Diabetics turn to black market in US, Canada for life-saving insulin

On a frosty January morning in a Minneapolis suburb, Abigail Hansmeyer leaves her car engine running and takes out a brown paper bag carrying needles and a vial, handing it over to its recipient in an anonymous shopping center parking lot.

The exchange is technically illegal, but these aren’t illicit drugs.



Instead, the vial contains insulin, a medicine that has since its discovery in the 1920s transformed a diagnosis of diabetes from a swift death sentence to a manageable disease.

Yet, its price has sky-rocketed in the United States over the past decade, creating informal networks of people who build up stockpiles and give to others what they don’t need themselves.

“Thank you so much,” says Annette Gentile, 52, as she takes the bag from Hansmeyer, checking the labels and doses. “I’ve been on a roller coaster in the last few days,” she adds, because of her elevated blood sugar levels.

Gentile doesn’t live in abject poverty. She receives a monthly disability allowance of $1,200 and has public health insurance. Crucially, however, that insurance does not cover prescription medicine.


The contents of the bag she just received, which will keep her going for a month, would cost her about a thousand dollars at a pharmacy. “I purely rely on donations,” she says.

Her 29-year-old benefactor Hansmeyer is unemployed and has type 1 diabetes, a chronic condition that appears in childhood where the pancreas produces little or no insulin, the hormone that lets sugar enter cells to produce energy.

People who have it need to inject themselves with insulin several times a day for the rest of their lives.

Both women are part of a group of diabetics who connect with each over Facebook or text messages to hand out or receive their prized medication, free of cost, sometimes using code words like “lifewater” to evade detection.

Nearly all of the stock that circulates comes from the relatives of patients who died.



For President Donald Trump’s rivals in the Democratic party, who begin their primary contests on Monday in Iowa, there are few scandals greater than the price of insulin: The epitome of pharmaceutical price-gouging that blights the U.S. health care system.

“We’re not poor,” says Hansmeyer. Her husband works and has started a small business, Abigail has her own car, and the couple live in a house that pet dogs and rabbits also call home.

But her husband’s employer doesn’t subsidize its workers health insurance. Not poor enough to qualify for state insurance, and not rich enough to buy their own, the couple gave up looking in January.

They joined the ranks of the 27.5 million Americans without coverage, praying that no calamity befell them.

“My entire adult life I’ve gone in and out of rationing my insulin,” Hansmeyer tells AFP.

A few years ago, when she won a battle against her then insurer for an insulin pump, a computerized device that continuously releases the right amount of the hormone, she remembers crying with happiness.

Death of a child

Hansmeyer acts as a go-between for her community of Minneapolis area diabetics, connecting those in need with those who have. And one of her major sources is a refrigerator in the basement of a house belonging to one Nicole Smith-Holt.

Smith-Holt opens its door to reveal a treasure trove: Dozens of vials of insulin, and a large stock of syringes, test strips and other supplies. She guesses its value at around $50,000.

“It is strictly illegal,” she says.


Selling or even giving away prescription medicine is technically a minor crime. But for Smith-Holt, it’s a cause that is devastatingly close to her heart.

“We don’t need another Alec,” she says, about her late son, who died in June 2017.

Alec Raeshawn Smith was covered by his mother’s insurance until he turned 26, the age up to which insurers are obliged by an Obama-era law to allow adult children to remain covered by their parent’s plans.

After crossing that threshold, he found himself unable to afford his own insurance on his meager salary as a restaurant worker.

He died 27 days after his insurance lapsed from diabetic ketoacidosis as a result of a lack of insulin.

There was not a drop of insulin to be found in his apartment, said Smith-Holt, but there was evidence her son had tampered with his insulin pens to try squeeze out the last bit.

“I think until I take my last breath I’ll feel a sense of guilt in some sort of way,” said Smith-Holt. “I wish he would have asked for help.”

The death of her son, who was himself a father, transformed Smith-Holt into an activist. One day she’s on television, the next she’s lobbying local politicians, or protesting outside a pharmaceutical company.

O Canada

Further to the north, diabetics can look to providers on the right side of the law but the wrong side of the border: Canadian pharmacies.


Unlike the U.S., Canada caps the price of insulin. Every three months, alone or with others, 47-year-old Travis Paulson makes the two hour drive from Eveleth in northern Minnesota to Fort Frances in Canada’s Ontario province, crossing the Rainy River to buy his insulin without prescription.

Customs agents don’t bother him so long as his supply is less than three months’ worth.

His insurance is excellent as far as doctor visits go, but only pays half the price of medicines.

He pulls out two almost identical vials of insulin: one is labeled NovoLog and costs $345 in the US, with his insurance leaving him responsible for half the bill.

The Canadian vial is sold under the brand name NovoRapid, and costs about $25. The math isn’t hard.

“It’s pharmaceutical greed. It’s greed is all it is, simple as that,” he says.

A Bernie Sanders sticker on his fridge shows off Paulson’s support for the self-professed democratic socialist, who has vowed to cut drug costs in half.

But even that might not be enough to reduce the appeal of his Canadian road trips. JB

source: technology.inquirer.net

In a first, three surgeries conducted using robots and 5G

BEIJING — Robots guided by doctors in a remote location through 5G wireless technology successfully completed major portions of three simultaneous orthopedic surgeries on Tuesday.

The whole process, monitored by specialists at a hospital in Beijing, was the first time three remote procedures were conducted at the same time.


The surgeries took place in Zhangjiakou, Hebei province; Karamay, the Xinjiang Uygur autonomous region; and Tianjin. Live images were transmitted to a team at Beijing Jishuitan Hospital as the robots executed their preset programming commands.

At 9:30 am, Tian Wei, head of the hospital in Beijing and team leader, issued the command for the surgical robots to begin their work.

The robots have been designed to carry out many of the tasks, but others must still be done by humans, such as implanting devices within bones.

The operations on Tuesday were all completed at around 1 pm.


“The combination of 5G technology with surgical robots is a huge technological advance that will help us share our skills with more patients in distant regions,” Tian said. “People across society can now have access to top medical resources. In the future, using robots and 5G will be common. The medical community will be smarter.”

Jiang Wenxue, head of orthopedics at Tianjin First Central Hospital, where one of the surgeries took place, said 5G technology provided clarity and continuity of images－videos and still photos－as well as stability, reliability and safety, which helped the doctors in Beijing monitor progress and communicate with their counterparts in remote operating rooms.

“With the network, we can perform surgery regardless of the distance,” Jiang said.

The Tianjin subsidiary of the State Grid Group has been promoting the integration of the electrical grid and 5G technology and has developed plans to ensure that power is not interrupted during surgeries.

Xiang Huangmei, vice-president of China Telecom’s Beijing branch, said the bandwidth of 5G is 10 times greater than 4G, which provides tremendous speed advantages.


“The high speed of 5G has resolved the time-lag problem and brought about dramatic progress in remote surgeries,” she said.

In June, Jishuitan Hospital performed 5G-assisted remote robotic surgery on a patient in Yantai, Shandong province, monitored by doctors in Beijing. China Telecom provided network support.

Luo Jun, secretary-general of the International Health Industry Forum, a Beijing-based think tank, said the use of advanced technologies such as 5G, 3D printing and artificial intelligence is an unstoppable trend in China’s medical sector.

“The risks of surgery are highly controllable, and the medical teams always have emergency plans for power or network failures,” he said.

source: technology.inquirer.net

No need for chemo in many breast and lung cancers – study

TAMPA, United States — Two major studies released Sunday show that many people with breast and lung cancers may forgo chemotherapy and still live longer, signaling a waning need for what was long seen as the standard of cancer care.

The findings were released at the American Society of Clinical Oncology (ASCO) meeting in Chicago, the world’s largest annual cancer conference.

The first study, described as the largest breast cancer treatment trial to date, found that the majority of women with a common form of breast cancer may be able to skip chemotherapy and its toxic, and often debilitating, side effects after surgery depending on their score on a genetic test.

As many as 65,000 women in the United States alone could be affected by the findings.

Until now, women have faced considerable uncertainty about whether to add chemo to hormone therapy after a diagnosis with hormone-receptor positive, HER-2 negative breast cancer when found at an early stage, before it has spread to the lymph nodes.

“With results of this groundbreaking study, we now can safely avoid chemotherapy in about 70 percent of patients who are diagnosed with the most common form of breast cancer,” said co-author Kathy Albain, an oncologist at Loyola Medicine in a Chicago suburb.

A 21-gene test called Oncotype DX, available since 2004, has helped guide some decisions on proper care after surgery.

A high recurrence score, above 25, means chemo is advised to ward off a recurrence, while a low score, below 10, means it is not.

The current study focused on those whose scores were in the middle range, from 11 to 25.

More than 10,000 women, aged 18 to 75, were randomly assigned to receive chemotherapy followed by hormone therapy, or hormone therapy alone.

Researchers studied their outcomes, including whether or not cancer recurred, and their overall survival.



‘No significant difference’

“For the entire study population with gene test scores between 11 and 25 — and especially among women aged 50 to 75 — there was no significant difference between the chemotherapy and no chemotherapy groups,” said the findings, published in the New England Journal of Medicine.

The results show that all women over 50 with a recurrence score of 0 to 25 can be spared chemotherapy and its toxic side effects.

For women under 50 with a score of 0 to 15, chemo can be skipped.

However, among younger women with scores 16 to 25, outcomes were slightly better in the chemotherapy group, so in those cases doctors may urge patients to consider a chemo regimen.

The results “should have a huge impact on doctors and patients,” Albain said.

“We are de-escalating toxic therapy.”

According to first author Joseph Sparano of Montefiore Medical Center in New York, “any woman with early-stage breast cancer 75 or younger should have the test and discuss the results” with her doctor.

Breast cancer is the leading cause of cancer death in women worldwide, causing some 1.7 million new cases annually and over half a million deaths.

The study’s primary funding came from the US National Institutes of Health (NIH).

Lung cancer

The second study tested a form of immunotherapy against chemo, in the most common lung cancer worldwide, known as non-small-cell lung cancer.

It found that Merck pharmaceutical’s drug Keytruda (pembrolizumab) — which famously helped former US president Jimmy Carter stave off advanced melanoma that had spread to his brain — helped lung cancer patients live four to eight months longer than chemo.

More than 1,200 people enrolled in the study, the largest clinical trial to date of pembrolizumab as a stand-alone therapy for lung cancer. The drug was approved in 2014 for melanoma and in 2015 for lung cancer.

“These are responses that are unlike anything we have seen in the past for non-small-cell lung cancer,” said lead author Gilberto Lopes, a medical oncologist at the University of Miami Health Center.

Still, he acknowledged that most patients with this form of advanced cancer will die within months, and “we need to do a lot more work.”

Lung cancer is the leading cause of cancer death worldwide, taking 1.7 million lives per year.

John Heymach, a professor at the University of Texas MD Anderson Cancer Center who was not involved in the Merck-funded study, described it as a “true milestone” and “a real important advance for patients.”

“We are now leaving an era where the only choice for non-small-cell lung cancer patients was to start with chemotherapy,” he told reporters at the ASCO conference.

“Now, the vast majority of patients can potentially receive benefits from immunotherapy instead,” he added.

“Immunotherapy is here to stay for the vast majority of non-small-cell lung cancer patients as a first-line treatment.” /cbb

source: technology.inquirer.net

‘Epidemic’ of fragranced products is affecting our health, says new study

The recent trend for “cleaner,” more natural, unprocessed foods for improved health and well-being has also led to a shift towards household and beauty products that are also more natural and without preservatives, and possibly for a good reason.

According to recent research, consumers’ extra attention to what they are putting on their bodies and in their homes could be beneficial for health, with a new study finding that one in three Australians report health problems related to fragranced products.

Professor Anne Steinemann from the University of Melbourne School of Engineering led a survey of a random sample of 1,098 people taken from a large, web-based panel held by Survey Sampling International (SSI).

She found that when exposed to fragranced products, 33 percent of Australians suffer a variety of adverse health effects, including breathing difficulties, headaches, dizziness, rashes, congestion, seizures, nausea and a range of other physical problems.

In addition, the results also showed that 7.7 percent of Australians have lost workdays or a job in the past year due to illnesses caused by exposure to fragranced products in their workplace, and 16.7 percent want to leave a shop or business as quickly as possible if they smell air fresheners or other fragranced products.

“This is an epidemic,” said Professor Steinemann commenting on the findings. “Fragranced products are creating health problems across Australia. The effects can be immediate, severe and potentially disabling. But they can also be subtle, and people may not realize they’re being affected.”

Professor Steinemann’s previous research in the United States found similar results, revealing that 34.7 percent of people experience health problems when exposed to fragranced products.

Fragranced products—which can include air fresheners, cleaning products, laundry supplies and personal care products—give off a range of chemicals including hazardous air pollutants, with Professor Steinemann adding that, “All types of fragranced products tested—even those with claims of ‘green,’ ‘organic,’ and ‘all-natural’—emitted hazardous air pollutants.”

According to Greenbiz, half of all consumer products contain fragrance, and more than 3,000 chemicals can add fragrance to consumer goods worldwide.

Although what product information is required to be disclosed to consumers varies in each country, fragrance ingredients are exempt from full disclosure in any product, not only in the U.S. but also internationally. Often, labeling is vague, with many ingredients just coming under the umbrella of fragrance.

Professor Steinemann’s research will now continue to investigate why fragrance chemicals are causing health problems, and what their effect may be in indoor environments.

The findings can be found published online in the journal “Preventive Medicine Reports” with more information also available on Professor Steinemann’s own website.

Information for consumers about products can also be found on www.ewg.org. JB

source: lifestyle.inquirer.net

Peanuts may reduce risk of death, heart disease

WASHINGTON, United States – Eating peanuts, in small amounts, may reduce the risk of mortality, especially death from cardiovascular disease, a new study Monday showed.

The report compiles research from people of varying races, including Caucasians, African Americans and Asians, all from low income backgrounds.

Researchers found that consuming peanuts regularly reduced mortality among men and women from all groups, and suggests that eating the nuts — which are relatively affordable — can be an inexpensive and nutritious way to reduce mortality and cardiovascular disease around the world.

The study, published in the Journal of the American Medical Association, Internal Medicine includes more than 70,000 Caucasians and blacks in the United States and some 130,000 Chinese people in Shanghai.

Reduced total mortality

“We found that peanut consumption was associated with reduced total mortality and cardiovascular disease mortality in a predominantly low-income black and white population in the US, and among Chinese men and women living in Shanghai,” said senior author Xiao-Ou Shu, associate director for Global Health at the Vanderbilt-Ingram Cancer Center (VICC).

There was a reduced risk of total mortality of in 17 to 21 percent of participants, the study showed.

The risk of death from cardiovascular disease was slashed by between 23 and 38 percent.

But co-author William Blot warned that because the data was from observational epidemiological studies and not randomized clinical trials, “we cannot be sure that peanuts per se were responsible for the reduced mortality observed.”

“The findings from this new study, however, reinforce earlier research suggesting health benefits from eating nuts, and thus are quite encouraging,” added Blot, who is also associate director for cancer prevention control and population-based research at VICC.

Less expensive nut

Peanuts are less expensive and more widely available than many other nuts, and are eaten by many cultures around the world.

The nutritious nuts — which are actually legumes — are high in and unsaturated fat, fiber, vitamins, and anti-oxidants and can boost cardiovascular health with as little as 30 grams eaten weekly.

“The results suggest that including a modest amount of nuts as part of a well-balanced diet may be of benefit,” said Peter Weissberg, director of the British Heart Foundation, who did not participate in the study.

“The data do not show that the more peanuts you eat the lower the risk of a fatal heart attack, so people should not start eating large quantities of nuts, particularly salted nuts, in the hope that it will protect them from heart disease,” he added.

Previous research has focused on white upper class research subjects.

The participants in this latest study were observed for between five and 12 years.

source: technology.inquirer.net

California family celebrates 3 heart transplants

SAN MARCOS, California — Deanna Kremis remembers the exhilarating day her young sons first had the energy to race each other up a flight of stairs.

The brothers, then ages 7 and 10, could barely walk before having heart transplants just a month apart. As they flew up the steps two at a time, jostling and shouting, she recalled, “my friend turned to me and said, ‘Are YOU ready to get one now?’”

It was a joke that became prophesy. Her health, too, was slipping away because of the same inherited cardiac condition. By the time she received her own transplant in July, her heart was so weak she fainted while walking down the hall, collapsed mid-sentence and passed out in the middle of dinner at a friend’s house.

Her decline was terrifying for her sons, who were just beginning to embrace their lives with donor hearts and now saw their worst memories reflected in their mother’s struggle. All three have hypertrophic cardiomyopathy, a genetic condition that causes the heart muscle to thicken until it can’t pump properly. Kremis’ mother and brother also have it, as did her grandmother.

“We just didn’t like seeing her go through the pain and stuff,” said Trevin, now 13. “We knew what it felt like.”

The 44-year-old stay-at-home mom for this family of five now finds herself in the unusual position of getting advice on post-transplant life from her sons while coordinating a never-ending regimen of pills and doctor’s appointments that has become her fulltime job. She also homeschools Trevin, who struggles with severe osteoporosis from the anti-rejection medicine he takes daily.

In the daily whirlwind, she still worries about her sons, who are thriving but face the constant threat of organ rejection and infection. Matthew has been hospitalized once for rejection and Trevin had eight fractures in one year from his osteoporosis. A third son — her eldest — and her husband are healthy.

“It’s just really hard seeing your babies go through anything. They’re amazing,” she said, holding back tears. “My goal was to get in and out of the hospital faster than them and I didn’t quite make it. And for them not to worry. I didn’t want them to worry about me. They’re my No. 1 priority.”

It’s not unheard of to have more than one transplant in one family when a genetic condition is involved, but the triple-transplant Kremises are a rarity even in the world of advanced cardiac specialty medicine.

Hypertrophic cardiomyopathy affects up to 600,000 people in the U.S. alone and is a leading cause of sudden death among young athletes, said Dr. Gregory Perens, one of the boys’ pediatric cardiologists at Mattel Children’s Hospital UCLA.

Many don’t have symptoms until there is a strain on the heart, while others experience shortness of breath and chest pain but have a milder version that can be controlled through medication and a pacemaker. A parent who carries the gene has a 50 percent chance of passing it along.

“For most families even having one child or one parent going through a transplant is a very big deal,” Perens said. “So to have three is an extraordinary amount of work.”

Still, the family never stops thinking about the anonymous donors who gave them all a second chance. After his transplant, the family would find Trevin crying quietly, worried about the family who had lost a child so he could live.

“I’ll take anything to feel the way I feel now,” said Kremis. “We’ve been blessed, just blessed, as a family and you live every day as best you can.”

The trio’s shared cardiac history is in plain sight around their house in suburban San Diego County, from the color-coded plastic bins that hold their prescriptions to the identical chest scars. Medical bills with eye-popping sums pour in for Kremis’ recent transplant and the family is still paying off the boys’ treatment six years later.

The family moved from Arizona to live with Kremis’ parents in San Marcos so they could to be close to the pediatric cardiology team at UCLA. Kremis’ husband, Richard, landed a job with AT&T. They have decent insurance, but with a high deductible, so that the boys can stay with the same specialists who oversaw the transplants.

“Has it affected our family? Yeah, but it’s just life,” said Kremis. “It doesn’t make our problems worse than anyone else’s. It just means when it comes, you just deal with it and you move on.”

Deanna Kremis’ grandmother, a no-nonsense outdoorswoman from Alaska, wasn’t diagnosed with the condition until she was in her early 70s. When Kremis was pregnant, her grandmother told Kremis to get her children’s hearts checked before they played sports — but said nothing more.

Her first son was healthy but when Matthew was born, doctors said he wouldn’t live past age 10. The family had to learn CPR just to take him home. His lips and nail beds were blue and his skin was so pale the veins in his chest and stomach popped through “like a see-through kid,” his mother said.

“They just told us to take him home and cherish him,” she said. “He’s been on medicine since the day he was born and he’s still on meds. It’s been his whole life.”

Doctors checked Trevin for the condition in utero, at birth and then every three years. The tests were negative until he turned six.

Within a year, Trevin needed a transplant — just as Matthew’s health spiraled out of control.

“We didn’t really know the extent to what it was in our family until after. We didn’t know how it affected siblings and how many siblings would be affected. You know, we just didn’t know any of that,” Kremis said, brushing away tears.

Donor hearts don’t last forever, but doctors haven’t given the trio a life expectancy. The Kremises prefer to focus on the future.

Matthew, now a high school senior, will study auto mechanics at a trade school next year. Trevin skateboards and has a passion for rebuilding electronics and repairing motorbikes. And the boys love dirt-biking with their father and older brother — a hobby their doctors don’t like, but haven’t forbidden.

“How many people can say that they’ve been through what I’ve been through and go ride dirt bikes for fun? There’s not a lot of people like me and my family,” said Matthew Kremis.

“It’s really part of what makes my family so awesome. All we really have is each other.”

source: business.inquirer.net

US approves more powerful, pure hydrocodone drug

WASHINGTON  — The U.S. Food and Drug Administration has approved a stronger, single-ingredient version of the painkiller hydrocodone, the widely-abused prescription medicine for chronic pain.

The agency said Friday it approved the pill Zohydro for patients with pain that requires “daily, around-the-clock, long-term treatment” that cannot be addressed with other drugs.

Hydrocodone is currently sold in combination pills like Vicodin to treat pain from injuries, surgery, arthritis, migraines and other ailments. The new drug from Zogenix is the first pure, non-combination form of the drug approved in the U.S.

The approval came as a surprise since the agency’s own panel of outside advisers gave the drug an overwhelmingly negative review last year. The agency’s panel of pain specialists voted 11-2, with one abstention, against approving the drug last December, questioning the need for a new form of one of most widely-abused prescription painkillers in U.S.

Zohydro’s approval was quickly criticized by patient safety advocates who had urged the FDA to reject the drug at a public meeting last year.

“We’re just going to kill more kids and then the FDA is going to come back and say, ‘oh, we made a mistake,’” said Avi Israel. Israel’s son Michael committed suicide in 2011 while struggling with painkiller addiction. Israel is the founder of a group called, Save the Michaels of the World, which aims to combat painkiller abuse in young people.

In 2011, U.S. doctors wrote more than 131 million prescriptions for hydrocodone, making it the most prescribed drug in the country, according to government figures. Hydrocodone pills also consistently rank among most-abused medicines in the U.S., according to the DEA.

The drug belongs to a family of medicines known as opiates or opioids because they are chemically similar to opium. They include morphine, heroin, oxycodone, codeine and methadone.

Friday’s news was also blasted by lawmakers in Congress who have been trying to rein in prescription drug abuse in their home states.

Rep. Bill Keating, a Democrat, said the FDA should have required the drug to contain anti-abuse design features that would make it harder for users to crush the pills and snort or inject them.

“FDA not only approves this dangerous drug, but does so without requiring any abuse-deterrent features. This is outrageous,” Keating said in a statement. “Abuse-deterrent technologies should not be the anomaly, they must be the norm.”

In recent years, Purdue Pharma, Pfizer Inc., Endo Health Solutions Inc. and other drugmakers have developed tamper-resistant versions of popular opioid drugs.

The timing of the FDA announcement also drew criticism from safety advocates and lawmakers. Only one day earlier the FDA said it would support stronger restrictions on combination drugs containing hydrocodone, including Vicodin and dozens of other generic formulations.

The drugs currently available mix hydrocodone with non-addictive pain relievers like aspirin and acetaminophen. For decades these drugs have been subject to less rigorous prescribing limits than other prescription painkillers like oxycodone.

Late Thursday, the FDA said it would recommend moving hydrocodone drugs from the schedule III class to the schedule II class of medications, a move that will limit the number of refills patients can receive and how many health professionals can prescribe the drugs.

The Drug Enforcement Administration had first asked the agency to take that step a decade ago, and lawmakers and safety advocates had increased their pressure on the agency in recent years.

Shares of Zogenix, Inc. jumped in trading Friday, climbing 80 cents, or 36 percent, to $3.04. Earlier shares set a 52-week high of $3.45.

source: business.inquirer.net

Doctor finds patients comforted by prayer before surgery

Dallas — At 83, Carl Smith found himself facing quadruple-bypass surgery and the real possibility that he might not survive.

Within hours on this spring morning, Dr. Mark Pool would temporarily bring Smith’s heart to a stop in an attempt to circumvent its blocked passages.

And to help his patient confront the uncertainty, Pool did something unusual in his profession: He prayed with him.

The power of healing: Medicine and religion have both had their day, and they haven’t always been able to coexist. But as today’s medical treatment becomes more holistic, doctors are increasingly taking spirituality into account.

Studies show a majority of patients want their spirituality recognized, and most med schools now have classes related to the topic. In general, the new thinking asks doctors to note their patients’ spiritual leanings and open doors to expression, especially when life is at risk.

Pool, a highly regarded heart and lung surgeon at Texas Health Presbyterian Hospital Dallas, is fervent about his Baptist faith. For about a year, he’s routinely asked patients if they’d like him to pray with them pre-surgery — a gesture he says is always appreciated but one that exceeds advocates’ suggested bounds.

“A physician should be open to a patient’s spirituality but shouldn’t push religion on patients,” says Nathan Carlin, assistant professor at the University of Texas Health Science Center at Houston. “That’s confusing personal and professional roles.”

An inherent power differential divides doctors and patients, says Christina Puchalski, director of George Washington University’s Institute for Spirituality and Health and co-editor of the recently published Oxford Textbook of Spirituality in Healthcare.

“They’re coming to us for something other than prayer,” Puchalski says. “If I, as a patient, perceive (a surgeon) as having my life in his hands, and he asks me to pray and I say no, he may not treat me well. And that’s putting undue pressure on the patient.”

As the saying goes, there are no atheists in foxholes: The idea that your fate is out of your hands offers fertile ground for re-examination.

“The moment somebody tells you that you have cancer,” says Methodist Dallas Medical Center’s Rohan Jeyarajah, a gastrointestinal surgeon who prays with patients, “you’re going to believe in something.”

But the situation, he says, requires caution: “We have to be careful about being in a position of perceived authority and not overstepping that bound. This is like a teacher-student relationship. There’s a chance you could be inappropriate.”

Pool pushes forward, eager to share the belief that drives him without making people feel awkward or flouting that power imbalance.

“I don’t want to exploit their situation,” he says. “At the same time, I want to give them the opportunity to explore the faith that I know.”

•••

Pool comes from a religious background. His father, his grandfather, his father-in-law, his brother-in-law: all ministers. Family members joke was that he started going to church nine months before he was born.

By age 6, he was well versed in Bible basics, but then something odd happened. One day at a prayer meeting, Pool says, he was touched by — well, not quite a vision, but an awareness.

“I had already understood that Jesus came to save the world,” he says. “That was nice. But then I understood: Jesus came to save me. And that changed everything.”

He’s pursued a path of faith ever since. Medicine seemed like a good way to help people. Even so, as a med student, Pool pondered ditching the whole thing to go to seminary instead.

As a member of First Baptist Dallas, he and wife Jessica lead relationship classes on Sundays for dozens of young married couples.

And as a cardiothoracic surgeon, another realization has set in: “I have a ministry. I don’t need to be standing in a pulpit. I have found a ministry I did not expect. I am able to minister to people in times of need.”

Since Texas Health is a faith-based hospital system, he felt at ease taking that step.

“The vast majority of people believe in God,” he says, “and yet when people come to the hospital, that’s completely ignored by doctors. If anything, they call the chaplain. It’s unfortunate that more doctors don’t try to engage that part of a patient’s life.”

That’s starting to change. Two decades ago, barely a few med schools offered classes on spirituality. Now, three-fourths of them do.

“Medicine has figured out that we ignore the more human sides of health care at our own peril,” says Craig Borchardt, interim chairman of humanities and medicine at Texas A&M University.

Studies show 60 to 80 percent of patients want their beliefs noted, he says — not as affirmation but as a sign that the doctor actually cares. But fewer than 20 percent of doctors bring it up.

The push has met with some backlash — from busy doctors reluctant to take time away from other concerns or others who don’t like talking about it.

“Some staff are more comfortable with it than others,” says Mark Grace, vice president of mission and ministry for Baylor Health Care System.

He doesn’t reject the idea of doctors offering to pray, but “if you don’t listen to the answer, that’s where you get into problems. ... The doctor needs to be prepared if the patient says no.”

George Washington University’s Puchalski says the bottom line is doing what’s best for the patient.

“Physicians are generally not trained to lead prayer,” she says.

•••

It’s 6 a.m., and Pool, shiny black boots poking from beneath blue scrubs, briefs Smith on his surgery. At 83, Smith is fit, mowing the yard occasionally, an active driver.

But coronary artery disease caught up with the retired Farmers Branch pharmacist, slowing his blood flow and causing chest pain. Over time, it could lead to a heart attack.

Madge Smith, his wife of 63 years, and Leah Wilson, his youngest daughter, are near. Scott Smith, his son, would join later.

Pool explains his plan: He’ll make an incision down Smith’s breastbone, then take arteries from his left and right side, and a vein from his leg, to form new channels for blood to flow through his heart.

“So,” he tells Smith, “you told me you’re a Sunday school leader. ... Would you mind if I said a prayer for you?”

Smith is touched. Pool places his hand on Smith’s shoulder and begins:

“God, thank you for Mr. Smith. We ask that you would guard his life, keep him safe and bring him through this operation. Replace any anxiety that he may have. Give him a great assurance of your love and your power.

“I ask you to watch over our team, that you give us all clarity of thought, that you guide my hands as they move. We pray these things in Christ’s name. Amen.”

“Amen,” Smith says.

Later, as Smith’s family awaits the outcome, his wife says: “I have never had a doctor do that. It just meant so much to us. We just thought it was sent from God.”

Pool initially wondered if his praying might give patients pause, whether they’d worry he wasn’t confident enough in his own skills to get through the surgery.

“It’s been the opposite,” he says. “They value the humility.”

Not long ago, Pool contacted a local evangelistic organization. “So I could up my game,” he says. He wants to learn how to share his faith without being a “turn or burn” proselytizer.

“I wouldn’t want for somebody to make a decision in a moment of crisis that they wouldn’t make otherwise,” he says. “I don’t want to say, ‘It’s your last chance: Smarten up or else.’

“It doesn’t mean I can’t share my faith just because it might upset somebody in the world. This nation was founded on Christian ideals.”

Pool pauses when asked if he’d pray with followers of Islam, a faith he considers antagonistic and unforgiving.

“I don’t think they would get the same meaning” from it, he says. “Not that they would feel offended, but ... not comforted.”

He tries to avoid a holier-than-thou air and doesn’t claim only certain believers get into heaven.

“It’s not my job to get somebody to make certain decisions,” Pool says. “All I can do is live a life that makes it appealing to somebody and then share it with them. If I share and they say, ‘I’m not interested,’ I say no problem and move on. But seeds can be sown that you never see the fruit of.”

•••

Smith’s operation was a success. Six weeks later, Pool meets with him one last time.

“You’re doing extremely well,” Pool says. “I’m going to fade away now. You don’t have to come back and see me.”

“I’d be six feet under if it wasn’t for you,” Smith says.

Pool dismisses the thought. “I’d like to say a prayer with you,” he says.

Smith bows his head and closes his eyes.

“Lord,” Pool begins, “thank you for getting Mr. Smith out of the hospital and getting him home. We ask that you continue that process of healing and give him a spring in his step once again. In Jesus’ name we pray.”

Smith is upbeat. He believes the gesture will help him get better. And in the end, that might be the most important thing of all.

source: lasvegassun.com

At more colleges, classes on genetics get personal

University of Iowa student Bakir Hajdarevic (BOCK-heer hye-dar-vich) didn't have to study for the most important test in his genetics class. He just had to spit.

The 19-year-old took an honors seminar in which students could choose to send saliva samples for testing to learn about personal health secrets such as whether they are at risk for cancer or carriers for genetic disease.

Taught at Iowa for the first time, the class is part of a growing movement in higher education to tackle the field of personal genetics, which is revolutionizing medicine. Several other universities have recently added similar classes.

They're forcing students to decide whether it is better to be ignorant or informed about possible health problems _ a decision more Americans will confront as genetic testing becomes cheaper.

source: lasvegassun.com

California, Nevada take opposite stances when disciplining the same doctor

Dr. Sean S. Steele was able to practice medicine in both California and Nevada until last year.

That’s when the California Medical Board revoked his license, based on evidence and testimony from a woman who said he sexually assaulted her in the back of a Mercedes during an evening of drinking in Las Vegas.

According to the official decision, the California Medical Board concluded that Steele had “brutally sexually attacked” the woman and then lied about it under oath. The board called his behavior “unbecoming to a member in good standing of the medical profession, and which demonstrates an unfitness to practice medicine.”

The board revoked Steele’s license, effective April 17, 2012.

In Nevada, however, Steele, an internist, is still licensed and has privileges at University Medical Center, MountainView Hospital, Valley Hospital Medical Center, Summerlin Hospital Medical Center and Centennial Hills Hospital Medical Center, according to the hospitals.

The Clark County District Attorney's office had charged him with felonies, including sexual assault — and then accepted Steele’s no contest plea to a lesser charge of misdemeanor battery.

Later, the Nevada State Board of Medical Examiners issued a “non-public action,” a sanction so negligible that it is not disclosed. A search of the board’s website shows no sanction against Steele.

In other words, there is no public disclosure by the Nevada State Board of Medical Examiners of an incident involving a doctor that was deemed so serious by California authorities that the doctor was prohibited from seeing patients there.

The case raises questions about how closely Nevada monitors its medical professionals. Legislators, members of the Nevada medical community and others have long criticized the Nevada State Board of Medical Examiners’ ability to effectively regulate, investigate and sanction doctors.

Through her attorney, Robert Murdock, the woman declined to comment. The Las Vegas Sun does not name the victims of sexual assaults.

A request to interview Steele was sent by email to his attorney, Russell Iungerich. The attorney did not respond to that request.

Steele is appealing the decision of the California Medical Board on the grounds that his due process rights were violated because Iungerich was ill on the day of the woman’s testimony and therefore she was not cross-examined.

In its ruling, the California Medical Board concluded, “(The victim) is telling the truth and (Steele) lied to the Medical Board investigators, lied in the civil suit and lied under oath in the present proceedings.”

source: lasvegassun.com

Physician Licensure Examination Result 2013

February 2013 Physician Licensure Examination Result











TOP 10

1. CHICCO XERXES DE LEON PANGAN - University of Sto Tomas

2 . DENVER FRANCISCO SAPO- Our Lady of Fatima University Valenzuela

3. KRISTINA ANNE BALCE CO - Our Lady of Fatima University Valenzuela

4. FRANCIA VICTORIA ABARCAR DE LOS REYES - University of the East Ramon Magsaysay Mem  Med Center

    MARIE ANGELIE FERNANDEZ SO - San Beda College

5. JENA ANGELA TANDUYAN PERANO - Our Lady of Fatima University Valenzuela

6 . ALEXANDREA CASTILLO BULANDOS - Our Lady of Fatima University Valenzuela

     HAZEL KAREN NOVIDO RAZ - Far Eastern University- Nicanor Reyes Medical Foundation

7.  HAROLD PABILLAR ITURRALDE - Our Lady of Fatima University Valenzuela

     JAN PAOLO ISAIS SANTOS - University of Perpetual Help System -Laguna

8.  LITO JAY PANGAN MACARAIG - Manila Central University Caloocan City

9. RANDELL SANTOS ARIAS - Far Eastern University- Nicanor Reyes Medical Foundation

    VANESSA MARIE VIOLAGO CALABIA - Our Lady of Fatima University Valenzuela

    MICHELLE JAY GONZALES FRANCISCO - Southwestern University -College Of Medicine

10.  MARJAN ORATA HEIDARI - Far Eastern University- Nicanor Reyes Medical Foundation

Cancer gene mutation more complex than previously thought: study

LONDON (Reuters) - Taking a sample or biopsy from just one part of a tumor might not give a full picture of its genetic diversity and may explain why doctors, despite using genetically targeted drugs, are often unable to save patients whose cancer has spread, scientists said.

A study by British researchers found there are more genetic differences than similarities between biopsies taken from separate areas of the same tumor, and yet further gene differences in samples taken from secondary tumors.

That might help explain why, despite recent development of a wave of highly targeted drugs designed to tackle cancers of specific genetic types, the prognosis remains poor for many patients with so-called solid-tumor disease like breast, lung, or kidney cancer that has spread to others parts of the body.

But the researchers, whose study was partly funded by charity Cancer Research UK and published in the New England Journal of Medicine, said it also pointed to a way forward.

The team carried out the first ever genome-wide analysis of the genetic changes or faults in different regions of the same tumor.

They looked at four patients with cancer in their kidneys, taking samples from different regions of the primary tumor and also from other organs where the tumor had spread.

They found that the majority of gene faults, around two-thirds, were not the same in one sample as in another, even when the biopsies were taken from the same tumor.

Samples taken from secondary tumors - which are a result of the disease spreading to other parts of the body - had yet more different genetic faults, suggesting that basing treatment decisions on just one primary tumor sample is not sufficient.

"We've known for some time that tumors are a patchwork of faults, but this is the first time we've been able to use cutting-edge genome sequencing technology to map out the genetic landscape of a tumor in such exquisite detail," said Charles Swanton, of University College London's cancer institute, who led the study and presented its results at a briefing in London on Tuesday.

He said they had uncovered "an extraordinary amount of diversity" at a genetic level both within tumors and within a single patient, with more differences between biopsies from the same tumor than similarities.

"The next step will be to understand what's driving this diversity in different cancers and identify key driver mutations that are common throughout all parts of a tumor," Swanton said.

PERSONALISED MEDICINE

Genetic profiling of patients and their tumors has become more common in cancer treatment in wealthy countries as drug companies develop new generations of so-called "personalized medicines" that target cancers with specific genetic features.

Roche's blockbuster breast cancer drug Herceptin is designed to treat only women who make too much of the HER2 protein, for example, while Novartis's Afinitor targets mTOR, a protein that acts as an important regulator of tumor cell division, blood vessel growth and cell metabolism.

James Larkin, an oncologist at London's Royal Marsden Hospital who also worked on the study, said the findings suggest the reality of personalized cancer treatment is far more complex than previously thought.

"The molecular changes that drive the growth of the cancer once it has spread may be different from those that drive the growth of the primary tumor," he said.

The researchers compared genetic faults in various tumor samples taken from the four patients.

They found 118 different mutations - 40 of which were "ubiquitous mutations" found in all biopsies, 53 "shared mutations" that were found in most but not all biopsies, and 25 "private mutations" only found in a single sample.

By analyzing where the shared mutations were in relation to the whole tumor, the researchers were able to trace the origins of certain subtypes of cancer cells back to what they called key "driver mutations." This allowed them to create a map of how the pattern of faults might have evolved over time.

Swanton likened the findings to a tree, in which the trunk is the primary tumor and the branches the secondary tumors from the cancer's spread.

While he stressed the results would need to be replicated with larger numbers of patients and in different types of cancer, he said these early indications showed "the importance of targeting common mutations found in the trunk of the tree as opposed to those found in the branches."

"It may also explain why surgery to remove the primary kidney tumor can improve survival," he added, since cutting out a tumor reduces the risk that cells resistant to drug treatment could go on to re-grow the tumor or spread elsewhere.

source: mb.com.ph

'Biological clock' is linked to heart attacks

Ventricular arrhythmia, or abnormal heartbeat, occurs most frequently after waking in the morning -- and also to a lesser degree in the evening hours -- and causes a high number of deaths.

Reporting in the journal Nature, researchers in the United States said they had uncovered the first molecular link between this risk and circadian rhythm, the term by which biological processes vary according to a 24-hour period.

The finger points at levels of a protein called Klf15, they said.

Previous research has found Klf15 to be a circadian controller -- and, startlingly, is also lacking among some patients with heart failure.

The team created mice that had been genetically engineered to either lack Klf15 or make the protein excessively.

In both cases, the rodents had a much higher risk of arrythmias compared to normal counterparts.

"It is the first example of a molecular mechanism for the circadian change in susceptibility to cardiac arrhythmias," said Xander Wehrens of Baylor College School of Medicine in Houston, Texas.

"If there was too much Klf15 or none, the mice were at risk for developing the arrhythmia."

Klf15 is only one step in a complex molecular cascade, the researchers believe.

It controls another protein, KChIP2, which affects potassium-generated electrical current that flows though heart muscle cells called cardiac myocytes.

When levels of KChIP2 fluctuate, this causes electrical instability in the myocytes.

As a result, the heart muscle's action becomes impaired and it takes longer (or conversely, less time) to empty the ventricle -- the heart's pumping chamber. The heart loses the regularity of the beat and labours to pump blood efficiently.

Co-author Mukesh Jain of the Case Western Reserve University School of Medicine in Cleveland, Ohio said that further work could well uncover other circadian-related causes.

The discovery opens up intriguing paths of research, in pinpointing individuals at risk of nocturnal death and devising drugs to shield them, Jain added. — Agence France Presse

source: gmanetwork.com

Tai chi may help balance in people with Parkinson's

The slow, controlled motions of tai chi can help the impaired balance of people with mild or moderate Parkinson's disease, and the improvements persist for at least three months, according to a small study out Wednesday.

Compared with people who received stretching exercises, tai chi practitioners had fewer falls, longer strides and better balance, researchers found.

"Tai chi fits very well to address the problem Parkinson's disease patients face," said Fuzhong Li of the Oregon Research Institute in Eugene, whose findings appear in the New England Journal of Medicine.

Difficulty walking and remaining standing are hallmarks of Parkinson's, which results from the death of brain cells that generate the chemical dopamine.

"We're not going to get rid of the symptoms. It's not a drug. It can't cure the disease. But, in my view, it can slow down the progression of the disease," Li told Reuters Health.

Although not all studies agree, other research has shown that because it is a balance-based exercise, tai chi may help improve strength and reduce falls in older adults. But there are few large studies in Parkinson's patients.

Li and his colleagues sent 195 seniors, all from Oregon, to one of three classes that met twice weekly for an hour. All could stand unaided, but some needed a device to help them walk.

The tai chi exercises were designed to improve balance with a controlled displacement of the center of mass. Resistance training with ankle weights and weighted vests was used in a second group to strengthen muscles important to posture, balance and gait. A third group had classes that involved gentle stretching.

People in all three groups started off with similar 64-point scores on a 100-point scale that measured how far they could lean or shift their center of gravity without falling.

But after 24 weeks of classes, those in the stretching group saw their average score drop by two points, indicating some deterioration in their condition.

The typical score rose by four points in the resistance group and by 10 points among the tai chi practitioners.

All of the volunteers were tested when their medication was working and their symptoms were controlled.

The improvement with tai chi was even more significant on a test to see how far the person could move toward a target without extraneous movement.

Stride length, walking velocity, knee movement and other measurements also showed more improvement. And people who did tai chi reported only 62 total falls during the training—less than half of what the other groups reported.

Three months after the classes stopped, some of the benefits persisted. For instance, tai chi practitioners had 60 percent fewer falls than the resistance-training group and 69 percent fewer than the stretching group.

"This is the first time to my knowledge that a study was able to show some durability as a treatment for balance," Li said. "This was a big gap in a research field that didn't have any follow-up data with an exercise regimen."

There was, however, some slippage. The average score for leaning and shifting gravity, which had improved by 10 points in the tai chi practitioners, appeared to drop slightly.

The nice thing about tai chi, he said, is that "this is not equipment-dependent. It can be practiced at any place, at any time."

Parkinson's affects at least 500,000 Americans, most of them elderly, according to the National Institute of Neurological Disorders and Stroke, which funded the new study.

The cost of tai chi classes varies, but prices are typically similar to those of other types of exercise classes. –Reuters

source: gmanetwork.com

Jack Tips, ‘naturopathic’ doctor, wants to help the body heal itself

I don’t want to work with conventional medicine, pharmacological drugs and insurance companies,” said Jack Tips, a naturopathic doctor. “They have an agenda to keep people on drugs and dictate to doctors what treatments are supposedly right for the individual.”

Tips is known for his work in the natural health field through his private consultations, lectures and books.

“From the natural health perspective, each person is biochemically, emotionally, mentally and spiritually individual; and must be treated accordingly,” he said. “This is why natural health is a creative engagement with the individual’s vitality, rather than a standardized process.”

Tips advocates methods of health restoration by using the body’s own capacity to express optimal health. He does this through a combination of homeopathy, nutritional and herbal supplements and diet guidelines.

Eyes

Based in Austin, Texas, Tips recently visited Manila to give a talk on approaches to natural healing.

His lecture was organized by the Comprehensive Iridology Practitioners Association of the Philippines (Cipap), the members of whom include graduates of the advanced course on Comprehensive Iridology of the International Iridology Practitioners Association based in the US.

A sclerologist himself, Tips explained that both sclerology and iridology are methods of diagnosing a person’s health by looking at patterns and colors of the sclera (white part of the eye) and iris (colored part of the eye).

Cells need energy

Tips’ talk featured the topic of cellular healing and how to restore and improve health by addressing the causes (instead of just symptoms) on the cellular level.

Cells use ATP (adenosinetriphosphate), which is produced by the body, to transport chemical energy for metabolism. “Poor health is the result of diminished ATP production within the cells. The goal is to restore energy to the cells so the cells can perform optimally.”

“When the cells have energy to spare, they repair their own genetic code and thus tissue function can improve dramatically.

“There are many supplements that help people daily—ionic minerals, omega-three fatty acids, vitamin D, ubiquinol. Supplementation is done to apply nutrients to address the key ‘points of leverage’ that interfere with the body’s desire to restore its health to the most optimal expression.

“In health, energy is everything, not vitamins, minerals, enzyme, anti-oxidants, proteins, fats, carbohydrates, or any other nutritional commodity, and certainly not any drug that causes side effects,” said Tips.

Homeopathy

Tips was sickly as a child. His mother brought him to homeopaths who helped cure his ailments. He started studying “the tools and principles of natural health including vitamins, minerals, amino acids, enzymes and herbs.”

He took formal studies with different experts in the fields of diet, naturopathy, tissue-mineral ratios, kinesiology, among others. He is a certified clinical nutritionist and has doctorates in clinical nutrition and naturopathy.

“The principle involved in homeopathy is ‘like cures like,’” he says. “The law of similars states that a remedy can cure a disease if it produces in a healthy person symptoms similar to those of the disease.

“Symptoms that we experience are what our bodies do to overcome perceived threats to its integrity. Thus it uses fever, diarrhea, coughs, vomiting, headaches, discharges, eruptions, etc. to help restore health.

“No one knows better than the body how to heal itself. Homeopathy elicits a pathway for the body’s own adaptive resources to correct its expressions of discomfort.

“The classical homeopath never ‘treats a disease’ but only helps the person’s innate vitality to correct the cause, and thus the effects, of any discomfort; the homeopath is a specialist in how the body’s ‘vital force’ struggles to adapt and survive.”

Cipap organizes talks on iridology and other natural health topics that are open to the public. E-mail admin@cipap.org; tel. 0920-9073075; visit www.cipap.org.

source: http://lifestyle.inquirer.net/32935/jack-tips-naturopathic-doctor-wants-to-help-the-body-heal-itself