Lead story on p.1 of Sunday's New York Times:
A reluctant evolution is taking place in residential drug treatment for opioid addiction. Here’s a look at one center’s wary shift.
MURFREESBORO, Tenn. — Just past a cemetery along a country road, an addiction treatment center called JourneyPure at the River draws hundreds of patients a month who are addicted to opioids and other drugs. They divide their days between therapy sessions, songwriting, communing with horses and climbing through a treetop ropes course. After dinner, they’re driven into town in white vans for 12-step meetings.
It is a common regimen at residential treatment programs, but as the opioid epidemic persists, JourneyPure is evolving. Though its glossy website doesn’t mention it, the company is ramping up its use of medications to blunt the torturous withdrawal symptoms and cravings that compel many with opioid addiction to keep using. There is substantial evidence backing this approach, which is supposed to be used in tandem with therapy. But because two of the three federally approved medicines are opioids themselves, it is spurned by people who believe taking drugs to quit drugs is not real recovery.
Addiction experts say such resistance is obstructing efforts to reduce overdose deaths and help addicted Americans get their lives back on track, even as many drain their savings or go into debt paying for repeated stints in residential rehab. Two-thirds of the patients admitted to JourneyPure’s program here over the last three months said it wasn’t their first time in treatment.
“I’m watching the dominoes fall on our industry,” said David Perez, JourneyPure at the River’s new chief executive, who has helped lead the push toward using more medication-assisted treatment. “People are dying, and we are feeling more and more impotent to stop it. That is what’s shifting beliefs, more than anything.” (continues)
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Monday, December 31, 2018
Thursday, December 27, 2018
Training the Next Generation of Doctors and Nurses
For decades, medical education has followed a timeworn path — heaps of book learning and lectures, then clinical rotations exposing students to patients.
But as technology explodes into patient care (surgeons can preview operations using virtual 3-D images built from a patient’s scans), the gap between medical education and real-world care has “become a chasm,” said Marc Triola, director of N.Y.U. Langone’s Institute for Innovations in Medical Education, created in 2013 to address the issue.
“The health care delivery system is changing every day,” he said, “and our medical education system has been lagging.”
In what looks like an urgent game of catch-up, medical and nursing schools across the country are retooling how and what they teach. This is also getting a boost from concern about the looming shortage of primary caregivers.
While “the national narrative is that we need more” doctors and nurses, said Erin Fraher, director of the Carolina Health Workforce Research Center, “that is precisely the wrong way to frame this. The question has to be: Where are the places in the U.S. where patients cannot get access to diabetes care, access to prenatal care?”
Those questions are redesigning health care education, with more community-based clinic rotations, special programs (and scholarships) for rural and underserved students, and a greater role for nurses and nurse practitioners. As schools seek to make learning more efficient, technology — including virtual reality, augmented-reality software and high-fidelity simulations (mannequins “breathe,” cry, sweat and respond to medication) — is a big part of that.
And it must be, given that students have to learn more information, faster. Much of medicine is slow; you can’t shortcut taking a medical history. But visiting the pathology lab to study a colon sample?
This is where Greg Dorsainville, a multimedia developer and one of 28 full-time staff members in the N.Y.U. institute, steps in, using a 360-degree camera to film a 45-minute session with a pathologist. He cut the lesson to 5:46, time that a medical student can spare to don goggles, zoom in and see what a polyp actually looks like, making it something to be remembered as “a visual in their mind. It’s not just a concept.”
But as technology explodes into patient care (surgeons can preview operations using virtual 3-D images built from a patient’s scans), the gap between medical education and real-world care has “become a chasm,” said Marc Triola, director of N.Y.U. Langone’s Institute for Innovations in Medical Education, created in 2013 to address the issue.
“The health care delivery system is changing every day,” he said, “and our medical education system has been lagging.”
In what looks like an urgent game of catch-up, medical and nursing schools across the country are retooling how and what they teach. This is also getting a boost from concern about the looming shortage of primary caregivers.
While “the national narrative is that we need more” doctors and nurses, said Erin Fraher, director of the Carolina Health Workforce Research Center, “that is precisely the wrong way to frame this. The question has to be: Where are the places in the U.S. where patients cannot get access to diabetes care, access to prenatal care?”
Those questions are redesigning health care education, with more community-based clinic rotations, special programs (and scholarships) for rural and underserved students, and a greater role for nurses and nurse practitioners. As schools seek to make learning more efficient, technology — including virtual reality, augmented-reality software and high-fidelity simulations (mannequins “breathe,” cry, sweat and respond to medication) — is a big part of that.
And it must be, given that students have to learn more information, faster. Much of medicine is slow; you can’t shortcut taking a medical history. But visiting the pathology lab to study a colon sample?
This is where Greg Dorsainville, a multimedia developer and one of 28 full-time staff members in the N.Y.U. institute, steps in, using a 360-degree camera to film a 45-minute session with a pathologist. He cut the lesson to 5:46, time that a medical student can spare to don goggles, zoom in and see what a polyp actually looks like, making it something to be remembered as “a visual in their mind. It’s not just a concept.”
Thursday, December 20, 2018
Aging
- Undoing Aging 2019 announces Program and Speakers! Undoing Aging is focused on the cellular and molecular repair of age-related damage as the basis of therapies to bring aging under full medical control. It brings together scientists and... http://undoing-aging.org/program.html
- Every Third Thought: On Life, Death, and the Endgame (McCrum) "This is a deeply personal book of reflection and conversation – with brain surgeons, psychologists, hospice workers and patients, writers and poets, and it confronts an existential question: in a world where we have learnt to live well at ..."
Monday, December 17, 2018
Dr. Google Is a Liar
Fake news threatens our democracy. Fake medical news threatens our lives.
It started during yoga class. She felt a strange pull on her neck, a sensation completely foreign to her. Her friend suggested she rush to the emergency room. It turned out that she was having a heart attack.
She didn’t fit the stereotype of someone likely to have a heart attack. She exercised, did not smoke, watched her plate. But on reviewing her medical history, I found that her cholesterol level was sky high. She had been prescribed a cholesterol-lowering statin medication, but she never picked up the prescription because of the scary things she had read about statins on the internet. She was the victim of a malady fast gearing up to be a modern pandemic — fake medical news.
While misinformation has been the object of great attention in politics, medical misinformation might have an even greater body count. As is true with fake news in general, medical lies tend to spread further than truths on the internet — and they have very real repercussions.
Numerous studies have shown that the benefits of statins far outweigh the risks, especially for people at high risk of heart disease. But they have been targeted online by a disparate group that includes paranoid zealots, people selling alternative therapies and those who just want clicks. Innumerable web pages and social media posts exaggerate rare risks and drum up unfounded claims, from asserting that statins cause cancer to suggesting that low cholesterol is actually bad for health. Even stories simply weighing the risks versus benefits of statins, a2016 study found, were associated with patients’ stopping the cholesterol-lowering drugs — which is associated with a spike in heart attacks... (continues)
She didn’t fit the stereotype of someone likely to have a heart attack. She exercised, did not smoke, watched her plate. But on reviewing her medical history, I found that her cholesterol level was sky high. She had been prescribed a cholesterol-lowering statin medication, but she never picked up the prescription because of the scary things she had read about statins on the internet. She was the victim of a malady fast gearing up to be a modern pandemic — fake medical news.
While misinformation has been the object of great attention in politics, medical misinformation might have an even greater body count. As is true with fake news in general, medical lies tend to spread further than truths on the internet — and they have very real repercussions.
Numerous studies have shown that the benefits of statins far outweigh the risks, especially for people at high risk of heart disease. But they have been targeted online by a disparate group that includes paranoid zealots, people selling alternative therapies and those who just want clicks. Innumerable web pages and social media posts exaggerate rare risks and drum up unfounded claims, from asserting that statins cause cancer to suggesting that low cholesterol is actually bad for health. Even stories simply weighing the risks versus benefits of statins, a2016 study found, were associated with patients’ stopping the cholesterol-lowering drugs — which is associated with a spike in heart attacks... (continues)
Thursday, December 6, 2018
Why Scientists Are So Upset About the First Crispr Babies
A rogue researcher defied myriad scientific and ethical norms and guidelines...
Here are answers to some of the numerous questions swirling around this development.
What happened?
The scientist, He Jiankui, said he used Crispr, a gene-editing technique, to alter a gene in human embryos — and then implanted the embryos in the womb of a woman, who gave birth to twin girls in November.
That is illegal in many countries, including the United States. China has halted Dr. He’s research and is investigating whether he broke any laws there. Among the concerns are whether the couples involved in Dr. He’s research were adequately informed about the embryo editing and the potential risks involved.
Dr. He says he has submitted his research to a scientific journal. But nothing has been published yet, and he announced the births of the twins before his research could be peer-reviewed by fellow scientists. He also appears to have taken other secretive steps that defy scientific standards... (continues)
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