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Update March 2018


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March 24, 2018 - March 30, 2018

Flu shot only 36 percent effective, making bad year worse

In this Wednesday, Feb. 7, 2018 file photo, a nurse prepares a flu shot from a vaccine vial at the Salvation Army in Atlanta. Most doses of vaccine are made in a production process that involves growing viruses in chicken eggs. (AP Photo/David Goldman)

Mike Stobbe

New York (AP) - The flu vaccine is doing a poor job protecting older Americans and others against the bug that’s causing most illnesses.

Preliminary figures released Thursday, Feb. 15, suggest the vaccine is 36 percent effective overall in preventing flu illness severe enough to send a patient to the doctor’s office.

There’s only been one other time in the last decade when the flu vaccine did a worse job.

Most illnesses this winter have been caused by a nasty kind of flu called Type A H3N2. The vaccine was only 25 percent effective against that type.

This kind of virus tends to cause more suffering and have been responsible for the worst recent flu seasons. But experts have wondered whether low vaccine effectiveness is another reason for the surprisingly severe season hitting the United States this winter.

Based on these numbers, the answer is yes.

“The fact that the vaccine doesn’t work as well as we would like is clearly a contributing factor,” said Dr. William Schaffner, a Vanderbilt University vaccine expert.

The estimates were published by the Centers for Disease Control and Prevention.

The numbers are a snapshot taken in the middle of a frantic flu season. They are based on relatively small numbers of people and they are considered preliminary. Numbers may change as the season continues and more patients are added to the study.

And experts say it’s still worth getting a flu shot. It still provides some protection, it can lessen the illness’s severity, keep people out of the hospital, and save lives. There are as many as 56,000 deaths connected to the flu during a bad year.

“Any type of vaccine is better than none,” said Scott Hensley, a University of Pennsylvania microbiologist who has led studies that raised critical questions about the vaccine.

The effectiveness estimates come from the tracking of about 4,600 children and adult patients in five states. To make the effectiveness calculations, researchers tracked who got the flu, and who among them had been vaccinated.

The vaccine provided good protection - 67 percent effective - against another common kind of flu virus, Type A H1N1, which has not been seen much this winter. And it was 42 percent effective against Type B flu viruses.

The vaccine worked relatively well in young children, but it performed worse in older people, including seniors who are most vulnerable. Against H3N2, the vaccine was 51 percent effective in children ages 6 months to 8 years. In every other age group, the numbers were low, falling in a range that made them essentially ineffective in preventing flu, statistically speaking.

That includes people 65 and older, a group that tends to suffer the highest hospitalization and death rates during H3N2 seasons. If the preliminary numbers hold, it will mean that in five of the last eight flu seasons, vaccine was essentially ineffective in seniors.

It points to a need for better flu vaccines, said Dr. Anne Schuchat, the CDC’s acting director.

“The vaccines that we have today are not the ones that we’d like to have in 10 years,” she said.

Scientists think part of the reason for that has to do with when people are born and what kind of flu viruses they’re first exposed to in life. Most seniors were first exposed to H1N1 viruses and their bodies seem to handle them better, but H3N2 viruses - which didn’t spread broadly in the United States until the late 1960s - seem to be harder for their bodies to deal with.

But some researchers say part of the problem is tied to how 85 percent of the nation’s flu vaccine doses are made. Manufacturers grow flu viruses in chicken eggs. But the viruses can mutate in the eggs, and researchers are finding vaccine from the egg-grown viruses is not a good match to the H3N2 flu bugs in people.

Some research suggests that newer vaccines, using newer production methods, seem to work better against recently circulating H3N2 strains, but not enough people in the effectiveness study got those kinds of shots to compare performance.


March 17, 2018 - March 23, 2018

Stuck in an opioids crisis, officials turn to acupuncture

David Ramsey, a Medicaid patient who suffers from chronic pain after falling off a cliff in 2011, receives acupuncture treatment in Warrensville Heights, Ohio. Long derided as pseudoscience, acupuncture is increasingly being used by doctors and officials seeking a new weapon in the nation’s struggle with opioids. (AP Photo/Dake Kang)

Jennifer McDermott, Dake Kang & Mike Stobbe

Providence, R.I. (AP) - Marine veteran Jeff Harris was among the first to sign up when the Providence VA hospital started offering acupuncture for chronic pain.

“I don’t like taking pain medication. I don’t like the way it makes me feel,” he said.

Harris also didn’t want to risk getting addicted to heavy-duty prescription painkillers.

Although long derided as pseudoscience and still questioned by many medical experts, acupuncture is increasingly being embraced by patients and doctors, sometimes as an alternative to the powerful painkillers behind the nation’s opioid crisis.

The military and Veterans Affairs medical system has been offering acupuncture for pain for several years, some insurance companies cover it and now a small but growing number of Medicaid programs in states hit hard by opioid overdoses have started providing it for low-income patients.

Ohio’s Medicaid program recently expanded its coverage after an opioid task force urged state officials to explore alternative pain therapies.

“We have a really serious problem here,” said Dr. Mary Applegate, medical director for Ohio’s Medicaid department. “If it’s proven to be effective, we don’t want to have barriers in the way of what could work.”

The epidemic was triggered by an explosion in prescriptions of powerful painkiller pills, though many of the recent overdose opioid deaths are attributed to heroin and illicit fentanyl. Many opioid addictions begin with patients in pain seeking help, and acupuncture is increasingly seen as a way to help keep some patients from ever having to go on opioids in the first place.

For a long time in the U.S., acupuncture was considered unstudied and unproven - some skeptics called it “quack-u-puncture.” While there’s now been a lot of research on acupuncture for different types of pain, the quality of the studies has been mixed, and so have the results.

Federal research evaluators say there’s some good evidence acupuncture can help some patients manage some forms of pain. But they also have described the benefits of acupuncture as modest, and say more research is needed.

Among doctors, there remains lively debate over how much of any benefit can be attributed simply to patients’ belief that the treatment is working - the so-called “placebo effect.”

“There may be a certain amount of placebo effect. Having said that, it is still quite effective as compared to no treatment,” said Dr. Ankit Maheshwari, a pain medicine specialist at Case Western Reserve University, who sees it as valuable for neck pain, migraines and a few other types of pain problems.

Many doctors are ambivalent about acupuncture but still willing to let patients give it a try, said Dr. Steven Novella, a neurologist at Yale University and editor of an alternative medicine-bashing website. He considers acupuncture a form of patient-fooling theater.

Acupuncturists and their proponents are “exploiting the opioid crisis to try to promote acupuncture as an alternative treatment,” he said. “But promoting a treatment that doesn’t work is not going to help the crisis.”

Acupuncture has been practiced in China for thousands of years, and customarily involves inserting thin metal needles into specific points in the ears or other parts the body. Practitioners say needles applied at just the right spots can restore the flow of a mystical energy - called “qi” (pronounced CHEE) - through the body, and that can spur natural healing and pain relief.

In government surveys, 1 in 67 U.S. adults say they get acupuncture every year, up from 1 in 91 a decade earlier. That growth has taken place even though most patients pay for it themselves: 2012 figures show only a quarter of adults getting acupuncture had insurance covering the cost.

The largest federal government insurance program, Medicare, does not pay for acupuncture. Tricare, the insurance program for active duty and retired military personnel and their families, does not pay for it either. But VA facilities offer it, charging no more than a copay.

Jeff Harris signed up for acupuncture two years ago. The 50-year-old Marine Corp veteran said he injured his back while rappelling and had other hard falls during his military training in the 1980s. Today, he has shooting pain down his legs and deadness of feeling in his feet.

Acupuncture “helped settled my nerve pain down,” said Harris, of Foxboro, Massachusetts.

Another vet, Harry Garcia, 46, of Danielson, Connecticut, tried acupuncture for his chronic back pain after years of heavy pain medications.

Acupuncture is “just like an eraser.  It just takes everything away” for a brief period, and keeps pain down for up to 10 days, said Garcia.

About a decade ago, the military and Veteran Affairs began promoting a range of alternative approaches to pain treatment, including acupuncture, yoga, and chiropractic care.

In 2009, former Army Surgeon General Dr. Eric Schoomaker chartered a task force to re-evaluate the Army’s approach to pain, which had centered on opioids. The focus was understandable - “nobody who has his leg blown off screams for acupuncture,” said Schoomaker, who is now a professor at the Uniformed Services University of the Health Sciences, a military medical school in Bethesda, Maryland.

But he added there was also openness to acupuncture and other approaches among soldiers and sailors who, while overseas, had tried non-drug approaches for chronic pain. Schoomaker said he was inspired to seriously consider alternative approaches by his wife, a yoga instructor.

Now two-thirds of military hospitals and other treatment centers offer acupuncture, according to a recent study.

The military’s openness to alternatives is “because the need is so great there,” said Emmeline Edwards of the National Center for Complementary and Integrative Health, a federal scientific research agency. “Perhaps some of the approaches have been used without a strong evidence base. They’re more willing to try an approach and see if it works.”

Her agency is teaming up the Pentagon and the VA to spend $81 million on research projects to study the effectiveness of a variety of nondrug approaches to treating chronic pain.

While research continues, insurance coverage of acupuncture keeps expanding. California, Massachusetts, Oregon and Rhode Island pay for acupuncture for pain through their Medicaid insurance programs. Massachusetts and Oregon also cover acupuncture as a treatment for substance abuse, though scientists question how well it reduces the cravings caused by chemical dependency.


March 10, 2018 - March 16, 2018

First blood test to help diagnose brain injuries gets US OK

Product development scientist Veronika Shevchenko works with patient samples at Banyan Biomarkers Tuesday, Feb. 13, 2018, in San Diego. The company is developing a blood test to help doctors diagnose traumatic brain injuries. (AP Photo/Denis Poroy)

Lindsey Tanner

Chicago (AP) - The first blood test to help doctors diagnose traumatic brain injuries has won U.S. government approval.

The move means Banyan Biomarkers can commercialize its test, giving the company an early lead in the biotech industry’s race to find a way to diagnose concussions.

The test doesn’t detect concussions and the approval won’t immediately change how patients with suspected concussions or other brain trauma are treated. But Wednesday’s green light by the Food and Drug Administration “is a big deal because then it opens the door and accelerates technology,” said Michael McCrea, a brain injury expert at Medical College of Wisconsin.

The test detects two proteins present in brain cells that can leak into the bloodstream following a blow to the head. Banyan’s research shows the test can detect them within 12 hours of injury. It’s designed to help doctors quickly determine which patients with suspected concussions may have brain bleeding or other brain injury.

Patients with a positive test would need a CT scan to confirm the results and determine if surgery or other treatment is needed. The test will first be used in emergency rooms, possibly as soon as later this year, but Banyan’s hope is that it will eventually be used on battlefields and football fields.

FDA Commissioner Dr. Scott Gottlieb said the test fits with the agency’s goals for delivering new technologies to patients and reducing unnecessary radiation exposure.

The test “sets the stage for a more modernized standard of care for testing of suspected cases,” Gottlieb said in a statement.

Traumatic brain injuries affect an estimated 10 million people globally each year; at least 2 million of them are treated in U.S. emergency rooms. They often get CT scans to detect bleeding or other abnormalities. The scans expose patients to radiation, but in many patients with mild brain injuries including concussions, abnormalities don’t show up on these imaging tests.

With Department of Defense funding, Banyan’s research shows its Brain Trauma Indicator can accurately pick up brain trauma later found on CT scans. It also shows that absence of the two proteins in the test is a good indication that CT scans will be normal. That means patients with negative blood tests can avoid CT scans and unnecessary radiation exposure, said Dr. Jeffrey Bazarian, a University of Rochester emergency medicine professor involved in Banyan’s research.

Bazarian called the test “a huge step” toward devising a blood test that can detect brain injuries including concussions.

Dr. Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke, and other brain injury experts say the test isn’t sensitive enough to rule out concussions.

“This may be a beginning. It’s not the pot of gold at the end of the rainbow,” Koroshetz said.

That prize would be a test that could detect and guide treatment for concussions and traumatic brain injuries, similar to a blood test that hospitals commonly use to evaluate suspected heart attacks, Koroshetz said.

“That’s what we’d like to have for the brain,” he said.

San Diego-based Banyan has partnered with French firm bioMerieux SA to market the test to hospitals using bioMerieux’s blood analyzing machines.

Other companies are developing similar blood tests to detect brain injuries. Abbott has licensed both protein biomarkers from Banyan and is developing its own blood tests. BioDirection is developing a test involving one of the proteins in Banyan’s test plus another one and using a portable device that can yield results from a single drop of blood in less than two minutes.

Quanterix is also working to develop a blood test to diagnose concussions and other brain injuries. It has licensed the use of both proteins in Banyan’s test to be used with its own technology.


Update Saturday, March 3, 2018 - March 9, 2018

Ethics dispute erupts in Belgium over euthanasia rules

In this Oct. 23, 2013 file photo, Belgium’s leading euthanasia doctor, oncologist Wim Distelmans, speaks in Wemmel, Belgium. (AP Photo/Geert Vanden Wijngaert, File)

Maria Cheng

A disputed case of euthanasia in Belgium, involving the death of a dementia patient who never formally asked to die, has again raised concerns about weak oversight in a country with some of the world’s most liberal euthanasia laws.

The case is described in a letter provided to The Associated Press, written by a doctor who resigned from Belgium’s euthanasia commission in protest over the group’s actions on this and other cases.

Some experts say the case as documented in the letter amounts to murder; the patient lacked the mental capacity to ask for euthanasia and the request for the bedridden patient to be killed came from family members. The co-chairs of the commission say the doctor mistakenly reported the death as euthanasia.

Although euthanasia has been legal in Belgium since 2002 and has overwhelming public support, critics have raised concerns in recent months about certain practices, including how quickly some doctors approve requests to die from psychiatric patients.

The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont’s patients might have been killed without meeting all the legal requirements. Prompted by the AP’s reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.

Euthanasia - when doctors kill patients at their request - can be granted in Belgium to people with both physical and mental health illnesses. The condition does not need to be fatal, but suffering must be “unbearable and untreatable.” It can only be performed if specific criteria are fulfilled, including a “voluntary, well-considered and repeated” request from the person.

But Belgium’s euthanasia commission routinely violates the law, according to a September letter of resignation written by Dr. Ludo Vanopdenbosch, a neurologist, to senior party leaders in the Belgian Parliament who appoint members of the group.

The most striking example took place at a meeting in early September, Vanopdenbosch writes, when the group discussed the case of a patient with severe dementia, who also had Parkinson’s disease. To demonstrate the patient’s lack of competence, a video was played showing what Vanopdenbosch characterized as “a deeply demented patient.”

The patient, whose identity was not disclosed, was euthanized at the family’s request, according to Vanopdenbosch’s letter. There was no record of any prior request for euthanasia from the patient.

After hours of debate, the commission declined to refer the case to the public prosecutor to investigate if criminal charges were warranted.

Vanopdenbosch confirmed the letter was genuine but would not comment further about the specific case details.

The two co-chairs of the euthanasia commission, Distelmans and Gilles Genicot, a lawyer, said the doctor treating the patient mistakenly called the procedure euthanasia, and that he should have called it palliative sedation instead. Palliative sedation is the process of drugging patients near the end of life to relieve symptoms, but it is not meant to end life.

“This was not a case of illegal euthanasia but rather a case of legitimate end-of-life decision improperly considered by the physician as euthanasia,” Genicot and Distelmans said in an email.

Vanopdenbosch, who is also a palliative care specialist, wrote that the doctor’s intention was “to kill the patient” and that “the means of alleviating the patient’s suffering was disproportionate.”

Though no one outside the commission has access to the case’s medical records - the group is not allowed by law to release that information - some critics were stunned by the details in Vanopdenbosch’s letter.

“It’s not euthanasia because the patient didn’t ask, so it’s the voluntary taking of a life,” said Dr. An Haekens, psychiatric director at the Alexianen Psychiatric Hospital in Tienen, Belgium. “I don’t know another word other than murder to describe this.”

Kristof Van Assche, a professor of health law at the University of Antwerp, wrote in an email the commission itself wasn’t breaking the law because the group is not required to refer a case unless two-thirds of the group agree -  even if the case “blatantly disregards” criteria for euthanasia.

But without a request from the patient, the case “would normally constitute manslaughter or murder,” he wrote. “The main question is why this case was not deemed sufficiently problematic” to prompt the commission to refer the case to prosecutors.

Vanopdenbosch, who in the letter called himself a “big believer” in euthanasia, cited other problems with the commission. He said that when he expressed concerns about potentially problematic cases, he was immediately “silenced” by others. And he added that because many of the doctors on the commission are leading euthanasia practitioners, they can protect each other from scrutiny, and act with “impunity.”

Vanopdenbosch wrote that when cases of euthanasia are identified that don’t meet the legal criteria, they are not forwarded to the public prosecutor’s office as is required by law, but that the commission itself acts as the court.

In the 15 years since euthanasia was legalized in Belgium, more than 10,000 people have been euthanized, and just one of those cases has been referred to prosecutors.

Genicot and Distelmans said the group thoroughly assesses every euthanasia case to be sure all legal conditions have been met.

“It can obviously occur that some debate emerges among members but our role is to make sure that the law is observed and certainly not to trespass it,” they said. They said it was “absolutely false” that Vanopdenbosch had been muzzled and said they regretted his resignation.
 


DAILY UPDATEE

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HEADLINES [click on headline to view story]

Flu shot only 36 percent effective, making bad year worse


Stuck in an opioids crisis, officials turn to acupuncture


First blood test to help diagnose brain injuries gets US OK


Ethics dispute erupts in Belgium over euthanasia rules


 



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