25 million gift from philanthropist Denny Sanford and matching fundraising from Sanford Health.

Veterans will access the test at their local VA facility, and Sanford Health will process the tests at its South Dakota-based Imagenetics facility, officials said.
The test results will help physicians with clinical decision-making for a variety of drugs, including those for mental health, cardiovascular disease and pain management. The National Institutes of Health estimates that inappropriate treatments and adverse drug reactions cost up to $30 billion a year.

What is Precision Medicine ?

VA Secretary Robert Wilkie announces precision medicine testing initiative with Sanford Health | FierceHealthcare:

Sunday, March 10, 2019

What Indoor Plants Clean the Air Best? None of Them. - The Atlantic

The science is clear: Indoor vegetation doesn’t significantly remove pollutants from the air.

For several years, research really did suggest that houseplants might cleanse the air of certain pollutants. But now most scientists say that’s not right.
“It’s such an alluring and enticing idea,” Elliot Gall, a Portland State University professor, told me. “But the scientific literature shows that indoor houseplants—as would be typically implemented in a person’s home—do very little to clean the air.”
“My view is even harsher than that,” Michael Waring, an engineering professor at Drexel University, told me. “I do not think that houseplants clean the air.”
“A resounding ‘no,’” agreed Richard Corsi, a longtime air-pollution researcher, in an email. Houseplants do not clean the air “any more than an old pair of socks or baseball cap that I would hang on the wall.”
In the late 1980s, the NASA scientist Bill Wolverton investigated whether common houseplants could remove a certain type of air pollutant, called “volatile organic compounds,” or VOCs, from the air. VOCs are regularly released by common household products such as drywall, house paints, nail polish, shampoo, and almost anything with a scent. Their harmful effects can range from an itchy throat to nasopharyngeal cancer.
Unlike other types of air pollution, such as soot or particulate matter, VOCs can’t be filtered out of the air with a fine-grade filter. This means that they can build up in hermetically sealed environments … such as laboratories or spacecraft. The problem for NASA was obvious. So Wolverton, a former military scientist who began his career studying whether plants could break down Agent Orange, now examined whether houseplants could absorb VOCs.
His 1989 report announced a cheerful answer. Plants were “a promising, economical solution to indoor air pollution,” it declared. “If man is to move into closed environments, on Earth or in space, he must take along nature’s life support system.” The report—jointly funded by NASA and the Associated Landscape Contractors of America, a trade group—was picked up by the media. The idea gained even more currency in 1996, when Wolverton published How to Grow Fresh Air: 50 Houseplants That Purify Your Home or Office(Wolverton did not respond to a request for comment.)
That study provides the scientific basis for almost all the plant-and-air-pollution content you see online. “I’ve seen it on so many pop internet sites—‘researchers from NASA’ is the common phrase you see,” Waring, the Drexel professor, said. He told me that there’s nothing especially wrong with Wolverton’s 1989 study. Its results “fall right in line with other stuff that’s been measured in the literature.”
Recently, Waring and his colleagues reanalyzed all 195 studies that have examined whether houseplants can filter the air. They found that some types of plants can remove higher amounts of VOCs than others. But once you factor in the effects of working in a large room, none of the plants are able to do much.

Waring told me to imagine a small office, 10 feet by 10 feet by eight feet. “You would have to put 1,000 plants in that office to have the same air-cleaning capacity of just changing over the air once per hour, which is the typical air-exchange rate in an office ventilation system,” he said. That’s 10 plants per square foot of floor space. Even if you chose the most effective type of VOC-filtering plant, you would still need one plant per square foot, Waring said.
Or as Waring (who owns 10 to 20 houseplants) recently put it in a presentation for the National Academies of Sciences, Engineering, and Medicine:
“Bringing plants in, bringing greenery in—it’s about having something near you that’s alive, that you’re caring for, that brings you joy and happiness,” she said. “And that affects your mood, whether or not it’s giving you more oxygen to breathe or something.
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What Indoor Plants Clean the Air Best? None of Them. - The Atlantic: The science is clear: Indoor vegetation doesn’t significantly remove pollutants from the air.

Saturday, March 9, 2019

Medicare Annual Wellness Visit Association With Healthcare Quality and Costs

Analytics are essential when making decisions in health care.  When I was a young physician I was told the annual wellness visit for patients was a waste of time.   Today, not so !

In the context of 2 primary care physician–led accountable care organizations, Medicare Annual Wellness Visits were associated with lower healthcare costs and improved clinical care quality for beneficiaries. Although use of the Medicare Annual Wellness Visit (AWV) is increasing nationally, it remains unclear whether it can help contain healthcare costs and improve quality. In the context of 2 primary care physician–led accountable care organizations (ACOs), we tested the hypothesis that AWVs can improve healthcare costs and clinical quality.

Between 2014 and 2016, we examined the association of an AWV with healthcare costs, ED visits, hospitalizations, and clinical quality measures. The sample included Medicare beneficiaries attributed to providers across 44 primary care clinics participating in 2 ACOs.

Results: Among 8917 Medicare beneficiaries, an AWV was associated with significantly reduced spending on hospital acute care and outpatient services. Patients who received an AWV in the index month experienced a 5.7% reduction in adjusted total healthcare costs over the ensuing 11 months, with the greatest effect seen for patients in the highest hierarchical condition category risk quartile. AWVs were not associated with ED visits or hospitalizations. Beneficiaries who had an AWV were also more likely to receive recommended preventive clinical services.

Conclusions: In a setting that prioritizes care coordination and utilization management, AWVs have the potential to improve healthcare quality and reduce cost.


Periodic health visits by primary care practice model, a population-based study using health administrative data.

Evaluation of Pharmacist Involvement in Medicare Wellness Visits.

The Medicare Annual Wellness Visit.
Improvement in preventive care of young adults after the affordable care act: 
Practices Caring For The Underserved Are Less Likely To Adopt Medicare's Annual Wellness Visit.

Medicare Annual Wellness Visit Association With Healthcare Quality and Costs: