Evaluation of a Remote Diagnosis Imaging Model vs Dilated Eye Examination in Detecting Macular Degeneration | Diabetic Retinopathy | JAMA Ophthalmology | JAMA Network

ADVANCES IN MEDICINE

JUST WHAT THE DOCTOR ORDERED:
IMPROVING PATIENT CARE WITH AI

Artificial Intelligence is transforming the world of medicine. AI can help doctors make faster, more accurate diagnoses. It can predict the risk of a disease in time to prevent it. It can help researchers understand how genetic variations lead to disease.

Although AI has been around for decades, new advances have ignited a boom in deep learning. The AI technique powers self-driving cars, super-human image recognition, and life-changing—even life-saving—advances in medicine.

Deep learning helps researchers analyze medical data to treat diseases. It enhances doctors’ ability to analyze medical images. It’s advancing the future of personalized medicine. It even helps the blind “see.”

“Deep learning is revolutionizing a wide range of scientific fields,” said Jensen Huang, NVIDIA CEO and co-founder. “There could be no more important application of this new capability than improving patient care.”

Three trends drive the deep learning revolution: more powerful GPUs, sophisticated neural network algorithms modeled on the human brain, and access to the explosion of data from the internet (see “Accelerating AI with GPUs: A New Computing Model”)

Community Medicine is a term used to describe medical conditions in a large population setting. It often involves the screening of large groups to select those with disease and provide appropriate treatment to avoid further complications.  This involves an examination of large groups of patients. Often more than 100 persons will be examined with a positive finding of less than five in one hundred examinations.  This is a massive undertaking when screening perhaps as much as 1000 or more persons. It is often not cost effective. 

However, the development of image analysis, high-speed computing power, and deep learning machines can be trained to accomplish this task. Algorithms can be developed to digitize images (x-rays, CT scans, and photographs.

Artificial intelligence or machine learning is bringing a new powerful tool for rapid interpretation of medical images, such as chest x-rays, retinal fundus photography, and scans.  Images of the skin can be analyzed for suspicious moles to rule out malignant melanoma rapidly.   As the science matures there are sure to be significant cost savings as well as time. 

Machine learning is dependent upon large data stores, and accuracy improves as images are added and curated by human beings (physicians).  It is doubtful if AI will ever stand alone without human oversight.  

A study of retinal fundus evaluation (as reported JAMA) using machine learning showed
Remote diagnosis imaging and a standard examination by a retinal specialist appeared equivalent in identifying referable macular degeneration in patients with high disease prevalence; these results may assist in delivering timely treatment and seem to warrant future research into additional metrics.

The study has shown equivalency in diagnosing age-related macular degeneration using ocular coherence tomography. 

The use of deep learning has also been applied in dermatology to screen for malignant melanoma or other skin malignancy.

As radiology is inherently a data-driven specialty, it is especially conducive to utilizing data processing techniques. One such technique, deep learning (DL), has become a remarkably powerful tool for image processing in recent years. In this work, the Association of University Radiologists Radiology Research Alliance Task Force on Deep Learning provides an overview of DL for the radiologist. This article aims to present an overview of DL in a manner that is understandable to radiologists; to examine past, present, and future applications; as well as to evaluate how radiologists may benefit from this remarkable new tool. We describe several areas within radiology in which DL techniques are having the most significant impact: lesion or disease detection, classification, quantification, and segmentation. 

Some are concerned that AI, or deep learning may replace human radiologists, however, this is unlikely to occur.  But deep learning won’t be replacing radiologists anytime soon, Bratt explained, and one key reason for this is that deep neural networks (DNNs) are naturally limited by “the size and shape of the inputs they can accept.” But deep learning won’t be replacing radiologists anytime soon, Bratt explained, and one key reason for this is that deep neural networks (DNNs) are naturally limited by “the size and shape of the inputs they can accept.” A DNN can help with straightforward tasks reliant on a few images—bone age assessments, for instance, but they become less useful as the goal grows more and more complex. This limitation, Bratt explained, is related to the concept of long-term dependencies.  Another issue related to DNNs is how easily they can fall apart when introduced to small changes. A DNN can be working perfectly after being trained on one institution’s dataset, for instance, but its performance suffers when it is introduced to new data from a new institution.

“This again reflects the fact that ostensibly trivial, even imperceptible, changes in input can cause catastrophic failure of DNNs, which limits the viability of these models in real-world mission-critical settings such as clinical medicine,” Bratt wrote.

In addition to evaluating images, DNN can be applied to other tasks.

MINING MEDICAL DATA FOR BETTER, QUICKER TREATMENT

Medical records such as doctors' reports, test results and medical images are a gold mine of health information. Using GPU-accelerated deep learning to process and study a patient's condition over time and to compare one patient against a larger population could help doctors provide better treatments.

BETTER, FASTER DIAGNOSES


Medical images such as MRIs, CT scans, and X-rays are among the most important tools doctors use in diagnosing conditions ranging from spine injuries to heart disease to cancer. However, analyzing medical images can often be a difficult and time-consuming process.

Researchers and startups are using GPU-accelerated deep learning to automate analysis and increase the accuracy of diagnosticians:

Imperial College London researchers hope to provide automated, image-based assessments of traumatic brain injuries at speeds other systems can't match.
Behold.ai is a New York startup working to reduce the number of incorrect diagnoses by making it easier for healthcare practitioners to identify diseases from ordinary radiology image data.
Arterys, a San Francisco-based startup, provides technology to visualize and quantify heart flow in the body using an MRI machine. The goal is to help speed diagnosis.
San Francisco startup Enlitic analyzes medical images to identify tumors, nearly invisible fractures, and other medical conditions.

GENOMICS FOR PERSONALIZED MEDICINE

Genomics data is accumulating in unprecedented quantities, giving scientists the ability to study how genetic factors such as mutations lead to disease. Deep learning could one day lead to what’s known as personalized or “precision” medicine, with treatments tailored to a patient’s genomic makeup.

Although much of the research is still in its early stages, two promising projects are:

A University of Toronto team is advancing computational cancer research by developing a GPU-powered “genetic interpretation engine” that would more quickly identify cancer-causing mutations for individual patients.
Deep Genomics, a Toronto startup, is applying GPU-based deep learning to understand how genetic variations lead to disease, transforming personalized medicine and therapies.

DEEP LEARNING TO AID BLIND PEOPLE

Nearly 300 million people worldwide struggle to manage such tasks as crossing the road, reading a product label, or identifying a face because they’re blind or visually impaired. Deep learning is beginning to change that.

Horus Technology, the winner of NVIDIA’s first social innovation award at the 2016 Emerging Companies Summit, is developing a wearable device that uses deep learning, computer vision, and GPUs to understand the world and describe it to users.

One of the early testers wept after trying the headset-like device, recalled Saverio Murgia, Horus CEO, and co-founder. “When you see people get emotional about your product, you realize it’s going to change people’s lives.”

Further DNN utilizes optical diffractive circuits in lieu of electrons

The setup uses 3D-printed translucent sheets, each with thousands of raised pixels, which deflect light through each panel in order to perform set tasks. By the way, these tasks are performed without the use of any power, except for the input light beam.

The UCLA team's all-optical deep neural network – which looks like the guts of a solid gold car battery – literally operates at the speed of light and will find applications in image analysis, feature detection, and object classification. Researchers on the team also envisage possibilities for D2NN architectures performing specialized tasks in cameras. Perhaps your next DSLR might identify your subjects on the fly and post the tagged image to your Facebook timeline.  For now, though, this is a proof of concept, but it shines a light on some unique opportunities for the machine learning industry.










Dewinner of NVIDIA’s first social innovation award at the 2016 Emerging Companies Summit, is developing a wearable device that uses deep learning, computer vision, and GPUs to understand the world and describe it to users.

One of the early testers wept after trying the headset-like device, recalled Saverio Murgia, Horus CEO and co-founder. “When you see people get emotional about your product, you realize it’s going to change people’s lives.”


Evaluation of a Remote Diagnosis Imaging Model vs Dilated Eye Examination in Referable Macular Degeneration | Diabetic Retinopathy | JAMA Ophthalmology | JAMA Network: This study evaluates a retinal diagnostic device and compares its utility and outcomes with those of traditional eye examinations by retinal specialists for patients with potential retinal damage from diabetic retinopathy and age-related macular degeneration.

Opioid Prescriptions Drop Sharply Among State Workers

The recent efforts by the CDC and public media have initiated important advances in the crusade against opioid addiction.

The agency that manages health care for California’s massive state workforce is reporting a major reduction in opioid prescriptions, reflecting a national trend of physicians cutting back on the addictive drugs.

Insurance claims for opioids, which are prescribed to help people manage pain, decreased almost 19% in a single year among the 1.5 million Californians served by the California Public Employees’ Retirement System. CalPERS manages health benefits for employees and retirees of state and local agencies and public schools and their families. CalPERS is the second-largest public purchaser of health benefits in the nation after the federal government, and medical trends among its members are often reflected nationally.
Most notably, doctors reduced the daily dose and duration of opioid treatment: The number of new users who were prescribed large doses dropped 85% in the first half of 2018 compared with the same period in 2017, while new users prescribed more than a week’s supply dropped 73%, according to new CalPERS data.

The CalPERS data represents a cross-section of patients throughout California who are enrolled in Blue Shield, Kaiser Permanente, Anthem Blue Cross and other health plans.

This rapid change in prescribing habits indicates how quickly physicians reacted to the data as furnished by DEA and other regulatory bodies.

“These reductions are substantial,” said Beth McGinty, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “They signal a reduction in the overprescribing practices that have driven the opioid epidemic in the U.S.”

Indeed, the data showing a decline in opioid prescriptions among CalPERS members mirrors a nationwide drop that has been reported in all 50 states.

About 22% fewer opioid prescriptions were written in the United States from 2013 to 2017, dropping from 251.8 million to 196 million, according to the American Medical Association, the nation’s largest physician group.

A March study by researchers at the federal government’s Centers for Disease Control and Prevention revealed a 13% decline in average opioids prescribed per person from 2016 to 2017. Maine, Massachusetts and North Dakota have experienced the biggest drops over the past decade.

One major factor is that many health insurers have imposed limits on prescriptions, as recommended by the CDC in 2016. The CDC advises doctors to prescribe new users no more than a seven-day supply and to keep daily doses under the equivalent of 50 morphine milligrams in an effort to prevent overdoses and new addictions.

In addition, the AMA created a task force in 2014 that has encouraged doctors to “start low and go slow” and use the drugs only if the benefits exceed the risks for a patient. The association also is offering doctors education programs on pain management.

Pain management courses are being emphasized in medical school curricula, as well as continuing medical education courses.

“These are very positive numbers,” said Kathy Donneson, chief of CalPERS’ Health Plan Administration Division. “But we’re all going to keep working on it. Opioids are still a national crisis.”

Declines in prescriptions have not yet led to reductions in deaths, said Dr. Patrice Harris, president-elect of the AMA and chair of its Opioid Task Force. “Reducing opioid prescriptions is important but will not by itself reverse the epidemic,” she said. “We will 

Medical experts also warned of unintended consequences of fewer opioid prescriptions: More people may suffer unmanaged chronic pain, and some may resort to illegal opioids, such as heroin or street versions of fentanyl. About 50 million Americans experience chronic pain.

“The focus on reducing opioid prescribing has likely left a large void in access to pain care,” Harris said.

Even as insurers set limits on opioids, they have not increased access to other pain care options, she said. “If policymakers solely focus on limiting access to prescription opioids for pain relief without increasing non-opioid options, the result will be increased patient suffering.”
















http://tinyurl.com/yxbh4xkl

Say Bye-bye to Aspirin: The Remarkable Story of a Wonder Drug

The Remarkable Story of a Wonder Drug, Which Now Comes to an End in the Primary Prevention Setting: Say Bye-bye to Aspirin!

Aspirin is to date the most used drug worldwide and, in 2018, with some dispute about its real birth date, celebrated its 121st birthday; 2018 will most probably be remembered as the year when aspirin came of age, whereby multiple studies re-examined, and at least partially questioned, its risk/benefit ratio in various clinical settings.[1–4] While aspirin remains the cornerstone treatment for secondary prevention in patients with established cardiovascular disorders, three large, independent, and high quality randomized controlled trials have shed new light on aspirin in primary prevention.[2–4] These recent results now have to be incorporated within the context of previously existing evidence, which altogether questions the somewhat liberal use of aspirin that has so far been recommended by some,[5] but not by other, guidelines committees.[6]

The advent of the digital age, data analytics, and meta-analytic have exposed many accepted theories and treatments invalid.

Say Bye-bye to Aspirin: The Remarkable Story of a Wonder Drug:

Nurses are striking. Where are the physicians?

Strikes are not in the DNA of physicians.

In March, members of the New York State Nurses Association (NYSNA) at New York’s “big four” hospitals (Montefiore, Mount Sinai, New York Presbyterian-Columbia and Mount Sinai West/St. Luke’s) voted by an overwhelming 97% margin to authorize a strike. The nurses’ fight centers around conditions for patient care, including safer staffing ratios inside hospitals so that nurses can adequately care for each patient. Throughout NYC, nurses are forced to work long shifts and are chronically understaffed. The nurses who recently threatened to strike recognize that these working conditions are part of hospital executives’ push to squeeze greater and greater profits out of workers at the expense of patient health — and they have had enough. New York nurses are fighting just as teachers across the country did earlier this year — including the tens of thousands of Los Angeles teachers who struck last January for better conditions for in schools. They are also taking up the example of health care workers around the world, including the 40,000 Irish nurses who recently struck. Nurses are recognizing they have the power to fight and win better patient care. But while nurses across New York are standing up for themselves and their patients, a big question remains: Where are the doctors and why are they not threatening to strike together with nurses?

Why are the physicians on the sidelines?

Strikes are not in the DNA of physicians.

Physicians see first hand every day how our dysfunctional health care system is simply not built to adequately address patient and community health. For many doctors, these frustrations manifest in burnout and dissatisfaction within a field they once loved. Today there is an epidemic of burnout among physicians, with some studies suggesting burnout affects up to half of all physicians. After training for years with the desire to help others, doctors come to experience medical system that values profit over all else and rarely gives them the tools to make a difference in the communities where they work. This can leave doctors feeling hopeless, and combined with other factors, can lead to depression or even suicide. Today physicians are committing suicide at two times the rate of the population as a whole. Yet, even at this moment of frustration and anger, they continue to keep their heads down, providing validity to this broken system. We see nowhere, among doctors, a resistance like that now being organized by nurses.

Strikes are not in the DNA of physicians.

In order to analyze why doctors are not throwing down their stethoscopes and finally saying enough is enough, a review of the U.S. medical education process is in order. As longtime public educator John Taylor Gatto highlights in his book, “The Underground History of American Education,” the education system is built to create “tools for industry.” Gatto points out that this system conditions those who pass through it to take direction well and to not question authority. At the same time, education aims to instill the importance of profit and continually reinforces the legitimacy of the capitalist system. Health care education is not excluded from this, and both patient and community health remains secondary to profit maximization nonetheless.

Strikes are not in the DNA of physicians.

Physicians have seen themselves as managers in the past...the head of the team, executives, leaders.  Leaders do not strike.  Only until recently have physicians seen their management roles go away, and not by choice, rather by economic penalties and/or perverse incentives. Within the hospital, doctors typically adopt an individualist mentality in which they consider only how they can personally make an impact on their patients’ health while ignoring the need for systemic change. Until physicians begin to put individual endeavors aside and begin to organize collectively, they will continue to see their patients harmed by the "health care" system. though it is important to note, physician control is ever decreasing as health care becomes more corporatized.

If a physician ever thinks of organizing collectively to withhold his/her labor in order to demand better conditions for her patients, employers declare that doctors are “abandoning” those in need of care. The Hippocratic oath taken by physicians to “do no harm” is cited. This argument obviously disregards the fact that it is the employer and ownership class which is directly harming patients every day in pursuit of profit— denying care, pushing individuals into bankruptcy, pursuing unnecessary treatments, neglecting systemic causes of illness, etc. It also ignores the fact that by continuing to focus the treatment on narrow individualistic explanations for disease and illness, the physician helps to redirect the patient’s attention away from the larger issues that are truly causing his or her suffering. Physicians may consider abandonment as an issue, so too will attorneys who would have the legal means to defend innocent patients, which has been accomplished many times.  It is considered prima facie evidence for medical malpractice

Strikes are not in the DNA of physicians.

Physicians around the world have organized and withheld their labor for better conditions around patient care in the past. 

Strikes by physicians: a historical perspective toward an ethical evaluation.

It is an issue for moral and ethical reasons, for physicians and is a conundrum for most physicians.

Recent strikes in other countries indicate the real dangers to patients and the public in general.

List of health and medical strikes in the past

In the past doctors and/or nurses have threatened strikes over inferior patient care due to understaffing and other hospital issues.  Rarely has it revolved around pay.

Michael Pappas is a family medicine resident. This article originally appeared in Left Voice.

Nurses are striking. Where are the physicians?: Until physicians begin to put individual endeavors aside and begin to organize collectively, they will continue to see their patients harmed by the "health care" system.

Broccoli sprout compound may restore brain chemistry imbalance linked to schizophrenia -- ScienceDaily

Eat your broccoli, it's good for your brain.

In a series of recently published studies using animals and people, researchers say they have further characterized a set of chemical imbalances in the brains of people with schizophrenia-related to the chemical glutamate. And they figured out how to tweak the level using a compound derived from broccoli sprouts.

They say the results advance the hope that supplementing with broccoli sprout extract, which contains high levels of the chemical sulforaphane, may someday provide a way to lower the doses of traditional antipsychotic medicines needed to manage schizophrenia symptoms, thus reducing unwanted side effects of the medicines.

"It's possible that future studies could show sulforaphane to be a safe supplement to give people at risk of developing schizophrenia as a way to prevent, delay or blunt the onset of symptoms," adds Akira Sawa, M.D., Ph.D., professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Schizophrenia Center.

Schizophrenia is marked by hallucinations, delusions, and disordered thinking, feeling, behavior, perception, and speaking. Drugs used to treat schizophrenia don't work completely for everyone, and they can cause a variety of undesirable side effects, including metabolic problems increasing cardiovascular risk, involuntary movements, restlessness, stiffness and "the shakes."

In a study described in the Jan. 9 edition of the journal JAMA Psychiatry, the researchers looked for differences in brain metabolism between people with schizophrenia and healthy controls. They recruited 81 people from the Johns Hopkins Schizophrenia Center within 24 months of their first psychosis episode, which can be a characteristic symptom of schizophrenia, as well as 91 healthy controls from the community. The participants were an average of 22 years old, and 58% were men.

According to the World Health Organization, schizophrenia affects about 21 million people worldwide.

Sulforaphane is found in a variety of cruciferous vegetables and was first identified as a "chemoprotective" substance decades ago by Paul Talalay and Jed Fahey at Johns Hopkins.

The scientists say further research is needed to learn whether sulforaphane can safely reduce symptoms of psychosis or hallucinations in people with schizophrenia. They would need to determine an optimal dose and see how long people must take it to observe an effect. The researchers caution that their studies don't justify or demonstrate the value of using commercially available sulforaphane supplements to treat or prevent schizophrenia, and patients should consult their physicians before trying any kind of over-the-counter supplement. Versions of sulforaphane supplements are sold in health food stores and at vitamin counters, and aren't regulated by the U.S. Food and Drug Administration.

IBM's AI can predict schizophrenia by looking at the brain's blood flow.  And it does so with 74 percent accuracy

Function biomedical informatics research network recommendations for prospective multicenter functional MRI studies












Broccoli sprout compound may restore brain chemistry imbalance linked to schizophrenia -- ScienceDaily:

Why Bolstering Trust in Journalism Could Help Strengthen Trust in Medicine | Vaccination | JAMA | JAMA Network

Declines in public trust in US institutions has been widespread and well documented.¹ Neither journalism nor medicine is immune from this trend, although the combination has the potential to adversely affect both population and individual health. Individuals are inundated with health information from news media, with news stories ranging from the latest trends in health and wellness to breaking news about new treatments or technologies that have the potential to revolutionize health care.
The relationship that medicine and journalism have with the people they serve relies fundamentally on trust. Yet, that trust can be jeopardized by the way in which news about medical research and health care interventions is often disseminated to the public. While science is incremental, journalists are faced with trying to break through a cacophony of information using attention-getting headlines. As a result, media messages often convey scientific certainty when that certainty does not exist. In a review of more than 2600 news stories over 12 years that included claims about interventions, approximately two-thirds received unsatisfactory grades on quantifying benefits, harms, and costs.3 When an earlier version of these data was published, an editorial commenting on this study noted this “alarming report card of the trouble with medical news stories is thus a wake-up call for all of us involved in disseminating health research—researchers, academic institutions, journal editors, reporters, and media organizations…”4 Reviews of public relations news releases—from government agencies, medical journals, academic institutions, and industry—demonstrate an even greater likelihood of an unsatisfactory grade.3

The Problem

The problem is not limited to authors of news releases and news stories. Authors of the research studies and the peer-reviewed journal enterprise are partially responsible through the use of “spin” in the abstracts of peer-reviewed research papers, ie, emphasizing or exaggerating beneficial findings while minimizing or ignoring limitations in the research or potential harms.5 This becomes compounded by spin in promotional public relations news releases and then in the eventual media news coverage. Some patients who see these exaggerated claims may come to their physicians with false hope, while physicians may be frustrated with having to debunk claims that have raised false hope in the minds of their patients.

Moreover, undue weight is often placed on celebrity health news that often has no relevance in readers’ lives. For example, a celebrity parent can amplify a harmful message that vaccines cause autism through her lack of knowledge.  While celebrity health endorsements have always existed, the rise of social media as a way to disseminate traditional news media has changed the pace with which such news is spread.

Efforts to repair trust in the news media that also promote fair, accurate and unbiased coverage of health care stories could contribute to restoring trust in medicine. The medical community could have an important role in these efforts by engaging in the following activities.

Possible Solutions

Support High-Quality Health Care Journalism

High-quality health care journalism often appropriately raises questions about the trustworthiness and integrity of research and clinical care. Investigative data-driven news stories can focus on conflicts of interest, scientific fraud and retractions, overdiagnosis, overtreatment, and nonevidence-based recommendations. When science does not self-correct, a vibrant health care journalism sector can play a vital role in pointing to needed improvement and perhaps even in helping to restore public trust.  However, the health care journalism sector in 2018 is far from vibrant, particularly at the local level where news organizations are smaller and less well staffed than ever before if they continue to exist at all.  Local health news has always been more trusted by communities, featuring individuals and institutions readers know, written by journalists and produced by publishers who are their neighbors.  

At the national level, alternative models are aiming to fill this void. Such examples include STAT News or the nonprofit Kaiser Health News, which cover a range of health and health policy topics. Likewise, nonprofit investigative newsrooms, such as ProPublica and the Center for Public Integrity, have published excellent investigations in the health and medical spheres that many legacy newsrooms now lack the staff and resources to produce. The reporting of these organizations benefits from engagement with those in the medical community who work with journalists to inform the public and investigate problems in the health care system. Clinicians and health care executives should work with local media to highlight stories of interest to their communities. For example, the University of Chicago has partnered with a local radio station to feature a community health focus hour to highlight the most pressing health issues the community reported in a needs assessment.⁷

Hopefully, this article can serve as a point of embarkation to find credible information. All of the aforementioned sources are non-profit and hold no allegiance to any hospital, health plan or other principals.

Engage Media to Amplify and Share Truthful Stories

As traditional news media struggle to reach people in an era of information overload and changing revenue models, it is even more important for clinicians to be involved to amplify, share, and help create truthful news stories. While social media is often dismissed as a way “fake news” is spread, it serves as an important conduit for the medical establishment to engage with news media and amplify truthful stories. Examples of recent ways in which clinicians have amplified stories to advance public health include pediatricians joining Twitter (dubbed “Tweetiatricians”) and working in consort to advocate on vaccine effectiveness (ie, #VaccinesWork). Another example is the weekly #BCSM Tweetchats moderated by an academic breast surgeon and a leading advocate of patients with breast cancer that offers evidence-based discussions that debunk hype each week and hopefully lead to an increasingly well-informed group of women with breast cancer who are active on social media. Likewise, clinicians can offer to serve as key informants for news media about health and wellness stories so that truthful messages are communicated. For instance, Seattle Mama Doc is a pediatrician-authored blog for a major children’s hospital and frequently serves as a reputable source for news media on stories regarding children.

Actively Correct Stories That Are Not Accurate

To rebuild trust in both medicine and health care news, the response of clinicians to health care news stories that are not accurate is as important as their response to those that are truthful. It is easy for physicians to dismiss a news story with a patient in the privacy of their offices. It is more difficult to do so on a public-facing comment forum. However, journalism benefits from these corrections and feedback. In the race to put out a headline first, the headline may not always be correct. Physicians have an important role in correcting the record both through comments and through social media. Likewise, it is equally important for clinicians to challenge celebrities who may be given a platform to spread misinformation in traditional news media or on social media. For example, an obstetrician has spoken out on her blog to explain why the jade eggs promoted for vaginal health not only lacked evidence but could cause harm⁸ and an oncologist actively uses Twitter to address hyped cancer treatments based on insufficient medical evidence.⁹

Article Information

Corresponding Author: Vineet M. Arora, MD, MAPP, Department of Medicine, University of Chicago Medicine, 5841 S Maryland Ave, MC 2007 AMB W216, Chicago, IL 60637 (varora@uchicago.edu).

Published Online: May 13, 2019. doi:10.1001/jama.2019.0636

Why Bolstering Trust in Journalism Could Help Strengthen Trust in Medicine | Vaccination | JAMA | JAMA Network: This Viewpoint discusses how proliferation of health misinformation to the public undermines trust in science and medicine, and proposes ways the medical community and media might work together to make medical professionals better producers and consumers of accurate health information and to make...

Chronic Fatigue Syndrome: It's Real, and We Can Do Better

Sunday, May 12, 2019, is ME/CFS awareness day

ME/CFS is a complex, chronic, debilitating illness with systemic effects. It's characterized by reduced ability to perform activities that were well-tolerated pre-illness, accompanied by profound fatigue not improved by rest, and lasting for more than 6 months.

Most School's of Medicine teach little about this real syndrome. Some may even call it psychosomatic. The CDC Institute for Viral illnesses classified this a real illness despite there being no specific markers for it.

It is estimated 836,000 to 2.5 million Americans suffer from ME/CFS, a serious, long-term illness that can severely impair the ability of those affected to live normal lives. But the majority of those affected are not diagnosed, and many struggle with symptoms for years before receiving a diagnosis.

The absence of a definitive diagnostic test contributes to this problem. In addition, most medical schools in the United States do not include ME/CFS in their physician training. Less than one-third of medical school curricula and less than half of medical textbooks in the United States address ME/CFS, so many healthcare providers need more information about this condition.

A major concern is the difficulty in finding good healthcare from informed and compassionate providers. To address this need, we released an updated CDC website about ME/CFS for healthcare providers in July 2018. The new site was designed specifically with clinicians in mind. It offers information about how clinicians can better assess and help their patients manage this illness.

The new content includes:

Presentation and clinical course of ME/CFS;

Prognosis, epidemiology, and possible causes of ME/CFS;

Diagnostic criteria for ME/CFS, released in 2015; and

2015 Institute of Medicine Report on ME/CFS

A major stumbling block until now is a definitive evidence-based conclusion about ME/CFS. and that ME/CFS was a rule out diagnosis after all other differential diagnoses were considered.











Chronic Fatigue Syndrome: It's Real, and We Can Do Better: Chronic Fatigue Syndrome: It's Real, and We Can Do Better

‘App Store for DNA’ Fizzles as Health Startup Shifts Strategy -

There's an app for that.......... maybe!

Genetic-testing startups are finding that selling consumers insights on their risk of getting cancer may not be as easy as telling them about their Irish roots.





 

23andMe Inc. and Ancestry.com LLC have capitalized on the public’s insatiable appetite for discovering their family trees. However, consumers have balked at paying other companies for health analysis of their DNA. 

Some testing firms are finding it works better when health-care providers are more directly involved. That way patients are better able to understand test results and integrate them into their care.

Helix, which launched in 2015 with $100 million from genome-sequencing giant Illumina Inc., had planned to sell tests directly through an “app store’’ for DNA. Instead, it’s now looking to partner with health-care providers. Illumina said on April 25 that it would no longer hold equity or participate on Helix’s board, ending the partnership.

Are health care providers ready or prepared to offer this service? 

Color Genomics has also changed course. It began by offering doctor-prescribed tests to consumers, but in January it said it would shift focus to partnerships that incorporate genetic testing into primary care for large numbers of patients. And recently 23andMe has drawn criticism for cancer tests that critics say can mislead consumers without a professional’s input.

A major barrier to this is the lack of coverage for an over the counter test. The price point of the test also may be a barrier to the patient and/or health plan.  The value and efficacy of a broad panel of genomics could lead to prevention, if possible, or optimizing other screening tests (imaging or invasive biopsy) i.e., BRCA for breast carcinoma.

When Helix rolled out its “app store’’ in 2017, the idea was that customers would pay Helix to sequence their DNA. They would then purchase DNA apps from other companies selling products on the Helix platform, depending on whether they were curious about ancestry or health, or perhaps in the market for custom socks printed with their own genetic code.  (A far-out marketing idea for clothing manufacturers. 

Changing Course

But now Helix is shifting gears. It deemed a partnership last year with the Healthy Nevada Project to sequence DNA of state residents so successful that it announced a similar deal with AdventHealth in Florida last month. In both arrangements, Helix sequences DNA and screens for specific genetic conditions then passes that information along to its health-care partners, which follow up with patients. For Helix, the arrangements give it access to large pools of customers in one fell swoop.

Color Genomics has also moved toward selling its services to companies that offer health care to large numbers of people. In January, it inked a deal with NorthShore University HealthSystem in the Chicago area to offer its kits to more than 10,000 patients. It also sells its services to several employers, which offer DNA testing as a benefit alongside insurance.

Color, which requires a doctor’s prescription and has always offered genetic counseling alongside test results, said the shift has been mostly about reaching larger numbers of patients in order to make precision medicine widely available. At the same time, it stopped its focus on recruiting individual patients to order tests through its website.

Recently, 23andMe has demonstrated the peril of offering nuanced and complicated health information directly to consumers. Critics argue that its tests for breast cancer could mislead people about their health. Because 23andMe tests only for a few of the many harmful genetic mutations to the BRCA genes associated with breast-cancer risk, one recent study by a competitor found nearly 90 percent of participants who carried a BRCA mutation would have been missed by 23andMe’s test.

Stephen Montgomery, a geneticist at Stanford University who criticized Helix when it launched, said the pilot seemed like a good idea. For most people, he said, the health information delivered by consumer genomics companies just doesn’t seem that useful. The biggest DNA testing company, Ancestry, doesn’t offer health testing at all.

“It’s not precise enough to be able to be actionable for most people,’’ said Montgomery. “The best way to deliver that information to people is a partnership with clinicians who know how to use it.’’







‘App Store for DNA’ Fizzles as Health Startup Shifts Strategy - Bloomberg:

State Bans Pesticide Linked To Developmental Problems | California Healthline

California officials announced a ban on chlorpyrifos, a widely used pesticide that has been linked to lower IQs, lower birth weights and other developmental issues in children, even as the federal government fights to protect it.







California will ban the use of a widely used pesticide in the face of “mounting evidence” that it causes developmental problems in children, state officials announced Wednesday.

Several studies have linked prenatal exposure of chlorpyrifos to lower birth weights, lower IQs, attention deficit hyperactivity disorder and autism symptoms in children.

The chemical is mostly used on crops — including citrus, almonds, and grapes — but is also applied on golf courses and in other non-agricultural settings.

The ban “is needed to prevent the significant harm this pesticide causes children, farm workers, and vulnerable communities,” Jared Blumenfeld, secretary of the California Environmental Protection Agency (CalEPA), said in a statement. California’s ban comes as federal regulators fight to keep the chemical on the market. Almost two decades ago, the U.S. Environmental Protection Agency, which regulates pesticides at the federal level, prohibited the sale of chlorpyrifos for residential use.

Some states aren’t waiting for the federal government to act, California Healthline reported last month. The New York legislature last week sent a proposed ban to Democratic Gov. Andrew Cuomo for consideration. A bill in the California legislature to ban chlorpyrifos was pending at the time of the CalEPA’s announcement. Oregon and Connecticut lawmakers also are considering bans.

Hawaii was the first state to enact a state ban last year.

“Because the science is pretty clear that this a dangerous chemical, it’s long past time to get it off the market,” said Virginia Ruiz, director of occupational and environmental health at the Washington, D.C.-based nonprofit Farmworker Justice. “There’s momentum now, and people and policymakers are becoming better educated about chlorpyrifos.”

Chlorpyrifos can be inhaled during application and as it drifts into nearby areas or ingested as residue on food. People also can be exposed through drinking water if their wells have been contaminated by it.

Globally, several companies make chlorpyrifos products. In the U.S., the most recognized brand names are Dursban and Lorsban, manufactured by Corteva Agriscience, formerly known as Dow AgroSciences.

Corteva Agriscience did not respond to requests for comment.

California citrus growers are among the groups that oppose the ban. They worry that eliminating chlorpyrifos could result in disease outbreaks among their fruit trees.

Casey Creamer, president of California Citrus Mutual, pointed to the Asian citrus psyllid, a tiny insect that feeds on citrus leaves that can transmit a disease known as Huanglongbing, or citrus greening, as one risk.

The task to defeat HLB may be made easier by Trained dogs actually smelling the bacteria within a few weeks after infection, Tim Gottwald, a U.S. Department of Agriculture plant pathologist, said during a presentation at the Riverside conference. In Florida they’ve been 99% accurate, and in tests in December and February under challenging conditions (such as distractions from homeowners’ dogs) in Southern California backyards, they were right more than 92% of the time, he added.

If the canines are right, HLB may be more widespread than standard tests show. Two years ago, the dogs signaled infections in 72 trees at UC Riverside and in four trees in two commercial groves in Kern County. The trees continue to appear negative on molecular tests, but this method typically lags infection. Some California scientists maintain, and hope, that the dogs are wrong, perhaps because they’re smelling something else in the trees, but only time will tell. Now researchers and farmers are racing to fend off the disease. This month, more than 500 scientists from around the world gathered in Riverside at the sixth International Research Conference on Huanglongbing, meeting in California for the first time. Their findings show that although the disease is spreading rapidly in the Southland and no breakthrough is imminent, a host of new detection methods and strategies could help California avert the kind of disaster that destroyed almost three-quarters of Florida’s citrus production.

Huanglongbing originated in Asia a century or more ago. It is caused by a bacterium, Candidatus Liberibacter asiaticus, transmitted by a tiny insect, the Asian citrus psyllid, which feeds on young citrus leaves. HLB clogs citrus trees' phloem, a vascular tissue that transports sugar from the leaves; this causes the most symptomatic fruit to become small and bitter, and eventually makes trees unproductive or kills them.

Candidatisus a budding yeast-like fungus, carries by the insect, the tiny  Asian citrus psyllid, which feeds on young citrus leaves. 

“The impacts are potentially significant,” he said. If farmers “don’t have the tools to effectively manage the psyllid, people are going to switch out or stop growing citrus.”

The agency added that its decision to ban chlorpyrifos “follows mounting evidence… that the pesticide causes serious health effects in children and other sensitive populations,” even at low levels of exposure.

The California Farm Bureau Federation warned that food may get pricier as a result of the ban, leaving state residents more dependent on produce grown in states with less stringent regulations.

The group most at risk are immigrant farmworkers, who are exposed as an occupational hazard. These workers bring home the pesticide on their clothing and skin which is contaminated.  This places their children and families at risk.

State Bans Pesticide Linked To Developmental Problems | California Healthline: 

9 Ways You Can Fight Addiction including Video Gaming Disorder

Opioid addiction is the new buzzword as rates of addiction have soared.  A less-known addiction is to video gaming. Studies have revealed an identical response to video gaming by teens, children and young adults.

Understanding Pornography Addiction (free e-book)

Withdrawing from any addicting substance will make you crave for more.  You might be clean from your addiction for weeks or months, but you can still have the craving at any point.  These cravings can be relentless, and they find you during a weak point. A desire to return to your addictive habit can be so convincing that you have no choice other than giving in.

This is due to a response in the pleasure center in the brain. A brain hormone, endorphin is released during pleasurable activities, ranging from gambling, pornography, cigarette smoking, marijuana, heroin, crack, methamphetamines, and even video-gaming, or internet use. Health addictions such as running or intense physical activity also produce endorphins.  Some addictions are beneficial in terms of health and wellness. Addictions are not necessarily harmful, some are beneficial.

The good news is that the model for treatment is very similar for any addiction.

Ways to Cut the Craving and Fight Addiction

The following points can help you fight addiction. Just choose the right thing for you and keep your mind at it:

Cognitive Behavioral Therapy

Cognitive behavioral therapy opens up several techniques that help you cope with cravings when they arise. They include distraction, redirection, visualization, and more. When you have a craving, you might choose to redirect your mind onto something else. You can also distract your craving by doing something better or by sticking to your a goal. The visualization technique helps you relax down and let you imagine your life will be without addiction.  Cognitive behavioral therapy helps you spot cognitive distortions in your mind. The kind of distortion also includes drug craving known as catastrophizing. When you experience a drug craving, you might catastrophize the situation by imagining that you’ll never get through this. The techniques are supposed to de-catastrophize your brain and look at things more objectively.

NAD Brain Restoration Therapy

Nicotinamide adenine dinucleotide (NAD) is present all through the cells of our body and helps to maintain metabolic reactions. Without NAD, our cells cannot metabolize carbs, amino acid or fats. It plays an essential role in gene expression and is linked to aging diseases.

NAD in Georgia offers brain restoration therapy by using innovative and effective treatments to promote healing of body and mind. It not only helps you fight addiction about also restores cellular production and protects DNA from damage. It is perfect for people who are majorly addicted or have relapsed several times.

Self-Talk

It could be one of the most underrated aspects in this list, but every other remedy starts with this one. If you are consciously addicted, self-talk can open up a new direction for you. When you come to terms with the fact that you need to get over an addiction, you’re already one step ahead. By talking to yourself and controlling your mind, you can give you brain logical reasons to control addictive activities.

Cravings are often blind and prevent you from looking at the bigger picture of its deadly results. You can write down a list of things you should or shouldn’t do and keep it handy. Keeping notes in front of you can curb your cravings too. The list can also incorporate reasons why you chose to quit and why you need to stick to it. Don’t forget to add the negative consequences that keep your brain away from taking it up again.

Get a Hobby

Hobbies aren’t just activities that you enjoy but also shape the person you are. It is one of the best ways to distract and concentrate on productivity. Cravings often arise when you’re bored, and you want to fill the void with something. A hobby is a perfect way to fill such emptiness.

Surf Your Urge

Instead of forcing yourself to stop the craving, Surf the Urge. Urge Surfing is a mindful technique that lies on the principle of accepting desires for what it is.

When you feel a craving, you must stop and acknowledge how you feel. Sit down with closed eyes and observe what your mind has to say, feel the sensation within your body, and then decide what to do. The process helps you verbally recognize your thoughts and emotions during the experience.

For instance, you can talk to your mind and remember the the destruction that drugs cause. You might have sweaty palms, a faster heartbeat, but you should pause to feel it. Describe your thoughts through the sensations till you don’t feel the craving anymore. The processes of Urge Surfing can help you realize the cravings and wave it off when you question yourself.

Self-Care

People who make up their mind to eat healthily and exercise every day soon start avoiding things that harm them. It is a smart way of improving health and emotional well-being and slowly takes you away from bad habits. You need the determination to maintain it once you start.

Know The Triggers

At the time of recovery, some people, places, or things will draw you into using drugs. When you can consciously figure out such triggers, then you can avoid those triggers to help keep you on the right track.  You can make a list of things that trigger you to take drugs. You must also recognize the inevitable things that will always pull you down. Once you know what they are, you can work towards dealing with them and fighting it out.

Reach Out to People Who Care

If you know that there are people who can help you come out of your condition, you must talk to them. Recovery needs people around to make sure you’re sober. It could be your family, your friends, or just one person you respect. They can make things much better for you and help you persevere.

Ignore Bad Memories

Several therapists work on Memory Reconsolidation that keeps craving away by removing memories that relate to drug use. You will need expert help for these, but it effectively prevents the urge at bay.

These are some of the ways to get out of an addiction. If you’re conscious enough to understand the damage, it does to you, start with self-care and self talk to stay healthy.

9 Ways You Can Fight Addiction