HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Listen Up
Monday, December 12, 2022
Statiscal Methods in Clinical Medicine, or What to Believe ? Bayes’ Theorem
Elon Musk's Neuralink could begin human testing in six months |
Friday, December 9, 2022
CHD Files Motion to Prevent California From Punishing Doctors for COVID ‘Misinformation’ Until Lawsuit Is Settled •
Mission
The mission of the Medical Board of California is to protect health care consumers through the proper licensing and regulation of physicians and surgeons and certain allied health care professionals and through the vigorous, objective enforcement of the Medical Practice Act, and to promote access to quality medical care through the Board's licensing and regulatory functions
Friday, December 2, 2022
Amazon’s Creep Into Health Care Has Some Experts Spooked
Amazon’s Creep Into Health Care Has Some Experts Spooked
The concept is simple: The patient will select their condition, fill out a questionnaire, and Amazon will connect them with a doctor to get a treatment plan. The scheme does not accept insurance; the cost of seeing a doctor will be around that of the average copay for a doctor’s visit, the announcement says: “At Amazon, we want to make it dramatically easier for people to get and stay healthy.”
It’s also seemingly another move by the tech giant to know every last detail about your life—even down to whether you’re suffering from erectile dysfunction (one of the conditions that Amazon Clinic will cover). Yet given that Amazon doesn’t have the squeakiest track record when it comes to protecting data, handing the company the keys to people’s intimate health information raises red flags for privacy experts.
If this feels familiar, it’s because we’ve been here before. The launch of this new service comes hot on the heels of Amazon’s takeover of One Medical, a US company described as a “Netflix-for-healthcare subscription” with around 800,000 members. The acquisition proved controversial due to concerns about patient data privacy mostly centered on the simple fact that Amazon would have access to the data. (When news of the $3.9 billion deal broke in July, it prompted protests outside One Medical’s headquarters in San Francisco.)
Amazon Care, a telehealth service Amazon piloted among its employees and then rolled out to other customers, shows how things can go wrong. Its shutdown was announced a few months ago, with the senior vice president in charge of the program, Neil Lindsay, writing in an internal memo Amazon shared with WIRED: “Although our enrolled members have loved many aspects of Amazon Care, it is not a complete enough offering for the large enterprise customers we have been targeting and wasn’t going to work long-term.”
But it was plagued by other problems, too. A Washington Post investigation alleged that moving at top speed and efficiency sometimes conflicted with best practices in medicine: For example, nurses were asked to process patient blood samples in their personal cars, the paper reported, and to store and dispose of medical supplies at home, which they protested. (Amazon told the Post that they could not find records of complaints about these matters.)
“Amazon Care followed common practices for in-home care and knows them to be safe and appropriate,” Smith told WIRED. “For example, Amazon Care clinicians were always equipped with Stericycle medical waste return equipment to properly and securely return or dispose of supplies.”
For Sharon, a big concern is how reliant we risk becoming on big companies as mediators of fundamental public needs. “This is a dangerous situation—that we would become dependent on a handful of private actors for the distribution of very basic goods, like health, or education, or public services,” she says. For instance, as these companies increasingly fund and perform their own research, it’s possible they could influence how the research agenda is set. That could be a problem if tech founders’ penchant for wanting to live forever results in a focus on funding longevity research over, say, cancer treatments.
At the very least, Amazon Clinic will be bound by HIPAA, the Health Insurance Portability and Accountability Act, which means individual patient records will be protected as soon as a person begins a process with a health care provider. But all the information you provide prior to this—for instance while searching for a doctor—falls outside of the purview of HIPAA, and is technically open for Amazon to gobble up,
Tuesday, November 29, 2022
Covid is no longer mainly a pandemic of the unvaccinated. Here’s why. - The Washington Post
It’s no longer a pandemic of the unvaccinated
For the first time, a majority of Americans dying from the coronavirus received at least the primary series of the vaccine.
Fifty-eight percent of coronavirus deaths in August were people who were vaccinated or boosted, according to an analysis conducted for The Health 202 by Cynthia Cox, vice president at the Kaiser Family Foundation.
It’s a continuation of a troubling trend that has emerged over the past year. As vaccination rates have increased and new variants appeared, the share of deaths of people who were vaccinated has been steadily rising. In September 2021, vaccinated people made up just 23 percent of coronavirus fatalities. In January and February this year, it was up to 42 percent, per our colleagues Fenit Nirappil and Dan Keating.
“We can no longer say this is a pandemic of the unvaccinated,” Cox told The Health 202.
Being unvaccinated is still a major risk factor for dying from covid-19. But efficacy wanes over time, and an analysis out last week from the Centers for Disease Control and Prevention highlights the need to get regular booster shots to keep one’s risk of death from the coronavirus low, especially for the elderly.
Anthony Fauci, the nation’s preeminent infectious-disease expert, used his last White House briefing yesterday ahead of his December retirement to urge Americans to get the recently authorized omicron-specific boosters.
“The final message I give you from this podium is that please, for your own safety, for that of your family, get your updated covid-19 shot as soon as you’re eligible,” he said.
White House press secretary Karine Jean-Pierre:
Ratio shift
Cox, like many experts, says she’s not surprised by the ratio shift. There are a few reasons:
- Individuals at greatest risk of dying from a coronavirus infection, such as the elderly, are also more likely to have received the shots.
- Vaccines lose potency against the virus over time and variants arise that are better able to resist the vaccines, so continued boosters are needed to continue to prevent illness and death.
The BA.5 omicron subvariant became dominant in July and consistently accounted for the majority of new coronavirus infections across the United States until earlier this month. The highly transmissible strain fueled a surge of new infections, reinfections and hospitalizations throughout the summer.
Boosters
It’s still true that vaccinated groups are at a lower risk of dying from a covid-19 infection than the unvaccinated when the data is adjusted for age. An analysis released by the CDC last week underscores the protection that additional booster shots offer against severe illness and death as immunity wanes.
Let’s take a look at deaths in August, when the highly contagious BA.5 variant reached its peak:
- That month, unvaccinated people aged 6 months and older died at about six times the rate of those who had received their primary series of shots.
- People with one booster dose were even better protected. Unvaccinated people over the age of 5 had about 8 times the risk of dying from a coronavirus infection than those who received a booster shot.
- Among individuals who were eligible to receive additional booster shots, the gap is even more striking. Unvaccinated people 50 and up had 12 times the risk of dying from covid-19 than adults the same age with two or more booster doses.
David French, senior editor for the Dispatch:
3 Federal Agencies Hit With Lawsuits in Ongoing Quest to Uncover Origins of COVID • Children's Health Defense
Saturday, November 26, 2022
NOVARTIS---The secret city
A secret city, you say, along the eastern bank of the Rhine, bordering Germany. Switzerland is long known for neutrality and a haven for secret bank accounts also has NOVARTIS, a juggernaut of pharmaceutical research and innovation.
Until very recently this industrial park was a tightly guarded place, not unlike the CIA in the United States. The development of new drugs is a tightly guarded secret, much like the security of the United States. It is hard to monetize the value of classified documents or the names of spies the value of new medications is enormous running into the hundreds of billions of currencies worldwide.
In a very public document, Novartis invites the public to tour its campus in Basil Switzerland. The announcement coincided with the opening of the Novartis Pavillon.
The Pavillion at Novartis |
Friday, November 25, 2022
The Blind Can See - Proto Magazine
Blind Spots - Proto Magazine
Hope in Sight - Proto Magazine
HOW MANY ELECTRODES CAN FIT ON THE BACK OF AN EYE? For the scientists who have spent the past 20 years competing to create a sight-restoring artificial retina, the question is hardly metaphysical. Taking inspiration from the cochlear implant, a device that stimulates the auditory nerve to produce sound the deaf can make sense of, the inventors of visual prostheses think they can prompt healthy cells in the retina to send visual information to the brain. One design uses a tiny camera mounted in eyeglasses to capture images, which are then sent to a video processor worn at the waist that converts them to light and dark pixels—like those that create images on electronic scoreboards. The signals are transmitted to electrodes implanted in the retina and thence along the optic nerve to the brain.
The 50 or so people who have received artificial retinal implants say they can now differentiate walls from windows, detect whether a computer monitor is on, point to the location of a person standing silently in a room and sort dark socks from white ones. Such achievements would represent a major advance in accomplishing what long has seemed beyond hope: restoring sight to the sightless. But some of these cases involve people who had some vision before the implant, making it difficult to know if the devices improved their vision, says neurologist and ophthalmologist Joseph Rizzo, director of neuro-ophthalmology at the Massachusetts Eye and Ear Infirmary and director of the Center for Innovative Visual Rehabilitation at the VA Boston Health Care System.
“It is utterly clear that people who have been blind for decades can see something when you stimulate the retina,” says Rizzo, who in the late 1980s was the first scientist to receive funding for work on an artificial retina. “But there is no evidence that the vision we’re able to create at this point provides enough detail to really make a difference in someone’s life.”
And so, more electrodes. The first generation of artificial retinas, created in the past decade, had as few as 16, while the most advanced current devices have 64. Each electrical contact stimulates cells in the eye—so additional electrodes mean more stimulation and, perhaps, better vision. Typically, the electrodes are embedded in a substrate that is many times thinner than human hair. This tiny electronic component can be tacked to the front of the retina or slid behind it. Now Rizzo and others are developing prototypes that pack as many as 200 electrodes onto the device. “With 200, people may be able to find the sidewalk and see cars, so they can safely navigate in an unfamiliar environment without a cane or a guide dog,” says Rizzo, who predicts the device will be ready for clinical trials as early as 2011. “Being able to do those things would be a stunningly large accomplishment.”
But there’s another, more direct approach to treating gene-related diseases: replacing a malfunctioning gene with a healthy one. While most attempts at gene therapy have turned out to be ineffective, there are several reasons injecting genes into the eye could succeed, says Katherine A. High, director of the Center for Cellular and Molecular Therapeutics at Children’s Hospital of Philadelphia.
The primary risk in gene therapy is that the immune system will reject either the donated genetic material or the viral vector—a virus that has had its own DNA replaced by the new gene—used to carry the gene into a cell. The body might also mount an autoimmune response that could threaten healthy cells. But since the eye is an “immunoprivileged” site, secluded from the direct blood supply, a harmful immune response is less likely. “Also, several molecules that inhibit the immune response are found in high prevalence in the eye, and it’s geographically segregated from other tissues,” says Jean Bennett, a researcher at the University of Pennsylvania School of Medicinein Philadelphia. “It’s a self-sustaining organ surrounded by pretty tough barriers.” What’s more, the retina, and particularly the tiny macula, are comparatively small, making it easier to deliver a high concentration of viral vectors relative to the number of cells to be treated—a result much more difficult to achieve when replacing genes in large organs.
The eye has yet one more advantage. Because people are born with a full complement of retinal cells, which don’t divide after birth, the healthy gene can be injected directly into the diseased tissue and expected to stay there, continuing to produce the protein that is lacking because of the faulty host gene.
All those factors convinced High, Bennett and others that the eye might indeed be uniquely suitable for gene therapy, and their work on Leber’s congenital amaurosis 2 has produced remarkable breakthroughs. In LCA2, which affects just 80 people in the United States, photoreceptor cells stop functioning and eventually die. The disease is caused by a defect in a single gene, RPE65, that normally produces a protein responsible for processing vitamin A; the retina’s photoreceptors use it to create the visual pigment rhodopsin, which absorbs light entering the eye. Without the RPE65 protein, there’s profound vision loss at birth and total blindness by age 30 or 40.
With just one gene involved and with a window of several decades during which retinal cells are injured but not defunct, LCA2 seemed an ideal testing ground for gene therapy. Bennett and her husband, Albert Maguire, a retina surgeon at Children’s Hospital of Philadelphia, made it work in animals, restoring sight to nearly 60 briards, a sheepdog with a gene that causes severe retinal degeneration similar to that of LCA2. Yet because the human disease is so rare, biotechnology companies had little interest in supporting a trial. So High convinced Children’s Hospital to produce the vectors and test the safety of the gene-transfer therapy.
Twelve people with LCA2, whose ages ranged from 8 to 44, participated in the trial. Before being treated, they all had trouble navigating a dimly lit obstacle course, and several could read nothing on an eye chart and were dependent on others to lead them everywhere. Afterward their vision was partially restored, and within two months a father who hadn’t been able to see his baby’s face was taking the child on neighborhood walks. Road signs and the numbers on cell phones and digital clocks suddenly came into view. The day vision of most subjects improved significantly, and in all subjects, night vision improved as much as 40,000-fold as their retinas became more sensitive to light.
But the most dramatic improvements occurred in four children, ages 8 to 11, who had less damage to their retinas from the progressive disease than did the adults. An eight-year-old who could read only large print on an electronic screen now needs no special visual devices and plays baseball. Another child, who since birth had been able to see only light and shadow, now plays soccer. And all the children navigated the obstacle course more quickly and with fewer errors than before gene therapy. (Not all of the adults improved their performance on the test course.)
Today, more than two years after the first subjects received the gene therapy, their enhanced sight hasn’t waned, and some have even reported ongoing improvements. Although Bennett isn’t sure how long the treatment will be effective, she is already thinking about how gene therapy might be used to treat “a huge list of single-gene defects that destroy the retina’s photoreceptors.” And the breakthrough sets the stage for inserting genes to slow or prevent other eye diseases. “The gene therapy trial for LCA2 has advanced a big area of potential treatment involving 500 identified genes that cause people to lose vision,” says Sieving of the National Eye Institute.
IT’S NO ACCIDENT THAT GENE THERAPY IN THE LCA2 TRIAL WORKED best with the youngest participants. Their retinal cells hadn’t died off altogether and could be revived by the introduction of healthy genes. But that approach won’t help older people, already blind, whose retinal cells will never grow back. For them the best hope may be self-renewing stem cells, which, at least theoretically, can replicate and differentiate themselves into many types of specialized cells—including those in the eye. “By putting a cocktail of stem cells in the eye that will proliferate in the right quantity and have the right characteristics, we can replace missing retinal cells and make the entire retina work again,” says Sieving. “This technology is poised to explode.”
David Gamm, assistant professor of ophthalmology and visual sciences at the University of Wisconsin–Madison, is a leader in that effort. He’s building on a landmark 2007 discovery by other University of Wisconsin scientists, who inserted four genes into an adult skin cell and programmed it back to an embryolike state capable of differentiating into any of the body’s 220 cell types. Gamm has taken those undifferentiated cells—known as induced pluripotent stem cells, or iPS cells—and used a chemical bath of proteins and growth factors to coax them into becoming retinal cells.
This approach has enabled Gamm to observe the entire process of how undifferentiated cells turn into retinal cells, moving from a primitive form to a fully developed retina. Now researchers can study the genes produced by those cells to understand better what goes awry in degenerative retinal diseases.
But perhaps the most exciting possibility is that iPS cells could replace dead or damaged retinal cells. A clinical trial, scheduled to begin soon in the United Kingdom, will test the viability of using embryonic stem cells to replace degenerated retinal pigment epithelium, which nourishes retinal cells, in people with AMD. The stem cells will be placed on an artificial membrane that will be inserted in the back of the eye. If the results are positive, Gamm hopes to test whether iPS cells—which avoid the ethical issues of harvesting stem cells from human embryos—would also work. He has grown retinal cells from both embryonic and induced stem cells and says they appear identical. “Five years from now, there could be clinical trials to replace cells in people with retinal degenerative diseases such as AMD and retinitis pigmentosa,” says Gamm.