A Pain in the Night and a Harrowing Drive: A Crisis in Rural Health Care Puts Mothers-to-Be on a Risky Road
(STAT News) – It is a common story in rural America. Financial pressures, insurance problems, and doctor shortages forced more than 200 hospitals to close their birthing units between 2004 and 2014, according to the University of Minnesota’s Rural Health Research Center. That’s left millions women of reproductive age facing longer drives to deliver babies — who sometimes arrive en route. The long drives, understandably, increase anxiety. They also make mothers and babies less safe; studies show these distances bring with them increased rates of complications and infant deaths, as well as longer stays in neonatal intensive care units.
(The Atlantic) – Holdouts who fear that gene editing is putting humanity on a slippery slope to disaster or who have religious objections to the technique or who just prefer “the old-fashioned way” in their gut will conceive a child. If he or she is healthy all will be fine. But some holdouts will give birth to a child with a painful or fatal condition that could have been prevented. People will get angry at those parents and seek to punish them. Or at least that is the course I foresee (even though there is arguably an ethical distinction between refraining from editing the genes of a future human and denying essential medical treatment to an already living human, who is understood to have individual rights independent from or not entirely subject to the beliefs of their guardians).
(Scientific American) – As many as three million people in the U.S. live with epilepsy, and more than 30 percent of them receive inadequate relief from medication, a number that persists despite the introduction of more than a dozen new antiepileptic drugs since 1990. Although surgery has helped some patients such as Shane, uncontrollable epilepsy remains a living nightmare for patients and an intractable foe for clinicians and researchers. “I hate to say it, but we do not know why” some people respond to medications and others do not, says neurologist Michael Rogawski, who studies epilepsy treatments at the University of California, Davis. And yet if the central conundrum continues, so does the determined quest for new and different approaches to treating the toughest cases.
(Managed Care Magazine) – Can some of these people be reached with assessment, support, and even therapy itself delivered by video and other digital means? The telehealth industry, approaching the $1 billion mark in annual investment, seems to think so. Last year, Mercer’s annual survey of large employers found that 59% offered telemedicine services, almost double the percentage that did in 2015. Major telehealth companies like Teladoc, MDHealth, and American Well are ratcheting up their mental health offerings, connecting patients with psychiatrists, psychologists, and social workers via their smartphones, tablets, or home computers.
(STAT News) – The virus that de Moraes caught is part of a broader outbreak that has taken authorities here by surprise. Although Brazil experiences what is known as a “sylvatic” cycle of yellow fever — in which the virus is spread between mosquitoes and monkeys in the jungle — the current outbreak has fanned far beyond the Amazon jungle and out to the coast. It has confounded specialists, doctors, and health officials, and raised fears of an epidemic in Brazil’s urban areas that could be devastating if not quickly contained. It is the worst outbreak of yellow fever in this country in recent memory.
(STAT News) – Human intelligence has long powered hospitals and health care. We rely on doctors, nurses, and a variety of other clinicians to solve problems and create new solutions. Advances in artificial intelligence are now making it possible to apply this form of computer-based “thinking” to health care. As the chief technology officer for a new state-of-the-art advanced medical learning facility, I have been closely watching developments in artificial intelligence. Here are three areas — training, surgical robots, and data mining — in which I believe it will begin making a difference sooner rather than later.
(Nature) – The US Food and Drug Administration (FDA) has started testing whether livers-on-a-chip — miniature models of human organs engineered to mimic biological functions — can reliably model human reactions to food and food-borne illnesses. The experiments will help the agency to determine whether companies can substitute chip data for animal data when applying for the approval of a new compound, such as a food additive, that could prove toxic. It is the first time that a regulatory agency anywhere in the world has pursued organs-on-chips as an alternative to animal testing.
(Science) – Scientific discoveries and new technologies that aim to improve human health challenge our understanding of what it means to be human. Perceptions of being and the boundaries between humans and other species may be disrupted by our potential to manipulate genes and their expression, regulate cellular functions, and replace tissues to improve the quality of life. As we gain a greater understanding of genetic complexity, molecular mechanisms, and cellular and tissue functions, technologies aimed at modifications could, in theory, also be applied to enhance our physical and cognitive abilities.
(The Washington Post) – On Thursday, Feng Zhang, one of the pioneers of CRISPR, and 18 colleagues published a paper in the journal Science showing how they had turned this system into an inexpensive, reliable diagnostic tool for detecting nucleic acids — molecules present in an organism’s genetic code — from disease-causing pathogens. The new tool could be widely applied to detect not only viral and bacterial diseases but also potentially for finding cancer-causing mutations.
(Dutch News) – The number of official cases of euthanasia in the Netherlands rose 10% last year to 6091 and euthanasia now accounts for 4% of total deaths, the regional monitoring boards said on Wednesday. In 10 cases, the rules for euthanasia were not followed correctly, most of which involved a failure to properly consult a second doctor, the RTE annual report said. In one case, a doctor was reprimanded for ‘crossing the line’ with a patient suffering from severe dementia.
(Reuters) – Smithfield Foods, the world’s largest pork producer, has established a separate bioscience unit to expand its role in supplying pig parts for medical uses, with the ultimate goal of selling pig organs for transplantation into humans. Routine pig-human organ transplants are years away, but recent scientific advances are breaking down barriers that frustrated prior attempts to use pigs as a ready supply of replacement parts for sick or injured people, making it an attractive new market.
(STAT News) – The University of California has filed an appeal to overturn a February decision by a US patent tribunal that dealt UC a setback in its efforts to win foundational patents on the revolutionary genome-editing technology CRISPR-Cas9. In that decision, the US Patent Trial and Appeal Board ruled that CRISPR patents issued to the Broad Institute of MIT and Harvard in 2014 did not cover the same inventions for which UC had sought patents.
(The Economist) – AFTER two years of war, a quarter of Yemen’s 28m people are on the brink of starvation. Attention is now turning to Hodeida (pictured), the country’s biggest port, through which the majority of food passes, especially to the rebel-held north where the bulk of the population lives. A military coalition led by Saudi Arabia and backed by Western nations, which sides with the president, Abd Rabbo Mansour Hadi, is finalising plans to invade and take the port.
JAMA (vol. 317, no. 9, 2017) is available online by subscription only.
- “The European Medicines Agency and Publication of Clinical Study Reports: A Challenge for the US FDA” by Anna L. Davis and James Dabney Miller
Ethics and Behavior (Online first) has a new article available by subscription only.
- “Healthcare at Your Fingertips: The Professional Ethics of Smartphone Health-Monitoring Applications” by Vivian Kwan et al.
(Science Daily) – An international effort to analyze the entire database of Ebola virus genomes from the 2013-2016 West African epidemic reveals insights into factors that sped or slowed the rampage and calls for using real-time sequencing and data-sharing to contain future viral disease outbreaks. Published in the journal Nature, the analysis found that the epidemic unfolded in small, overlapping outbreaks with surprisingly few infected travelers sparking new outbreaks elsewhere, each case representing a missed opportunity to break the transmission chain and end the epidemic sooner.
(UPI) – Don’t fall for products claiming to cure autism, the U.S. Food and Drug Administration warns. There’s no cure for the neurodevelopmental disorder, the agency said. Yet bogus “cures” and therapies abound — from toxin removal to raw camel milk. Some of these fraudulent treatments could be harmful, and should be avoided, the agency said Wednesday. Among them: chelation therapies, hyperbaric oxygen therapy and detoxifying clay baths.
(New Scientist) – A new 4D-printing technique that creates complex structures in minutes could be used to make temperature-activated cardiac stents, drug capsules and flat-pack furniture. 4D printing creates 3D objects that change their shape over time in response to stimuli such as heat, moisture or light. It is useful for making structures that can adapt to their environment, but is often a laborious process. The most common materials used in 4D printing, shape-memory polymers, normally require at least five steps to make them into adaptable objects. Hydrogels are simpler to use, but too soft to fashion into rigid structures.
(STAT News) – When the largest Ebola outbreak in history exploded across West Africa in 2014, public health authorities raced to test experimental vaccines and drugs they hoped would quell the massive epidemic. But the trials process was too slow, and in the end, a massive influx of outside medical help and strict enforcement of measures to prevent ongoing infection were what brought the outbreak under control. Now, a new report commissioned by the National Academies of Sciences, Engineering, and Medicine attempts to chart a road map for expedited clinical trials for future epidemics, hoping to ensure that the lessons from the devastating Ebola outbreak are not forgotten.
(The Hill) – Regulators and medical-device-makers are bracing for an expected barrage of hacking attacks even as legal and technical uncertainties leave them in uncharted territory. Tens of millions of electronic health records have been compromised in recent years, a number that is growing and, some say, underreported. High-profile attacks have hit hospitals and health insurers, and now attention is turning to a new vulnerability: medical devices like pacemakers and insulin pumps.