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Archive for the ‘Preventative Medicine’ Category

Chronic Inflammation Is a Huge Problem. But This Specialized CBD for Inflammation Can Help. – Futurism

Thursday, November 21st, 2019

Inflammation has become one of the biggest buzzwords in health and wellness circles in recent years. And while all the fuss over inflammation it may seem like yet another fad promulgated by television quacks and bloggers, its really not. Many health professionals now believe that understanding and controlling chronic inflammation is the future of preventative medicine. Thats why Mellowment CBD has specifically developed a specific type of CBD for inflammation. Its called Mellowment High Impact for Inflammation, and it combines CBD and curcumin for maximum inflammation relief, recovery, and comfort.

Inflammation is an essential survival mechanism of the human immune system. As such, its usually a good thing, a sign that the body is working to heal an injury or fight off some pathogen or disease. When cells are in distress, they release chemicals that alerts the immune system. The immune system in turn sends inflammatory cells to capture the pathogens or heal damaged tissues. Meanwhile, blood vessels in the area expand to accommodate the additional immune system traffic and bring fluid to the site of the injury or infection. This is called acute inflammation. And while it is painful and uncomfortable, its also necessary.

Unfortunately, for a variety of reasons, sometimes this natural immune system response does not get switched off. Sometimes its because the cause of the initial immune system response cannot be eliminated. Sometimes the immune system simply malfunctions. Either way, the immune system tells white blood cells to attack healthy tissues and organs, resulting in chronic inflammation.

While all adults experience some level of chronic inflammation that slowly wears down our organs and tissues, in some people this chronic inflammation is more extreme. And what scientists have finally realized is that this excessive chronic inflammation causes major damage that contributes to many of the most common degenerative diseases, including coronary artery disease, diabetes, cancer, and Alzheimers.

The good news? Numerous studies suggest that treating chronic inflammation can significantly reduce the risk for these diseases.

That brings us to Mellowment High Impact CBD for Inflammation.

Mellowment has become one of the leading names in CBD over the last few years thanks to their exacting scientific methods and rigorous quality control. With High Impact for Inflammation, theyve combined their proprietary CBD formula with and curcumin, a compound found in the spice turmeric that has been used as an herbal medicine in India for thousands of years.

CBD has long been observed to have anti-inflammatory effects. Now were finally starting to understand why. According to one study, for example, CBD reduces inflammation by modulating the endocannabinoid system and disrupting the production of cytokines, which are proteins secreted by immune cells that trigger inflammation. As for curcumin, modern science has proven it has anti-inflammatory and antioxidant properties, and numerous studies have shown it to be effective in treating inflammation and pain associated with arthritis.

One of the problems in treating inflammation with CBD and curcumin is that both compounds typically have poor bioavailability. That means they are not easily absorbed into your system due to poor absorption, rapid metabolism, and rapid elimination. However, Mellowment has solved the bioavailability problem. By subjecting CBD and curcumin to an advanced nano-emulsification process that shrinks and suspends the active ingredients microscopic droplets of oil which can easily pass through cell walls, Mellowment more than doubles their bioavailability. That means more CBD and curcumin reach systemic circulation, ensuring maximum effectiveness.

Each bottle of Mellowment High-Impact for Inflammation contains 30 softgels, with each softgel containing a 25mg dose of CBD and a 10mg dose of curcumin. Theyre formulated to be taken as needed, and most customers take one to four softgels per day. Mellowments CBD extracts are meticulously engineered from Colorado-grown hemp using an advanced chromatography process that removes all THC, eliminating the risk of failed drug tests and undesired psychoactive effects.

Whether youre looking for natural relief from discomfort caused by acute inflammation, or you want to combat chronic inflammation and reduce your risk for more serious degenerative conditions, Mellowment High Impact for Inflammation could be right for you

This supplement has not been evaluated by the FDA, and is not intended to cure or treat any ailments. Do not take CBD products if you are allergic to any of the ingredients in the product you are consuming. Tell your doctor about all medicines you may be on before consuming CBD to avoid negative reactions. Tell your doctor about all medical conditions. Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins and herbal products. Other side effects of CBD include: dry mouth, cloudy thoughts, and wakefulness. You are encouraged to report negative side effects of any drugs to the FDA. Visit http://www.fda.gov/medwatch, or call 1-800-FDA-1088.

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Restorative Medicine: IV Therapy in NYC Announces Partnership with Better Health Chiropractic, PC – Press Release – Digital Journal

Thursday, November 21st, 2019

Restorative Medicine: IV Therapy, based in New York, NY, has announced a trusted partnership with Better Health Chiropractic, PC. Restorative Medicine: IV Therapy is a provider of IV therapy nutrition New York NY services and was founded by Dr. Vladimir Alexeyenko, M.D. The practice is geared towards serving the needs of those who want a way to counteract the damage that stress and modern living have been causing. Dr. Alexeyenko wants to emphasize that people often work long hours at a desk, eat on the run, have disrupted sleep, and are exposed to environmental toxins. All of that stress can weaken the bodys immune system and make it more difficult to fight off disease.

Dr. Vladimir Alexeyenko says, We offer vitamin infusions, hydration IV therapy treatments, and other IV therapy solutions that will energize you and restore your body and mind. Our bodies need fuel, not just any fuel, but the right mix of vitamins, minerals, water, and hormones. The human form is a complex system that relies on many compounds to get up and go. There is a perfect balance that helps us feel great but, modern life, especially in urban areas, robs us of that balance.

Dr. Vladimir Alexeyenko is a licensed physician who has developed IV infusion therapy using his in-depth knowledge regarding the human body and what it requires to be able to perform at peak efficiency. He wants to point out that he established Restorative Medicine: IV Therapy based on the philosophy that preventing disease is better than cure.

He says, We can prescribe and administer any infusion that can restore your energy, increase your metabolism, rebalance levels of vitamins and minerals, and strengthen your immune system. You will see and feel the results immediately. At Restorative Medicine, your body will regain the ability to heal itself thanks to IV vitamin therapy and other IV drips that will revive your energy, restore cell function as you go back to your vibrant and busy life.

With nutrients, vitamins, minerals, and fluids being essential in helping the body function well and in flushing out toxins, these are provided in IV drips and booster form for preventative medicine. The treatments supervised by Dr. Alexeyenko can help in fighting disease, boosting energy levels, and strengthening the immune system. This allows patients to have more control over their health journey. However, this requires the guidance of an experienced physician like Dr. Alexeyenko.

Dr. Vladimir Alexeyenko also provides IV ozone therapy New York NY services. This is designed to get rid of viruses, toxins and infections from the body. Its purpose is to oxygenate the blood to create an aerobic environment, which is hostile to microbes that thrive on anaerobic metabolism. It should be noted that while ozone can be dangerous when inhaled, it is not harmful in the bloodstream. Ozone therapy may be used by people who frequently travel and breath recycled air. It may also help during the flu season as it may be able to boost the bodys immune system.

According to Dr. Alexeyenko, IV therapy may be able to provide long lasting vitality and bring back systemic balance to the human body. IV therapy has an advantage over supplements or pills because the latter are taken orally and are diluted during digestion. On the other hand, IV therapy allows the nutrients, vitamins and minerals to their work at the cellular level.

Dr. Vladimir Alexeyenko has been practicing medicine for more than 25 years. He has always sought to be up-to-date regarding the study and use of restorative, holistic treatments. He also prescribes modern medical treatments but his long term goal is to guide his patients into the use of conventional and integrative practices and treatments designed to prevent ill health.

Those interested in IV therapy NYC services can visit the Restorative Medicine: IV Therapy website or contact them on the phone or through email. They are open from Monday to Friday, 9:00 am to 6:00 pm. Saturdays and Sundays are by appointment only.

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For more information about Restorative Medicine: IV Therapy, contact the company here:

Restorative Medicine: IV TherapyDr. Vladimir Alexeyenko(917) 994-9390doctor@vladimiralexeyenkomd.comRestorative Medicine: IV Therapy2 W 46th St Ste 806, Rm2New York, NY 10036

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A guide to CBD topicals, balms, and lotions – Leafly

Thursday, November 21st, 2019

Rae LlandNovember 18, 2019

(Irina_Strelnikova/iStock)

CBD, or cannabidiol, is a compound produced by cannabis and hemp plants. Unlike THC, CBD doesnt produce a feeling of being high.

CBD topicals such as lotions, balms, gels, or creams are infused with CBD to produce skin-friendly products that contain the medicinal properties of CBD. In topical form, CBD is most popularly used for managing pain and inflammation.

CBD topicals penetrate the skin to provide targeted relief, without entering the bloodstream. This makes them a fantastic choice for anyone who wants to focus the healing properties in specific problem areas rather than feel the effects throughout their body. CBD topicals can potentially provide relief for a variety of pain, headache, and skin issues such as:

Lo Friesen, lead chemist for cannabis wellness company Heylo, believes CBD topicals are also a fantastic preventative medicine. She says using these topicals every day, multiple times a day allows the body to not only uptake CBD quicker, but also build a CBD level in those areas and prevent worsening inflammation.

Its just preventative maintenance, says Friesen. For example, people who have arthritis in their hands who use [CBD topicals] on their hands every day are going to have less pain, less inflammation. Theyre going to have less pain in their hands over time than people who use it to treat [the pain as it happens].

Some CBD topicals may have bases such as shea butter, or oils like coconut, avocado, jojoba, or vitamin E. These nourishing ingredients are great for the skin, providing added benefit to the medicinal properties of CBD. Its also possible to find more traditional lotions with CBD or products with an Aquaphor base.

While lotions will be water based, creams usually have a fat or oil base, and balms a thicker base such as beeswax. Water-based lotions absorb more quickly into the skin, but oil based CBD topicals are more easily absorbed and get into the skin deeper. Meanwhile, gels can be useful for easier thicker application, making them possibly preferable for those with reduced hand dexterity, such as arthritis patients.

At the end of the day however, Friesen says, Just take your favorite skin care product and find something with similar ingredients, add CBD, and youve already made it better.

Unfortunately, due to an oversaturated market and lack of regulation, not all CBD topicals will produce the desired results. CBD can be sourced from either hemp or traditional cannabis, but their resulting extracts typically have quite a few differences in terms of the diversity of compounds found within them.

CBD extracts from cannabis tend to include a wide diversity of helpful compounds whereas hemps chemical diversity is more limited. Youll also want to make sure that a hemp-derived product actually contains CBDhemp seeds or stalk dont produce CBD, so its important to understand which part of the hemp plant was used in the extraction process.

Whats more, some products claim to have an abundance of CBD in them, but the reality doesnt always match the label. So how can consumers make sure they are getting a quality product?

Dr. Jeremy Riggle, chief scientist with cannabis wellness company Marys Medicinals weighed in:

Not all CBD products are created equal, and consumers should do their research. Ask questionswhat type of CBD extract does it contain: full spectrum, broad spectrum, or isolate? Where is the raw material sourced from? Does the producer use organic and sustainable agricultural practices? Does the supplier have a Certificate of Analysis showing test results for pesticides, heavy metals, residual solvents, microbials, cannabinoid potency, and terpene profile?

Finally, its worth noting that milligram content can make a difference, and with CBD, higher is generally better. Friesen says you get what you pay for, but that this is also why some make the switch over to CBD:THC topical products. Friesen believes these 1:1 or 1:3 ratio products are more effective than CBD on its own, due to the cannabinoids tendency to amplify each others effects. As such, patients may be able to use less to achieve similar effects, than they would with a CBD only product, and save money in the process.

All in all, there are plenty of great topical CBD products on the market for those who want to try a targeted method of delivering these helpful cannabinoids to problem areas and add CBD to their wellness routine.

Rae Lland is a freelance writer, journalist, and former editor for Weedist and The Leaf Online. With a focus on culture, music, health, and wellness, in addition to her work for Leafly, she has also been featured in numerous online cannabis publications as well as print editions of Cannabis Now Magazine. Follow her on Instagram @rae.lland

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Beefing Up the East End’s Substance Abuse Treatment – East End Beacon

Thursday, November 21st, 2019

When Quannacut Outpatient Services substance abuse treatment center was preparing to move into its new facility across Riverhead in July, a rumor quickly spread through patients that it may be closing. But that rumor was quickly replaced with the real news, which is quite good: Not only has the facility tripled in size in its new location, but it is now better able to accommodate its mission to treat not only substance abuse, but also mental and physical health needs that are often unavailable to people in substance abuse treatment.

Stony Brook Eastern Long Island Hospital and Quannacut held a ribbon-cutting celebrating the opening of the new 1,400-square-foot offices at 905 East Main Street in Riverhead on Nov. 20, and theyre planning to open another satellite outpatient center at 291 Hampton Road in Southampton this month, which will fill a gap in outpatient substance abuse treatment on the South Fork.

The expansion was made possible by a $1.6 million grant received in 2017 from the New York State Department of Healths Statewide Health Care Facility Transformation Program. A goal of this program is to make it easier for people, especially those with Medicaid, to receive preventative medical services, in an effort to reduce emergency room visits for non-emergencies.

The new Quannacut outpatient center in Riverhead has three medical examination rooms, and is in the process of hiring medical staff under the guidance of Medical Director Dr. Jarid Pachter, said Quannacut Outpatient Services Director David Cohen on a mid-November tour of the facility. He said some of the top medical needs among patients there are infectious diseases, often related to substance use, and basic primary care needs, often longstanding chronic conditions that have gone untreated.

Theres a general rule of thumb, he said, that about 1/3 of people who visit the emergency room also have an untreated behavioral health need, while 1/3 of the people in Quannacuts program also come in with untreated medical needs.

Stony Brook Eastern Long Island Hospital, which is in Greenport, opened Quannacut as an inpatient rehabilitation program in 1989, expanding with an outpatient program that moved from Mattituck to Harrison Avenue in Riverhead in 2001. Quannacut is a Native American word that means hope.

Mr. Cohen said that, when he arrived shortly after that, the outpatient program was seeing around 70 patients at a given time. Now, he said, they have about 300 active patients, and accept walk-in patients on Mondays and Fridays from 9 a.m. to noon.

This new integration of medical and psychiatric services builds on strengths already existing within ELIH and Stony Brook University Hospital.

ELIH has long had the only inpatient psychiatric facility on the East End, and the hospitals recent affiliation with Stony Brook University Hospital, which has a psychiatric emergency room, is designed to integrate mental health and substance abuse treatment throughout the continuum of care.

This is a sea change for health care, where traditionally medical, psychiatric and substance abuse professionals had worked in separate silos. Mr. Cohen said some medical and substance abuse practices dont want to deal with people with certain mental health issues or medications, he said, in part become some psychiatric medications are addictive.

Were experts here on co-occurring conditions, he said. Our staff is heavily trained. Not one thing works best for each individual.

Dr. Richard Rosenthal, director of the Division of Addiction Psychiatry at Stony Brook University, said the addition of Quannacuts services to the Stony Brook network is part of a larger endeavor integrating addiction, mental health and primary care.

Substance use disorders are classified as psychiatric disorders, but they are overseen by different regulatory agencies, said Dr. Rosenthal. The truth is a continuum is the rule rather than the exclusion.

Dr. Rosenthal added that, as part of this integration of care, the Stony Brook University Hospital network is training doctors to administer buprenorphine shots in the emergency rooms in Southampton and Greenport.

Buprenorphine has not gotten as much public attention as naloxone, better known as Narcan, an immediate opioid antidote carried by first responders to revive people from opioid overdoses. But once they survive an overdose, opioid users who want to quit will need a way to manage their withdrawal symptoms. Thats where buprenorphine, a medically administered opioid used to treat withdrawal, comes in.

Dr. Rosenthal said Dr. Kenneth Kaushansky, the dean of the Universitys Renaissance School of Medicine, has fully backed training Stony Brook doctors to administer buprenorphine, which has historically had a difficult time gaining traction with medical doctors.

To prescribe buprenorphine, you need to be trained, and its substantive training, said Dr. Rosenthal. Patients come in and agree to go into treatment, theyre given a couple doses, which they complete at home, and they get a referral and connection to outpatient treatment. They may need to stay overnight.

Its very safe, and its really no big deal, he said, adding that 130 Stony Brook doctors have been trained to administer buprenorphine. The patient feels better. It protects them from the nods and it medically stabilizes them. Its a lifesaver.

Dr. Rosenthal added that the way doctors are trained also plays a role in alleviating the opioid crisis.

Were training doctors differently regarding pain, he said. Thats a big, big shift in terms of what we were doing even five years ago.

Even primary care doctors operating in practices affiliated with Stony Brook are now giving patients screening questionnaires for substance abuse and mental health issues as soon as they walk in for routine medical appointments.

Doctors are practical people. They believe the same thing regular people do, said Dr. Rosenthal. Theres a culture change. We want to know if people are thinking of self-harm. We need to do a better job helping people when they feel desperate and hopeless.

Despite the major leap the new facility is bringing to Quannacut, the staff there arent resting on their laurels. They are currently working on an adolescent program, and they run two sober houses within 15 minutes of the Riverhead center.

But those houses, which have just 18 beds, all for male residents, are just a drop in the bucket compared with the need. Quannacut would ultimately like to add a female sober house as well.

Housing is the number one thing that undermines treatment, said Mr. Cohen. A lot of people we see are one step away from homelessness. Our houses are always filled, and theres always a waiting list.

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ViiV Healthcare announces exclusive licensing agreement with the National Institutes of Health for investigational bNAb with potential for long-acting…

Thursday, November 21st, 2019

LONDON--(BUSINESS WIRE)--ViiV Healthcare, the global specialist HIV company majority owned by GSK, with Pfizer Inc. and Shionogi Limited as shareholders, today announced that the company will be developing the investigational broadly neutralising antibody (bNAb) N6LS for the treatment and prevention of HIV-1, as part of an exclusive licensing agreement between GSK and the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH).

Broadly neutralising antibodies are antibodies that can recognise and block the entry of different strains of HIV into healthy cells. N6LS is an antiviral bNAb that works by binding to a specific site (gp120) on the surface of HIV that prevents its entry into uninfected immune system cells (CD4+ T-cells). By blocking HIVs entry into human CD4+ cells, HIV replication is halted, and the HIV transmission process may be prevented.1

Kimberly Smith, M.D., Head of Research & Development at ViiV Healthcare, said: We are excited to advance N6LS from its current proof of concept stage to the next step in its development by studying this bNAb as a long-acting medicine that could potentially be used for both treatment and prevention of HIV. By continuing to research new ways that people living with HIV can reach undetectable viral loads, we build on our ten-year history of furthering innovative science in HIV and take another important step forward in ending the epidemic.

ViiV Healthcare looks forward to initiating a phase IIa study with material manufactured by the NIAID Vaccine Research Center that will evaluate the efficacy, safety, tolerability, and pharmacokinetic profile of N6LS in adults living with HIV.

Additional details about N6LSN6LS was originally discovered and developed by scientists at NIAIDs Laboratory of Immunoregulation and VRC. NIH and GSK entered into a Cooperative Research and Development Agreement (CRADA) to jointly identify and further develop new bNAbs such as N6LS that could serve as the next generation of treatment regimens for people living with HIV and preventative options for HIV transmission. This exclusive license outlines a programme for ViiV Healthcares development of N6LS as well as milestone payments and royalties to the NIAID.

About ViiV HealthcareViiV Healthcare is a global specialist HIV company established in November 2009 by GlaxoSmithKline (LSE: GSK) and Pfizer (NYSE: PFE) dedicated to delivering advances in treatment and care for people living with HIV and for people who are at risk of becoming infected with HIV. Shionogi joined in October 2012. The companys aim is to take a deeper and broader interest in HIV/AIDS than any company has done before and take a new approach to deliver effective and innovative medicines for HIV treatment and prevention, as well as support communities affected by HIV.

For more information on the company, its management, portfolio, pipeline and commitment, please visit http://www.viivhealthcare.com.

About GSKGSK is a science-led global healthcare company with a special purpose: to help people do more, feel better, live longer. For further information please visit http://www.gsk.com.

_____________________1 Kumar R, Qureshi H, Deshpande S, Bhattacharya J. Broadly neutralizing antibodies in HIV-1 treatment and prevention. Ther Adv Vaccines Immunother. 2018;6(4):6168.

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Regenerative Medicine: Overcoming The Supply Chain Challenges – Contract Pharma

Thursday, November 21st, 2019

Regenerative medicine is one of modern sciences most exciting developments. Defined by the Medical Research Council, regenerative medicine is an interdisciplinary field that seeks to develop the science and tools that can help repair or replace damaged or diseased human cells or tissues to restore normal function.

In the human body, the liver is the only organ capable of regenerating itself spontaneouslyeven after serious injurybut in the future, any part of the human body may be capable of doing so. Our own cells will also be able to treat and cure diseases and conditions of the blood and immune system, as well as restore the blood system after treatments for specific cancers.

Once only imaginable in science fiction, the latest applications include engineered skin tissue to treat burn victims, custom-grown bones for implants and joint replacements, personalized dietary treatments using gut bacteria and just recently, the worlds first 3D vascularized engineered heart was created using a patients own cells and biological materials.

As scientists understanding and the tools at their disposal become more advanced, the closer to the widespread commercialization of regenerative medicine the pharmaceutical industry finds itself.However, offering regenerative medicine therapies at scale requires one of the biggest shake-ups to the global pharmaceutical supply chain ever seen. Without it, the world risks missing out on the curative promises of this next-generation medical technology.

Regenerative medicine is one of, if not the most, exciting advancements in modern science which has far-reaching benefits for big pharma, healthcare systems and patient outcomes.

Regenerative medicine is a growth industry in more than one sense of the word; as a sector, its growing from strength to strength. In fact, last year the global regenerative medicine market was worth $28 billion and its expected to grow to $81 billion by 2023.

As a more efficient and less invasive alternative to transplanting cells or organs to replace damaged or lost tissue, established pharma companies alongside small biotech start-ups are racing to discover and bring to market medicine-based approaches that stimulate the bodys natural ability to repair itself.The cutting-edge innovations of regenerative medicine generally fall into three distinct categories:

Replenish Replace Rejuvenate

Stem cells can generate vital growth factors to naturally reduce inflammation, increase muscle mass, repair joints, grow hair and boost the immune system, replenishing the body. Organ regeneration and 3D printing are replacing the reliance on the failing donor system and overcoming the issue of organ rejection. The root causes of aging are being better understood and delayed by using stem cells to rejuvenate the body.

Marking a new era in healthcare and one which has the promise of addressing the needs of an aging population challenged by escalating chronic diseases, regenerative medicine is certainly a game-changer. Beyond more effective medical treatments that can be applied routinely despite age, comorbidities, or disease severity, it also has the potential to cure many of todays incurable diseases and support healthcare systems to move towards a preventative model.

Today, regenerative medicine is largely confined to a research environment. In fact, according to a recent report, there were 1,028 clinical trials for regenerative therapies taking place globally at the end of 2018.

Regenerative medicine is poised to transform healthcare as we know it, offering potential cures for deadly diseases which before would require long-term treatment to manage. However, while billions are being spent on regenerative medicine research and clinical studies, little resource has, so far, been allocated to the management and delivery of innovative medical therapies at scale.

Currently, the race appears to be on between smaller Medtech companies and large multi-national pharmaceutical companies to see who wins first-mover advantage in the regenerative medicine market. Today, many established pharmaceutical companies prefer to partner with Medtech startups to in-license products in early clinical development stages as opposed to conducting early development on their own which comes at a huge cost. This is a risk-reduction tactic, but it could mean big pharma misses the boat.

The question remains unanswered as to whether a peer-to-peer collaborative model will prosper where Medtech companieswho are in some instances one step ahead of big pharma in terms of drug developmentare happy to be a third-party provider to big pharma who have the budgets and networks to truly deliver the regenerative medicine revolution.

Regulation is, and will continue to, play a hugely important role in delivering regenerative medicines from a lab setting to a clinical setting. Only recently, the FDA announced a new policy framework for the development of regenerative medicine products, taking into account the dynamic and fast-moving nature of the field.

Ultimately, the governments aim is to protect patients from products that pose potential significant risks, while accelerating access to safe and effective new therapies according to Former FDA Commissioner Dr. Scott Gottlieb. The FDA plans to achieve this over the coming years by driving stakeholder engagement with the developing regulatory framework in order to efficiently advance access to safe and effective regenerative medicine advanced therapies.

However, so far, progress by the pharma industry in coming into compliance with FDAs regulations for regenerative medicines has been slow, despite the grace period set by the FDA before it fully exercises enforcement fast approaching (ending in November 2020).

In order to speed up the process of bringing novel medicines to market, the FDA is toying with the idea of fast-tracking products that are deemed low risk to patients if sponsors have engaged with the regulatory process and demonstrated responsibility by filing Investigational New Drug Applications (INDs).

The FDA has also promised to strengthen its enforcement action against drug developers who are marketing unapproved products, prioritizing cases where the threat to patient health and safety is largest.For example, last November the FDA stepped in where a Californian business was selling stem cell products using umbilical cord blood for the treatment of arthritis and other conditions, despite this form of treatment not having FDA approval for that particular use. Several patients (at least 12) undergoing this treatment were hospitalized after developing infections of the bloodstream and joints, as well as abscesses along the spine and skull.

In summary, one of the FDAs central aims over the coming years is to drive stakeholder engagement with the developing regulatory framework for regenerative medicine advanced therapies in order to efficiently advance access to safe and effective new products.

The promise of regenerative medicine requires an innovative look at the complete product lifecycle, including the development of an efficient distribution network.

Once these novel drugs become mainstream, the entire healthcare ecosystem will have to adapt. Regulatory approval for any drug relies on it safely and successfully fulfilling its medical intent. As such, information about supply chain management needs to be submitted to the regulator after the completion of phase three clinical trials, including packaging, labeling, storage and distribution.

The clinical supply chains required to deliver these therapies are arguably the most complex the industry has seen so far, even more so than for biologic medicine. Thats because, unlike many mass-market drugs, regenerative medicine is either personalized or matched to a unique donor-recipient.

The distribution of regenerative medicine therapies is further complicated by the fact they are also extremely sensitive to exogenous factors like time and temperature. Therefore, there are strict conditions under which these therapies must be transported and received.

Advanced IT solutions and monitoring systems are being developed and employed to ensure end-to-end traceability across the pharma supply chain. These are giving clinicians access to view the progress of therapies and their distribution in real-time and allow users to automatically schedule or amend material collections in line with manufacturing capacity, helping to keep the supply chain as agile as possible and avoid costly wastage.

The live tissues and cells which form the basis of regenerative medicine products are highly sensitive and some have a shelf life of no more than a few hours, making distribution a complex task. Therefore, materials need to be transported from the site of harvest to manufacturing facilities, and from manufacturing facilities to medical institutions under strictly controlled conditions, within certain time periods and temperatures, according to different cell and tissue requirements which can vary from product to product.

Temperature-controlled logistics solutions are vital to ensure a safe, effective and financially viable supply chain network for these high-value shipments. Cryopreservation is one technique increasingly being used to deliver medicines at optimum temperature using vapor phase nitrogen, however, many clinical settings remain ill-equipped to handle such equipment.

Onsite production is an alternative manufacturing arrangement, particularly for autologous products which are derived from a patients own cells. However, this throws up a number of compliance and infrastructure challenges, as the hospital would need to comply with a host of regulations including installing a licensed clean room which may not be possible given budget restrictions and limited space onsite.As a first-generation technology, stakeholders will have a greater tolerance for higher pricing, but only for a limited time period. By streamlining the currently very expensive manufacturing process and improving supply chain management, yields will automatically get larger and costs will slowly come down.

While there are many challenges in the road ahead, 2019 certainly appears to be the start of regenerative medicines move to the big time. Just like big data and artificial intelligence is transforming the practice of medicine, regenerative medicine holds the promise of extending the bodys natural ability to replenish, replace and rejuvenate itself.

If the global health industry can work collaboratively on overcoming the challenges presented by delivering safe and effective advanced therapies, a dramatic extension of the human healthspan is possible. We may even reach the point where no disease is considered incurable, transforming healthcare as we know it.

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The Opioid Epidemic: Past and Future – Psychology Today

Thursday, November 21st, 2019

When I said goodbye to Dylan on November 21st, 2013, I did not think itwould bethe last time I would see him. He left me smiling, on his way to visit a friend in Long Beachfor the night.That evening, at the young age of 26, Dylan was found deceased. His cause of death was an accidental overdose on Oxycodone.

Dylan was one of over 16,000 Americans who died in prescription painkiller related deaths in 2013 (in 2017 it was 47,600).The current opioid epidemic is unprecedented. Reports state that more than 130 people die from opioid-related drug overdoses each day, with the economic cost of the opioid crisis estimated to be $504 billion.

While effective analgesics, opioids are highly addictive, and adult patients undergoing surgery who receive an opioid prescription are at an increased risk of misusing and persistently using opioids. Time and time again, America witnesses thesame story:a patient visits a doctorcomplaining about a sudden moderate pain or perhaps a chronic issue; the doctor provides the quickest solution on the market, prescription narcotic painkillers; the patient leaves satisfied and often on their way to a nasty addiction.

But whyis this story becoming more common rather than less, despite increasing awareness of the prevalence of addiction in mainstream American culture? Why havephysicians dishedoutmore of these medications in recent years,rather than refusing to provide them to patients?How and why did opioids transition from being a treatment for end of life illness and postoperative pain relief to a commonly doled out solution to headaches and back pains? Theory suggests, and research confirms, that doctors were influenced by pressure from two angles: that of the manufacturers and of the patients.

The irony is that prescription narcotics do not fit their new purpose. According to Dr. Andrew Kolodny, president of the Physicians for Responsible Opioid Prescribing, controlled narcotics such as Hydrocodone and Oxycodone are actually ineffective in treating long-term pain.However, in a culture of fast food, instant messaging, and quick results, Americans seeking pain relief are not as concerned with the long-term solution.

A lot of societys trust goes into the capabilities of modern medicine, and while the rise of prescription opioids was strongly driven by manufacturers and pharmaceutical companies, patients welcomed it.And when the patients have a demand, the pressure to fulfill these needs falls on the doctors. As Celine Gounder, physician, public-health specialist, and medical journalist wrote in the New Yorker, The promise of a set of medicines that could cure pain was appealing to many patientsand, with a customer-is-always-right mentality having pervaded the doctors office, patients were able to pressure physicians to satisfy their requests for the pain pills theyd begun hearing about. Gounder explains the difficulties for a doctor to deny the requests of their patients and send them out of their visit dissatisfied. Doctors have a hard time saying no, whether a patient is asking for a narcotic to relieve pain or an antibiotic for the common cold. We are predisposed to say yes, even if we know it isnt right.

Whats worse is the consistent consumption of drugs like Hydrocodone and Oxycodone leads to increased tolerance and a condition called hyperalgesia, which is the increased sensitivity to pain after long term intake of pain medication.These consequences, in turn, require more pain medication for the patient and dependency develops before the drugs were ever technically abused.

With such a gradual progression to reliance on drugslabeled as legal and supplied in unnecessarily high quantities by an authority figure in a lab coat, patients and drug seekers do not fear the consequences of addiction or overdose. It is difficult to believe that the doctors we trust and depend on would put us at risk with the frequency and justification of prescription, the amount of opioids per prescription, and the number of refills on each prescription. The reality is that pain medication is not meant for long term use and the amount of pain after an operation should only last up to one weekHowever, theres not enough awareness about how serious this crisis is, Kolodny said. I dont think enough doctors know that these painkiller medicines dont work for chronic pain.

The pharmaceutical companies, from the start of this painkiller epidemic,capitalized on their ability to keep doctors misinformed. Big drug manufacturers recruited attractive marketers to convince physicians that their drug was the best painkiller on the market. We had cheerleaders from Big Ten schools, with no medical background or knowledge, put into a boot camp to learn the workings of the pharmaceutical industry, the doctor they will be selling to, and the benefits of their drug. It is these businessmen and women that are going into our doctors offices and selling our health care providers on what will be best for us, our family, our friends, and our loved ones.And doctors have been temporarily pleased when their patients reportless pain, considering their job well done.

Unfortunately, once a doctor has begun prescribing these medications to the patients, it is difficult for them and their successors to cease providing these drugs. Taking that stand would lead to unhappy and dissatisfied patients, and the potential accusations against the doctors of malpractice. There are also the doctors who just dont want to take the extra time during a busy day to explain why that prescription for a narcotic isnt a good idea and those who use the promise of prescription narcotics to persuade patients to keep their medical appointments, or to take their other medications, writes Gounder.Dr. Sanjay Gupta expressed similar concerns in hisCNN article:It is easier for a doctor to write a prescription than to explore other effective options to combat pain, and it is easier for patients to take those prescription pills than to search for alternatives themselves. Both those things must absolutely change."

So how can the methodology of doctors treating pain be improved? Just as important, how can the patients understanding of a doctors decision to deny narcotics in certain circumstances be improved? The work must be done on multiple levels.Primarily, between the physicians and the FDA, there needs to be a relabeling of painkillers. Currently, the labeling on narcotics has no suggested maximum dose or duration of use by the FDA. Kolodny describes this as being very broad. He insists thatthe way to turn this epidemic around is for doctors to prescribe painkillers more cautiously." And according to Kolodny, the FDA must change the labeling requirements on prescription painkillers so that it is easier for medical schools and the larger medical community to prescribe these meds more cautiously."

The next step would be providing education to healthcare providers from sources other than the pharmaceutical companies. While doctors, for the most part, have good intentions when prescribing medication, they receive no more than a week's worth of education on pain and pain management. Education on addiction, predispositions to addiction, and abuse of medication could help doctors better identify at-risk patients and take preventative measures or connect those suffering to treatment.

As patients of our doctors and consumers of the pharmaceutical industrys products,we must also take some action. With the knowledge that these medications could lead to negative consequences, we have the choice to seek other forms of pain management. Further, there are DNA tests available to see if you are predisposed to addiction. As a society, it is important that we know our own bodies and takesteps to put an end to this pill epidemic.

Dylans death isjust one of the countless lives lost. When we receive a prescription, we never think it could change our lives or the lives of others. Dylan did not get his first pain killer prescription with the intention to abuse the medication. However, as the refills were readily available, so was the opportunity to develop what turned out to be adeadlydependency. In a society where we are addicted to relief, a small prescription needs a big warning.

This blog has been written by Dina Khoury and Dr. Zeev Kain. Khouryisa medical student who is planning a career in psychiatry,UC Irvine School of Medicine.

Read more:
The Opioid Epidemic: Past and Future - Psychology Today

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Smart toilets could turn your pee into research gold – Mashable

Thursday, November 21st, 2019

Pee could be a health goldmine. And to make the most of it, the world needs smart toilets.

That's what a new, small-scale study published in Nature this month seeks to establish: whether regular urine collection and analysis of the thousands of telling, changing indicators in our pee can reliably serve up information about a person's health.

The study's University of Wisconsin authors, Dr. Joshua Coon and Dr. Ian Miller, say more research is still needed as the 10-day experiment only had two subjects: Coon and Miller themselves. However, they also think that a non-invasive device that could collect and analyze a person's urine like, say, a smart toilet could work as a revolutionary tool for personalized, predictive health care.

Oh, and wouldn't you know it, they're making one such smart toilet themselves. But they're not the only ones.

How Coon and Miller envision the smart toilet of the future.

Image: Dasom (Somi) Hwang

Recently, health-tech companies and even big tech players like Apple and Google have gotten into the business of harvesting health data, mostly from AI assistants, fitness trackers, smartwatches and even the smartphone in your hand. The current drumbeat in healthcare is that big data will be able to help us monitor our health in real time, as well as predict disease and health trends at a societal level in the future. And in this coming era of data-driven medicine, the study's authors think that urine is an untapped resource.

Coon and Miller research metabolic systems at the University of Wisconsin and Morgridge Institute for Research (with work partially funded by the National Institute for General Medical Sciences). They analyze the molecules that reflect what our body has metabolized (called "metabolites"), whether that's something we ingest, or is the consequence of an internal bodily process.

Researchers have already established that there are thousands of metabolites in urine, with many of them linked to our own habits like smoking, drinking, sleep, exercise, and even disease. As our habits change, so do the levels of these metabolites.

"There aren't that many bodily fluids that you can get access to that have a window into health," Dr. Michael Snyder, a Stanford University professor who studies biomedical data for healthcare, and is not involved in the study, said. "Urine is just one of those that it makes sense to be monitoring."

The theory is that, on an individual level, regularly keeping track of your urine could give you information you can act on. For example, it could eventually tell if you have a urinary tract infection brewing before you even display symptoms, or if you're getting enough exercise, drinking too much alcohol, or are registering inflammation that could cause disease down the line.

It could also serve as a compliment to the sort of digital healthcare many people are already doing, such as monitoring heartbeats with Apple Watches. Coon says that analyzing urine for lifestyle information could give a person a fuller vision of the why behind having heart troubles something an Apple Watch alone can't do.

Your pee could turn out to be somewhat of a "fingerprint."

Even beyond what this data can tell about an individual, Coon says we don't yet know what a large batch of this data from many people could tell us about disease outbreak, or other types of medical predictions down the line.

To tap into this potential, Coon and Miller tried to see if they could measure how information in urine corresponds with lifestyle choices, such as sleep or alcohol consumption. By keeping track of their habits, they were able to establish that specific metabolites do fluctuate based on lifestyle.

Your pee could also turn out to be somewhat of a "fingerprint." The metabolic makeup of our urine varies from person to person it looked different even just between the study's two subjects! Knowing a person's "baseline" levels could make personalized healthcare more precise. For example, if a person's baseline changes, Miller says that that could serve as a warning sign, enabling "preventative treatment, instead of dealing with symptoms as they show up."

Regularly comparing that baseline to changes is what particularly intrigues Snyder.

"This frequent measurement lets you really follow changes in [a person's] health state, and that's rarely done in medicine," Snyder said. "Knowing your own personal health state is very, very important. And then finding shifts from that is the key to early detection of disease long before it's symptomatic."

The study presented a third finding: Collecting pee is not only time-consuming and resource-intensive it's annoying. Which is why they say the technology needs to catch up.

"It turns out its not convenient to collect every urine sample you make we found that out," Coon said. "But if you had a toilet that did that for you, that would make a difference."

Coon's research group is working on a smart toilet that does just that. They say they will have a prototype to demonstrate their ideas in Spring 2020, though they declined to share any preliminary images with Mashable. After that, it will be about getting funding, conducting clinical trials, and bringing it to market. It may sound like a long way off, but their vision is clear.

"The device that we are working toward is just the toilet," Coon said. "It looks like a toilet, and it samples [urine] without you having to do anything. That is a way I think to be able to acquire data that will be helpful to people."

Coons' device would sample urine every time an individual uses the toilet, and has a built-in lab tool (called a mass spectrometer) to measure samples. That reading would go to a patient's smartphone, where they could monitor their health in real time, or even send that info to doctors, or healthcare analysis companies.

An early model of Toto's discontinued smart toilet.

Image: YOSHIKAZU TSUNO / AFP via Getty Images

Another company, Toto, built a smart toilet in the early 2000s that would allegedly "analyze sugar levels in urine, check blood pressure, body weight and even measure body temperature and hormone balance." However, Toto discontinued it, owing to low demand.

Other companies including Panasonic and even Google have made moves to develop smart toilets. But they were all limited in function, collecting measurements like blood pressure, body fat, and blood in the urine. Coon sees his device as more far-reaching, with consequences for both the individual and society.

"The fascinating thing for me about this is that there are so many possibilities that one could imagine," Coon said. "It really comes down to if one could build this device, and make these measurements on a large population, it would really, we think, open the doors to changing how we think about tracking health and lifestyle."

Is Coon's vision for his smart toilet realistic?

While Snyder agrees with the theory that regularly monitoring metabolites in urine can deliver health insights, he is skeptical that Coon's 10-day, two-person study lays sufficient groundwork.

"I think we need larger studies to demonstrate utility," Snyder said. "I don't doubt in the long run they will be useful. The question is just how quickly, and I don't know the answer to that."

Other experts (and competitors) are even less gung-ho.

"I just dont think its very practical," Vik Kashyap, the founder of human waste analysis company Toi Labs, said. "They're exploring interesting things, but I dont know if theyre ever going to make their way into the real world."

At Toi Labs, Kashyap and his team have been studying the best way to bring health tech into the bathroom for years. His company is currently conducting clinical trials for their own smart toilet product, True Loo. It uses AI to analyze pictures of stool and urine for health insights (what your poo looks like can apparently tell you a lot about your health!). Kashyap said that the choice to use photography instead of the "mass spectrometer" lab tools like Coon was intentional because he says that the tools and science Coon is relying upon have some major flaws in a commercial setting.

"Weve been working on a smart toilet for more than a couple decades combined," Kashyap said. "For this kind of approach to reach the market, it would be a very slim chance."

Kashyap views mass spectrometers as large, expensive tools that work in the lab, "but don't necessarily work in an everyday toilet environment."

Kashyap is also not sold on Coon's science. He says that mass spectrometers are good at looking for specific things, like in drug testing. But does not believe they are proven as well as they need to be for a true at-home smart toilet.

Other competitors and experts share that skepticism. Raja Dhir, the co-founderand co-CEO of microbiome research company Seed Health, doesn't see the potential for urine testing without also testing blood and poop.

"The concept of continuous measurement of biological data is intriguing," Dhir told Mashable. However, he's not convinced that people will actually get much use of out of it in the real world.

Still, Coon, Miller, and even Snyder are optimistic that, with enough study, time, and investment they can prevent the future of healthcare from just being flushed down the drain.

"Ive been saying that someday, we need a smart toilet," Snyder said. "I think the day is here."

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Breaking Down The Invitae Short (Podcast Transcript) – Seeking Alpha

Thursday, November 21st, 2019

Editors' Note: This is the transcript of the podcast we published last week on Invitae (NYSE:NVTA). We hope you enjoy.

Daniel Shvartsman: Welcome to the Razor's Edge. I'm Daniel Shvartsman. I'm joined by Seeking Alpha author Akram's Razor on this show. Each episode we take an investing idea or theme that Akram has been looking at for his personal investing as well as the Seeking Alpha marketplace service he runs, also called The Razor's Edge. We look at the ideas themselves, stress test them, try to figure out where they might go right or wrong, talk about what's been going on, and talk about the research and analysis that led to this take.

The idea to share some current investing ideas here into consideration, but also get the ins and outs of deep fundamental market research today. This week's topic has a lot behind it. The ticker symbol is NVTA. The stock is Invitae. Akram released a short case on the company on Seeking Alpha on October 11th, that went long in terms of breaking down why the genetic testing company was more like a WeWork than an Amazon. In other words, the company has had prodigious revenue growth, but it's come at a cost of increasingly negative cash flows and limited competitive advantage, in Akram's view. Was a thoroughly researched short case and as is often the case it's attracted a lot of attention, both positive and negative.

On today's Razor's Edge, we're going to talk about what brought Akram to this case, what investors are missing, and some of the reactions since he went public on Invitae. We're also joined by a colleague of Akram's, James who can add some insight on this topic based on research he's done on the stock as well.

Before we begin a quick disclaimer and disclosure; The Razor's Edge is a podcast on Seeking Alpha's The Investing Edge channel. The views discussed belong to either Akram, James in this case, or me respectively, and nothing on this podcast should be taken as investment advice. We'll disclose any positions in any stocks discussed at the end of the podcast, though upfront I can say I have no positions in any of the stocks we plan to discuss, Akram is short Invitae and long Myriad Genetics, and James is short, Invitae. We're recording this on the morning of November 4th.

Listen to or subscribe to The Investing Edge on these podcast platforms:

All right, guys. Good morning. Welcome.

Akram Razor: Good morning.

James: Good morning. Thanks.

DS: So let's just go really basic, why Invitae? What brought -- why does your radar get on this stock? Where did they come up?

AR: That's definitely an interesting part of the story. I guess the starting point was, there was people shorting Myriad. So I follow the Southern Investigative Reporter. And they've done a couple short pieces on that. And I kind of have taken a look at it briefly, which caused me to take a brief look at Invitae, and that was probably like, May or June. And then Ilumina missed big time on earnings, and I've traded Ilumina several times of the year. I've never traded any of these other stocks in terms of that. But it kind of got me interested in the space. And I guess what kind of, I mean, like, I think I had pinged James on it a couple times being like this is like this is worth looking into, but like neither of us had really gotten that excited about it.

And then there was a report that came out by a short seller, recommending the stock is an amazing long idea, which I read, because I know the short seller and his work. Once I read that, I was like, I need to look at this company a little closer. And then just the typical process, like pulling up their filings, seeing exactly what's going on financially, and I was just like, wow, this is just an incinerator. What are they doing? Why is -- like, what's the business model?

And that brought me to, there's an author on Seeking Alpha who had published a lot on this over the years, capital markets, laboratories and read their work, and they made these Amazon compares where, obviously, that's where you get a little bit of a heightened radar, when a laboratory diagnostic company is being compared to Amazon, which I mean, I don't know also if you know -- and I had like a brief experience with Theranos in 2000 it was say like, early 2014, like back when it was like -- I was picking on the Decacorns then, my favorite, like when I used to write my market commentary and I'd have a little bit of fun with it.

At the time, the two I was having fun with were Zenefits and Theranos. But I mean in Theranos' case, like I was just curious as far as what like -- I mean, it was a private company, $10 billion, obviously a lot of hype. I was like, wow, do I short Quest and LabCorp, right? I mean, I can't make -- I can't invest in Theranos. But if this company is so revolutionary like it, there's this pretty simple thesis out there in the public markets where I mean, if they're going to stick a lab in a box, I should go short Quest Diagnostics and LabCorp.

And I have, on the medical side, an extensive network of friends and family. So I ended up doing just one call with someone who'd been at Quest and in the laboratory diagnostic space, pretty senior for about 20 years. And like, I mean, it was like a 30 minute conversation. I felt stupid by the time it was over. It was just like, he's like, are you an idiot, you can't stick a Lab-in-a-Box. It was like -- it was literally like that, after like being very polite for a little while. So that type of stuff kind of intrigued me. And Theranos ended up being Theranos. I never really did much more with it after that. And then Wall Street Journal came after it, and it became this cautionary tale. I don't know if James -- did you follow Theranos very closely, I don't even know if we really discussed that?

J: No, I had heard from some VC friends who were very skeptical of it all the way through. But I wasn't that close to the name myself.

AR: Yeah, I mean, neither of us I would say, I would characterize myself as close to it. But I mean, I did take the time to literally be like, hey, do I short these stocks because of Theranos, right? It was like an investment idea at the time.

So yeah, I mean, I guess that's what started it, right. I mean, like Theranos had this -- and then the message was just kind of just like affordable blood testing for all, a social cause being compared more to, like technology differentiating companies and I mean, Elizabeth Holmes like to associate herself when she talked about things, when she compared herself to the Google Founders and Facebook and like, I mean, if you saw the documentaries like here we were at, in Brazil, and this is where we -- who was sitting there, and the Google guys, and the Amazon and Facebook, and we are the stars of the show, right?

And if you look at Invitae, I mean, like on the surface, it's like there's a social enterprise element to it, right? Where it's just like, we have a mission, and this mission is to make genetic testing affordable for all. I mean, like, they don't care, they don't describe themselves as like a laboratory diagnostics company, right?

DS: Well, they --

AR: That was a genetic information company. Go ahead.

DS: Yeah. I mean, if you look, I have got their 10-K open, their last one and it's -- our goal is to aggregate a majority of the world's genetic information into a comprehensive network that enables sharing of data among network participants to improve healthcare and clinical outcomes. So it's this.

AR: Yeah, so what does that mean?

DS: Right. You know, it is this very -- it is very big mission, right. It is very big.

AR: Yeah, I mean, James, obviously has some views on this. Like, I mean, what do you think of that part?

J: Well, I think that really comes down to the crux of the investment case here, which is, just because something sounds good as a sound bite doesn't mean that it actually makes sense in business. And so the idea of accumulating the world's genetic information, you would argue, seems like if you could do that would allow you to capture rents on that database. But there are very real issues with that. Namely the company has said that they won't do that. And then when they're pressed about how -- whether or not they will do that, they kind of seem to give non answers what I can tell.

So that's one of the questions right that that I think would be very helpful for the company to lay out there, very specifically, which is, if we gather all this data up, and specifically what data is being gathered? Are they -- is that data, they've also released to a common database, like they say they have been doing, is there additional data that they're not releasing?

AR: Well, I mean, the data that they're sharing with the common database is the variant of unknown significance data, right? So I mean, that's what they're contributing to Clinvar. We don't really know. But like, I mean, I'll be honest, like if I was to go in and have hereditary cancer test, I would have never thought once about, like, who the lab doing the test is or ask the oncologist anything, but like literally now knowing this business, I mean like, make sure you're not using Invitae, because I have no clue what they're going to do with that data.

Like my DNA is a product for them to figure out somewhere down the road just to do something with it, I mean, it's so -- like James just said, it's very bizarrely unclear, which is decidedly convenient when you're running a business model like this.

DS: So step back for a second. So the thesis -- the company's thesis is that they're providing genetic tests. And then they're aggregating that, they provide it at -- arguments are they providing it for below the cost that they actually have to pay to their providers to actually deliver the test but low cost testing that they can then -- if we're going to use the Silicon Valley jargon, that they get the flywheel of more genetic data and improve, they get a lot of volume, and eventually, that's both going to give them scale to lower the costs, but then also they're aggregating this huge genetic database, which as you kind of point out, Akram, they're going to have to do something with to make it reasonable, which raises concerns in of itself. But the idea is that eventually they'll get scale from offering at cost that will allow them to become a profitable business, I think. That's how I understood the company's take and the company's argument.

AR: I mean, like James just said the company hasn't explained that. So if you look at this company's history, this isn't like a startup, number one, right. So this company was founded in 2009. They've been at this for a decade, okay. Initially, they were kind of rare disease focused, right?

Like where they're deriving the revenue, if they were to actually describe themselves accurately, they would be like, we do hereditary cancer testing far cheaper than Myriad, right? And I mean, like, I think that's an important thing to look at this. I mean, there are sources of revenue, which is generally speaking what has attracted people to the stock, it's not science, right. It's not like you've developed a test or you're like Foundation Medicine and you've got this companion diagnostic clinical trials and you are about to do something where you're going to earn a high margin, because you've developed something nobody else has. That's typically, what people get excited about in science and biotechnology, right?

You get rewarded for R&D, okay. These guys have approached the market that Myriad discovered the BRCA mutation in 1994, okay. That's like what the indication of hereditary cancer right? I understand cancer, 90% of it is not hereditary. So you're looking -- when you talk hereditary, there's a less than 10% chance that it's something hereditary. That's helpful from a clinical standpoint, as far as your treatment for cancer diagnosis, whether it's early or late stage or whatnot.

So this company came into this space in the sense that Myriad had a monopoly on this gene, right? They started doing their first BRCA testing lab kit was like 1996. They had the patent on that gene till 2013 when the Supreme Court struck it down, right. So these guys entered this space, essentially, from that standpoint as a competitor against Myriad. And once that space kind of opened up in hereditary cancer testing, I mean like, well, you can't patent these genes, right? Which is great for competition, but what's the flip side of it?

If I make a major discovery on gene X correlates to disease Y, right? And I can't patent it and I'm running like a test that kind of identifies that historically, kind of tough to build a very profitable business around it. So when we go back to like what you were saying about like this whole genetic information and whatnot, the most interesting thing about this business is look at the rest of the landscape. Nobody's selling the story, like Myriad's still the revenue leader in hereditary cancer testing.

The other space the company is in deriving revenue from is reproductive health, carrier screening, non-invasive prenatal screens. And that's the most crowded market ever. It's got Ilumina and Sequenom, which is owned by LabCorp, like pretty much, they control the IP there. And then there's like a half a dozen other competitors owned by large companies.

So like, in hereditary cancer, you've got Myriad. And then you kind of have this like at a huge, huge, huge discount to Myriad prices, Invitae, right? I mean, like now they're running what, $99 tests, okay? So you look at it and you can sit here we can just, like figuring out what they want to do data wise and the fact that it's Vegas kind of important. It's also important in the context of -- well, there's a whole industry here, right? I mean, this is at least what -- we got some heat when we cautioned this like, some of this has attracted obviously a lot of retail investors by using the Amazon compare. And, in the initial thesis it was like a cautionary mention at the end, like that the laboratory diagnostic space doesn't need another Theranos.

And at least in Theranos' case, what they were selling to investors was we're building a better mousetrap essentially, right? Like we've got -- we've engineered something that's going to change the way we are able to do testing. And that's not the story here. The story here, I mean, if you go back to the founder in 2016, there's a couple of interviews with him. And he literally says like, we're providing the same test that everyone else is providing, we're just making them more affordable. That was that's their initial story, right.

So I mean, you do kind of run into something like that, which is where, like some people may think it like, you know, oh, it's very, self-serving or opportunistic to compare this to WeWork. It is, exactly like WeWork from a business standpoint. Like you can't get around that fact. And I think the Amazon like -- and this is not like some guy writing a really bullish Seeking Alpha article and using hyperbole, the management sticks to compares. I mean, they -- literally they have a slide in their investor deck, what we can learn from Amazon, and they make statements like our competitors -- what did they say, James, is like the competitors margin is our opportunity or

J: Yeah, something that effect. Yeah, you've heard a lot of ground there, Akram. I think the important aspect of what you've said and the commonality among all those points is that the management team has made some very high level statements about the promise of this industry and the promise of their company. And they could really answer a lot of these questions if they wanted to, right? They could say, okay, here is our revenue breakdown from cancer or nips [ph], kind of other panels, which don't have necessarily the clinical efficacy.

Or they could say, here's our -- here's what we're getting from the various cost cutting or network effects or economies of scale that we promised. And here's how this is going to develop, but they don't they just say, trust us, it's all going to work out. And the way that it's not [ph] going to work out is that it worked out for Amazon. So it's there's not much transparency, there's a lot of just kind of big picture verbiage I would say.

AR: Yeah. I mean, 100% and like, I mean, you get the Amazon story, Daniel, right. I mean, if you look at it, people like, if you look, well, come on, Amazon was losing money. No, Amazon was improving operating cash flow from literally from day one. I mean, people forget, like, you make money selling DVDs and books online, particularly if you don't pay your suppliers for 100 days, right? I mean, like, where was Amazon after a decade? It was already a behemoth, right?

So when you look at it, Amazon had someone else, i.e., their suppliers funding their growth. It's free, cheap capital. This company went and IPOed in 2015, at $16 a share, had like 25 million shares outstanding. They're at 100 now, four years later, right? I mean, it's like, they keep going back to the well. So if you're an investor and you're looking at it from a return on investment on money, you're giving them. I mean, you have a serious problem. And if you look at it, and you say, hey, I'm going to compare myself to Amazon. Well, Amazon had a cost structure that attacked this cost structure of brick and mortar, okay?

They benefited from so many things. We didn't have sales taxes, if you were paying on Amazon as a consumer. They benefited from the fact that they went into markets with huge existing volume already, books and DVDs. They didn't have to convince people to buy X, Y and Z. They were already huge volume markets. I mean, I'm sorry, but like hereditary cancer testing. It's not something people get excited about to go online or buy as a gift for a friend.

I mean, like, we get the DTC space, and even that has already slowed down drastically, and that's Ancestry. And if Ancestry slowed down at like 30 million tests, right, like, you really think people are going to be super excited as individual consumers to be like, I really need to figure out whether I have a history of cancer right now. I mean

J: Well, and more importantly, more importantly, I think there's a healthy amount of skepticism in the medical community whether or not these tests are useful, right? Like the issue with any test is, if you find something, an indicator of a disease. Does that help you catch the disease? Does it help you catch it earlier than existing testing or physical exams, or other ways of seeing the diseases there? And then can you do anything about it?

So, I think one of the issues here is even if you were to send your saliva [ph] sample out, and you came back with saying indication that you might have liver cancer potentially. A, you wouldn't know, if that were real, because it's really just a correlation at this point. There's not enough data. B, even if you knew, it was real, there's really not much to do except worry about it. And so you have a lot of additional burdens on the patient and the healthcare system in terms of emotional and financial burdens, without any clear benefit.

And so I think within -- as I'm saying, within breast cancer, that there is a clear benefit in terms of efficacy and outcomes. But for the rest of the space, it's really not clear. And that's why, if you look at the treatment protocols for most of the commercial payers, they don't pay for all these tests, because the research doesn't demonstrate that they should.

DS: So one of the things I'm -- as we're throwing around these comparisons. I'm thinking about the -- there's a notion in Silicon Valley and sort of abroad, the market, the idea of tech, tech as a category is becoming less and less meaningful, because companies are adopting online models or tech models to different verticals. And what I think about with Theranos and Invitae, specifically, healthcare is a very complicated sector, both in terms of the way payers work and we can get into Medicare in a little bit, but the way the payment system works.

And I'm not talking even about what might or might not happen in the future with changes to insurance. But just -- that's, I think, always been fairly -- you have to really work through it. And the articles for example, there's looking at the different reimbursement codes and that sort of thing. Like, it's more than you have to do to figure out, well, are they going to buy this software tool or not?

And then also, Theranos is a problem, because they were actually -- there were issues of fraud around people, things that were supposed to help people's health. And so I guess I'm just kind of, I guess, I wanted to hear a little bit more about like, because -- a lot of the response.

AR: Well, I mean, look -- let's, I mean, if you think about Theranos, where really was the fraud. The fraud like, I mean, if you read the indictment, what she's really on the hook for the biggest time is misleading investors, okay. I mean, that's the biggest part.

Yes, correct, like at the end, there was issues with the lab testing and they were getting inaccurate results because by the time she did that deal with Walgreens, and clearly they were at a point where they were desperate for showing meaningful revenue, because they need to raise more cash, right? Because they still haven't made the Edison work, right? They're trying to engineer a problem. They're working on it.

She didn't set out to commit fraud, right? She set out to build -- to stick a Lab-in-a-Box, right? But she had bigger aspirations. She wanted to take -- that she wanted to aggregate your data. She wanted to stick it in this cloud called Yoda, right? I mean, if you look today, you still have people who defend -- I mean, what's his name?

DS: Yeah.

AR: Tim Draper has really defended her. And what does he defend her on the point, and his point is that look, she had this vision to give you a movie of your health, i.e. like look, I get my blood work once a month, and that goes into a cloud, right? And my physician can track it. And I'm building a historical picture of a trend, by having more real time information on my blood work, cholesterol, everything right? So that creates preventative medicine in their view, right? Like your ability to have an earlier and more accurate versus a snapshot, right?

So he's like, look, she had that and was great and I genuinely have discussed this with James. I believe if she had IPOed this company and the company had started out as like, hey, she's got this Edison and this finger stick. It would have been just like binary tech play, right? She either makes it or she doesn't. And people would have debated that and thought that out there would been the believers. And then there would have been the skeptics, but she would have had plenty of time, as she gauged how that was working, okay?

To find something that generates revenue, which investors are willing to pay for, like with her inflated market cap on the Edison optimism, where she could just do regular lab testing like Quest and like LabCorp, but she would obviously do it at a lower price, right? But she would sell you the story that I'm going to stick this in the cloud, and you're going to pay a subscription fee, right? And that subscription fee to that cloud, Yoda, where all your information is and your general practitioner can access it and whatnot, that's the business. That's where I make money.

Of course, what's the problem with that business? And that business is -- well, I mean, that you're going to be like, well, you're losing a lot of money per test, doing your tests at a lower price than Quest and LabCorp or whatever to provide this back end service, why can't they do that, right? I mean, like, that becomes the same thing because you're going to need the same infrastructure. That's where she ran into issues. She's collecting data and she doesn't have the lab infrastructure to do it at the scale that these guys are doing.

If she'd been like these DTC companies, 23AndMe ancestry, she could have actually struck a deal, which is like, I'll be the cloud and I'll outsource the testing to them. And I will take a loss on the tests, because my investors are going to subsidize it, right? I mean, there was -- there would have been many Ways, but of course, she was also trying to kill their businesses. So it didn't work, right, with her engineering. but like, I mean, the bottom-line is, is if you look at it, like, it's something where you had a potential business model in that sense, where we would be asking the same questions that you'd ask about in detail, right? Like what are you doing that's different?

If you look at them today, Quest and LabCorp, they've entered into direct-to-consumer testing. I can go online and order my own tests and schedule the appointment and go pick them up, right? I'd like it's really, like, it's something where I don't even need to go through my medical practitioner if I want to get tested. And I don't know, to the degree I mean, I've discussed this with other people in the medical community on the testing side and I'm just, why isn't there a VIP service like, if I'm an extremely wealthy individual, where they come to my house, do the work, store in a cloud. And there's access to my blood work, on let's say -- but we don't have to do a monthly but let's say every three months, right?

These -- I mean like these are obviously options. So when you look at something like that and you see what went wrong with this company, her biggest mistake was being private. It's like -- because with her turtlenecks and Steve Jobs and Stanford dropout, I mean, the benefit of doubt, she would have gotten, if you look at the benefit of doubt, for example, that this company, Invitae has gotten. I mean, their CEO says one thing, and then he does the other three months later and nobody has cared like, at all. No one's asking questions. I mean, I don't know if you -- have you watched the CNBC, the Invitae interview with him on CNBC, Daniel?

DS: No. No, I haven't pulled that up.

AR: If you watch that, you would not understand what the company does. It's like we are the company the key opinion leaders turn to and this -- like, he does not say I'm a laboratory diagnostics genetic testing company, who derives primarily its revenue from doing these types of tests. And we're doing them at a significant discount to a competitor, who has had a monopoly in the space for ages. And we're using that to generate volume and we're hoping to parlay that into other sectors. And this is like -- this is our business model. Because to be -- to tell you the truth, if you look at this closely, I don't think they figured it out. They are trying to figure it out as they go along and that's part of the problem here.

DS: Isn't -- you said, if Theranos that they could have arguably sold tests below costs, but then put the -- like, isn't that essentially what the Invitae has? They haven't maybe laid out that vision but they're essentially selling below cost to get into -- like they could build that into the cloud sort of approach like?

AR: Okay. No, let's not make that mistake, okay? I'm saying that Theranos, if they wanted to, okay, and wanted to pivot for a story to sell, that sells well, when you're dressed like Steve Jobs, and you dropped out of Stanford, and you're a unique character and you're -- you've got a Board that has these people on it. And you've convinced Tim Draper and Larry Ellison to invest in you and whatnot, right? When you've dressed something like that, and you've ticked all those boxes, okay, you could just be like, hey, I'm going to do the same blood work everyone else is doing, I'm going to do it cheaper. So come to me. And how I'm going to make money off of it down the road, is I'm going to store that data, and it's going to give you a real time picture.

Now if you were to compare this on genetic information, my DNA isn't constantly changing, right? So if I'm doing -- if my focus is hereditary screening, i.e., what's been passed on to me, and what does that indicate?

What is the usefulness of that sitting there, right? Number one. And number two, in her case, it would be like, well, you still need to build the lab infrastructure to do the tests. You're going to have to do huge volume. So any business that -- like I mean, if you listen to the CEO, he literally sits on conference calls. And he's like, we hope to do half a million tests this year and reach a million people next year, and on our way to billions across the world. Well, what kind of infrastructure, you need Amazon infrastructure for that, right? I mean, how many geneticists do you need, genetic counselors? The industry doesn't even have the employees. I mean, we were discussing this, like, how big is that industry James.

J: It's well smaller than then I thought it was. I think it's in the thousands of genetic counselors. I forget it, 10,000 or 15,000.

AR: So you're going to need lab technicians, genetic counselors, you're going to need the physical footprint. You're going to need logistics. I mean have you looked -- like part of the thing that like -- we found kind of interesting is just look at Quest Diagnostics. I mean, there was a $100 price target slapped on this thing. That's the market cap of Quest, okay? They have 3,500 trucks like 26 planes, 6,000 patient access points, right? They have infrastructure to test everybody.

The internet bull on this stock, he's been close to management. He's done a lot of write ups on it. One of his write ups was just recently, and I read it and he's like, I visited the company and the CEO told me that they're actually paying for the trucks to go to FedEx, to pick up the samples and bring them back instead of waiting for FedEx to bring them to the lab. And he's like, I've never seen a company who cares about the customer so much. And I am like -- I mean, sorry, logistics are part of his business. Collecting the samples and the turnaround time and what the infrastructure you need to do it, right?

Like that's not something of like, hey, I really care about my customer. It's something you have to do and unfortunately, Quest and LabCorp are sitting there with huge economies of scale and scope and infrastructure and the same machines available to them, and the lab technicians and the geneticists and everything to flip this switch on, and they're not flipping it on. Why?

DS: Right.

AR: It doesn't make money, because the volume isn't significant enough and the cost isn't at that point. So when this company talks about driving down costs, no, they're not driving down costs. Everyone else has a lower cost per test already established, because they have higher volumes in the space, right? If you look at it Myriad's cost per sample is in the $140, $150 range. If you look across all these other labs, who are doing the stuff and the testing on the reproductive health they're all far lower, right?

So this is a last person in the space coming and trying to get to the volume, trying to get to the economies of scale and trying to drive it down, right? But they still are subject to the same cost infrastructure limits. It's not amazon.com. They haven't eliminated the blockbuster employees sitting, that when they're competing against in DVDs like a Netflix or an Amazon or whatnot, they haven't eliminated the huge physical retail footprint that a Barnes & Noble needed, right? Like, they still have the same limitations, from a cost standpoint. They're relying on Ilumina machines, consumables, Agilent, Read [ph] everybody -- like it's the vials from, what's the company that sells the vials?

J: OraSure

AR: OraSure, right, like you're buying the same stuff from the same people. So it's when you look at it from that standpoint, like if they were to sell you a story about data or whatever, it's like, well, everybody else can sell us a story about data. Why are they selling it to us?

J: It's an interesting dynamic here, because when there was the rebuttal by this bullish commentator/endorsed analyst of the company, there was a comment that, hey, it's not just the raw data, it's not just the genetic information that is useful, because genetic information in and of itself doesn't tell you enough about the disease. And I think that's a partial indictment of the whole process. But more importantly, what the analyst said is, what the company does is they take that information and they combine it with a patient's medical record. That includes all of their scans, their CTs, their MRIs, all their historical blood tests, all their physical exams, and then it takes that data. And if you get enough of that data, then you can start running effectively very large statistical relationships and figure out, okay, which genetic mutations might be associated with which diseases.

The problem with that is, as far as we know, that's not what's happening. And yet the company, again, they've kind of endorsed this, this guy is an analyst of record, the company hasn't come out and said that. But that's not what's happening. Because if it is what is happening, I think they're serious privacy concerns. So I think it's very different, if you as patients and [indiscernible] into 23AndMe, you might sign a paper, some paperwork somewhere, but if they're actually signing away the rights to all their medical records. Again, I don't believe they are, but again, this is what would need to happen in order for this data to be proprietary and useful. Then I would imagine the consumers are not aware of that.

And so you kind of have this catch 22, if you're getting the data, whatever, this guy refers to it as the golden data, whatever it is, if you're getting that data, such that it's useful, you're probably in violation of some privacy laws, whether or not you are in terms of you're covered legally, I think just patients don't understand that's what's happening. And if you're not getting that data, then there's a very real question as to what exactly is the use of just this genetic information without putting it into -- in context without kind of correlating it to these other disease markers?

And again, this is a question that could -- that's very answerable by the company as far as we know, has decided not to answer.

J: I mean, look, there's also two elements of that, right. If you remember also, in his rebuttal, he pointed out to a subscription model, right ,where he was even saying that this should be looked at from a dollar-based retention standpoint like a SaaS company. So I mean, again, if he's saying this, it's something that well was spoon fed to him, okay? And that's part of the element here, when you're dealing with something like this, and you look at that, it's like, all right, so like, I go in, I do a test for cancer, but you know, a BRCA screen. And you're saying -- are you essentially saying that, in year one, you generated revenue off of the actual testing, but then in year two, and year three, supposedly, my DNA is something that just sits there, and they can find ways to make money off of, by farming it for some sort of data that they can sell to pharma.

And it's tenuous at best to even understand how that model would work, because if you look at the rest of the industry, you just have to assume, they're all idiots. I mean, how many tests has Myriad done? I mean, look, when you go back to this thesis, Daniel, one of the most important things here is, when I put this on, this company was bigger than Myriad, literally in enterprise value, it was bigger than a company with $850 million in revenue, 20 years of testing. They've done 6 million tests through some -- to that effect I think it is at this point.

They have a database that they've made a trade secret since 2004, as far as variant data. They have four times the employees of Invitae. I mean, if you were to look at this company from there -- one notable institutional bull in the space, like this bull doesn't own any Myriad, okay. And they have a genetic spawn, and they did like kind of throw like a little bit of a shade at this thesis when it came out. And I mean, I can imagine they got a lot of questions because they own a lot of the stock and they were like, these are the companies leading in AI.

And then they like -- they listed Invitae like two other names. And then they put in their tweet, which was almost essentially directed, not my gen [ph], which I mean, for someone like me, I just -- I didn't even really spend much time getting into the AI nonsense. But if you look at Myriad how many people with machine learning backgrounds and data scientists do they employ, plenty.

You could just go on LinkedIn, look at it, and draw your conclusion. But they're not out running around saying, hey, we got AI, we're doing stuff. We're literally running machine learning models on your DNA. We're figuring out better ways, a secret sauce. Like who would advertise that? If you actually have made the data a trade secret, and you refuse to share it and they've gotten a lot of heat for it, literally the whole industry had to band together to contribute data freely to Clinvar, because Myriad won't share, because they're like, hey, fine, you took away our patent, but who cares about that. Our ability to interpret this is better than everybody else at this juncture.

So again, you look at it, at something like that, and you're just like, well, there's companies who've been doing this for decades. And you're just supposed to assume that like data science is completely irrelevant to them. But the company that acquired an AI startup in July, by September is a leader in this space. I mean what, you know.

DS: Solet me -- so there are a few directions to go here. But let's quickly touch on Myriad. It's -- you're using it as a payer here, as I think you mentioned, it's -- short sellers have kind of had their eyes on it. Somebody like Southern Investigative Reporting Foundation has reported about it. Why are you comfortable with that as the other side of this trade given the fact that they've also come under fire?

AR: I mean, I don't know James, you want to tackle this? I'm obviously a lot more bullish on Myriad then most people. I would say, like, I can't really get my head around the short thesis, and I can't get my head around the short thesis in a relative context. I mean, if you've looked at the space there are some companies with some pretty crazy valuations. Myriad is not a hard business to understand. They have a cash cow in hereditary cancer. They've used that to diversify into companion diagnostics, into carrier screening, now into these pharmaco-genetic tests, psychotropic like for depression, which is a very controversial area.

A lot of a lot of volatility around Myriad lately, let's say the last six months, has been tied to this gene site division, and the way the FDA wants to treat these tests, where I get a DNA test that like tells me, I'm more tolerant for Zoloft over Prozac. And no science has shown any clinical efficacy yet, and it's a controversial area, because there's obviously some doctors, and they've been doing -- they've been running clinical studies to try to get this approved. And they missed the primary endpoints on it. But there's also an argument that in depression, which is like opioids, a national crisis, essentially speaking, and it's not going to get better, that there's nothing, and something is better than nothing. I mean, two-thirds of antidepressants are prescribed by general practitioners. Not -- you're not talking about the psychiatry side here. These are not experts on these drugs or on mental health.

And the argument is that maybe you give them something that starts this out with a little bit more direction, however little incremental it is. Now when the stock got hammered in the summer, on its last earnings, was because they said the FDA is pushing back on them on the labeling. And then recently, there was another genetic psychotropic-related test company where the FDA allowed them to resume sending the test information, but to the doctors. So the patient just gets this, like here's what your genetics say, but nothing about the drugs. But the doctor actually gets the drug indications. And then that doctor can see that and that doctor can use that as part -- like as a helpful part of his treatment.

But again, you go back to -- they haven't been able to show scientifically and it's hotly debated. I mean, there was just recently something in -- two Harvard doctors had published something in one of the big journals on mental health, same thing with oncology, like outside of BRCA, like there was a recent paper basically like these other genes are like no better than a placebo.

So this is part of the problem in the space but I mean, I haven't -- I don't have the numbers in front of me. I mean, James do you remember off the top of your head, but I mean, I think it's like $850 million in revenue and like $150 million in EBITDA, something like that against a company with -- that did what, like $144 million in revenue last year and lost what $100 million.

J: Yeah, but larger now.

DS: Yeah, $850 million, trailing 12 months revenue, looks like EBITDA of over $100 million at least.

AR: Yeah. So like, you can look at that, I mean, and this is something when you look at stocks, I mean I was long, some Pinterest against the Snapchat short. And I thought about closing it before earnings. And the reason I thought about closing it is that you know, Snap is $16 billion and Pinterest is 15 billion and Twitter after its 35% decline is 18.2 billion AV. Yeah, Twitter's growing slower than the other two. But it's like three to four times the revenue base. And you got to kind of adjust for that, when you get to that point.

And you're like, this is a company that is in the advertising space, and it's doing -- it's going to do whatever issues its got, it's going to do 3.5 times what this is going to do and their enterprise values are a hair apart. So when you -- like this wasn't -- this is a case where if you would look at an Invitae, you'd be like, this has got to be like a quarter a fifth of the size of like, even if you are a believer and you're willing to buy into the speculation of a Myriad.

And then the other problem you have with it is that they're interrelated. All the revenue growth that is coming for Invitae is coming because Myriad hasn't come down in pricing. They've been fighting this price decline, because they've had the luxury to fight it as the leader in the space and they're extracting a premium for their testing, because they -- like there's a compelling argument, at least from their end, that based on the data we have in the history, our tests can more accurately predict what you have, as far as a likelihood of a hereditary cancer and indication reliably.

And it's ironic, and we were discussing this when we were working on this, like this company throw shade at who -- I mean, they throw shade at the DTC companies. Like they literally just gave a scientific presentation at this Houston Cancer Conference with Genetics or whatever, just like two weeks ago, where they were like, here's 23andMe's tests, okay, and this is what's wrong with it. Like 23AndMe gives you a BRCA test, that only is designed to detect three variants. Basically, if you're not an Ashkenazi Jew, it's useless.

But it's literally a report that is bundled in with the ancestry, with the health with the 50, 60, 70 reports, you get for $100 okay. It's not like you're going into buy this or you're going to your doctor and you're like, okay, I had breast cancer, I'm worried about a potential recurrence. Let's see family history. Do I need to get a mastectomy early because I have this mutation and that's a good preventative measure, et cetera, et cetera. They're not looking at 23AndMe. Like, it's -- you're competing in the clinical grade medical diagnostics market. But here's this company attacking the DTC companies who are not really their competitors.

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Homeless with HIV: A lack of housing makes a preventable disease deadly in Oregon – OregonLive

Monday, November 11th, 2019

Every month, Tim Menza receives reports about new HIV diagnoses and compares them to previous years. As a doctor and data analyst for the Oregon Health Authoritys sexually transmitted disease and HIV program, hes familiar with how the HIV epidemic has waxed and waned.

Oregon is four years into a five-year, federally sponsored program to end HIV transmission by testing vulnerable Oregonians, alerting them of their HIV status and providing them with treatment and preventative medication. Menza had been optimistic Oregon was on track to eliminate future HIV transmissions.

But a year ago, he noticed a troubling trend that Oregon was ill-prepared to tackle an HIV outbreak exacerbated to a deadly pitch by the harsh living conditions of the street.

While the uptick in new cases is driven by drug use, it is difficult to contain because of homelessness.

Few places nationwide have seen such a wave of new HIV cases as Multnomah County, where the number has more than tripled to 71 over the past two years. In this year alone, 37 people have been diagnosed close to equaling the total for 2016 and 2017 combined.

The virus has historically targeted marginalized communities, devastating an entire generation of gay men in the U.S. in the 1980s and 90s, and later taking hold in communities of color. But in the past few years, the outbreak has surged among intravenous drug users who are or who soon become -- homeless, and their sexual partners.

Public health officials have had to start envisioning their work as tied to the homeless services system, actively canvassing camps to seek out those who are sick. While health care providers have become homeless service providers, troubleshooting patients needs beyond medication.

People who have homes can fairly easily survive HIV, a pill taken once daily allowing them to live nearly symptomless. Yet it remains a potential death sentence for homeless people, who have their medication stolen, lack clean shelter facilities and suffer poor nutrition and sleep -- leaving their immune systems unguarded against the deadly virus.

A compounding factor

When Menza looked at the data a year ago, he found that across the state -- in both rural and urban areas -- new HIV cases were popping up among people who inject drugs and didnt have access to stable housing.

It wasnt necessarily a surprise. He had seen reports of syphilis and Hepatitis C rising in those populations often precursors to an HIV infection.

He knew the state needed to take immediate action, but the traditional path wouldnt work this time.

HIV cases among people who use heroin and methamphetamines jumped to 30% in the last two years, more than double the percentage of years before, according to state data.

Drug users typically separate themselves into social and sexual networks based on their drug of choice. But recently, those circles seemed to overlap more than ever. Officials say cheap, high-quality meth has flooded into the state over the past few years, a popular drug for people who live outside and want to stay up through the night to avoid being assaulted or robbed. The spike in meth use coincides with an existing opiate crisis, and many people have turned to using both the depressant and stimulant.

On top of that, Menza said that there is growing evidence that homelessness is a compounding factor.

Every time a campsite or group of people who use drugs together is dispersed through sweeps or clean-ups, the people there move and form new networks. Single-sex shelters split heterosexual couples up, making it hard to stay with one partner long-term.

That slowly extends the number of people who are capable of spreading the disease geographically and demographically.

A public health worker trying to contain an outbreak in a small group of people now must navigate ever-expanding networks.

If youre trying to do an intervention in a camp, Menza said, you have to work fast.

Taking healthcare to camps

In Multnomah County, many people who are homeless or on the brink of it receive HIV care from the publicly funded HIV Clinic, housed in the gleaming new health department headquarters near Union Station.

From that outpost, public health workers are adjusting how they mobilize around the HIV outbreak nearly on the fly.

Jaxon Mitchell leads the countys disease investigation team and field outreach. Hes used to tracking people down. Usually he can look up someones cell number or send them a message on social media. But that doesnt work with this outbreak.

To locate people, Mitchell and his team must search camps, scour social media profiles for clues and trace leads from hospitals and friends. Thats made even harder by strict health privacy laws that mean Mitchell often cant tell neighboring campers why he is looking for a specific person.

The rise in HIV -- and its accompanying diseases of syphilis, shigella, hepatitis A and C mean that Mitchell often receives test results for homeless people who went to an ER for short-term treatment but were discharged to the street before the results came back.

When he does find the person he is looking for, he often has to work quickly to identify anyone else who might be infected sexual partners or people that have shared needles and get them tested or into treatment.

Out of a van designed for such field work, the county offers on-the-spot medical help, testing and provides other necessities like clean socks, snacks and tampons.

The public health department has faced smaller scale outbreaks before. For instance, Mitchells team is dispatched when a homeless person is diagnosed with tuberculosis and they must make sure the patient takes several months worth of pills to contain it.

But this is a much larger undertaking than ever before.

Its all based on being able to find people, said Jennifer Vines, the countys deputy health director. Now suddenly were in a new situation of having to figure out how to use our tools when people are hard to find -- or not wanting to be found.

Training the front lines

In his role at the county, Chris Hamel must train service providers on how to talk to their clients and patients about getting tested for HIV.

He seeks out homeless service agencies, primary care doctors, detox centers, parole and probation officers anyone who might interact with people at risk of HIV to try to make that step easier.

County officials have found that if they can get someone who is newly diagnosed into HIV care within 30 days, they are more likely to stay in care long-term. So field workers try to keep in contact through the first few appointments.

Were trying our hardest now to go to people, Hamel said. But I would like to see us continue to build a public health system that people feel comfortable enough that they will come to us.

Public health workers face the challenge of being as focused on those who havent yet contracted HIV as they are on people with positive test results.

Pre-exposure prophylaxis, or PrEP, is a daily medication that is highly effective at preventing transmission of the disease. Mitchell and his team also track down everyone they can who might be in the orbit of a someone with HIV to make sure they have access to the medication.

Thats a new sell to many. The pill has largely been targeted at gay men because it works even without use of a condom. But state data shows a 600% increase in women getting syphilis a sure sign that HIV will parallel that rise.

In this outbreak, the people most at risk are women, sex workers and intravenous drug users who tend to be straight men -- all people who likely never considered needing the preventative medicine.

Its the art of public health, Vines said. Were thinking about the individual, but we also have to think about the persons social circle.

Hard to help

In 2014, Indiana had more than 200 cases among intravenous drug users in one county. Last year, West Virginia experienced 80 new HIV cases tied to intravenous drug use.

Officials are seeing the HIV resurgence across the country, but the West Coast is unique in its profound lack of housing affordable to sick or addicted people.

In 2018, a cluster of HIV cases in Seattle caught the federal governments attention. The outbreak was within a distinct group of people who hadnt before been a driving force among new cases: Heterosexual people who were homelessness and using intravenous drugs.

Twenty-one homeless people in Seattle were found to have passed around HIV sharing needles and sex. The cluster bumped King Countys rate of HIV among homeless heterosexuals who inject drugs by 286%. Months after the cluster was identified, seven of the 21 people were still not receiving HIV care.

The King County outbreak demonstrates how difficult it is to engage the most socially marginalized persons with medical care, said a U.S. Centers for Disease Control and Prevention report.

San Francisco has seen a steady increase in deaths among this growing population. Someone with HIV who is homeless is 27 times more likely to die than a person with HIV who is housed, said Elizabeth Imbert, the doctor who oversees a new private clinic at Zuckerberg San Francisco General Hospital.

The citys homeless people account for 14% of all new HIV diagnoses, despite making up only 1% of the citys population, according to the local public health department.

The hospitals Ward 86 served at the forefront of a burgeoning AIDS crisis in the 1970s. Now its launched the POP-UP Clinic, a program designed to get homeless people in the door and in treatment.

Imbert knew from local data that only one-third of San Franciscos infected homeless population has been able to lower the amount of HIV in their blood stream to the point where they cant transmit it anymore what health officials call viral suppression. That is well below the average rate of 74% for all people with HIV in San Francisco.

The hospital launched its own survey to find that of 1,200 patients, the amount of the virus in their body increased as their housing situation became more unstable. And, as the amount of virus in their body went up, the more they missed primary care appointments and ended up in the emergency room and urgent care.

So leaders of Ward 86 created a new way to treat those patients. They had to find a way to get sick people in the door who dont trust institutions like hospitals.

Ward 86 employs people who focus on non-medical needs in hopes that it will help patients stabilize enough to stay on their medication. They also work with housing specialists from the state health department and community organizations to connect patients to services and ask that those workers come into the health clinic to do so.

The clinic is open four hours daily on Monday through Friday, and patients dont need appointments to see a doctor. Currently, about 180 patients are eligible for the program, which targets people who have missed an appointment in the last year.

Once they do come in the door, they are offered financial incentives to keep coming. The hospital offers a $10 gift card for every week theyre in the program, a $10 gift card to have blood work done and $25 if the patient achieves viral suppression.

Nearly a year in, 60 people are enrolled. Most have started on medication and Imbert said that shes already seen some in the program whove had their virus become undetectable. About half of the patients come regularly, while a quarter visit a few times a week.

We are using essentially every resource in the city, Imbert said, to get them indoors, housed, on a waiting list.

-- Molly Harbarger

mharbarger@oregonian.com | 503-294-5923 | @MollyHarbarger

Visit subscription.oregonlive.com/newsletters to get Oregonian/OregonLive journalism delivered to your email inbox.

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Tucsonans who have been moved, promoted or appointed in July-December 2019 – Arizona Daily Star

Monday, November 11th, 2019

Elizabeth R. Betsy Cantwell has been appointed as senior vice president for research and innovation for UA.

Cantwell will lead the UA Office of Research, Development and Innovation, which includes the Corporate Engagement Program, Tech Launch Arizona and the UA research parks.

She will be responsible for expanding the universitys capacity for knowledge creation and discovery; integrating efforts by faculty, students, staff and executive leaders to move inventions and technologies to the marketplace; increasing the UAs connectivity with external collaborators; spearheading industry and public partnerships; and increasing total research funding.

She joins the UA after serving as the CEO of Arizona State University Research Enterprise.

Cantwell moved to higher education after working for the Lawrence Livermore National Laboratory, where she was director for economic development and currently serves as a guest scientist.

Cantwell earned a masters in business administration from the Wharton School at the University of Pennsylvania after earning a doctorate from the University of California, Berkeley, in mechanical engineering and a bachelor of arts in human behavior from the University of Chicago.

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November is not only known as the start of the holiday season, it’s also known for Open Enrollment – WZZM13.com

Monday, November 11th, 2019

GRAND RAPIDS, Mich. When it comes time to enroll in a health insurance plan, there are often many questions or misconceptions.

Dr. Kristen Brown, president of Mercy Health Physician Partners, stopped by to talk us through what Open Enrollment means and which details should not be overlooked.

Open enrollment is the period of time where you select your health insurance coverage. This is generally the only time, outside of a qualifying life event, when you can add or drop a coverage plan or make changes to your coverage.

The choices you select during open enrollment set up how you will be managing your health care in the coming calendar year. One of the important, but sometimes overlooked, pieces of open enrollment is selecting your Primary Care Provider.

Primary Care is a relationship with a health care provider that is focused on taking care of you with your whole well-being and health history in mind. They are your first contact for undiagnosed health concerns, as well as preventative and continuing care of medical conditions.

PCPs offer a variety of services from annual wellness visits to vaccines and minor surgical procedures. They will also refer you to specialty care when needed.

There are several types of Primary Care Providers what is the difference?

Primary Care can also be referred to as Internal Medicine, Family Medicine, Geriatric Medicine or Pediatric Medicine.

When choosing a provider, your goal should be to build a lasting relationship. This individual will be your first medical contact and the health provider who knows you best. Some things to consider while select your PCP include:

In-Network vs. Out-of-NetworkStart by referencing your health insurance coverage, which typically publishes a list of providers who are In-Network. These providers will offer the best rates and work seamlessly with your health insurance.

Meeting Your NeedsNarrow down the list of providers in your area by reviewing their health care specialty, education and experience.

ConvenienceYou may want to consider the location of the office and office hours when choosing a provider. The following questions may be helpful when choosing a physician.

Research and Ask QuestionsTo find the best fit for you, we encourage you to research providers by reading online reviews, checking if your health insurer offers quality ratings or asking friends and family for referrals. You can ask to see if the provider is available for a simple meet and greet to assess your comfort level with the individual.

Mercy Health Physician Partners offers more than 90 locations in West Michigan. You can search for a provider atMercyHealthPhysicianPartners.com

Your wellness visit is an important step in maintaining good health. Taking part in regular screenings, routine preventative care and scheduling visits for minor acute issues can help you get ahead of illnesses and health conditions and help reduce health care costs.

Find a physician at MercyHealthPhysicianPartners.com or 844-BeRemarkable

Make it easy to keep up to date with more stories like this.Download the 13 ON YOUR SIDE app now.

If you would like more information about advertising with 13 ON YOUR SIDE, please contact Jeff Olsen at jolsen@wzzm13.com.

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Animal Planet’s ‘Crikey! It’s the Irwins’ features Oregon Coast Aquarium – The News Guard

Monday, November 11th, 2019

Animal Planets 'Crikey! Its the Irwins' will feature the Oregon Coast Aquarium in an upcoming episode on Saturday, November 23 at 5 p.m.

The non-profit Aquarium in Newport, invited the Irwin family to learn first-hand about the extensive animal care that the AZA-accredited facility provides.

The Animal Planet film crew documented Bindi Irwin assisting Aquarium husbandry staff in veterinary procedures and health checks for a wide variety of animals.

Boots, a harbor seal at the Oregon Coast Aquarium, is especially loved by visitors for her friendly demeanor. She found her home at the Aquarium after stranding on a beach in Mexico in 1988 as a pup.

At 31 years old, Boots is living much longer than she would in the wild. As a result, she needs increasingly specialized care to treat geriatric-related issues like arthritis. On the episode, Bindi works with Oregon Coast Aquarium Curator of Mammals, Brittany Blades, and Oregon Coast Aquarium Head Veterinarian, Dr. Dan Lewer, to provide a health check, laser therapy and chiropractic care to Boots.

It was great to meet and share information about animal care with Bindi, said Blades. She clearly has a good animal sense about her, and Boots responded very well to her, even interacting with her in the water after the exam.

"Bindi also mentioned that she had been considering using laser therapy at the Australia Zoo, so I think it was great for her to get this experience.

Laser therapy is just one example of the state-of-the-art medical care that the Aquarium provides for its animals. During her day at the Aquarium, Bindi also helps conduct an ultrasound on Dotty, the female dogshark, to check for pups and assists in annual health checks on a giant Pacific octopus and Japanese spider crab.

The Oregon Coast Aquarium is committed to providing the best quality care for its animals, which serve as ambassadors to the public for their wild counterparts. Restaurant quality seafood diets, highly trained staff, animal enrichment, and functional, natural habitats all contribute to this commitment, which is highlighted on the Crikey! episode. The Aquarium also partners with Willamette Veterinary Hospital to provide highly specialized veterinary care, including surgery, eastern medicine, preventative care and physical and laser therapy.

Terri Irwin, a Eugene, Oregon native, has visited the Oregon Coast Aquarium with her family for many years. The Irwins currently live in Australia where they own the Australia Zoo, a global zoological destination and world leader in wildlife conservation.

The entire Oregon Coast Aquarium team was ecstatic to host the Irwin family and Animal Planet and share our passion for wildlife. I think for many of us, it realized a lifelong dream, said Sally Compton, Oregon Coast Aquarium Communications and Marketing Manager. These relationships are essential because even from opposite sides of the world, we can work together to learn best practices for animal care. Ultimately, we share the same mission to educate people about wildlife and protect the planet.

If you are interested in watching the episode, tune into Animal Planet on Saturday, November 23 at 5 p.m. or catch it after it airs on http://www.animalplanet.com/tv-shows/crikey-its-the-irwins.

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Laughter Therapy: 11-10-19 – West Hawaii Today

Monday, November 11th, 2019

Aloha all! Responding to several readers, I will start with some one-liners as a warm up. Then well get to some serious LOLs.

Why are math textbooks so stressed? They deal only with problems.

Why was the farmer upset? His cows were very moo-dy.

Why are movie stars so cool? They have so many fans. One more?

What happened when the wheel was invented? It caused a world-wide revolution! Duh!

The Texas sheriff was looking for a deputy. So, Chad, the new recruit who was a blonde man wanted the job.

OK, the sheriff drawled, Chad, what is 1+1?

Chad replied, 11.

The sheriff thought it was not what he expected for an answer, but it was correct. Then he asked, What two days of the week start with the letter T?

Chad answered, Today and tomorrow.

Again, the sheriff was surprised and thought that maybe Chad had a creative mind.

Now Chad, listen carefully, Who killed Abraham Lincoln?

Chad looked a bit surprised, thought for a few minutes, then responded: I dont know!

The sheriff said, Well, why dont you go home and work on that one for awhile.

So, Chad wandered over to the pool hall where his pals were waiting to hear about the results of his interview.

Hey Chad, How was it?

Chad responded, It went great. First day on the job and Im already working on a murder case! (Did you forget that Chad was blonde?)

Why did the snail get a giant letter S painted on his Ferrari? So people will say, Look at that S-car go!

A man and a dog walk into a talent agents office. The agent says, OK, lets make this quick. Im busy. Whats your talent?

The man says, Its not me sir, its my dog. He talks!

Yea right, says the agent. Get out! Im busy.

No wait, says the man, Ill prove it. He turns to the dog and asks, What do you normally find on the top of a house?

Roof! says the dog, wagging its tail. Then the man asks the dog, How does sandpaper feel?

Rough, exclaims the dog.

The agent again says, Youre wasting my time!

Just one more, pleads the dogs owner. He then asks the dog, Who was the greatest baseball player ever?

Ruth, barked the dog!

OK, thats it, and the agent forces them out the door. Turning to the man, the dog sighs and says, Maybe I should have said Joe DiMaggio?

A man tells his doctor that he cant do all the things around the house that he used to do. After a thorough exam and some blood test, the doctor says to the man, Well, in plain English, I think you are just lazy.

With a smile, the man says, OK, now give me the medical term so I can tell that wife of mine. Maybe shell even have some sympathy for me.

Yes, it is almost winter time. So remember, you know its a cold day when your teeth start chattering and theyre still on the night stand.

Now to close, looking at my medical career, I can honestly say that impeachment is like the emergency room. We need to practice preventative medicine. Last LOL, my friends, be well, do good deeds.

Aloha, a hui hou.

Shay Bintliff, MD, writes a monthly humor column for West Hawaii Today.

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New Hays business brings traditional office therapies to the door – Hays Post

Monday, November 11th, 2019

By JAMES BELLHays Post

Physical therapy is typically something a person does not think about until it is needed and then finding time during a workday when offices are open is often a challenge.

ButAimee Riegel opens to change that with her new business Fit PT and Physical Therapy.

What I have done is created a mobile concierge physical therapy practice where I can come to the client, Riegel said.

And she offers different services than what you might see in a traditional physical therapy office such as working with employers to develop programs for their employees to help them before therapy is needed.

A lot of them are simply because we sit too long during the day, she said. There is a lot of things I can teach people and employers to show their employees.

Working directly with the public can be beneficial for the individual as well in both well being and pricing, she said. Not being contracted with insurance companies means she can offer a flat rate sometimes lower than out-of-pocket costs after a traditional office setting.

You know what you get up front,Riegel said.

Working outside of insurance she said also allows her the flexibility to work with what the client needs regardless of the mandates of an insurance company.

We can make a plan and really follow through without having insurance dictating (care), Riegel said.

When the range of motion is recovered, insurance companies will often stop covering treatment thats where her new service can come in.

Working with people to maintain a range of motion can help stop problems from occurring that can happen when not seeking treatment.

She launched the business in September and has been gaining clients through word of mouth and continues working at Progressive Physical Therapy two days a week in order for clients who are going through insurance companies to be able to use her services as well.

But through the new business, she offers flexibility in scheduling that a regular office normal will not.

Im available evenings. I can be available weekends. I try to be as flexible as I can for my clients, Riegel said.

Ive gotten some really great responses from the community, she said, adding many have told her this service is much needed in Hays.

And while the service is new, many will already know Riegel as she has been a long-time practitioner of physical therapy.

I have been practicing physical therapy for about 12 years and decided I wanted to branch out into something a little different, she said.

Using her services can help maintain motion and stay pain-free, and utilizing physical therapy prior to a specific incident is becoming more popular.

The American Physical Therapy Association is actually pushing really hard for preventative wellness and medicine, Riegel said.

By doing so, they hope to keep insurance costs lower, she said, by engaging people before they have an issue.

Wellness services can also more personally directed than insurance-mandated treatment.

Its more than developing exercises for an individual. Its very personal, Riegel said.

She helps see how people move and can direct their treatment to address their specific concerns.

Riegel offers a free discovery consultation where she can hear problems and see if her services would be a good fit.

An initial full consultation is $150 for approximately an hour and a half and includes a full evaluation and treatment during the visit.

A regular session is $125 for wellness or physical therapy.

She also offers a half-hour session for $70 or stand-alone dry needling for $45.

Health Spending Accounts and Flexible Spending Accounts can be used and if multiple sessions are needed she offers discounted rates packages.

For more about the business or to set up a consultation, visit http://www.fitptandwellness.com, Facebook or call (785)261-1772.

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Gene Tech Company Claims to Have Found a Cure for HIV/AIDS – NewNowNext

Monday, November 11th, 2019

by Sam Manzella 11/8/2019

A group of medical researchers in Maryland believe the answer for curing HIV/AIDS may be gene therapy.

American Gene Technologies (AGT), a Rockville-based medical research company, has submitted a Investigational New Drug (IND) application with the FDA to begin gene therapy trials that researchers believe could eliminate HIV in people already living with the virus.

The drugan HIV treatment program called AGT103-Tis a single-dose, lentiviral vector-based gene therapy that AGT says could remove infected cells from the body and decrease or eliminate the need for lifelong antiretroviral treatment in HIV-positive patients.

If approved, the company hopes to begin a Phase 1 clinical trial that will examine the safety of AGT103-T in humans.

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In a press statement, AGT chief science officer C. David Pauza, PhD, said the companys objective is to treat HIV disease with an innovative cell and gene therapy that reconstitutes immunity to HIV and will control virus growth in the absence of antiretroviral drugs.

AGTs approach differs from other medical researchers attempts to cure HIV. As NewNowNext reported earlier this year, researchers in Europe made headlines when two separate HIV-positive patients no longer had the virus after obtaining bone marrow transplants from donors with an HIV-resistant mutation to treat unrelated cancers.

Those patients marked the second and third time doctors were able to effectively cure patients living with HIV via bone marrow transplant in the history of modern medicine. However, HIV/AIDS activists and medical professionals were quick to raise concerns about the feasibility of curing HIV with bone marrow transplants on a more widespread basis.

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Kenneth Freedberg, MD, a professor of medicine at Harvard Medical School and Massachusetts General Hospital, told NewNowNext in March that the method is not a remotely plausible strategy for HIV treatment for the vast majority of patients.

A bone marrow transplant is an extraordinarily toxic and life-threatening intervention, which you do if someone has an illness thats clearly going to be fatal, Freedberg explained. There must be no other treatment options available. It puts people at massive risk for infections and toxicity complications.

As the fight against HIV/AIDS wages on, communities at risk of contracting the virus continue to take preventative measures against new infectionsincluding daily use of Pre-exposure prophylaxis (PrEP), a potentially life-saving HIV prevention drug that is massively popular among gay, bisexual, and queer men.

In the United States, PrEP is pretty much exclusively available as Truvada, its brand-name version manufactured by Gilead Sciences with a very high retail markup. That may change soon, though: Earlier this week, the government filed a lawsuit against Gilead alleging patent infringement on PrEP, which was patented by public health researchers at the Department of Health and Human Services years ago.

Brooklyn-based writer and editor. Probably drinking iced coffee or getting tattooed.

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Living Longer Is All About Chemistry and the Miracle Molecules – Qrius

Monday, November 11th, 2019

Lizzy Ostler, University of Brighton

Given the opportunity to live much longer lives, many of us might feel less than thrilled at the prospect. After all, you might think, who would want to live an extra 20 years dealing with arthritis, dementia or heart problems?

But what if those years could be filled with youthful vigour or at least middle-aged comfort?

The ability to reverse, or slow down, the degenerative processes that come with increased age has been a long held human aspiration. Indeed it has provided a consistent focus for decades of scientific research on ageing.

But it is only in the last ten years that the replacement of palliative treatments (which suppress the symptoms of age-related diseases) with genuine anti-degenerative medicines (which prevent and repair) has become more than a pipe dream.

This paradigm shift stems from recent research that shows that just a few biological root causes underpin almost all the diseases of old age. Such a discovery is an opportunity to address a wide range of illnesses simultaneously with treatments that target single biological mechanisms. For the first time, ageing has become druggable.

One leading cause of age-related changes, including illness, is known as cell senescence. This is a consequence of evolution that only really comes into play when organisms outlive their normal reproductive age, or are subjected to a very damaging environment. When cells become senescent they can no longer divide, and typically behave in a way that damages the tissue around them.

For many years, much of the gerontological community had considered cell senescence to be a symptom rather than a cause of age-related decline. However, recent groundbreaking research showed that removing senescent cells from mice not only prevents normal ageing, but actually reverses many of the symptoms. This proof that senescent cells cause ageing finally provides us with the potential to develop a cure.

Follow up work has revealed that the positive effects of senescent cell removal in mice extend to myocardial infarction (which causes heart attacks), Alzheimers disease and metabolic dysfunction. The challenge now is to translate these findings to treatments in ageing humans.

To that end, major investors have now joined researchers in the search for ways to kill, remove or rejuvenate senescent cells. And they have made exciting progress.

For example, when combined, dasatanib (a leukaemia drug) and quercetin (a natural product found in vegetables), show improved health and lifespan in mice. And early results from clinical trials of this combination have demonstrated the first ever alleviation of physical dysfunction in patients with idiopathic pulmonary fibrosis, a progressive degenerative lung disease with no current effective treatment.

The list of common side effects associated with dasatanib means it would likely be restricted to only the most seriously ill patients. But the trials give hope for medicinal chemists to develop a more palatable second generation of similar drugs.

An alternative strategy is the rejuvenation of senescent cells. Resveratrol, found in red wine and chocolate, was shown to be able to rejuvenate senescent cells in the lab, restoring their molecular fingerprint and growth to that of normal youthful cells.

Importantly, this work also demonstrated that small synthetic modifications were able to tune the effects achieved - again demonstrating that a medicinal chemistry approach to the problem is highly likely to be successful.

Elsewhere, Fisetin, a natural product found in strawberries, apples and onions, was recently shown to confer both improvements in health and a reduction in the senescent cell load in old mice. It is now also the subject of clinical trials.

Interestingly, Fisetin also interacts with other key ageing mechanisms, such as nutrient sensing the biological mechanism that underlies the well known health and lifespan increasing effects of calorie restriction.

It is not yet clear whether this is a new kind of super-therapeutic that simultaneously targets more than one cause of ageing, or whether it will reveal a new piece of the jigsaw that allows us to integrate the known paths to morbidity into a coherent whole.

The research conducted so far, just using natural products and existing drugs, has shown unequivocally that small molecules can produce a broad spectrum of anti-degenerative effects.

Drug discovery for ageing is moving beyond its infancy, and preventative medicine that will revolutionise 21st-century healthcare is now genuinely possible. Now we need to add synthetic medicinal chemistry to the mix to develop safe and effective drugs that will help us all into a healthier and more active future.

Lizzy Ostler, Head of Chemistry, University of Brighton

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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13 Unexpected Reasons Why You Might Have A Fever – HuffPost

Monday, November 11th, 2019

Feeling a little heated? Its typically nothing to worry about especially if youre sick. However, other issues can cause your temperature to rise.

A normal body temp is typically around 98.6 degrees Fahrenheit (37 degrees Celsius) but can vary slightly for each individual, and even fluctuate depending on the time of day.

It can be lower in the morning and higher in the late afternoon and evening, said Michael Hall, a physician based in Miami. But when your temperature gets to 100.4 degrees Fahrenheit or higher, and lasts more than a few hours, youre getting into fever territory something that can be caused by a number of conditions.

Most of my patients understand that a fever is a common symptom of cold and flu, said Christopher Dietz, an area medical director at MedExpress Urgent Care. However, what some people might not realize is that a fever isnt always just a sign that youre coming down with something.

Heres what could also be at play, according to medical experts:

PhotoAlto/Frederic Cirou via Getty Images

Infections

If you are looking for the reason behind your elevated temperature, start here. Experts note that infections are commonly associated with a fever.

When the immune system detects a threat such as bacteria or virus, a substance known as pyrogens is released into the bloodstream to reach the hypothalamus, which regulates body temperature, said Diana Gall, a general practitioner with Doctor4U in the U.K. When the hypothalamus detects pyrogens, it raises body temperature and causes fever in an attempt to kill off bacteria and viruses.

She noted that a high fever is one of the ways your body is responding and fighting the infection but a body temperature that is too high can also be dangerous.

If the fever is persistent and isnt coming down with home remedies, you should see a doctor, particularly if the fever is accompanied by a severe headache, difficulty breathing, blood in your urine or stool, redness of the skin or rash, or vomiting, etc. The infection may be serious and your body temperature may not reduce without medical treatment, she said.

Overexerting yourself outdoors

Hot outdoor temperatures and internal heat generation from exercise and mechanical movement of the body can heat you up, said Phil Mitchell, national medical director at DispatchHealth.

Under normal circumstances, your body will function well enough to cool you down through sweating and dilation of blood vessels. But if these basic systems are overcome and you cannot cool down, your body will continue to increase in temperature.

This typically does not happen from exercise alone, but exertion in a hot environment can cause this under the right circumstances, Mitchell said. He noted that you should immediately remove yourself from the heat and try other methods to cool your body down if this is the case.

Heatstroke can occur if heat exhaustion is not treated promptly. You need immediate medical attention if you become confused, lose consciousness or if you have an elevated temperature in this situation, said Steven Reisman, a cardiologist and director of New York Cardiac Diagnostic Center.

Vaccinations

Vaccines to prevent a bacterial or viral infection prepare your body to come in contact with that infection later, said Erik A. Larsen, assistant director of EMS and emergency preparedness at White Plains Hospital in New Yorks Westchester County.

So when you get the vaccine, your bodys immune response is stimulated and the body says, Whoa, what is this? It then mounts a fever, he said.

Larsen added that when you get a vaccine, youre not really invaded by an active infection, but it tips your body off that sometime in the future you may come across this.

tommaso79 via Getty Images

Alcohol withdrawal

Low-grade fevers can occur during the first few days of alcohol withdrawal as the central nervous system, which has been suppressed by alcohol, readjusts, said Holly Phillips, a board-certified general internist in New York and a medical expert for RxSaver.

Alcohol withdrawal also causes tremors, which can affect your heat, Larsen said.

The body is reacting to the loss of not receiving alcohol, which creates muscle contractions. This makes the body shake like a tremor, and it raises the bodys temperature, he said.

Inflammatory conditions

Certain inflammatory conditions, like rheumatoid arthritis and lupus, can cause fevers, said Lisa Alex, a physician at Medical Offices of Manhattan. This also occurs because the body is producing pyrogens, which raises your temperature. So if you have underlying inflammatory conditions and have a flare-up of any sort, the result may be a fever.

Certain medications

Many medications like antibiotics [and] antimalarials can also cause drug-induced fever. Anticonvulsants and some herbal medications can also do the trick, said Soma Mandal, a New Jersey-based physician.

You should monitor your bodys reaction when taking any new medication.

Look for a fever that starts a week after starting a new medication and goes away once you stop taking the drug, said J. David Gatz, an assistant medical director of the emergency department at the University of Maryland Medical Center.

Blood clots

Blood clots are an under-discussed source of fevers, according to Nate Favini, medical lead at preventative primary care service Forward.

If youre experiencing fever along with pain, swelling and redness in your leg or shortness of breath, that could be a sign of a blood clot, he said.

Endometriosis

While rare, several of my patients have had fever and flu-like symptoms every month at the start of their periods, likely due to severe pelvic inflammation caused by chronic bleeding into the stomach from wide-spread endometriosis, said Kenneth Ward, director of Predictive Laboratories and a scientific advisor for Predictive Technology Group in Salt Lake City.

If you experience this, Ward suggested making an appointment with your physician to get screened for the condition. Additional symptoms can include debilitating cramps during your period or pain with sex, urination or bowel movements.

Recent surgery

If youve recently gone under the knife, especially for a chest or abdominal procedure, you may experience an elevation in temperature in the days to follow, known as postoperative fever.

The body produces inflammatory proteins in response to the trauma surgery ... This causes fever as a reaction for the first few days post-operatively, said Laurence Gerlis, CEO and lead clinician at SameDayDoctor in London.

Studies show that this is a common side effect from surgeries, with up to 90% of patients reporting elevated temperature after the fact. In most cases, this resolves on its own.

Fevers could also be a side effect to anesthesia, although thats more rare, said Erin Nance, an orthopedic surgeon and hand and upper extremity specialist in New York. This is called malignant hyperthermia.

When this happens, according to Nance, its because of your bodys response to common anesthetic agents used during surgery. This can present as a high fever, muscle rigidity and rapid heart rate. The condition can be fatal and is treated with a medication called Dantrolene and ice packs.

If you have a family history of malignant hyperthermia, it is critical to tell your anesthesiologist before proceeding with surgery, she said.

STIs

Rina Allawh, a board-certified dermatologist with Montgomery Dermatology LLC in Pennsylvania, said that certain sexually transmitted infections may cause a higher-than-normal temperature.

Initially, syphilis presents with a non-tender chancre (i.e. an ulcer). However, if left untreated, may result in high fevers, joint pain, lymph node enlargement and fatigue, he said.

Gonorrhea, if left untreated, may result in high fevers associated with a rash, Allawh said. To prevent life-threatening consequences, prompt recognition and treatment of the condition is essential, he said. Additionally, practicing safe sexual practices and sexual-transmitted disease testing is equally as important.

Traveling to another country

Depending on the area of travel, a rise in body temperature can often be attributed to tropical bacteria and protozoa not often seen in developed countries, said Amna Husain, a board certified pediatrician and founder of Pure Direct Pediatric in New Jersey.

For this reason, I recommend travelers consult with their physicians and refer to the (Centers for Disease Control) guidelines for safe food and water recommendations, she said.

laflor via Getty Images

Hormone disorders or changes

Hyperthyroidism itself does not cause a fever, but we can see a very dangerous and fatal disorder associated with a large influx of thyroid hormone into the body called a thyroid storm, which does have fever, along with rapid heartbeat, fluctuations in blood pressure, and tremors associated with it, Husain said.

She noted that thyroid storm can occur because of a major stressor such as trauma, heart attack, delivery of a baby or because of an infection in people with uncontrolled hyperthyroidism.

In rare cases, it can be caused by treatment of hyperthyroidism with radioactive iodine therapy for Graves disease, she said.

Hormonal changes that occur during menopause can also cause you to feel warmer than normal, which are typically known as hot flashes.

Cancer

Keep in mind that a fever isnt necessarily the first sign or a major sign of cancer. However, it could be one of many symptoms.

Several cancers are associated with fever, which are most commonly leukemias and lymphomas, although other cancers can cause this as well, said Timothy S. Pardee, chief medical officer at Rafael Pharmaceuticals and an oncologist and director of Leukemia Translational Research at Wake Forest Baptist Health in North Carolina.

Pardee said this occurs because, in some cases, cancer cells create an inflammatory response, which then causes the body to respond with a fever. In other cases, the cancer cells themselves secrete cytokines or substances in the body that can cause a fever. And, according to Pardee, cancers like leukemia can impair your bodys ability to fight off infections resulting in prolonged illnesses and fevers.

Additional symptoms to look for are unintended weight loss and drenching night sweats (where you have to change your shirt or sheets when you wake up). These symptoms should prompt a call to your doctor for further evaluation, he added.

When you should be concerned about a fever

A fever may not be cause for alarm, unless there are some specific situations, said David Cutler, a family medicine physician at Providence Saint Johns Health Center in Santa Monica, California.

He added that medication to reduce fever when there is an infection like a cold, flu or pneumonia can help minimize bothersome symptoms like headache, body aches and dehydration from excessive sweating.

But if the fever is caused by hormonal effects, such as menopausal hot flashes or muscular activity like strenuous exercise, these medications will not be effective. In these instances, Cutler said to use measures like cooling fans to lower the bodys temperature.

According to Amesh A. Adalja, senior scholar at Johns Hopkins Center for Health Security in Maryland, a person should be concerned for fever above 101 degrees Fahrenheit (38.3 degrees Celsius) when it is unremitting, when it is associated with other symptoms such as dehydration, extreme fatigue, shortness of breath and severe rash.

Additionally, someone suffering who has a compromised immune system should have a low threshold for seeking medical attention. Same goes for those who are pregnant, have heart or lung disease, or who are very young, he said.

That said, if youre ever concerned about a fever, its always worth it to call your doctor. Thats what theyre there for, after all.

Originally posted here:
13 Unexpected Reasons Why You Might Have A Fever - HuffPost

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UCT medical volunteer organisation to cut back activities after funding cuts – News24

Monday, November 11th, 2019

The Students' Health and Welfare Centres Organisation (Shawco) at the University of Cape Town (UCT) is set to cut back on some of its work after the institution reduced funding in October.

The university announced in a statement last week that Shawco would continue to provide its normal range of medical activities on the Cape Flats, but certain educational activities would be reduced.

Shawco has more than 3 000 student volunteers, but the number has dropped in recent years, placing the programme on a short list for UCT's tightening budget.

The organisation lost several members of its leadership after the cutbacks, leaving university officials and students unsure of its operating status.

"The current situation at Shawco requires an immediate response, and the executive leadership is committed to finding a viable solution that will ensure that its legacy is preserved," said UCT spokesperson Elijah Moholola.

Shawco has been operating for more than 75 years, providing free medical services to under-served communities in Cape Town. During apartheid, the organisation became well-known for providing medical services to protesters during conflicts with the police.

Today, Shawco runs 15 health and education projects across the Cape Metropole.

UCT medical students work at mobile clinics to provide services like screenings, testing for sexually transmitted infections, and preventative care.

The educational programmes are designed to better community understanding of health, wellness, and medicine, as well as reduce stigma toward diseases like HIV and tuberculosis.

These are the programmes that will be reduced over the summer holidays.

GroundUp contacted several members of Shawco's executive board for answers, including CEO Crain Soudien, to no avail.

Link:
UCT medical volunteer organisation to cut back activities after funding cuts - News24

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Medical Wellness Market with Leading Players are: Massage Envy, HEALING HOTELS OF THE WORLD, Steiner Leisure Limited, Fitness World, Universal…

Monday, November 11th, 2019

The latest research Medical Wellness Market both qualitative and quantitative data analysis to present an overview of the future adjacency around Medical Wellness Market for the forecast period, 2019-2024. The Medical Wellness Markets growth and developments are studied and a detailed overview is been given.

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A thorough study of the competitive landscape of the Medical Wellness Market has been give presenting insights into the company profiles, financial status, recent developments, mergers and acquisitions, and the SWOT analysis. It provides a refined view of the classifications, applications, segmentations, specifications and many more for Medical Wellness Market. This market research is an intelligence report with meticulous efforts undertaken to study the right and valuable information. Regulatory scenarios that affect the various decisions in the Medical Wellness Market are given a keen observation and have been explained.

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Segmentation by Type: Complementary and Alternative Medicine, Beauty Care and Anti-Aging, Preventative & Personalized Medicine and Public Health, Healthy Eating, Nutrition & Weight Loss, Rejuvenation, Other.

Segmentation by application: Franchise, Company Owned Outlets.

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Table of Contents

2019-2024 Global Medical Wellness Market Report

1 Scope of the Report1.1 Market Introduction1.2 Research Objectives1.3 Years Considered1.4 Market Research Methodology1.5 Economic Indicators1.6 Currency Considered

2 Executive Summary2.1 World Market Overview2.1.1 Global Medical Wellness Market Size 2014-20242.1.2 Medical Wellness Market Size CAGR by Region2.2 Medical Wellness Segment by Type2.2.1 Complementary and Alternative Medicine2.2.2 Complementary and Alternative Medicine2.2.3 Preventative & Personalized Medicine and Public Health2.2.4 Healthy Eating, Nutrition & Weight Loss2.2.5 Rejuvenation2.2.6 Other2.3 Medical Wellness Market Size by Type2.3.1 Global Medical Wellness Market Size Market Share by Type (2014-2019)2.3.2 Global Medical Wellness Market Size Growth Rate by Type (2014-2019)2.4 Medical Wellness Segment by Application2.4.1 Franchise2.4.2 Company Owned Outlets2.5 Medical Wellness Market Size by Application2.5.1 Global Medical Wellness Market Size Market Share by Application (2014-2019)2.5.2 Global Medical Wellness Market Size Growth Rate by Application (2014-2019)

3 Global Medical Wellness by Players

Continued.

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Medical Wellness Market with Leading Players are: Massage Envy, HEALING HOTELS OF THE WORLD, Steiner Leisure Limited, Fitness World, Universal...

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