StemCell Therapy

Mike Ellis, Anderson Independent Mail Published 7:43 a.m. ET May 28, 2020 | Updated 7:46 a.m. ET May 28, 2020

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This story is part of a series begun by USA TODAY capturing what America looks like as state economies slowly reopen. The Rebuilding America project examines what consumers can expect in key drivers of SC commerce.

Healthcare in Anderson County is likely to see fundamental changes in the wake of coronavirus.

Much of the fallout is not yet clear, but it will certainly accelerate telehealth, which isessentially meeting with doctors over video calls instead of in person, and will also accelerate changes in how billing works, said twoexperts from AnMed Health, Anderson County's main health care provider.

An independent physician, Dr. Shane Purcell, agreed those are the major two changes that can be predicted from the coronavirus pandemic at this time.

Purcell said that he would add a third change. His practice has been stable with no layoffsthroughout the coronavirus pandemic as other health systems, including AnMed Health, have had layoffs. Thatcould drive more health care providers and patients into practices like his.

Purcell is one of several doctors atDirect Access MD, an Anderson area family practice that operates outside of traditional insurance and government healthcare models and uses a membership model.

AnMed Health staff and bystanders take photos and video of F-16 planes from The South Carolina Air National Guard 169th Fighter Wing flying over the hospital in Anderson, S.C. Monday, April 27, 2020.(Photo: Ken Ruinard / staff)

Recent: AnMed Health to furlough employees, reduce salary of leadership because of coronavirus

Telehealth may be the most visible change to patients as medical offices go further and faster on long-existing trends in response to coronavirus concerns, said Michael Seemuller, a physician in family practice at Wren Medicine and chair of AnMed Health'sQuality and Safety Committee.

There are a lot of medical appointments that had been done in the past in person that can be done over a video chat, and it will likely become more widely used as people work to avoid potential infections and get comfortable with the format, he said.

The challenge with telehealth is that there is a lot that can be done remotely, such as routine visits, but there will always be people who need to see a doctor physically, for certain tests or checkups, Seemuller said.

Perhaps the biggest challenge, however, is access to telehealth, saidJuana Slade, chief diversity officer for AnMed Health.

She said she recently did a routine medical visit online, it took her 20 minutes.

But that is 20 minutes for someone who is familiar with computers, has the time and space to take 20 minutes and has Internet access that can often require money and locations that not everyone has, she said.

Fixing access in telehealth leads into the other major change, Sladesaid.

Virtual appointments: Coronavirus pandemic drives exponential growth of telehealth in the Upstate

The billing changes may not be as visible as telehealth to most people but may be more meaningful, the experts said.

AnMed Health, and other health systems,had already been working on value-based health care, which shiftsbilling from a per-procedure to an outcome-based billing process, Slade said.

The change will be driven by contractual incentives both from outside vendors and providers and from AnMed Health employees, she said.

Employees look at two wood pallets left on a wall on South Fant Street at AnMed Health, painted with words of encouragement and thanks in Anderson Thursday.(Photo: Ken Ruinard / staff)

If a hospital had been doing 100 of a given procedure with 85 good outcomes, it would have been paid more than if it did 90 of the same procedure with 85good outcomes. The new system aims to give contractual incentives on the outcome, rather than procedure side, and could result in fewer procedures being done because fewer are necessary, Slade said.

Doing fewer procedures would mean less income, illustrated by the furloughs at AnMed Health and in the broader health care economy. But changing the measurable to outcomes could lead to better health overall by nipping problems early, when they are cheaper, which also is better for people, Sladesaid. It also could help improve bottom-line revenue by reducing costs.

The change in emphasis to value-based billingcould help communities by focusing on underlying problems, shesaid.

Instead of treating heart attacks at the emergency room, typically the most expensive way to get health care, it would give AnMed Health incentives to treat a particular few blocks, for example, with preventative medicine like regular doctor's appointments that can be done virtually, Sladesaid.

The change won't be easy, and there are a lot of hurdles.

Slade estimates that 10 percent of health outcomes are up to the work of doctors and medical staff, the rest is the patient's responsibility, and a lot of the patient's outcome will be closely tied to factors like availability of healthy foods and good jobs, of education access and opportunities for health activities.

That means AnMed Health will be working a lot more with police and business communities to get those outcomes, Sladesaid.

Sarah Crowder of St. John's United Methodist Church decorate a cross with a white ribbon for health care workers to go with blue ribbons, before Maundy Thursday in the fellowship hall in Anderson Monday.(Photo: Ken Ruinard / staff)

And because much of this will tie back to regular, and increasingly virtual, doctor's visits, Internet access will be a big factor in any success.

The fallout from coronavirus has so far included furloughs for health care workers and others, it will likely have many other consequences for people's health and the financial structure of health care models in the country.

Many of those are unknown or subject to change, but an increase in telehealth and changes to billing structures are two fairly reliable predictions about the future of health care in Anderson County.

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Major changes coming to Anderson health care in wake of virus - Independent Mail

Updated at 10:15 p.m. May 27 with Mayor Lyda Krewson's announcement that Dr. Fred Echols will be acting health director

Members of the St. Louis Board of Alderman are questioning Dr. Fred Echols qualifications to be the city's health director.

After learning that Echols no longer has a license to practice medicine, the boards Rules Committee scheduled a meeting this week to investigate his credentials.

As a result, Echols has had to defend his expertise, and city officials and medical professionals have defended his record. But late Wednesday, Mayor Lyda Krewson announced that she and Echols agree that it's in the city's best interests to amend his appointment to acting director.

Under the city charter, the health director must have one of the following qualifications: be a licensed physician, have a master's in public health, or be certified by the American Board of Preventative Medicine and Public Health.

Echols graduated from the Boston University School of Medicine and served as a Navy doctor. He completed a public health training program at the Centers for Disease Control and Prevention and worked at the Illinois Department of Public Health and the St. Louis County Department of Public Health as an infectious disease specialist.

While Echols held a license to practice medicine in the Navy, he let it lapse after he completed his military service and started working in public and community health.

Krewson hired Echols as the citys health director early last year. Echols lack of a license surfaced earlier this spring when he testified in a lawsuit Arch City Defenders filed against the city that sought to block city officials from removing a homeless tent encampment downtown.

Echols and city attorney Julian Bush submitted a correction to Echols testimony in which he originally stated he was licensed to practice medicine. He had misheard the question and worked to correct the record as soon as he could, Echols said.

Alderwoman Sharon Tyus, D-1st Ward, called a joint meeting of the Health and Human Services and Rules committees on Wednesday to investigate Echols qualifications.

One of things thats important about civil service is that we vet people and make sure they meet the qualifications and make sure theyre not being unfairly advantaged or disadvantaged, said Tyus, who chairs the Rules Committee.

Tyus has been critical of the Health Departments response to the coronavirus pandemic, saying she is disappointed by a lack of testing in areas of north St. Louis where many have become ill from the virus.

When Alderwoman Megan Green, D-15th Ward, asked Bush if Echols meets the requirements outlined in the city charter, Bush said regretfully that Echols did not.

I think hes done a splendid job as director of health and hospitals; I think he almost satisfies those requirements, but hes not quite there. And I say that with great regret, Bush said.

Echols told members of the committees Wednesday that he has the educational qualifications to serve as director. He also defended his record, saying the department has worked tirelessly to promote better health for the citys poorest residents and black people in particular.

As long as Im in this role, my heart is in this community, he said. My integrity is really important to me as I move forward. Whether Im in the city or somewhere else, I always want to be truthful and forthcoming with information, particularly as it relates to me and my role and the impact that may have.

Dr. Will Ross, chairman of the Joint Board of Health and Hospitals, told the committee that the training Echols received at the CDC is equal to a public health degree.

I can say, based on my extensive knowledge of public health training programs, this program is robust enough to qualify anyone to serve in a public health leadership position, Ross said.

Krewson said that Echols experience and training are sterling and that he is fully qualified for the position.

Some seek to discredit this highly qualified physician; it is unclear what their motive is, Krewson wrote in a letter to the Board of Aldermen.

Dr. Echols credentials as an MD with extensive public health training are far superior to the minimum qualifications allowed by the city charter, she wrote.

In announcing the decision to amend Echols' appointment to acting director, Krewson wrote in a Facebook post that Echols has the training and experience necessary for the job.

Krewson wrote that in light of that distraction, and the opinion of Bush, she, Echols and Ross had decided it was best for Echols to serve as acting health director.

The committee is expected to resume the hearing Thursday.

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Members Of The Board Of Aldermen Question St. Louis Health Director's Qualifications - St. Louis Public Radio

For the foreseeable future, the preventative measures installed throughout the healthcare community to prevent the spread of coronavirus spread arent expected to go anywhere.

That, at least, is the prediction by those in local medical and senior care industries for the coming weeks and months as Tuscaloosa begins its slow crawl back to pre-COVID-19 conditions.

"I just think theres a lot of unknowns," said Dr. Phillip K. Bobo, "and the next month to month-and-a-half will be critical."

Bobo, a founding partner of Emergi-Care Clinic who has worked in the fields of emergency and family medicine for more than four decades, said he expects society to slowly return to normal as long as people believe it to be safe.

And that, he said, will take a while as many wait to see whether reopening restaurants and non-essential businesses will lead to a sharp increase of coronavirus cases.

"Theyre going tend to stay away from places that they think there will be a high likelihood of contact restaurants, obviously; all medical: hospitals doctors office, clinics, surgery centers all of those are going to have a slow comeback, I think," Bobo said. "If theres a second surge, then we dont know. If theres not a second surge and we survive it and we get into the fall (and) if theres no surge and people are doing better and were out functioning more and we have events ... I think itll come back more rapidly."

Until then, those needing medical procedures can expect to undergo scrutiny and safety measures. And those wanting to visit will still have to wait.

At DCH Health Systems Northport Medical Center and Regional Medical Center in Tuscaloosa, visitation either has been limited or not allowed at all.

Andy North, the hospital systems vice president of marketing and communications, said a number of preventative measures have been put in place since the coronavirus awareness took hold in early- to mid-March. These include universal masking of staff, physicians and visitors, temperature checks of everyone prior to entry, Plexiglas sneeze guards installed at most points of consumer interaction and, on most days, remote site screening services.

And while the Alabama Department of Public Health allowed elective surgeries to resume on May 1, there are currently no plans to relax these measures and, if necessary, the additional services may be halted.

"As a safeguard, the results of a COVID-19 test will be obtained on each patient prior to proceeding with the surgery," North said. "In addition, the current no visitation policy and processes will remain in place for now.

And in places where people are at risk, professionals are getting creative.

While no positive coronavirus cases have been reported at the Crimson Village assisted living facility off 18th Avenue East, Executive Director Rebecca Dennis said she intends to keep it that way.

"The biggest thing were up against right now is these residents are lacking the socialization," she said.

To provide some level of interactivity, Dennis said Crimson Village officials have taken to providing FaceTime conversations with residents and their relatives or bringing residents to windows to see their families through the safety of glass.

But, for now, there are no plans to allow face-to-face interactions like those that took place before the coronavirus arrived.

And, Dennis said, shes not sure when -- or if life will return to normal for Crimson Village seniors.

"Right now, Im not letting them come any closer than the front door," Dennis said. "And as far as physical contact, I dont think the health department or CDC is going to permit families to come in and do huggings and touchings any time soon.

"I know its going to continue for the next few weeks and probably several months. Whats the old saying? Well just have to play it by ear."

Read more:
Healthcare precautions likely to persist for near future - Tuscaloosa News

Friday, May 22, 2020 9:18 a.m. EDT by Thomson Reuters

By Michael Erman and Ankur Banerjee

(Reuters) - The anti-malarial drug hydroxychloroquine, which U.S. President Donald Trump says he has been taking and has urged others to use, was tied to an increased risk of death in hospitalized COVID-19 patients, a large study published on Friday showed.

In the study https://www.thelancet.com/lancet/article/s0140673620311806 that looked at more than 96,000 people hospitalized with COVID-19, the respiratory disease caused by the novel coronavirus, those treated with hydroxychloroquine or the related chloroquine had higher risk of death and heart rhythm problems than patients who were not given the medicines.

The study, published in the Lancet medical journal, showed no benefit for coronavirus patients taking the drugs.

Demand for the decades-old hydroxychloroquine has surged as Trump repeatedly promoted its use against the coronavirus, urging people to try it. "What have you got to lose?" he asked.

Trump said this week he has been taking hydroxychloroquine as a preventative medicine despite a lack of scientific evidence.

The Lancet study authors suggested that hydroxychloroquine and chloroquine should not be used to treat COVID-19 outside of clinical trials until studies confirm their safety and efficacy in such patients.

There is a frantic search for drugs to treat COVID-19 at the same time that multiple research teams pursue a safe and effective vaccine to combat a pathogen that has killed more than 335,000 people worldwide and sickened millions more.

The U.S. Food and Drug Administration has allowed healthcare providers to use the drugs for COVID-19 through an emergency-use authorization, but has not approved them to treat it.

Dr. Mandeep Mehra, one of the study's authors, said the research shows that the FDA should withdraw that authorization.

"That will help move this towards more, stronger evidence because it will then force the use of these drugs only in the setting of control trials," Mehra said in an interview. "That would be an extremely wise decision."

The FDA has said that, for safety reasons, hydroxychloroquine should be used only for hospitalized COVID-19 patients or those in clinical trials. The drug has been tied to dangerous heart rhythm problems.

The Lancet study looked at data from 671 hospitals where 14,888 patients were given either hydroxychloroquine or chloroquine, with or without an antibiotic, and 81,144 patients were not given such treatments.

Both drugs have shown evidence of effectiveness against the coronavirus in a laboratory setting, but studies in patients had proven inconclusive. Several small studies in Europe and China spurred interest in using hydroxychloroquine against COVID-19, but were criticized for lacking scientific rigor.

Several more recent studies have not shown the drug to be an effective COVID-19 treatment. Last week, two studies published in the medical journal BMJ showed that patients given hydroxychloroquine did not improve significantly over those who were not.

Hydroxychloroquine is used to treat lupus and rheumatoid arthritis as well as malaria.

Hospitalized patients tend to have a more severe version of COVID-19. Some proponents of the drugs for COVID-19 argue that they may need to be administered at an earlier stage to be effective.

There are ongoing randomized, controlled clinical trials to study the drug's effectiveness in preventing infection by the coronavirus as well as treating mild to moderate COVID-19. Some of those may yield results within weeks.

(Reporting by Ankur Banerjee and Manas Mishra in Bengaluru and Michael Erman in New York; Editing by Saumyadeb Chakrabarty, Bill Berkrot, Jonathan Oatis and Will Dunham)

Read the rest here:
Drug touted by Trump to treat COVID-19 linked to higher death risk: study - WHTC News

BACAVI, Ariz.

Standing in his cornfield, Ahkima Honyumptewa said everything about the traditional Hopi lifestyle is meant to strengthen the body, mind and spirit.

Ive always had a connection to this land and a culture to lean on, said the 39-year-old Honyumptewa, who is of the Snake Clan. He suggests the best thing to do during this time of pandemic is to stay engaged in productive activities.

Thats how you can get out of all this craziness mentally, he said. What Im doing to get through is a lot of arts and crafts and farming. Directing energy toward anything constructive, including learning new skills, is a perfect way to make use of this time, and grow as a person, says Honyumptewa. If you keep busy and focused on something productive, youre mind is developing, he said.

As a Hopi farmer, Honyumptewa stresses the importance of going back to some of the basic traditional staples and modeling that for the young people. An award-winning artist, his schedule is that of discipline and structure, including getting up early every morning to work on his craft.

His artwork depicts the seasonal Katsina dances that occur in Hopi. I show the people what we see, he said. I portray it in paintings.

Honyumptewa says he enjoys sharing his culture through his work, which draws a lot of positive feedback, especially from young people. They are just in awe, he said. They take it to heart.

He also makes Hopi textiles and has won numerous awards, including Best of Show for weaving at the 2019 Museum of Northern Arizona Hopi show for a traditional manta, a shawl used for protection.

A dedicated runner, Honyumptewa puts in his miles across the mesas every week in the midday sun.

Be careful in life, but dont be afraid to live life, advises Honyumptewa. Be humble and truthful and we will get through this.

We catch sicknesses because our bodies are out balance, whether its a virus or a cold, said Honyumptewa. All of that is caused by an imbalance.

He said people who behave in a negative way or are mean to other people make themselves more vulnerable, because the energy builds and builds until explodes.

You start getting health problems and youre more vulnerable to sickness when your attitude and your whole being is devoted to to negativity, he said. Not only does it affect the person, he says, but everybody around them. Thats not how were supposed be acting, he said. Were supposed to be the other way. Were supposed to be honest, respectful, and kind.

Honyumptewa believes that people can best help others by first helping themselves through self-knowledge and healing. The number one way to fight any sickness or disease is through happiness, not only loving yourself but loving others, he said. The more you feel that positive energy, the more you protect yourself from harm.

Exercising, eating healthy, and studying new things are key to that, he said. He recommends learning about history, other cultures, sages, and practices such as martial arts and yoga. Study the truth to better the mind, he said.

Honyumptewa believes the best way to serve is through virtue. When you help people you start to gain trust and build connections, he said. As you generate more and more positive energy, you have enough to give it away, he said.

The more positive things you do, the more people want to be around you, said Honyumptewa. Even the animals want to be around you. This relates to the laws of karma, he says, which keep everything in balance. Treat people the way you want to be treated, he said. We all want to be treated with respect.

That also applies to leadership, he said, which keeps a people balanced. Without that, a nation is in chaos, he said. Theres corruption, mistrust, bribery. He believes that is the case with the United States government today. There are all kinds of side deals that the government does that we dont even know about as people, he said. Thats why I dont like this way of life because its like one big crime syndicate. This government robs and steals from the people our energies, our spirits, our selves.

Thats why the world is falling apart, he says, because we are all distracted. The real anti-Christ is someone pretending to be God, said Honyumptewa. Theyre covering it all up behind closed doors.

He says real, true people dont go around claiming they can do things, they just do it out of the goodness of their heart. Most importantly, we never ask anything in return, he said. Everything is supposed to be given freely. He says that is how you know the real medicine men. They dont go out advertising, he said.

Honyumptewa believes people should learn to depend on their own goodness and energy. The only way it works is through good, through compassion, and unconditional love, he said.

As a steward for the land, Honyumptewa feels a strong responsibility to take care of it. We were put here for a reason, he said. This is the center for all spiritual development. He said that was the whole purpose of Hopi migration, which led to Oraibi, from where he descends. The whole Southwest is the spiritual center and what we do here magnifies by ten, he said. If were not strong enough mentally, physically and spiritually, we can hurt ourselves if were unaware of that power that is here.

He says the power can be used for bad or good. For example, if you exercise and train on this land, you can develop ten times faster than anywhere else, he says. Thats why this land is so important, said Honyumtewa. Its a sacred, sacred spot.

Even the Bible talks about the area, he says. Everyone around the world knows this spot as the Garden of Eden, said Honyumptewa. Thats what the Hopi Mesas are, the actual spot of creation.

In the old days, there were springs flowing out of the mesas and water was abundant, he said. He believes all of North and South America belongs to the Natives. That was our responsibility as Native cultures of this land, to migrate and send spiritual roots into the ground, said Honyumptewa. That way the land knows who we are; it feels us.

Long ago, everyone knew that all things were connected, he said. Everything was intertwined, the planting, the ceremonies, the races, everyday life, he said. Thats why we were told not to go away from our culture because of our connection with the earth.

Honyumptewa says today it is a minority who are living by the old ways that served as a natural form of preventative medicine. His advice is to work toward giving up cravings and bad habits, born of this modern world.

It takes patience and time, he said. You just cant give up on yourself. Honyumptewa urges people not be afraid of death, which is a natural part of life, he said.

Life and death is a continuous cycle that repeats itself over and over again, he said. We evolve from stage to stage. Humanity is our teacher, said Honyumptewa. Its a teaching tool spiritually, he said. It teaches us how to connect universally.

He says politics and technology should be avoided, as they are meaningless to spiritual development and are a waste of time. We want to learn things now that will develop our spirit lifetimes from now, he said. The only way to progress through the cycle of life and death is enlightenment.

Related

More here:
Surviving the coronavirus crisis: A Hopi perspective - Navajo Times

Photo: Contributed

Is the wealth of information about your individual health risks worth the anxiety of knowing?

DNA testing kits have made it possible to access previously unmined information about your health. As a huge advocate of preventative medicine, Ive explored the pros and cons of accessing this wealth of information to see whether your spit is worth the price tag and the consequences.

Firstly, what is it? Companies like 23andMe offer a home-based saliva collection kit you spit in the tube and send it to the lab. From there, your DNA is extracted from the spit and a process called genotyping analyses the DNA.

You then receive a report with your health predispositions (diseases you are more likely to get due to your genes) and your carrier status of certain diseases, such as cystic fibrosis.

The most obvious benefit of getting your DNA tested is identifying your personal health predispositions. For instance, the report might indicate youre at risk of getting type 2 diabetes, or heart disease. With this information, you can make changes to your lifestyle to help prevent these diseases from occurring, such as quitting smoking, drinking less caffeine or eating less sugar.

Despite these benefits, it is important to consider the emotional stress of receiving unfortunate results. Finding out you are at high risk of Alzheimers has a huge emotional impact on an individual and their family, especially as there is little you can do to prevent it.

Personally, I wouldnt want to know Im at high risk for a disease I cant do anything about I think the anxiety the knowledge would cause wouldnt be worth the information.

Its also important to note that genealogy results arent definitive. For instance, they may identify the gene that can cause high cholesterol, which in turn can increase the risk of heart disease. However, the test doesnt take into account any other personal or environmental factors, such as your diet, exercise and lifestyle. Without input from your own family doctor or a genetic counsellor, the results cannot be taken as gospel.

The uses of genealogy DNA databases extend beyond personal use for health and ancestry information, and this is the part where I begin to question the safety of using these kits. Although companies have rigorous privacy policies, they do still keep your DNA and information in a database in order to identify future clients that may be within your family tree.

This data is vulnerable to hackers, but also to police and immigration officials. The CBSA uses genealogy DNA testing in an immigration setting to ascertain a persons identity, such as the country they originate from.

From the uses we know about, to those yet to be found Im not sure I want my DNA in a database with unknown potential.

There are also important financial implications that accompany genetic testing, such as the fact that some insurance companies now say you must disclose any genetic risk information you are aware of, which can mean higher premiums for health, life and travel insurance.

Having mused over the idea for several weeks, with my mouse hovering over the Add to Cart button more than once, Ive decided genetic testing is not for me, for now. I personally dont think you should need a genetic test to tell you to live a healthier lifestyle to exercise more, eat more greens and get better sleep.

If its something youre thinking about, or have done, I would love to hear your thoughts on it. If not, take it from me get out for a cycle or a run, spend more time with your family and eat some broccoli with a smile on your face.

See more here:
The benefits and the costs of home DNA tests - Health and Happiness - Castanet.net

Mike Haynes is a professor of economics at the University of Wolverhampton in the United Kingdom. His article, Capitalism, class, health and medicine, was published in 2009 by International Socialism and is republished with permission.

I ask myself how, as a physician, I find myself up to my ears with the problems of society, writes Michael Marmot. It is a question that committed doctors have been asking for several generations as they try to explain and cope with the way that illness is moulded by society. Evidence for the social gradient is astonishingly widespread. It affects us all. It is not just about the contrast between the rich and poor but is so fine grained that if we graph illness against some indicator of relative position we see that as relative position improves so does health. Wilkinson calculated that 50 to 75% of the differences in average life expectancy in rich countries are now determined by differences bound up in the distribution of income and related factors. Table 3 shows how this is reflected in the pattern of key illnesses in the UK.

Why should this be? Material need cannot be ignored. Income poverty is not the basis for a good life, and societies with the greatest levels of inequality will also have the largest numbers of poor people. But it is relative poverty and position that matter most. So what is going on? The biomedical answer seems to be that vulnerability and susceptibility to illness and death are related to the degree of adversity in our lives. Some exercise is good for you but relentless physical demands in circumstances over which you have no control drain the body. Similarly, some stress is good for you but relentless worrying about job, home, family, etc not only drains you emotionally but feeds back into physical and mental ill health:

The relationship among the nervous system, the endocrine system, and the immune system is emerging as the pathway that can help our understanding of the changes in health which are associated with changing social and economic conditions.

In other words, although illness arises from bodily processes it is really a product of social organisation. And this is crucial because health follows the social gradient it is not just about improving the conditions of the poorest. In health terms it is in our collective and individual interest to tackle the problem more systematically. As Marmot puts it:

Much of the discussion about social inequities in health has focused on the health disadvantage of the lower class. This is analogous to seeing social problems as particular to a disadvantaged minority, rather than a problem for society as a whole.

Table 3: The UK disease pattern by social group 1991-3, standardised rates per 100,000 for men aged 20-64.

Source: Acheson, 1997.

Marmots argument here is partly a reformulation of RH Tawneys famous comment that what thoughtful rich people call the problem of poverty, thoughtful poor people call with equal justice the problem of riches but it is more. The steeper the social gradient, not only the bigger the health gap between those at the top and those at the bottom, but also the lower the average position of all. The countries with the longest life expectancy are not the wealthiest but those with the smallest spread of income and the smallest proportion of the population in relative poverty. There is therefore a problem with thinking that because I am near the top in UK terms (and the level of inequality in the UK is one of the highest) I will live longer than someone at the bottom or in the middle. This is true. But it is also true that you would live longer still if society were more equal. It was realised in the 1990s that the mortality rate for the lowest social class in Sweden [with less inequality] is less than that for the top social class in the United Kingdom.

The narrow biomedical mechanism that produces this has three elements. The first is the psycho-social impact of pressure on bodily processes. This is socially determined. The second is our health behaviour and how we respond in terms of what we eat, whether we smoke and drink, take exercise, etc. This too is socially determined. The third is how supportive our family, friends and social networks are. This is also socially determined. Only then does the fourth issue, healthcare, become a central issue and, when it does, it too is socially determined.

If we look at our lifestyles as a whole, their patterns reflect either the accumulation of advantage or disadvantage. The story starts in the womb with fetal development, it is manifest in the early years, at primary and secondary school. It is then compounded by what type of job we get and how precarious our employment is, and so on. But why can this not be explained by people at the top choosing wisely and those at the bottom choosing badly?

The really interesting aspect of the social approach to health is how careful the analysis is of what conditions our behaviour. The cleverness of the Whitehall Studies of UK civil servants is a good example. The researchers took a large group in which the members appeared to be similar and apparently had some more positive elements in their work conditions. They then designed a study of how work, position, life, social situation, etc interacted and combined. This analysis allowed them to nail the myth that top managers are prone to more heart attacks because of pressure. They are not and we now know why. With responsibility comes status, power, control, means to relieve stress (membership of the gym, a night at the opera, a holiday villa) often arranged by your secretary and so on. As you move lower down, peoples lives become more bound up with lower status, less control and the need to battle and juggle a host of other commitments. It is the harassed worker on the shopfloor or in the office who is more at risk of a heart attack and, beneath them, the cleaner doing two jobs on the minimum wage. This also explains negative health behaviours and why these should give rise to different incidences of disease when the same immediate causal factors, eg smoking, appear to be present.

But some readers may be puzzling about a theoretical problem in the link between social class and the health gradient. Those who insist that we live in a class society have to defend themselves not only against those who deny the reality of class but also those who want to define it simply in terms of hierarchy. It is here that we run up against the fundamental weakness of the argument about social gradients in health. It is clear that they exist, but what causes them? What is the cause of the cause? To solve this problem we have to look behind the gradients and explore what determines the different incomes, jobs and degree of control that people have over their lives. This means that the central thing has to be class analysis and showing how any gradient is structured by ownership and control and not least, in capitalism, by ownership and control of the means of production.

Here several related concepts are absolutely central alienation, exploitation, class and class conflict. Inequalities are a consequence of how these interact and it is from this that social gradients and gradients of ill health flow. Marmot makes occasional gestures towards this but they are weak and inconsistent. The same is true of Wilkinson even though he has a more systematic grasp of the social side. To insist on the importance of this is not just about adding an additional layer of possibly superfluous explanation. It makes the argument stronger in terms of its logic and explanatory power, and it gives it a clearer political thrust because it also forces us to consistently address the political economy of both health causation and the limits of reform within the system.

Alienation, for example, is fundamental to explaining both our loss of control of social processes and the way that they are turned against us, and our resulting inability to relate to one another as proper human beings. Exploitation gives us the possibility of understanding how and why the rewards go to the few who make so little contribution to our real wealth. And class and class conflict help us to understand the resulting texture of social relationships and their antagonisms.

We can make these arguments work in a more precise fashion too. As organisations have become more powerful the argument arises about who has effective disposition of capital and labour within them. The key social argument here is that the more your position gives you control over capital and labour, control over yourself, your work, the work and lives of others, the lower the levels of ill health. The more your life is controlled by others the less the level of health. The social gradient is not simply about who has what but the capacity to command people and resources the very issue that is at the centre of class analysis.

But to take this analysis further we need people whose expertise is the analysis of capitalisms social structures to link up with the people whose expertise is in health and illness. One of the most creative ways of making the connection was set out nearly three decades ago by Eric Olin Wright. Wright took on the argument that class was disappearing in modern society because of the alleged explosion of groups in the middle. These groups appeared to stand between capital and labour; they had what he called contradictory class locations. He then devised a way of mapping these contradictions, focusing crucially on how much control of capital and labour they had. It becomes obvious in his analysis that these intermediate groups often have little and are therefore closer to labour than capital. This reflects what many of us understand intuitively: the badge may say manager but we all know that in reality it means some low-grade supervisory responsibilities that do not preclude trade union membership and even militancy.

Using these ideas to map how capitalism really operates and divides us has an obvious attraction for those seeking to more systematically underpin the analysis of health gradients, and some researchers have already looked in this direction. But heres the problem. Almost immediately Wright had set out this argument, he retreated under the pressure of the anti-class theorists. This has meant that it has fallen to others to defend this extension of class analysis as a way to understand capitalism. But it has also acted as a disincentive to use the argument to tighten the theoretical and empirical links between class and health.

But this argument raises other political issues and not least for the medical establishment. Prevention, as everyone knows, is better than cure. The most sophisticated and effective healthcare in the world cannot produce results as good as simply remaining healthy in the first place. But creating healthy societies and individuals largely results from action outside the health sector. Healthcare can never remove the gradients in causation, only deal with some of the consequences.

This type of argument is difficult to make. We are rightly appalled by inadequacies in healthcare but we tend to take for granted the inequalities in health causation. It is awful that when Julie had her heart attack in her 50s she had to wait 30 minutes for an ambulance; then there was the four-hour wait in accident & emergency and the dirty wards on which she eventually died. But the prior question is why she had a heart attack in her 50s and why Jane, who worked as a cleaner in the same office, had one a couple of years later and died before help could get there?

We need to take any argument about the role of medicine in health in two stages. The first is to stress the absolute importance of what is called primary prevention and not to fall into the trap of thinking that we can leave the causes of illness alone and focus on better treatment. Primary prevention saves lives but primary prevention may not involve medical measures in the narrow sense at all. Only three out of the 39 proposals made by the 1997 Acheson Report of the Inquiry into Inequalities in Health related directly to health service provision. If the problem is a choice between a worse treatment and a better one, we should obviously demand the better one. But the issue should not be about whether we can afford treatments but whether we can afford people to be ill. It is often said that medical costs will always rise. This is an absurd argument in itself because it ignores the way in which the drive for profit is behind the cost rises that exist. But even if it were true, reducing the numbers of ill people in the first place would reduce the cost problems. The less people that you have to treat, the more you can afford to spend on making those who have the genuine misfortune (and not the socially determined one) to fall ill. The real problem then is to alter the fundamentals of the generation of illness caused by class society.

Primary prevention is therefore politically challenging. There has always been a minority tendency in the medical establishment that links health improvement to real social reform, and within this group a smaller one still who continue to insist that so long as capitalism and class society exist we will remain trapped in unequal lives and unequal deaths. But many health professionals also see the immediate attraction of the medical fix. And so do we as patients once we get trapped in ill health. Even the members of the team that produced the original Black Report were split on this issue. According to Sir Douglas Black:

We were all agreed that education and preventative measures, specifically directed towards the socially deprived, were necessary. But the sociological members of the group considered that the consequent expenditure should be obtained by diversion from acute services. On the other hand the medical members felt that the acute services played a vital role in the prevention of chronic disability and could not be further cut back without serious effects on emergency care, on the training of doctors for both hospital work and for family practice and on the length of waiting lists. We spent a long time, without real success trying to resolve this matter.

This fudge is not enough. Consider the problem of mental ill health. Its burden continues to rise in the advanced world. There is a big question over whether the medical fix actually works. But suppose the evidence was clearer that it did. It would still not be enough for three reasons. First, it is inconceivable that enough professionals could be trained and employed to treat the many millions of casualties of our psychologically toxic social environment one at a time. Second, if the problem is the toxic environment then once people are returned to it their symptoms are likely to recur. Third, this approach does nothing to stop new cases appearing. But the same logic applies to other areas. Britain, for example, is acknowledged to have one of the poorest records in the advanced world for longer-term survival after major incidents like cancer and heart attacks. You can now guess that there may be two explanations for this. One is medical the weaknesses of early identification, treatment and follow up. The other is inequality. If inequality increases your chances of getting a life threatening disease, then however good the medical fix the pressure will be on again once you return to the environment that helped to cause the illness in the first place.

At this point, however, many take fright. It seems easier to imagine that the way forward is to work on medical solutions to ill health and demand more resources for these. But this takes us to the second issue of whether a health system run for profit can ever rationally answer human need. The answer is an unequivocal no. The first simple rule of healthcare is Tudor Harts inverse care law, which says that the availability of good medical care tends to vary inversely with the need for the population served [and this] operates more completely where medical care is most exposed to market forces. A national health system has to be based on principles of comprehensiveness, universality and equitability. Supply and demand, internal and external markets, subvert these principles and undermine the capacity of rational health planning. They even undermine the very sources of information which would make such planning possible. The result is variation in the coverage of basic services. With this comes a huge loss in real efficiency.

A second simple rule of healthcare then emerges: the more the logic of capitalism determines the supply of healthcare, the higher the costs, the larger the management layer, and the greater the diversion of resources away from treatment and care and into private hands. With this level of irrationality in the system we can then move to a third simple rule of healthcare: the more the logic of capitalism determines the supply of healthcare, the more the healthcare system itself may become a threat to social health.

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From the Archive | Part two: Class, health and medicine - newframe.com

Heads up, ACT readers: According to a recent survey, your lifestyle is one of the healthiest in the country! In the inaugural AIA Vitality Wellbeing Index report, you score big on physical activity, you're non-smoking and you've ditched those sugary drinks. Take a flexible and well-hydrated bow.

For the rest of us, well it could be time for a friendly wake-up call, because the lifestyle choices we make now will contribute to our wellbeing long-term.

Lifestyle is often the driver of non-communicable diseases (think cardiovascular disease, diabetes, respiratory disease and cancer) which are responsible for 90 per cent of premature deaths in Australia and New Zealand and, according to the World Health Organization, may make you more susceptible to COVID-19.

The good news is that a bit of preventative healthcare can help. "Proactive preventative healthcare means taking small steps now to improve and maintain all aspects of your life," explains preventative health expert Dr Zac Turner.

"By having a lifestyle focus which considers the impact of exercise, diet, smoking and alcohol, it can enable great health outcomes."

While the ACT is ahead of the rest of the country with 18 per cent of the population meeting the physical activity guidelines, the recommended 150 minutes of moderate exercise per week is something we can all aim for.

Trainer and co-founder of Sydney's Flow Athletic, Ben Lucas, agrees. "A moderate intensity is an intensity that makes you work hard enough to burn off three to six times more energy per minute than when you are sitting," he says.

"Take a very brisk walk, ride a bike at a medium effort, do some light toning/strength training that doesn't involve the heaviest weights or some high intensity interval training."

Victoria tops the country on nutrition, the survey revealed, while NSW is all over the recommended daily fruit guidelines, and Tasmania has the most veggie eaters.

But it's not hard for every Australian to get on track. Integrative medicine practitioner Madeline Calfas says the biggest no-no is sugar, which can lead to health issues like diabetes, heart disease and high blood pressure.

"The best way to ensure you truly have a healthy diet is to follow the J.E.R.F. protocol: Just Eat Real Food," she advises. "By minimisingfoods that don't come from a packet, you can not only avoid hidden sugars, but you are also avoiding preservatives and additives that can wreak havoc in our bodies."

Smoking? Stop, or at least start cutting down, says Dr Turner. "If you go from 20 a day to 13, then nine, to six and then three, for example, over a three-month period there will be a significant improvement in your health," he says. "If you stop all together, in five to seven years you will get your lungs back to a pre-smoking state."

As for how much is OK when it comes to your favourite tipple, lifetime alcohol guidelines say we shouldn't consume more than two standard drinks a day.

"Drinking every day, or binge drinking more than four standard drinks on one day, means that you are putting your body at risk of alcohol-related illness such as fatty liver disease, diabetes, heart disease and depression," explains Calfas.

"Also, try to reduce the number of sugary drinks and cocktails you consume it's not just the alcohol that's the issue here."

Got all that? Turns out this preventative health lark is actually quite straightforward.

"Yes," agrees Dr Turner. "It's really all about keeping healthy people healthy."

And that's important no matter where you live.

AIA, with AIA Vitality, is on a mission to get all Australians making the small changes they need to become the healthier version of themselves. Head to aia.com.au/onelife for more healthy-living inspiration.

Original post:
How healthy are you, really? - 9Coach

The coronavirus pandemic may seem to be on a scale the Middle East has not seen before and in many ways, it is.

But the world and the region is no stranger to outbreaks of disease.

In fact, the UAE's first brush with a potential large-scale epidemic may have been in 1947, the year cholera tore through Egypt, Iraq and Syria, and arrived in Dubai, then part of the Trucial States, which was under British rule at the time.

The disease caused panic among the British, who put people into quarantine, grounded flights, sent for huge stocks of vaccines from London and went door-to-door to ensure people were inoculated against infection.

Because of the 1947 scare, the country was well equipped to address the outbreak

Sara Farhan, historian

It was this outbreak that caused some of the first examples of large-scale border closures, travel restrictions, quarantine, contact tracing and flight groundings.

And while the two diseases are very different (cholera is a bacterial infection that is transmitted via excrement in water, and Covid-19 is a respiratory illness transmitted by infected people or surfaces), the method in which outbreaks were dealt with 73 years ago provide a fascinating insight into how our healthcare has both developed, and remained the same.

The National has studied the 228-page report, A Outbreak of Cholera in the Trucial Coast, held by the British Library, and worked with a historian to determine how this could have informed the response to the 2020 pandemic.

"This is a lesson of how early state mitigation can prevent an outbreak," Sara Farhan, assistant professor of history and medicine historian at the American University of Sharjah, says.

"The scare prompted local officials to embark on an inoculation campaign, invest in advancing the health apparatus of their sheikhdoms, and ensure that should an outbreak occur, they would be adequately prepared to address it promptly and swiftly."

In September 1947, Egypt was experiencing a cholera outbreak that had yielded 20,804 cases and 10,277 deaths a staggering 50 per cent mortality rate. The epidemic went on to reach Syria, and neighbouring countries such as Iraq and Palestine. August 1947 was also when India was partitioned; during which, a devastating cholera outbreak killed millions across India and Pakistan.

This was all of great concern to the British, who wielded great influence over Egypt through its proprietorship of the Suez Canal, and were wary of the country's proximity to the Arabian Gulf and its trade routes. They feared that an outbreak in the Trucial States was only a matter of time.

"In the aftermath of the Second World War, British troops were in India, Iraq, Egypt, and the Trucial States to name a few. The connection between these areas facilitated a marvellous exchange of vibrant culture, people and ideas. These interactions also facilitated the communication of diseases," Farhan says.

"Cholera outbreaks emerged in the 19th century and quickly reached pandemic status through increased communication and improved transportation."

Much the same as Covid-19, cholera spread quickly through trade and ports, and caused economic and agricultural devastation.

The first case of cholera arrived in Dubai on November 4, 1947. In a letter, the residency agent of Sharjah informed the political agent in Bahrain of a case of cholera and two suspected deaths from the disease.

Immediately, demands were made to find out the patient's movements for the past 10 days, as well as their contacts. It was then requested that anyone the cholera patients had come into contact with, as well as the patient themselves, be isolated.

So, could this have been a very early form of contact tracing?

Perhaps, says Farhan. But it was also an instant and aggressive measure by the Brits to stymie the disease, as they "anticipated an outbreak similar to that reported in Egypt".

In Dubai, the report of the infected case outlined a servant dying after vomiting and purging. "He looked dried up," it says.

People who had come into contact with the deceased were moved to another house on the outskirts of the city.

"Under the circumstances, Dubai and Sharjah must be considered as infected localities and necessary quarantine restrictions imposed," the report says. "Till the contrary is proved by the non occurrence of further cases for a period of at least three weeks."

The next day, a letter to Bahrain outlined the fact the Trucial States had "limited resources to counter the outbreak" and a request was made for quarantine medical officer, Captain MLA Steele, to be permitted to fly to Sharjah by RAF plane "immediately".

In the following days, 20,000 cases of the cholera vaccine were sent for from Sharjah to London and a request was made that "inoculation is energetically carried out".

Quarantine efforts and border closures across the Arabian Gulf came quickly afterwards.

On November 6, Iraq closed its borders to travellers from India, Pakistan and the Arabian Gulf.

In Kuwait, travellers arriving from Egypt were quarantined for six days.

"The main reason for the isolation of Kuwait and Bahrain from Iraq is fear that travellers may leak through from Egypt without undergoing quarantine," a letter dated November 14, says.

"A case of America Oil Company employees who went to Kuwait from Egypt by air, stayed there, 'passed a day or two' and then flew on to Baghdad where they did not reveal they had recently been in Egypt and stayed at a hotel in quarantine."

Later, as guidelines were updated, the residency agent in Sharjah was instructed to stop all passenger traffic by dhows or steamer heading to Bahrain. Boats from Karachi and Bombay were ordered to have cholera inoculation certificates.

The scare led to the inoculation of a quarter of the populations of Sharjah and Dubai a cost-effective measure to dealing with the alternative a devastating cholera outbreak

Other travellers were warned they may suffer four days' delay "due to steamers being placed in quarantine at the entrance of the [Iraqi] port".

Cholera inoculation certificates were later introduced as mandatory for other countries.

"The policies were indicative that local officials were specifically isolating areas where there was a cholera outbreak Syria, Pakistan, India and Iraq," Farhan says.

And even 1947 wasn't immune from misinformation. As we are experiencing on social media amid the coronavirus outbreak, it isn't always easy to tell fact from fiction.

On November 8, Bahrain's political agent sent a seemingly contradictory report to all agents in the area, saying there was no cholera outbreak in Dubai as there was "bacteriological proof lacking".

"As a precaution Dubai is being treated as cholera infected and preventative measures are being taken," the same report says.

"The only means at our disposal of suppressing the epidemic is preventative inoculation and to try his best to inoculate every resident in Dubai."

Doctors then went door-to-door vaccinating the city's residents.

But to confuse matters further, at the same time, authorities in Dubai and in Bahrain were alerted to a report by the BBC that had "specifically mentioned Dubai as the port at which cholera had broken out". Questions abounded as to where the erroneous information had come from.

A report at the time from Sharjah to Bahrain reads: "The news about cholera was not sent by anyone from the Trucial Coast to BBC. On the 4th of November, the Officer Commanding, Royal Air Force, Sharjah, wired to Royal Air Force Headquarters informing them of the outbreak of cholera in Dubai as reported to him by the Medical Officer and it is very likely that the Royal Air Force or others passed on the information to BBC."

Farhan says this announcement "puzzled local health officials as only three cases were recorded and a handful of suspected cases."

"Nonetheless, local officials quickly adopted the policies of neighbouring countries. Sharjah grounded the Royal Air Force, and limited entry into the country."

Daily case counts were also enforced, much the same as they are today.

This came after a dressing down for the Bahrain resident from his counterpart in Kuwait on November 14 for his tardiness: "A report three days old is useless. I require an up-to-date daily telegraph report until Trucial Coast is officially declared free from infection."

Case counts were then sent each day.

Farhan says "it really forced local authorities to adopt preventive measures".

"The scare led to the inoculation of a quarter of the populations of Sharjah and Dubai a cost-effective measure to dealing with the alternative a devastating cholera outbreak."

Subsequent daily reports from Sharjah to Bahrain outlined zero new cases until November 21, two weeks after the first case.

That was the day Iraq relaxed its quarantine restrictions and resumed some flights, except its Cairo to Baghdad route.

Dhows from Bahrain, Kuwait and the Arabian Gulf were once more allowed to enter Iraq's Shatt Al Arab port after a traveller underwent one stool (faecal) examination. This was also on the understanding crew and passengers had been twice inoculated against cholera.

After another week of zero cases, as promised, Dubai relaxed its quarantine restrictions and Iraq relaxed all border restrictions.

However, people coming from Egypt were still required to undergo a stool examination and quarantine for six days.

In the end, the 1947 cholera outbreak in the Trucial States amounted to 12 suspected and three confirmed cases.

So how was a more sinister outbreak avoided? After all, this occurred a year before the World Health Organisation was formally founded, which put in place a more streamlined way of combatting and tracking infectious diseases.

Shortly after the inauguration of the WHO, all participating countries were required to report disease outbreaks, which were later published in the Weekly Epidemiological Record.

And it wasn't for another year, on January 1, 1949, that streamlined instructions for travellers arriving into the Trucial Coast were laid out.

"The scare in the Trucial States led to the delivery of a surplus of anti-cholera remedies as well as the inoculation of a quarter of the local population. It also led to the expansion of the public health apparatus," Farhan says.

"By 1949, the Trucial States began to take serious measures to advance its health apparatus. Hospitals, clinics, as well as vaccination policies and health protocols were implemented."

And the healthcare system in the region continued to be tested. Also in January 1949, Bahrain experienced a smallpox outbreak, which resulted in another contact tracing and quarantine drive.

So, could the 1947 cholera outbreak have informed our response to 2020's Covid-19 pandemic? It certainly laid the foundations for our healthcare system and large-scale disease outbreak response.

And lessons learnt in 1947 certainly stymied a pandemic situation 23 years later.

Farhan points to August 1970, when another cholera outbreak reached the Trucial States.

"Because of the 1947 scare, the country was well equipped to address the outbreak," she says.

Much has changed in the past 73 years. The UAE's healthcare system has rapidly developed and modernised. But our basic response remains the same. Perhaps, 70 years from now, we will be looking back to the Covid-19 response as the event that shaped our response to the next pandemic. Because there will be another one.

Updated: May 29, 2020 04:19 PM

See the original post:
What quarantine was like in 1947: the fascinating story of the Middle East's cholera outbreak - The National

Your head is pounding yet again. You grab another round of pain meds, only to find they no longer work.

You may be suffering from a MOH -- a medication overuse headache -- brought on when the very medications you relied on for relief suddenly become the enemy.

Some 60 million people around the world suffer from headaches brought on by the overuse of medication. It typically happens to people who suffer from migraines, cluster headaches or tension-type headaches who are using medications that don't work.

When the pain doesn't ease, they take another pill, thus setting the scene for what is often known as a "rebound" headache.

Instead of a headache that might call for pain medications two or three times a week, people with MOH now have a headache nearly every day, typically upon awakening. For many, this is a new level of chronic pain -- and there's no miracle pill to fix it.

Is cold turkey best?

Withdrawal therapy is currently the only treatment for this disorder, sometimes combined with physical or behavioral therapy and preventative medicine treatments, sometimes called "bridge therapies."

Those preventative medicine treatments include anticonvulsants, antidepressants, beta blockers and calcium channel blockers that might help control withdrawal pain without risking medication overuse headaches. At times a patient may be given injections of Botox or antibodies designed to thwart migraines.

But not always. In Denmark, for example, guidelines suggest a complete withdrawal, totally discontinuing any pain medications for two months before other options are provided.

"Withdrawal has been recommended for years in European Guidelines, including the most recent published from May 2020," said Dr. Rigmor Jensen, a professor of headache and neurological pain who directs the Danish Headache Center at the University of Copenhagen, and is lead author on a new study to see if those recommendations were right.

In fact, doctors have long debated whether any preventative treatments were necessary to help patients wean off medications -- believing the vast majority of patients did just as well with a cold-turkey approach.

After all, most withdrawal headaches tend to improve in less than a week, although some patients did need to be hospitalized, especially if they were withdrawing from opioids.

"In placebo-controlled studies for preventive treatment, the effect has been modest," Jensen said. "So, we decided to compare these treatment strategies directly in this study to clarify the question."

Jensen and his coauthors hypothesized that withdrawal alone, or withdrawal with preventatives, would work better in reducing overall headache days per month than a preventative approach.

However, the results of their study, published Tuesday in the journal JAMA Neurology, surprised the authors.

While all three treatments were effective in reducing MOH, the largest reductions in headache and migraine days, days with short-term medication use and days with headache pain intensity were seen in the withdrawal plus preventive medicine group.

In addition, people who withdrew from meds with the help of preventatives had a significantly higher chance of being cured of their medication overuse headaches than patients who used preventatives or withdrawal alone.

"We were surprised of the study results and the excellent adherence to the treatment," Jensen said. "We now recommend withdrawal and early start of preventive treatment."

"Having good medical evidence to support the common practice of both stopping the offending agent or agents, and starting a patient on prevention medication right away, will clear up some of the controversy and confusion," said Dr. Rachel Colman, director of the Low-Pressure Headache Program at the Icahn School of Medicine at Mount Sinai in New York.

Doctors should use this study to "provide patients with guidance, support and hopefully relief from a disabling condition," said Coleman, who was not involved in the study and is a member of the National Headache Foundation Health Care Professionals Leadership Council.

Coleman also pointed out that due to timing of the trial, the study did not include the newest options for prevention, called CGRP monoclonal antibodies, that have become available in the last two years. These are a new class of medication created specifically for migraine headaches.

However, Jensen said that going "cold-turkey" may still have some benefits for patients, especially those with less severe rebound headaches. Prior studies have found that when patients feel their actions exert control over their headaches, it can help them from overusing medications in the future.

"Patients who withdraw completely experience that a headache can disappear by itself, and that experience is important when talking about preventing relapse into a new medication overuse," Jensen said.

What causes a MOH?

Just how much pain medication will cause a rebound headache depends on the medicine.

According to the American Migraine Foundation, over-the-counter pain relievers, such as aspirin, acetaminophen, ibuprofen, naproxen and indomethacin, can cause MOH when used 15 or more days per month.

It will only take about 10 days of use for medications that combine caffeine, aspirin and acetaminophen to contribute to a MOH. Ten days is also the max for tryptamine- and ergotamine-based drugs often prescribed for migraines, as well as any of the opiates: oxycodone, tramadol, butorphanol, morphine, codeine or hydrocodone.

Just 200 milligrams of coffee will also trigger a medication overdose headache. That's just one cup of coffee combined with a coke and a plain chocolate bar.

It's not just pain in the head either. Often MOH can cause memory issues, difficulty concentrating, depression, anxiety, irritability, restlessness and nausea.

Now, more than ever, the world needs trustworthy reportingbut good journalism isnt free.Please support us by subscribing or making a contribution today.

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Treating rebound headaches with early preventative meds best choice, study finds - Henry Herald

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Letter to the editor: Can they hate Trump any more? - TribLIVE

CHAPEL HILL, N.C., May 27, 2020 /PRNewswire/ --Leading thrombosis specialists from the International Society on Thrombosis and Haemostasis(ISTH) and World Thrombosis Day(WTD) Steering Committee recommend administering either standard preventative or larger doses of heparin (blood thinning medicine) to combat excessive clotting in all hospitalized COVID-19 patients from the time of hospital admission, unless they have contraindications to those medications.

This proposed "universal" intervention strategy is a change from the current practice of using only preventative levels of such medications after individual venous thromboembolism (VTE) risk assessment of hospitalized patients.

The recommendations are published in a new paper, titled "Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients with COVID-19," published on May 27, 2020 in the Journal of Thrombosis and Haemostasis (JTH). The peer-reviewed paper outlines new practical guidance on the prevention and treatment of VTE in hospitalized patients with COVID-19.

The recommendations were developed by a multidisciplinary panel of thrombosis experts as a response to widespread clinical reports of unusual, difficult-to-control clotting in COVID-19 patients."Early reports suggest COVID-19 is one of the most thrombotic disease states we've ever seen," said lead author Alex Spyropoulos, M.D., member of the WTD Steering Committee. Co-authors include leading scientists from six countries (see below for list).

In issuing new guidance, the authors analyzed reports from colleagues around the world who observed that patients hospitalized with COVID-19 had a high incidence of thrombotic events (blood clots). The authors caution that the data are based on anecdotal reporting rather than rigorous scientific research. Thus, guidance may change as data improves, though the scientists generally agree the recommendations are sufficiently supported to be adopted into practice.

"We consider this a living document," Spyropoulos said. "This is a very fast-moving target. The data are important, but even more important is our need to take care of patients now. We see this correlation with clotting, and we must act."

"In the United Kingdom, we are seeing high rates of blood clots in our patients even as they receive standard doses of blood thinners," said Professor Beverley Hunt, M.D., OBE, WTD Steering Committee Chair. "These patients seem to need larger doses than other sick patients. We need to know the best doses going forward."

Additional research is in development in the UK at this time, via a clinical trial named REMAP-CAP, to capture the response of COVID-19 patients to different dosing levels of blood thinning medications. This will provide more guidance for healthcare professionals globally, Hunt said.

While much remains unknown, the authors have concluded that patients with severe cases of COVID-19 develop VTE at a much higher rate than severely ill patients in general. VTE is a condition in which blood clots form (most often) in the deep veins of the leg (known as deep vein thrombosis or DVT), and can travel in the circulation to lodge in the lungs (known as pulmonary embolism, or PE). The development of this condition in hospitalized COVID-19 patients results in a much higher risk of death, particularly in patients with preexisting cardiovascular disease.

COVID-19 patients in the intensive care unit (ICU) are three to six times more likely to experience DVT than a patient in ICU for some other reason, such as congestive heart failure.

The authors also noted that the clots exhibit particular characteristics. Clots that lead to cardiac events, such as heart attacks and strokes, are typically large. In COVID-19 patients, however, in addition to the usual large clots seen in these patients, smaller clots (microthrombi) are also present in the lungs.

Clinicians have not identified a specific cause of blood clotting in COVID-19 patients, but believe it is due to the extreme immune response to COVID-19 that causes very sticky blood. Early research on COVID-19 found that blood clots are playing a role in a significant percentage of all COVID-19 deaths in the United States. Patients in the United States, however, are not routinely given blood thinners, in contrast to patients in the United Kingdom.

For more information on the paper, "Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients with COVID-19," visit https://onlinelibrary.wiley.com/doi/abs/10.111/jth.14929.

Co-authors include: Jerrold H. Levy (United States), Walter Ageno (Italy), Jean Marie Connors (United States), Beverley J. Hunt (United Kingdom), Toshiaki Iba (Japan), Marcel Levi (United Kingdom), Charles Marc Samama (France), Jecko Thachil (United Kingdom), Dimitrios Giannis (United States), and James D. Douketis (Canada)

SOURCE International Society on Thrombosis and Haemostasis

http://www.isth.org

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Leading Thrombosis Specialists Issue Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients...

(Reuters) - The anti-malarial drug hydroxychloroquine, which U.S. President Donald Trump says he has been taking and has urged others to use, was tied to an increased risk of death in hospitalized COVID-19 patients, a large study published on Friday showed.

In the study https://www.thelancet.com/lancet/article/s0140673620311806 that looked at more than 96,000 people hospitalized with COVID-19, the respiratory disease caused by the novel coronavirus, those treated with hydroxychloroquine or the related chloroquine had higher risk of death and heart rhythm problems than patients who were not given the medicines.

The study, published in the Lancet medical journal, showed no benefit for coronavirus patients taking the drugs.

Demand for the decades-old hydroxychloroquine has surged as Trump repeatedly promoted its use against the coronavirus, urging people to try it. "What have you got to lose?" he asked.

Trump said this week he has been taking hydroxychloroquine as a preventative medicine despite a lack of scientific evidence.

The Lancet study authors suggested that hydroxychloroquine and chloroquine should not be used to treat COVID-19 outside of clinical trials until studies confirm their safety and efficacy in such patients.

There is a frantic search for drugs to treat COVID-19 at the same time that multiple research teams pursue a safe and effective vaccine to combat a pathogen that has killed more than 335,000 people worldwide and sickened millions more.

The U.S. Food and Drug Administration has allowed healthcare providers to use the drugs for COVID-19 through an emergency-use authorization, but has not approved them to treat it.

Dr. Mandeep Mehra, one of the study's authors, said the research shows that the FDA should withdraw that authorization.

"That will help move this towards more, stronger evidence because it will then force the use of these drugs only in the setting of control trials," Mehra said in an interview. "That would be an extremely wise decision."

The FDA has said that, for safety reasons, hydroxychloroquine should be used only for hospitalized COVID-19 patients or those in clinical trials. The drug has been tied to dangerous heart rhythm problems.

The Lancet study looked at data from 671 hospitals where 14,888 patients were given either hydroxychloroquine or chloroquine, with or without an antibiotic, and 81,144 patients were not given such treatments.

Both drugs have shown evidence of effectiveness against the coronavirus in a laboratory setting, but studies in patients had proven inconclusive. Several small studies in Europe and China spurred interest in using hydroxychloroquine against COVID-19, but were criticized for lacking scientific rigor.

Several more recent studies have not shown the drug to be an effective COVID-19 treatment. Last week, two studies published in the medical journal BMJ showed that patients given hydroxychloroquine did not improve significantly over those who were not.

Hydroxychloroquine is used to treat lupus and rheumatoid arthritis as well as malaria.

Hospitalized patients tend to have a more severe version of COVID-19. Some proponents of the drugs for COVID-19 argue that they may need to be administered at an earlier stage to be effective.

There are ongoing randomized, controlled clinical trials to study the drug's effectiveness in preventing infection by the coronavirus as well as treating mild to moderate COVID-19. Some of those may yield results within weeks.

(Reporting by Ankur Banerjee and Manas Mishra in Bengaluru and Michael Erman in New York; Editing by Saumyadeb Chakrabarty, Bill Berkrot, Jonathan Oatis and Will Dunham)

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Drug Touted by Trump as COVID-19 Treatment Tied to Increased Risk of Death: Study - The New York Times

In mid-March, filmmaker Robert Cibis at the time best known for a 93-minute documentary about a master piano tuner uploaded a short interview with the German physician and socialist politician Wolfgang Wodarg to YouTube. In the video, Wodarg alleges that the Covid-19 pandemic is a hype drummed up by sensationalist virologists and spread by scientists who want to be important in politics because they need money for their institutions.

Within days, the Wodarg interview had been viewed hundreds of thousands of times (the total now tops 2 million on YouTube), and Cibis and his production company, Oval Media, started raising money for a documentary, called Corona.film. Featuring Wodarg and other scientists, the film is billed as an exploration of the coronavirus and its media influence. On the crowdfunding platform IndieGoGo, hundreds of people have chipped in donations totaling about $105,000 to keep the project going.

The trailer for Corona.film features a high-profile scientist alongside Wodarg: John Ioannidis, a professor of medicine, epidemiology, and population health at Stanford University. Ioannidis co-directs a major center at Stanford that pushes for more rigorous biomedical research; a 2010 Atlantic magazine profile argued that he may be one of the most influential scientists alive. During the current pandemic, while praising public health officials, Ioannidis has criticized the lockdowns as based on too-thin evidence a position that has earned him fierce, albeit respectful,criticismfrom many colleagues. (The pushback intensified this week over a new Ioannidis analysis that many of his colleaguespilloriedonline, with somecitingoversights and inconsistencies in the data included in the study.)

In the teaser, after Wodarg calls for a closer look at the coronavirus epidemic that we allegedly are having right now, Ioannidis explains that, while elements of the pandemic are serious, he thinks there is a very high chance we are exaggerating the risk of the novel coronavirus.

Asked about Corona.film, Ioannidis told Undark he had never heard of it.

As SARS-CoV-2, the coronavirus that causes Covid-19, has swept across the globe, killing hundreds of thousands of people and overwhelming medical systems in the United States, Italy, Ecuador, and other countries, the pandemic has also nurtured a rich ecosystem of digital backlash. To be sure, some people have raised serious and reasonable questions about whether global lockdowns are worth the economic and social cost, which could be especially devastating in some developing countries. But many more hew to unfounded theories that the pandemic is, for example, caused by 5G towers; that it emerged from a lab in China; or that it is the result of a conspiracy by global leaders and plutocrats, especially billionaire Bill Gates.

The story of how footage of the Stanford professor ended up in Corona.film is just one example of how, amid the confusion of the pandemic, the views of serious scientific dissenters are being swiftly metabolized by a sprawling world of ideologues and conspiracy theorists. The tale runs through an independent film distribution company, and it involves a New York-based filmmaking team that has found millions of viewers online through an interview project that features a rich mix of marginal perspectives and pedigreed academics, Ioannidis most prominent among them.

The scientists in the films are not conspiracy theorists, theyre not anti-vaxxers theyre not like us, says one of the filmmakers, John Kirby, who suggested, without citing specific evidence, that the pandemic has been engineered by a global elite seeking to expand itscontrol over the world. But they are incredibly eminent, respected people who are thankfully independent enough to raise a question.

Before the Covid-19 pandemic began, Kirby and his filmmaking partner, Libby Handros, were working on a documentary about the assassinations of the 1960s, including the 1963 murder of President John F. Kennedy, which some people have long-maintained was the result of a government conspiracy. Media coverage of the coronavirus, Kirby told Undark, sounded similar to how they see coverage of the Kennedy assassination: an obfuscation of a deeper, more frightening truth. We sensed a rollout, a very large rollout, Kirby said.

We just want to keep bringing out alternative, sometimes overlapping opinions from experts and journalists.

The filmmakers approached Ioannidis for an interview, producing an hourlong video in which he analyzes the Covid-19 response, speaking in detail about the difficulty of pinning down precise data about a fast-moving pandemic. With the Ioannidis interview in hand, Handros and Kirby pitched the series to Journeyman Pictures, an independent film distributor in the United Kingdom that works with hundreds of documentaries each year.

We saw it as something interesting which would give, exactly as we called it, Perspectives on the Pandemic a broader perspective than we were getting from the increasingly controlled and narrow line being fed to us by the mass media every day, said Mark Stucke, the founder and managing director of Journeyman Pictures.

Journeyman signed Handros and Kirby up and began sharing the Ioannidis video with its 1.4 million YouTube subscribers. Off we went, Stucke said. And boom! It did go boom.

The interview soon picked up hundreds of thousands of views. Thousands also tuned into a conversation with David L. Katz, a physician, former Yale professor, and expert in preventative medicine who has drawn attention for a New York Times op-ed arguing that the negative effects of the lockdowns could outweigh the benefits.

Millions more people watched a viral interview with Knut Wittkowski, a former biostatistician at Rockefeller University who argues that the virus should be allowed to spread unchecked among healthy people until enough people become immune a strategy, widely criticized by experts, that has been partly adopted by the chief epidemiologist in Sweden.

Follow-up conversations with Wittkowski and Ioannidis, in which the latter described the results of his controversial study of Covid-19 prevalence in California, brought hundreds of thousands more views.

In a wide-ranging interview, Kirby and Handros spoke with Undark about the Kennedy assassination, Handros clashes with Donald Trump in the 1990s over a film she made, and Kirbys opposition to current vaccine policies, as well as his suspicion that Bill Gates is planning and manipulating the pandemic response. Most people are not ready to understand that this is not just sort of a public health crisis that governments are doing their best to respond to and maybe screwed up, Kirby said, without offering clear evidence. We just want to keep bringing out alternative, sometimes overlapping opinions from experts and journalists, he added, noting that they may start covering a range of topics. We want to ease people into some of the harder-to-appreciate stuff.

Some of the content in Perspectives on the Pandemic veers more directly into anti-government politics. In the first interview with Wittkowski, published in early April, the scientist said: Im not paid by the government, so Im entitled to actually do science. He also suggested that, left unchecked, the virus could exact a death toll of 10,000 in the U.S. and disappear on its own.

Today, the official U.S. death count is above 90,000, with cases rising in much of the country. In a phone conversation and follow-up emails, Wittkowski defended his projections, arguing that, while specific predictions may not bear out, he was correct to question lockdowns, and that the current death count was dramatically overstated. (There is growing evidence that it is actually an underestimate.) He claimed that the course of the pandemic was as predictable as the effects of gravity. Social distancing is a strategy for the government to reduce the democratic rights of the people, he wrote.

The idea that the Covid-19 pandemic is the result of a conspiracy is ludicrous.

Rockefeller University has publicly distanced itself from Wittkowski, explaining in a statement that comments about discouraging social distancing he has made do not represent the views of The Rockefeller University, its leadership, or its faculty. But his videos for Perspectives on the Pandemic have received widespread attention, including in the New York Post and The Epoch Times an outlet, analysts say, that has been instrumental in pushing the thus-far-unfounded claim that the SARS-CoV-2 virus originated in a Chinese lab and the American Institute for Economic Research, a right-leaning think-tank. Wittkowski has also appeared on an internet talk show hosted by Del Bigtree, a prominent anti-vaccination activist.

Earlier this month, YouTube removed one of Wittkowskis interviews for Perspectives on the Pandemic, citing unspecified violations of its policies. This week, YouTube removed Wittkowskis other interview, as well as the first, long, interview with Ioannidis.

According to YouTube, the Ioannidis video violated the platforms Covid-19 Medical Misinformation Policy, which, among other rules, states that YouTube doesnt allow content that spreads medical misinformation that contradicts the World Health Organization (WHO) or local health authorities medical information about Covid-19. A YouTube spokesperson did not respond to a request on Friday afternoon for specific details about how the Ioannidis interview had violated that policy.

Journeyman Pictures is asking YouTube for clarification regarding the decisions.

After watching the Ioannidis interviews, Cibis approached Journeyman about using the footage in his Covid-19 documentary. The distributor had worked with Oval Media on a previous documentary, also featuring Wodarg, that alleges corruption at the WHO. Stucke agreed, which is how Ioannidis ended up featuring prominently in a trailer for the film, alongside Wodarg, who has continued to argue, despite the mounting global death toll, that the pandemic is largely a fabrication.

Cibis told Undark that he had been surprised and a little frightened by the strong reactions to his original interview with Wodarg, acknowledging that it may have been just naive to publish the video without any research or context. But he rejected characterizations of Wodarg as a conspiracy theorist. His new film, he said, will have diverse perspectives although he added that he has concerns about using footage from one high-ranking Italian public health official who has warned that the virus is particularly dangerous, because Cibis feels it was unscientific and just fear-making.

Stucke, meanwhile, said that while he was aware that Handros and Kirby fit comfortably at the conspiratorial end of the world of journalism, he thought their project seemed sound, and that they were speaking with qualified sources. The Wittkowski interview, though, ultimately gave him pause. He said that if he had seen this interview first and as a standalone piece, rather than in the context of other interviews in the series, I would have probably thought twice about saying Yes, go for it. He admitted to knowing little about certain details of the Cibis project.

Some participating scientists, too, seemed surprised about the context in which their interviews were being presented. Asked whether he was aware of the conspiracy-oriented side to the Perspectives on the Pandemic project, Yale Universitys Katz replied No in an email, adding that the idea that the Covid-19 pandemic was the result of a conspiracy is ludicrous.

The interview was long-form, meaning I could speak my full views so it seemed a good venue, Katz wrote.

All that I really count on the production side to do, he added, is (a) not alter my views by editing them or taking them out of context; [and] (b) give me an audience.

Ioannidis said he was unaware that Journeyman had licensed footage of his interview to the German filmmakers. He also expressed surprise that there might be a conspiracy-oriented dimension to the Perspectives on the Pandemic series. I am clearly not aware of that, he said. Ive talked with John Kirby for two hours during these interviews. None of these questions arose.

People with different conflicts of interest, they will probably use ammunition from perspectives or data or science that has nothing to do with their agenda. It is a concern, Ioannidis said. I do share that concern, but its impossible to censor science, or to, lets say, factor every possible crazy perspective into account before you say, well, These are my data, and this is what I think about them.

But Leah Ceccarelli, a scholar of rhetoric and communication the University of Washington who studies scientific controversy, was skeptical about that line of argument.

Of course, the scientist wants to present the ethos of the disinterested searcher for truth, she said. As a scientist, Im just telling you the way that it is, and its not my job to think about the politics of this.

But that, Ceccarelli said, is totally naive.

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In Online Covid-19 Videos, A Mix of Science and Conjecture - Undark Magazine

WASHINGTON - Malaria drug hydroxychloroquine, which U.S. President Donald Trump says he has been taking, is tied to increased risk of death in COVID-19 patients, according to a study published in medical journal Lancet.The study which observed over 96,000 people hospitalized with COVID-19, showed that people treated with the drug, or the closely related drug chloroquine, had higher risk of death when compared to those who had not been given the medicine.Demand for hydroxychloroquine, a drug approved decades ago, surged after Trump touted its use as a coronavirus treatment in early April. Earlier this week, he surprised the world by admitting he was taking the pill as a preventative medicine.The Lancet study authors suggested these treatment regimens should not be used to treat COVID-19 outside of clinical trials until results from clinical trials are available to confirm the safety and efficacy of these medications for COVID-19 patients. The authors said they could not confirm if taking the drug resulted in any benefit in coronavirus patients.Weeks ago, Trump had promoted the drug as a potential treatment based on a positive report about its use against the virus, but subsequent studies found that it was not helpful. The U.S. Food and Drug Administration in April issued a warning about its use.The Lancet study looked at data from 671 hospitals, where 14,888 patients were given either hydroxychloroquine or chloroquine, with or without the antibiotic macrolide, and 81,144 patients were not on any of the treatment regimens.

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Drug Touted by Trump as COVID-19 Treatment Tied to Increased Death Risk, Study Finds - Voice of America

The first UK frontline NHS worker will today enrol in a new study designed to test the potential of hydroxychloroquine to prevent infection with novel coronavirus.

COPCOV is the largest multi-national interventional clinical study into the prevention of COVID-19 using hydroxychloroquine, which will involve around 40,000 healthcare workers.

The study has launched at Brighton and Sussex University Hospitals and the John Radcliffe Hospital in Oxford, which are the first of 20 UK hospitals set to participate.

Researchers hope to determine whether hydroxychloroquine/chloroquine can be used to effectively protect frontline medical staff, allowing them to undertake their vital roles more safely.

Accord Healthcare, a UK-based medicines manufacturer, has donated over two million tablets to enable this landmark trial to go ahead.

Based on the known pharmacology of hydroxychloroquine, coupled with the emerging knowledge surrounding SARS-CoV-2 viral replication and COVID-19 pathophysiology, we were very keen to test the effectiveness of this molecule in a preventative, rather than late-stage treatment setting, said Dr Anthony Grosso, VP & head of Scientific Affairs, Accord Europe & MENA.

A large-scale, prospective, randomised, double-blind clinical trial in a high-risk setting is the only way to robustly determine if this medicine can lessen or prevent human infection. Previous studies have not adequately tested this hypothesis; the results of COPCOV are therefore of critical importance to public health.

Even though lock-down measures appear to have significantly reduced the current rate of infection in the UK, healthcare workers will continue to be at risk of contracting COVID-19, especially as measures are relaxed, added Professor Martin Llewelyn, Brighton and Sussex Medical School and lead COPCOV UK Investigator.

Whilst we wait for an effective and widely available vaccine, the race is on to find a well-tolerated preventative treatment. The results from COPCOV are expected later this year and, if they show that hydroxychloroquine can reduce the chances of catching COVID-19, this would be incredibly reassuring for myself and my frontline colleagues.

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First UK healthcare worker to enrol in COVID-19 prevention trial - PharmaTimes

The buck arguably stops with Dr. Wilma Wooten as the San Diego region starts to reopen its economy amid the worst pandemic in a century.

Wooten, the countys public health officer, cleared the way this week for resuming in-person dining at restaurants, as well as shopping at retail stores and swap meets. Her plan, which received state approval on Wednesday, makes San Diego the largest county in California to move ahead on Gov. Gavin Newsoms official timeline for easing lockdown conditions.

So far, the region has fared notably well under Wootens leadership when it comes to fending off the new coronavirus. Hospitals have not been overwhelmed with sick patients, and while its taken time, testing capacity and contact tracing appear to be ramping up.

Still, the largest challenge for the 63-year-old Alabama native may lie ahead. As corporate heavyweights and small business owners push for commerce to resume, health experts have said hospitals should brace for a spike in illnesses and deaths.

Wooten is a widely respected medical professional who received high praise for her handling of the 2009 swine flu outbreak that started in San Diego, but her political skills could be tested. Four years ago, she was thrust into the spotlight when a rash of hepatitis A cases ripped through the local homeless community. A state audit found she mishandled the crisis by not forcing the city to deal with the outbreak sooner and more forcefully.

A spate of new COVID-19 cases could force Wooten into a faceoff with elected leaders eager to please their out-of-work constituents something she says shes prepared for.

It will be difficult to dial back, but we will have to if things get out of hand, she said during an interview Thursday. This is a challenge of all health officers across the nation.

So far, disagreements over tackling the coronavirus pandemic have been relatively minor, such as when conservative Supervisor Jim Desmond recently downplayed the seriousness of the coronavirus outbreak by pointing out that all but six of the countys fatalities involved underlying health conditions.

Dr. Wilma Wooten, San Diego County public health officer

Wooten quickly rebutted the supervisors comments at one of the countys regular press briefings, saying that the lives of those with existing medical conditions were no less valuable than others.

Still, Desmond is not alone in his push to loosen restrictions far beyond what Newsom and his team in Sacramento have called for. San Diego Mayor Kevin Faulconer and the entire Board of Supervisors save its lone progressive, Supervisor Nathan Fletcher have called for reopening the economy far beyond what the state and the health officer appear comfortable with.

Wooten, with Fletchers support, has repeatedly called for following the guidance of state leaders as well as the Centers for Disease Control and Prevention.

We are very sensitive of the importance to balance protection of the publics health with economic viability, and we are following the governors guidance, she said.

That message comes in contrast to a letter recently penned by San Diego Mayor Kevin Faulconer and Supervisor Greg Cox urging the governor to allow local jurisdictions to control the speed at which they reopen.

Our businesses are ready to thoughtfully reopen and adapt with necessary protective measure, but they need to be provided that opportunity, the letter reads in part.

Wooten grew up with what she described as meager means in Thomaston, Ala., a rural town of fewer than 1,000 people and one streetlight.

Raised by her great grandparents, she and her brother spent a lot of time helping the local elderly community. She said the experience helped her develop an enduring sense of public service, and from a young age, she knew she wanted to get into medicine.

Valedictorian of her high school class, she attended Spelman College in Atlanta. Before graduating from the historical black college for women in 1978, she met Roslyn Crisp, who would become her lifelong friend.

Crisp, a 63-year-old pediatric dentist from North Carolina, said they mostly avoided parties and focused on their academic careers. They still see each other a few times a year and regularly vacation together.

She has the qualities that I think anybody would want in a friend, Crisp said of Wooten. Shes very compassionate. Shes understanding. Shes a good listener.

If she gives you an opinion, honestly, I really feel like she has thought it out, and shes done her homework.

Wooten went on to attended the University of North Carolina School of Medicine, where she graduated with a degree in medicine in 1986. She did her residency at the recently closed Providence Hospital in Washington, D.C.

She came to San Diego in 1989 to do her residency in preventative medicine at San Diego State University under Dr. Kevin Patrick, now a professor emeritus of family medicine and public health at the UC San Diego School of Medicine.

A year later on Patricks advice, Wooten applied to work at UCSD and was hired to, among other things, research family and preventive medicine.

She was very practical in her approach to things and very hard working, Patrick recalls. Obviously, she cares for the community. I think the social justice component was really important for Wilma.

Wooten was hired by San Diego County in 2001 to serve as deputy health officer. At the time, she was also volunteering on medical trips to Jamaica, Kenya and Ghana to treat and educate patients vulnerable to communicable diseases, such as AIDS.

In 2007, she was elevated to public health officer, overseeing the countys Public Health Services agency, which currently has about 500 employees and a $100 million budget. She currently makes a salary of $270,836 a year.

Her first big challenge came in 2009, when San Diego became ground zero for the countrys H1N1 swine-flu epidemic. Wooten would later win a national Public Health Heroes award for her work.

She is one of my public-health heroes, said Dr. Ron Chapman, public health officer for Californias Yolo County. He serves with her on the Public Health Accreditation Board. Dr. Wooten is brilliant, insightful, caring, and a strategic thinker.

Dr. Wilma Wooten showed the proper way to cough during a 2009 briefing on the H1N1 flu death of a county resident.

In March 2017, Wooten declared an outbreak of hepatitis A, which was infecting homeless people and illegal drug users through feces. Nobody knew at the time, but it would become the countrys worst eruption of the disease since a vaccine was introduced in 1995.

What happened over the next six months led to intense media scrutiny and finger pointing between county officials and San Diego Mayor Kevin Faulconers team.

While the county would later suggest the city dragged its feet on sanitation, the mayors team faulted the county for not taking charge during the outbreak.

This is a dark stain on our communitys civic record, said Assemblyman Todd Gloria, D-San Diego. Hepatitis is a disease that we know a lot about, that we have tests for, that we have a vaccine for. The fact that it killed 20 people and infected over 500 more was a real indictment of our public health infrastructure.

At the time, the city much like other parts of Southern California that experienced simultaneous, albeit smaller outbreaks of hepatitis A had long been entwined in a debate about whether homeless communities had adequate access to toilets and proper sanitation.

Advocates had routinely criticized Faulconer for not increasing the number of public toilets downtown, citing grand jury reports from 2010 and 2015 that warned unsanitary conditions in the city could lead to an outbreak of disease.

The issue became a political hot potato, with residents and local business owners complaining that public toilets invited unsavory behavior. In 2015, the mayor removed one of two metal toilets downtown, known as Portland Loos, which had cost the city roughly $560,000. The second loo was then removed at the height of the hepatitis outbreak.

Assemblyman Todd Gloria, D-San Diego

Wooten issued the first public health directive of her career on Aug. 31, 2017, calling on the city of San Diego to expand access to public restrooms and hand-washing stations, as well as to ramp up street-cleaning efforts.

The next day she declared a health emergency, and Faulconer made his first public statements on the issue, despite that fact that the city had quietly warned its own workers for months about the danger of infection.

Nobody wanted to take the lead, recalled Michael McConnell, a prominent local advocate for the homeless. Nobody wanted to be in charge of this thing, and on the ground it was just a train wreck.

Wooten and her team ramped up a vaccination program that eventually helped stem the outbreak.

However, California State Auditor Elaine Howle released a report in 2018 that found they should have acted faster. It faulted both the city and the county for not tackling sanitation earlier, but called out the county for being too lenient with Faulconers team.

The county health officer did not issue a directive sooner because she wanted to collaborate with the city instead of mandating its compliance, the report read. However, by exercising her legal authority before August 31, 2017, the county health officer likely would have prompted the city to implement the important sanitation measures sooner.

Gloria and Assemblywoman Lorena Gonzalez, D-San Diego, co-authored a bill in response to the audit report that cemented a local health officers authority to compel other government agencies to take action to curb the spread of disease.

According to the audit report, the countys own legal counsel questioned Wootens authority to issue Faulconer the health directive.

Neither Wooten nor Faulconer want to relitigate the hepatitis A crisis, citing the need to collaborate during the current pandemic.

That happened, and were in a different place now, and we have a great relationship with actually all of the municipalities that are in San Diego County, Wooten said.

Wooten has been much more visible in the current crisis, and the stakes are much higher due to the weeks-long shutdown of the economy and pressure to reopen it. She and other officials are giving regular video updates on Facebook and Twitter concerning issues that intimately impact the lives of nearly everyone in the county, from wearing face masks to opening local beaches.

The relationships been a bit rocky at times.

Wooten, for example, suggested in a press briefing this month that she would block casinos on tribal lands from reopening, saying: We feel that the health officers order does extend to our tribal nations in this particular situation.

Wooten reversed her position the next day after meetings with tribal leaders, acknowledging that, Tribal nations have sovereign authority, so our plan is to provide guidance and advice where possible.

In an appearance at the Rock Church on March 15, Wooten dismissed the idea that the virus could be spread by those without symptoms.

Oh, I heard that it was that you could without symptoms, said Pastor Miles McPherson during an exchange.

There are a lot of rumors and misinformation out there, Wooten responded. Even if theyve been exposed to someone who did have symptoms, if they do not have symptoms, others who have come in contact with that individual should be at low or no risk for developing the disease.

At the time, evidence of asymptomatic transmission was just starting to percolate. Its now believed that has played a significant role in spreading the virus. Wooten was not technically wrong about the state of research at the time, as shes quick to point out.

That was not a misstep, Wooten told the Union-Tribune. That was based on the facts that we had that day.

County public health officer Wilma Wooten M.D., and other officials, provide the latest updates on COVID-19 Coronavirus at the County Operations Center on February 14, 2020 in San Diego, California.

(Eduardo Contreras/The San Diego Union-Tribune)

Now Wooten has taken another bold leap into the unknown.

On Tuesday, she submitted a plan to the state for reopening restaurants, retail businesses and swap meets. Officials in Sacramento approved the plan the next day, making San Diego a test case for lifting stay-at-home orders in a highly urbanized area.

While Los Angeles County doesnt currently appear to meet the states requirements for reopening such businesses, several Bay Area counties seemingly do but have chosen to remain under lockdown, including Marin, San Mateo, Contra Costa, Sonoma and San Francisco.

San Diego has fared reasonably well during the pandemic, with about 6,300 cases and about 240 deaths as of Friday. Still, the decision to reopen comes at a time when the region is barely meeting the states benchmarks for doing so.

For example, the state has required as a condition for reopening such businesses that San Diego County be testing at least 4,950 people for the virus a day, or 1.5 people per 1,000 residents. The county reports that its currently testing only about 4,000 people a day on average, although it expects to meet or exceed the states benchmark by June.

The state has also called for counties to have enough open hospital beds to accommodate a surge in COVID-19 patients of roughly 35 percent. San Diego County currently has just enough free space across its 24 hospitals to meet the requirement, according to the report.

Theres also a question about whether the San Diego has enough contact tracers to be able to isolate infection clusters before they get out of control.

The state has called on counties to have at least 15 contact tracers for every 100,000 residents in order to open shops and eateries. That would be roughly 500 trained professionals for the San Diego region. Currently, the county reports that it has only 87 tracers, although its says the county has hired another 329 tracers that are currently completing their training. San Diego State University will also provide another 100 tracers at some point, according to the county.

Still, Wootens plan for reopening certain businesses appears to have the support of the local medical community. UC San Diego Health CEO Patty Maysent called the plan on Tuesday incredibly thoughtful.

I think it addresses the main issues that we need to follow, she said. The metrics that are laid out in the plan are in my mind pretty factually based.

The plan also has the backing of Fletcher, who appears to be Wootens firewall against politicians who would swing the doors open on the economy tomorrow if they could.

Dr. Wooten is one of the hardest-working public servants that Ive encountered in my time working in government, he said. She works on these issues of public health every single day, seven days a week, all day long.

Read more here:
Meet Dr. Wilma Wooten, who wrote the plan to open San Diego restaurants and shops - The San Diego Union-Tribune

Naoki Yuda,1 Miyuki Tanaka,1 Koji Yamauchi,1 Fumiaki Abe,1 Izumi Kakiuchi,2 Kyoko Kiyosawa,2 Mitsunaga Miyasaka,2 Naoki Sakane,3 Masahiko Nakamura4

1Food Ingredients and Technology Institute, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan; 2Department of Nursing, Matsumoto Junior College, Matsumoto, Nagano, Japan; 3Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan; 4Matsumoto City Hospital, Matsumoto, Nagano, Japan

Correspondence: Naoki YudaFood Ingredients and Technology Institute, Morinaga Milk Industry Co., Ltd., 1-83, 5-Chome, Higashihara, Zama, Kanagawa, JapanTel +81 46 252 3051Fax +81 46 252 3017Email n-yuda@morinagamilk.co.jp

Background: Preventative measures have recently been taken to reduce the incidence of Alzheimers disease worldwide. We previously showed that Met-Lys-Pro (MKP), a casein-derived angiotensin-converting enzyme inhibitory peptide with the potential to cross the bloodbrain barrier, attenuated cognitive decline in a mouse model of Alzheimers disease. However, the effect of MKP on cognitive function improvement in humans remains unknown. This exploratory study sought to investigate whether MKP intake could improve cognitive function in adults without dementia.Methods: A total of 268 community-dwelling adults without dementia participated in this 24-week randomized controlled trial. Participants were randomly allocated to the MKP (n = 134) or placebo (n = 134) group. The MKP group received four tablets daily, each containing 50 g MKP, while the placebo group received four dextrin tablets containing no detectable MKP for 24 weeks. Scores on the Japanese version of the cognitive subscale of the Alzheimers Disease Assessment Scale (ADAS-cog) were used as the primary outcome to compare cognitive function between the MKP and placebo groups. The study products were also evaluated for safety.Results: The intention-to-treat analysis showed that there was no significant difference between the groups in terms of the ADAS-cog total score. Orientation, as measured by the respective ADAS-cog subscale, was significantly improved compared to placebo at 24 weeks post-MKP administration (P = 0.022). No serious adverse events due to MKP intake were observed.Conclusion: To the best of our knowledge, this is the first study to report the effects of MKP on human cognition. These preliminary results suggested the safety of daily MKP intake and its potential to improve orientation in adults without dementia. Further clinical studies are needed to confirm the present findings and the benefits of MKP on cognitive function.

Keywords: humans, MKP, cognition, cognitive dysfunction, orientation, Alzheimers disease

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Effect of the Casein-Derived Peptide Met-Lys-Pro on Cognitive Function | CIA - Dove Medical Press

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New Delhi: The Indian Council of Medical Research (ICMR), the countrys apex body in the field, has found that consuming the drug hydroxychloroquine reduces the chances of getting infected with Covid-19.

As a result, ICMR released an advisory Friday to expand the usage of HCQ an anti-malarial drug as a preventive treatment against the novel coronavirus.

The conclusion has been drawn on the basis of three studies conducted by the ICMR.

The advisory suggests surveillance workers, paramilitary and police personnel, as well as medical staff working in non-Covid hospitals and blocks to start consuming the pill as preventive therapy.

ICMR had issued an advisory to begin using HCQ in March, but it had drawn criticism for lacking scientific evidence that the drug works against the novel coronavirus.

Also read: How the humble hydroxychloroquine has become Indias unlikely new global strategic asset

According to the advisory, the premier health body undertook investigation at three central government hospitals in New Delhi. While it did not reveal the names of the hospitals, it said the investigation indicates that amongst healthcare workers involved in Covid-19 care, those on HCQ prophylaxis were less likely to develop SARS-CoV-2 infection, compared to those who were not on it.

The advisory also states that the National Institute of Virology in Pune has found in laboratory testing that HCQ reduces the viral load.

The ICMR also analysed data collected previously, known as retrospective case-control analysis, and found a significant relationship between the number of doses taken and frequency of occurrence of Covid-19 infection in symptomatic healthcare workers who were tested for SARS-CoV-2 infection.

It further said the benefit was less pronounced in healthcare workers caring for a general patient population.

Another observational study was conducted among 334 healthcare workers at the countrys largest public hospital, New Delhis All India Institute of Medical Sciences (AIIMS). The 248 workers who took HCQ as preventive drug for an average of six weeks had lower incidence of the infection than those not taking the pill.

Based on the findings of the studies, the government has decided to administer the drug as a prophylaxis or preventive therapy to asymptomatic healthcare workers working in non-Covid hospitals as well as non-Covid blocks of hospitals earmarked for Covid treatment.

Asymptomatic frontline workers, such as surveillance workers deployed in containment zones, as well as paramilitary and police personnel involved in Covid-related activities will be asked to pop HCQ pills.

Until now, only high-risk individuals, including asymptomatic healthcare workers involved in containment and treatment of Covid-19 patients, and asymptomatic household contacts of laboratory-confirmed cases, were being administered the drug. They will continue to consume the drug.

While the dosage will remain the same as before, eight weeks, the ICMR advisory suggests that it can be used beyond that period as well, but with close monitoring.

With available evidence for its safety and beneficial effect as a prophylactic drug against SARS-CoV-2 during the earlier recommended 8 weeks period, the experts further recommended for its use beyond 8 weeks on weekly dosage with strict monitoring of clinical and ECG parameters, which would also ensure that the therapy is given under supervision, it stated.

In clinical practice, HCQ is commonly prescribed in a daily dose of 200mg to 400mg for treatment of diseases such as rheumatoid arthritis and systemic lupus erythematosus for prolonged treatment periods with good tolerance, the advisory added.

The ICMR had earlier announced that some side effects, such as abdominal pain and nausea, have been observed in healthcare workers who were administered HCQ.

The anti-malaria drug isoften blamed for triggering irregular heartbeat.

However, in the final results of the studies (HCQ prophylaxis among 1,323 healthcare workers), the ICMR found mild adverse effects such as nausea in 8.9 per cent workers, abdominal pain in 7.3 per cent, vomiting in 1.5 per cent, low blood sugar (hypoglycaemia) in 1.7 per cent and cardio-vascular effects in 1.9 per cent.

The advisory states the drug should be discontinued if it causes the rare side effects related to the heart, such as cardiomyopathy, a disease which makes it harder for heart to pump blood to the entire body, and heart-rate disorders.

The advisory mentions that HCQ, in rare cases, can cause visual disturbance, including blurring of vision, which is usually self-limiting and improves on discontinuation of the drug.

ICMR has clarified that for the above cited reasons heart and vision the drug has to be given under strict medical supervision with an informed consent.

Also Read: Ashwagandha the new HCQ? Modi govt begins study to see if herb keeps coronavirus away

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HCQ breakthrough: ICMR finds its effective in preventing coronavirus, expands its use - ThePrint

Mallons distrust of Baker was not an isolated incident: trust in public health was unevenly distributed among communities, Conis says. For instance, many immigrants came from countries where government-enforced vaccinations were unheard of. The power Baker wielded as a municipal authority was wholly unfamiliar.

Stereotypes about immigrant communities including those to which Baker herself subscribed further hampered trust in public health.

In her autobiography, Baker frequently refers to Irish immigrants en masse as shiftless, and says of the Irish in Hells Kitchen that they were altogether charming in their abject helplessness, wholly lacking in any ambition and dirty to unbelievable degree. In Bakers view, the only other group who could match the Irish distinction of living in the most squalor was Russian Jews, who managed to survive out of thrift.

For communities so frequently maligned and stereotyped, trust was not easily given just because someone with Bakers authority asked for it.

What Baker never seemed to understand about the immigrant communities she served was that when her advice was ignored, it often wasnt a failure of understanding. Rather, it was that those, like Mallon, who she explained the science of germs to, had little control over their own lives and circumstances.

Even though Baker retired from the Bureau of Child Hygiene in 1923, her work extended beyond the health department. She was prolific writer, publishing hundreds of journal and newspaper articles on public health and five books on child health and hygiene for non-experts. She also founded the American Child Hygiene Association, of which she became president in 1917, and served as president of the Womens Medical Association in 1935.

Baker spent the last years of her storied life on a farm in New Jersey with her partner, the novelist and screenwriter Ida Wylie, and their friend, physician Louise Pearce. She died of cancer in 1945.

While she went to greater lengths than any other public health official to learn the needs of tenement residents, Baker never seemed to quite understand why some greeted her and her municipal authority with scepticism. Nor did she reflect on the role she may have played in perpetuating that distrust.

Had she done so, its easy to imagine how many more lives she could have saved. As it is, however, she deserves a reputation as one of the earliest and most influential crusaders for preventative public health and provides an example of not only what to do, but what not to do, when it comes to public health.

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Missed Genius

Ask people to imagine a scientist, and many of us will picture the same thing a heterosexual white male. Historically, a number of challenges have made it much more difficult for those who dont fit that stereotype to enter fields like science, math or engineering.

There are, however, many individuals from diverse backgrounds who have shaped our understanding of life and the Universe, but whose stories have gone untold until now. With our new BBC Future column, we are celebrating the missed geniuses who made the world what it is today.

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Portrait of S. J. Baker by Emmanuel Lafont.

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SJ Baker: The woman who transformed public health - BBC News