Regular exercise before breast cancer tied to lower heart risk after treatment

(Reuters Health) – Older breast cancer patients who exercised regularly before their cancer diagnosis may be better protected from the heart-harming effects of cancer treatment, a large U.S. study suggests.

Among more than 4,000 women diagnosed with breast cancer when most were in their 60s or older, those who got regular exercise in the five years before diagnosis were up to 37% less likely than more sedentary women to develop and die of cardiovascular disease in the decade after diagnosis.

And the more exercise they got before diagnosis, the lower their odds of heart disease and cardiovascular-related death later.

The five-year survival rate for breast cancer in the U.S. is nearly 90%, the study authors note in JACC: CardioOncology, and heart disease is the number one cause of death among survivors.

In part, this may reflect women living long enough after a cancer diagnosis to develop other age-related health conditions like heart disease. But cancer drugs and radiation also can damage the heart’s structure and function, the authors note.

“Cancer is a stressor to the system. People that exercise prior to any sort of systemic stressor, whether its cancer or stroke, would do better if they were already pre-conditioned prior to this life-stressor,” said Dr. Tochukwu Okwuosa of Rush University Medical Center in Chicago, who led the study.

Okwuosa, a cardiologist, told Reuters Health she started studying the issue because of her own experience with cancer patients.

“What I was finding in the clinic was that those who used to exercise prior to receiving treatment tend to be less tired and less weak while going through treatment, and they recover faster after treatment,” Okwuosa said by phone.

“We did not find any data in the scientific literature that examined this.”

To see whether pre-diagnosis exercise was associated with post-cancer heart disease, the researchers analyzed data on 4,015 participants in the long-term Women’s Health Initiative study who’d been diagnosed with breast cancer. All were free of heart disease before their cancer diagnosis.

Okwuosa’s team looked at the women’s self-reported exercise history for up to five years before the breast cancer diagnosis. They also examined cardiovascular disease deaths over an average of 13 years post-cancer diagnosis as well as heart-disease related events over about eight years, including heart attacks, strokes, heart failure, peripheral artery disease and procedures to clear a blocked heart artery.

Overall, compared to women who did no exercise or very little, those who got light to moderate exercise weekly before diagnosis were 20% less likely to experience cardiovascular events in the follow-up period. Women who did the greatest amount of moderate-to-vigorous exercise were 37% less likely to experience these events.

The researchers saw similar trends for individual heart-related events and heart-disease deaths, but after adjusting for age and other factors, some of the differences were too small to rule out the possibility they were due to chance.

Among the study’s limitations is that exercise after breast cancer diagnosis was not analyzed, so its contribution to heart-related outcomes is unknown.

But past research suggests people who regularly exercise before cancer diagnosis are more likely to keep it up during and after treatment, the study team notes.

The study wasn’t designed to prove whether or how exercise before a breast cancer diagnosis protects against heart disease afterward, the study team acknowledges. But it is plausible that going into cancer treatment with a higher “reserve” of cardiovascular fitness makes patients better able to tolerate the heart toxicity of cancer drugs and radiation, they write.

“As more and more patients survive their breast cancer, cardiovascular disease is and will continue to become a major risk of morbidity and mortality for survivors,” Dr. Lindsay Peterson of Washington University School of Medicine in St. Louis, Missouri, and Dr. Jennifer Ligibel of the Dana Farber Cancer Institute at Harvard Medical School in Boston write in an editorial accompanying the study.

“Finding strategies to help patients engage in recommended amounts of physical activity before and after a breast cancer diagnosis will be critical to improving outcomes in women with early breast cancer,” they write.

SOURCE: and JACC: CardioOncology, online September 24, 2019.

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Infection amnesia: Measles ‘destroys immune system memory’

LONDON, Oct 31 (Reuters) – Getting measles is even more dangerous than doctors had realized, because it destroys immunity that the victim has acquired to other diseases, researchers said on Thursday.

FILE PHOTO: A vial of the measles, mumps, and rubella (MMR) vaccine is pictured at the International Community Health Services clinic in Seattle, Washington, U.S., March 20, 2019. Picture taken March 20, 2019. REUTERS/Lindsey Wasson/File Photo

The findings help to explain why children often catch other infectious diseases after having measles, and underscore the dangers of growing resistance to childhood vaccination in some countries, according to two studies published simultaneously.

They show for the first time how measles – one of the most contagious diseases – resets the human immune system back to an immature state like a baby’s, with only limited ability to fight off new infections.

The findings have implications for public health globally, since a decline in trust in vaccines, and so in vaccination rates, is leading to outbreaks of measles – which in turn can allow a resurgence of other dangerous diseases such as flu, diphtheria and tuberculosis.

“This … is a direct demonstration in humans of ‘immunological amnesia’, where the immune system forgets how to respond to infections encountered before,” said Velislava Petrova of Britain’s Wellcome Sanger Institute and Cambridge University, who co-led one of the studies.

Stephen Elledge, a geneticist and researcher at the U.S. Howard Hughes Medical Institute who co-led the second study, said its results constituted “really strong evidence that the measles virus is actually destroying the immune system”.

The measles virus causes coughing, rashes and fever, and can lead to potentially fatal complications including pneumonia and an inflammation of the brain known as encephalitis.

Measles can be prevented with two doses of a vaccine that has proven safe and effective and has been in use since the 1960s, but World Health Organization (WHO) experts warned three weeks ago of an “alarming upsurge” of cases in pockets of unvaccinated people in all regions of the world.

In the first three months of this year, the number of cases quadrupled from the same period in 2018, WHO data show.

“The (measles) virus is much more deleterious than we realized, which means the vaccine is that much more valuable,” Elledge said.

For this research, the two teams looked at a group of unvaccinated people in the Netherlands to find out what measles does to the immune system.

In one study, they sequenced antibody genes from 26 children, before and then 40 to 50 days after measles infection, and found that specific antibodies that had been built up against other diseases had disappeared from the children’s blood.

Results from the second study found that measles infection destroyed between 11% and 73% of the children’s protective antibodies – the blood proteins that “remember” past encounters with viruses and help the body avoid repeat infections – leaving them vulnerable to infections they had previously been immune to.

By Kate Kelland, Health and Science Correspondent, Editing by Kevin Liffey

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‘Invincible’ Teen Vapers Face Fears, Ask For Help

It all started at the mall when a friend offered her a puff from a Juul e-cigarette.

“It was kind of peer pressure,” said Beth, a Denver-area 15-year-old who started vaping in middle school. “Then I started inhaling it,” she said. “I suddenly was, like, wow, I really think that I need this — even though I don’t.”

Soon, Beth — who asked that her last name not be used because she hasn’t told her parents about her vaping — had a Juul of her own. She was vaping half a pod of e-liquid a day, the nicotine equivalent of half a pack of conventional cigarettes. She used other brands, too — a Suorin, a Smok Novo and a modified device, which gives users custom vaping options.

Beth tried to quit on her own, so her mom wouldn’t find out. But it was hard and her school didn’t have the resources to help her, she said.

“When you wake up in the morning, you’re just like, ‘Oh, I need to hit my thing. Where is it?’ You can’t really get it off your mind unless you distract yourself,” Beth said.

Colorado had the highest rate of teen vaping of 37 states surveyed in 2017, according to the Centers for Disease Control and Prevention. A quarter of those students said they currently used an electronic vapor product — double the national average. Beth guesses half of her classmates vape regularly. Her school does offer some tobacco-prevention education, but teens could use a lot more support to help them to quit, she said.

Beth said she managed to stop vaping a few weeks back, motivated by news stories of young people falling ill. And when her own friend got sick, that was a turning point.

Before, she said, “I didn’t really take it super seriously, because I was like, oh, what are the chances that that’s going to happen to me? And then my friend actually almost had his lung collapse, and he was coughing blood and mucus. And I just couldn’t do it anymore. It’s not worth it.”

Last week, the CDC reported it was investigating more than 1,600 lung injury cases nationwide associated with using e-cigarettes, including more than 30 deaths.

A federal survey shows more than a quarter of U.S. high school students have used an e-cigarette in the past 30 days. But public health advocates say that funding for anti-tobacco efforts is inadequate. Although states receive annual payments from tobacco companies as part of a 1998 lawsuit settlement, they’re not following CDC guidance on setting aside large chunks of that money to help smokers quit or prevent others from starting. States can spend that money on whatever they want, and most do.

Don Daniels, a Chatfield High teacher in Littleton, Colo., runs the school’s tobacco education program, and keeps these vaping devices (confiscated from students) on hand to show students and parents what they look like.(John Daley/Colorado Public Radio)

Another traditional funding source for antismoking programs has been cigarette taxes. But with fewer people smoking cigarettes, that revenue source has been less reliable. In Colorado, cigarette sales have declined by 41% since 1990, according to Colorado’s health department. And in more than half of the states, including Colorado, vapes aren’t taxed — at least not yet.

“It is daunting,” said Alison Reidmohr, tobacco communications specialist for Colorado’s Department of Health and Public Environment. “We’ve got more problems than we’ve seen before and fewer resources with which to deal with them.”

An estimated 27,000 Colorado high schoolers report vaping more than 10 days a month, Reidmohr said. “More people are using more nicotine products. Our young people are facing an epidemic of vaping. We’re not funded to deal with vaping products.”

Colorado spends nearly $24 million a year on tobacco prevention, but according to a recent report from the Campaign for Tobacco Free-Kids, that’s less than half of what the CDC recommends, and a fifth of what the tobacco industry spends on marketing in the state.

“Really, we have almost nothing in terms of treatment for these kids,” said Dr. Christian Thurstone, who runs substance abuse programs for teens in Denver. He said teens have gotten addicted to nicotine so fast, it’s uncharted territory.

Though there are websites, hotlines, therapists and coaches to help kids manage nicotine cravings, those efforts were all designed around traditional cigarettes, Thurstone said. He has turned up no studies about adolescents quitting e-cigarettes.

“We need some research, fast,” Thurstone said.

A spokesman for the popular Juul brand said no young person or non-nicotine user should ever try Juul. But he didn’t say how minors who’ve started to use the product might quit.

Most teens just need to decide they’re not going to use anymore, said Gregory Conley of the American Vaping Association. “It’s only a small sliver that may actually need some assistance to get off the products,” Conley said.

Colorado’s health department disputes that; it estimates 10% of the state’s high schoolers are vaping nicotine more than 10 days a month.

In July, National Jewish Health in Denver launched a cessation program tailored to teens’ needs. In a large open office, coaches answer calls. “Thank you for calling My Life My Quit,” one said. “Congratulations on making the decision to quit.” The program — which uses a traditional help line, chats and live coaching — has seen a sharp surge in sign-ups in the past month.

Thomas Ylioja, a clinic director with National Jewish Health in Denver., chats with Nichole Lopez, a tobacco cessation coach for a program there. In July, the hospital launched “My Life, My Quit” a vaping cessation program aimed at teens. The program has a traditional phone helpline, but also offers coaching by text and chat.(John Daley/Colorado Public Radio)

My Life My Quit serves Colorado and is available in 11 other states — Iowa, Massachusetts, Michigan, Montana, Nevada, North Dakota, New Hampshire, Ohio, Pennsylvania, Utah and Wyoming. Thomas Ylioja, who leads the Health Initiatives program at National Jewish Health, said data shows that 12% of high school seniors in the U.S. are using e-cigarettes every day.

Teens are “telling us they can feel their lungs burning when they’re using these products,” Ylioja said. “They’re telling us that they can’t exercise the same way they used to before. They’re telling us that they can’t give up these products just on their own, that they need help.”

The program even added coaching by text, he said, because that’s how many teens like to communicate.

In his office, Ylioja reads from a printout of text conversations between teens and coaches. “‘I’m 16 years old. I’m super addicted to vaping. I can’t seem to quit when I don’t have it, that’s all I think about,’” one student writes.

“‘My family is worried and all the stories about people getting sick,’” said another text. “‘I don’t know if it’s really bad to vape, but because of these stories, they could be rare occasions, but I’m worried about it.’”

Nichole Lopez, one of the program’s coaches, said teens often think they’re invincible, but news of young people getting sick is suddenly making the dangers seem real.

“It’s freaking them out,” she said. “They’re scared. They don’t want to die. I had somebody say, ‘I just don’t want to die, so I need to quit.’”

The Truth Initiative, a nonprofit public health group aimed at helping young smokers quit tobacco use, has expanded its resources to include a program focused on e-cigarettes. It’s a free text-messaging program “tailored by age group” to give teens and young adults appropriate recommendations about quitting. It also provides resources for parents looking to help children who are vaping and may want to quit.

Don Daniels, the director of the tobacco education program at Chatfield High in Littleton, Colo., said he senses what he thinks could be a sea change in teen attitudes.

The reports of people being “truly sick and dying from these devices is enough for young people to make a decision that’s going to benefit their health,” Daniels said. “They’re savvy. This is a smart generation and they’re thoughtful and they have the ability to make good choices.”

Chatfield senior Mia Norrid, a swimmer, doesn’t vape. But her mom posted a story about the vaping-linked illnesses on Facebook and tagged her daughter as a nudge to speak up.

“I think she tagged me so I could let my friends know about it, because a lot of my friends do it,” she said.

This story is part of a partnership that includes Colorado Public Radio, NPR and Kaiser Health News.

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New York set to become latest U.S. city to ban foie gras

NEW YORK (Reuters) – New York City, often viewed as the fine dining capital of America, was poised on Wednesday to become the latest U.S. city to ban the sale of foie gras, sparking manufacturers to vow a court battle to overturn it.

FILE PHOTO: An employee prepares foie gras (duck liver) at the Maison Lafitte company factory in Montaut, France January 10, 2019. REUTERS/Regis Duvignau/File Photo

The New York City Council was expected to pass a bill to “ban the sale or provision of certain force-fed poultry products.”

Foie gras, French for “fatty liver,” is a delicacy produced from the enlarged livers of ducks and geese that have been force-fed corn.

Animal rights groups contend that the force-feeding process is painful and gruesome.

“The council is banning a really cruel and inhumane practice,” said Jeremy Unger, spokesman for Council Member Carlina Rivera of Manhattan, who introduced the bill.

But the nation’s largest maker of foie gras, Hudson Valley Foie Gras in Ferndale, New York, located about 100 miles (160 km) northwest of New York City, defended the practice it uses to make the luxury item.

“I can tell you we take proper care of the birds,” said Hudson Valley manager Marcus Henley. He said the farm, which employs 400 people, makes foie gras “in conformity with humane animal management and in compliance with the laws of the state of New York.”

The ban would take effect in three years, in a move meant to give farmers time to retool their businesses to focus on other products, Unger said.

But Henley said New York City represents about a third of his farm’s revenues and rather than planning to adjust its business, he intends to head to court to seek to overturn it. There are three foie gras makers in the United States – Hudson Valley, La Belle Farms, both in Ferndale, and Au Bon Canard in Caledonia, Minnesota.

It was unclear how many restaurants and groceries would be affected by the ban.

“We don’t have an exact number but roughly 1 percent of restaurants in New York City serve it,” Unger said.

Foie gras bans passed elsewhere in the United States have had mixed results. Chicago’s City Council approved a ban in 2006, only to repeal it two years later after then-Mayor Richard Daley called it the “silliest ordinance” ever passed in the Windy City, which made it “the laughingstock of the nation.”

California’s ban on foie gras went into effect in 2012 and remains in effect after the U.S. Supreme Court, the nation’s highest court, in January declined to hear an appeal from foie gras producers.

Editing by Barbara Goldberg; Editing by Cynthia Osterman

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No country immune to risk of African swine fever spreading: OIE

PARIS (Reuters) – African swine fever will spread further across Asia where it has devastated herds, and no country is immune from being hit by the deadly animal virus, the head of the World Organisation for Animal Health (OIE) said on Wednesday.

Dr Monique Eloit, Director General of the World Organisation for Animal Health (OIE), poses for a portrait at their headquarters in Paris, France, October 30, 2019. REUTERS/Benoit Tessier

The disease, which has hit the world’s top pork producer China hard, originated in Africa before spreading to Europe and Asia. It has been found in 50 countries, killing hundreds of million pigs, while reshaping global meat and feed markets.

“We are really facing a threat that is global,” OIE Director General Monique Eloit told Reuters in an interview.

“The risk exists for all countries, whether they are geographically close or geographically distant because there is a multitude of potential sources of contamination.”

African swine fever, which is not harmful to humans, can be transmitted by a tourist bringing back a ham or sausage sandwich from a contaminated country, throwing it away and the garbage being reused by farmers to feed their pigs, Eloit said.

There are additional risks from trading live animals and food products across borders and from small breeders using restaurant or train station waste to feed their stock.

The disease has spread rapidly to several countries in Southeast Asia including Vietnam, Cambodia, Laos, Korea and the Philippines and more countries are likely to be hit in the coming months.

“In the short term we are not going towards an improvement. We will continue to have more outbreaks in the infected countries. Neighbouring countries are at high risk and for some the question is when they will be infected,” Eloit said, stressing that controls were difficult to implement.

The spread of African swine fever has not only ravaged the Asian pig population, but also sent international pork prices rocketing and hit animal feed markets such as corn and soybeans.

It has also weighed on results of agricultural commodity groups due to weaker feed demand for hog breeding.

China’s hog herd was more than 40% smaller in September than a year earlier, its farm ministry said earlier this month. But several in the industry believe the losses are much greater.

Beijing issued a series of policies in September aimed at supporting national hog production and securing meat supplies.

Eloit said the measures were adequate but needed to be fully implemented.

“There is a difference between what is decided on paper – I do not think there is any concern here – and how we actually get to apply them on the ground especially in countries that are very large, which have a wide variety of production,” she said

In Europe, the situation is different because outbreaks mainly concern wild boars, Eloit added.

African swine fever has been found on farms in eastern Europe but its spread had been mostly contained, due mainly to tight security measures implemented in some countries.

Reporting by Sybille de La Hamaide; Editing by Veronica Brown and Mark Potter

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Is Head Injury Causing Dementia? MRI Might Show

News Picture: Is Head Injury Causing Dementia? MRI Might Show

Latest Alzheimer’s News

MONDAY, Oct. 28, 2019 (HealthDay News) — When a loved one shows signs of dementia, sometimes a head injury is the cause and MRI scans can help prevent a misdiagnosis of Alzheimer’s, researchers report.

As many as 21% of older adults with dementia may be misdiagnosed with Alzheimer’s disease, a previous study found. Up to 40% of dementias are caused by conditions other than Alzheimer’s disease, according to the Alzheimer’s Association.

A misdiagnosis can be devastating for patients and their families, and result in patients not receiving appropriate treatment or taking part in clinical trials that could benefit them, according to the authors of this new study.

It included 40 patients, average age 68, who’d suffered a traumatic brain injury (TBI) and later developed memory problems. The patients underwent brain MRI scans, which were analyzed with a software program.

“We already knew that MRIs can reveal subtle abnormalities in patients with neurological disorders, such as Alzheimer’s,” said study author Dr. Somayeh Meysami, a postdoctoral clinical research fellow in cognitive and behavioral neurology at the University of California, Los Angeles.

“The purpose of our study was to evaluate whether MRI also could reveal distinct abnormalities in traumatic brain injury. And, if we could identify such a pattern, it would lead to improved diagnosis of TBI-related memory loss from other causes of dementia,” Meysami explained in a university news release.

The MRI scans revealed that in the TBI patients, most of the brain damage was in a region called the ventral diencephalon, and the least amount of damage was in the hippocampus. The ventral diencephalon is involved in learning and emotions, while the hippocampus is involved in memory and emotions and is the region of the brain most impacted by Alzheimer’s disease.

According to study co-author Dr. Cyrus Raji, the method the team used to “measure brain volumes in these individuals is useful because it can be applied on the same type of MRI scans we obtain in the clinic with no special type of imaging required.” Raji is an assistant professor of radiology at Washington University in St. Louis.

The study was published recently in the Journal of Alzheimer’s Disease.

About 2.9 million Americans experienced a TBI in 2014, and the rates are highest among people aged 75 and older, according to the U.S. Centers for Disease Control and Prevention.

— Robert Preidt

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One of the first symptoms of Alzheimer’s disease is __________________.
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SOURCE: University of California, Los Angeles, news release, Oct. 23, 2019

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For Seniors, Financial Woes Can Be Forerunner to Alzheimer’s

News Picture: For Seniors, Financial Woes Can Be Forerunner to Alzheimer'sBy Deborah DiSesa Hirsch
HealthDay Reporter

Latest Alzheimer’s News

TUESDAY, Oct. 29, 2019 (HealthDay News) — Unpaid bills, overdrawn accounts, dwindling investments: When seniors begin experiencing fiscal troubles, early dementia or Alzheimer’s disease could be an underlying cause, researchers say.

In the early stages of the disease, people with undiagnosed Alzheimer’s are at high risk of making foolish and dangerous decisions about their finances, mostly because families may not know they need help, researchers say.

“Individuals often aren’t diagnosed early enough, and it’s a perfect storm,” said study author Carole Gresenz, a professor of health systems administration at Georgetown University in Washington, D.C.

“They’re vulnerable to large reductions in liquid assets because they’re not making wise decisions about their finances, savings and checking accounts. This can also reduce net wealth,” added Gresenz.

Ruth Drew, director of information and support services for the Alzheimer’s Association, pointed out that Alzheimer’s destroys the brain.

“As the disease progresses, everyone with Alzheimer’s will reach a point where they need help with their finances and ultimately assistance with daily tasks and around-the-clock care. We have certainly spoken to people whose finances were significantly affected,” she said.

In some cases, people responsible for making major financial decisions, either at work or at home, were unaware of their own mental decline, added Drew, who wasn’t involved with the study.

“Others around them either did not notice or did not feel they could alert the family until there was already significant financial impact,” she said. “By the time we met them, family members were facing the challenges of caring for a person with far fewer financial resources than expected.”

The new study linked Medicare fee-for-service claims data and the national Health and Retirement Study of Americans over the age of 50 for the years 1992 to 2014. The health and retirement study included questions about households’ financial assets and liabilities.

The sample included nearly 8,900 U.S. households, of which nearly 2,800 included someone with Alzheimer’s or related dementia. In these households, the financial “head of the household” had the thinking disorder in 73% of them.

Gresenz said declining financial skills associated with Alzheimer’s may mean unpaid bills, overspending on credit cards or paying too little attention to investments and other forms of wealth. Impaired money sense also makes the elderly more vulnerable to fraud and scams.

The bottom line: “Living in a house with early-stage AD puts both the patient and family members at heightened risk of a large reduction in liquid assets — money that’s easily accessible, like checking, savings, money markets, bonds and stocks,” Gresenz explained. “One reason this is so concerning is that these core financial outcomes are occurring just prior to a time when they will have substantial costs placed on them.”

Alzheimer’s costs $341,000 on average from diagnosis to death, the Alzheimer’s Association says. Families pay 70% of this out of pocket.

Alzheimer’s disease affects 5.5 million people in the United States and 50 million worldwide, the researchers noted. As the U.S. population ages, prevalence of Alzheimer’s will rise, with a near tripling by 2050, they said.

Gresenz said families need to be involved as early as possible.

“It’s always a good idea to check in on loved ones and make sure that the vital financial activities of the household bills are happening, maybe checking credit scores. Even if there are not yet any obvious signs, making sure there’s a safety net,” she said.

“There’s also a role for financial institutions, which could play an important part in protecting elderly individuals,” Gresenz added.

Drew said that when it comes to Alzheimer’s and dementia, it’s never too early to put plans in place.

To older adults themselves, Drew said, “Talk to your financial planner early. When you’re setting up financial plans, put in provisions that say who the trusted people are in your life.” That way, if you start to show symptoms of mental decline, “your banker or financial planner will know who those trusted people are, and will have the paperwork that authorizes them to share their concerns.”

The study was published Oct. 25 in the journal Health Economics.

Copyright © 2019 HealthDay. All rights reserved.


One of the first symptoms of Alzheimer’s disease is __________________.
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SOURCES: Carole Gresenz, Ph.D., professor, health systems administration, Georgetown University, Washington, D.C.; Ruth Drew, M.S., LPC, director, information and support services, Alzheimer’s Association; Oct. 25, 2019, Health Economics

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Potential new target for treatment of gout

Researchers have identified a new therapeutic target for the treatment of gout, a common type of arthritis that causes episodes of painful and stiff joints. Their study suggests that blocking a signaling molecule known as TAK1 can suppress inflammation caused by gout. The research lays the foundation for the development of potential new treatment strategies for gout.
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California Fires Illuminate Trauma And Resilience

SANTA ROSA, Calif. — Dorothy Hammack had planned to wash her thick, dark hair in the kitchen sink Friday morning. She couldn’t yet shower, due to the incision on her breast from a biopsy a few days before. Her doctor had already called to let her know the results: She had breast cancer.

She was supposed to be researching treatment options and organizing doctor appointments. Instead, Hammack, 79, was standing in her pajamas in the parking lot of a makeshift evacuation center in Santa Rosa, the urban center of Sonoma County’s celebrated wine country. The Kincade Fire was blazing in the mountains above the home she shared in nearby Windsor with her fiancé, Aldo Lovati, 64. Winds predicted to be fast and furious were expected that evening, and the couple was among the 180,000 people who ultimately would be ordered to evacuate as the fire tore through the rugged terrain of northeastern Sonoma County and bore steadily southwest.

Much to Hammack’s dismay, her hair remained wrapped in a gray-and-black nightcap. There had been no time to wash it. She was upbeat, though, laughing at the stream of banter and jokes Lovati told to keep them distracted.

By Saturday, hundreds of others would join them at the shelter set up by the Red Cross at the Santa Rosa Veterans Memorial Building, in the southwestern corner of the city. Across the street, hundreds more evacuees got set up at the Sonoma County Fairgrounds. Like Hammack, many of them came with ongoing health concerns and urgent medical needs made all more challenging by the chaos of evacuation.

Peggy Goebel, a nurse from Windsor, was helping oversee the medical operation, run largely by volunteers who had responded to calls from Goebel or their employers to lend their services. They provided basic care (like making sure Hammack’s incision was clean) and helped people fill prescriptions or get medical equipment such as walkers and wheelchairs. There were also licensed therapists trained to counsel people during disasters.

Winds in excess of 70 to 80 mph whipped through the region, bringing down trees and pushing the Kincade Fire toward the house of nurse Peggy Goebel, a Red Cross volunteer, as she helped oversee medical operations at an evacuation shelter in Santa Rosa. (Anna Maria Barry-Jester/KHN)

This is Goebel’s third year volunteering with the Red Cross, a relationship that began during another fire. Twenty-five hours into a shift with no foreseeable end, she still had enough spunk to organize newly arrived volunteer physicians from the local Sutter Health hospital and nursing students from Santa Rosa Junior College, where she teaches. As she showed them around, a fire blazed across the street from her home in Windsor. She didn’t know whether the house would be there when she got back. Her sister’s wasn’t when she returned after the 2017 Tubbs Fire, a massive wildfire that devastated Santa Rosa, killing 22 people and incinerating thousands of homes.

“It’s very traumatic. People just passed the anniversary of the 2017 fires, and they went through this big PTSD,” Goebel said. “Lots of people had issues.”

Two years ago, the situation was very different. In 2017, people arrived at the shelters in the middle of the night, startled awake by a fire that roared fast and unexpected from the forested hills north of town. They came without shoes, in their nightgowns, without medicines, money or important documents. “That was hard to deal with, trying to provide physical, emotional, medical support,” Goebel said.

This time around, people were calmer, because they had time to prepare. The scale of evacuations posed a challenge, but it was nothing like the last time, she said.

That let the medical personnel focus on the extreme needs of some people who ended up at the shelter. There was the frail elderly woman who was near death when she arrived — another volunteer called nearly two dozen convalescent facilities before finding one that could take the woman, ensuring she wouldn’t die in the shelter. And there was the elderly man with dementia who had been dropped off alone. Afraid he might wander away or otherwise hurt himself, fellow evacuees volunteered to look after him during the night.

A police officer brought an elderly woman with Parkinson’s disease after the people living with her decided they couldn’t take her with them during the evacuation. She was taken to a room at the shelter where the elder residents of an assisted living facility in Healdsburg were lined up in hospital beds, many accompanied by their caretakers.

The Red Cross volunteers always ask those caretakers to stay, said Goebel. Not everyone in need came with help, though. Among them were people with Alzheimer’s disease and a man with multiple sclerosis.

As she made her way between the veterans’ hall and the fairgrounds, Goebel said she was rejuvenated by how quickly people mobilized to help one another, and the resilience of her community after the last set of big fires.

Not only had the community pulled together, but it was much better prepared this time. The winds whipping through the region at 70 to 80 mph were stronger than they had been in 2017. But through mass evacuations and an all-hands-on-deck assault on the fire, authorities and firefighters so far have prevented the worst. As of Tuesday morning, there were no deaths and just a couple of injuries.

Patients in the hospitals across the county that had been evacuated were transferred to other facilities without incident. A doctor described the parade of newborns in their tiny beds, taken from Sutter Santa Rosa Regional Hospital’s neonatal intensive care unit and transferred to hospitals farther south. As buses pulled away with patients, two people stood outside clutching a balloon reading, “Congratulations.”

Through mass evacuations and an all-hands-on-deck assault on the fire, authorities and firefighters so far have prevented the worst. As of Tuesday morning, there were no deaths and just a couple of injuries. (Anna Maria Barry-Jester/KHN)

On Saturday, the day after his arrival, Aldo Lovati walked across the same parking lot he had stood in the day before, wearing the same green long-sleeve shirt and gray sweatpants. Today, he was much quieter. It had been a rough night of little sleep in close quarters. He was mad at himself for being ungrateful — he desperately wanted to focus on the generosity of strangers, and how lucky they were to have food and shelter. But he was feeling tired, sad and frustrated. “I’ve lost my dignity in here; I just really feel that I’ve lost my dignity,” he said.

Lovati had struggled through some mental health issues that predate the fire. A breakdown a few years ago had taken a toll on family relationships, and it was all coming to the surface now that he was in need of help. “It’s gotten to me. I just want to go home,” he said.

Hammack wandered out to find him, her thick, dark hair fluttering in the wind, and the two held hands as they talked. She, too, was feeling more tired than the day before, and the news of her diagnosis was starting to set in. The incision from her biopsy hurt; she was supposed to put hot compresses and pressure on it and made do with unused sanitary pads she’d gotten at the makeshift Red Cross clinic. They began to laugh again, recounting how she’d pulled one out to give him when they couldn’t find a napkin at lunch.

Hammack said she was tired and wanted to go back in to lie down on a cot. Lovati agreed she should be lying down and asked why she had come out. “We’re a couple, right? We look out for one another,” she replied.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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Hospitals Take Shot At Opioid Makers Over Cost Of Treating Uninsured For Addiction

While thousands of cities and counties have banded together to sue opioid makers and distributors in a federal court, another group of plaintiffs has started to sue on their own: hospitals.

Hundreds of hospitals have joined in a handful of lawsuits in state courts, seeing the state-based suits as their best hope for winning meaningful settlement money.

“The expense of treating overdose and opioid-addicted patients has skyrocketed, straining the resources of hospitals throughout our state,” said Lee Bond, CEO of Singing River Health System in Mississippi in a statement. His hospital is part of a lawsuit in Mississippi.

Hospitals may discover downsides to getting involved in litigation, said Paul Keckley, an independent health analyst.

“The drug manufacturers are a soft target,” he said. But the invasive nature of litigation may generate “some unflattering attention” for hospitals, he added. They’d likely have to turn over confidential details about how they set prices, as well as their relationships with drug companies.

So, despite representing the front lines of the opioid epidemic, most hospitals have been hesitant to pile on.

Just about every emergency room has handled opioid overdoses, which cost hospitals billions of dollars a year, since so many of the patients have no insurance. But that’s just the start. There are also uninsured patients, like Traci Grimes of Nashville, who end up spending weeks being treated for serious infections related to their IV drug use.

“As soon as I got to the hospital, I had to be put on an ice bath,” Grimes said of her bout with endocarditis over the summer, when bacteria found its way to her heart. “I thought I was going to die, literally. And they said I wasn’t very far away from death.”

Grimes is in recovery from her opioid addiction but still getting her energy back after spending a month being treated through a special intravenous line to her heart at Vanderbilt University Medical Center. Most patients could be sent home with a PICC line, but not someone with a history of illicit IV drug use who could misuse it to inject other substances. Vanderbilt and other academic medical centers recognize the problem and have established special clinics to manage these complex patients.

Grimes, 37, said she’s grateful for the care she received, which included multiple procedures and treatment for pneumonia, hepatitis A and hepatitis C. But like most patients in her situation, she’s uninsured and strapped for cash.

“I can’t pay a thing. I don’t have a dime,” she said. “So they do absorb all that cost.”

Hospitals estimate treating complicated patients like Grimes costs an average of $107,000 per person, according to court documents. The total costs to U.S. hospitals in one year, 2012, exceeded $15 billion, according to a report cited in the suits. And most patients either couldn’t pay or were covered by government insurance programs.

The expense is a leading reason cited by the hospitals who’ve banded together in a handful of lawsuits in Tennessee, Texas, Arizona, Florida, Kentucky, Mississippi and West Virginia. These suits are separate from the consolidated federal case in Ohio that includes cities and counties around the country. But the most prominent hospitals in those states, like Vanderbilt, have opted not to join the litigation.

West Virginia University President E. Gordon Gee, who oversees the state’s largest hospital system, has been urging others to join the suits. He and former Ohio Gov. John Kasich established an organization meant to highlight the harm done to hospitals by the opioid crisis.

“I think the more hospitals we have that want to be involved in this in some way, the better off we are,” he said. “You know, there’s always safety in mass.”

By “safety,” Gee acknowledged a central concern for hospitals weighing the risk versus reward of going to court. They may have the tables turned on them by the pharmaceutical companies since, until recently, patients in the hospital were often prescribed large quantities of opioids, contributing to the epidemic.

“I suspect there are some hospitals … who are afraid that if they get into it, those who are on the defense side will point out, well, maybe hospitals were really the problem,” he said.

The lead defendant in the suits, Purdue Pharma, did not respond to requests for comment.

Gee said hospitals can claim they were victims of dubious opioid marketing.

Still, many high-profile hospitals are sitting out the lawsuits, even though they’re typically the ones that treat the most complicated and expensive patients.

Health analyst Keckley said if hospitals join the litigation, they may be forced to cough up actual totals for their opioid-related financial damages. That could force hospitals to reveal how much more they charge for some services, compared with the actual costs of providing the care.

“Hospitals basically have charged based on their own calculations and the underlying cost of delivering that care has been virtually nontransparent,” Keckley said. “Then you open a whole new can of worms.”

Big academic medical centers especially, Keckler said, have relationships with drugmakers that they may not want publicly highlighted.

Still, hospitals might benefit without having to put their names on lawsuits and exposing themselves to risk. In Oklahoma, the state won an early opioid lawsuit in August. The payout does not direct money to hospitals, per se. However, Patti Davis, president of the Oklahoma Hospital Association, said they’re happy to see some of the money was earmarked for treatment.

“When we see treatment, we get very excited because it’s our hospitals providing a lot of the treatment,” she said.

But nationally, hospitals can’t count on potential settlement money to trickle down to their bottom lines, said Don Barrett, a Mississippi litigator helping hospitals sue in state courts.

Two decades ago, when the target of litigation was Big Tobacco, Barrett was working for states. He said hospitals didn’t join in, to his surprise. And when the states won those suits and started getting paid damages, hospitals missed out. Only about a third of the money was even spent on health or tobacco control, according to one watchdog’s estimate.

“I guess they thought that the states were going to take care of them, that these local governments were going to take this money and give it to the hospitals where it would do some good,” he said. “Of course, they didn’t give them a damn penny.”

Some states did set up trust funds that might help patients in the hospital stop smoking. But many are using the money to fill potholes, pay teachers and otherwise close gaps in state budgets.

Though not detailed in the lawsuits, many of the participating hospitals are in varying levels of financial distress, and not always primarily because of the opioid epidemic. Facilities owned by Community Health Systems make up a large share of the hospitals suing in Alabama, Florida, Mississippi, Tennessee and Texas. The investor-owned hospital chain, based in Franklin, Tenn., has been struggling mostly because of an outsize debt load taken on during a rapid period of expansion.

A CHS spokesperson declined to comment, citing a policy not to talk about pending litigation.

But Barrett said he expects more hospitals to join the cause rather than relying on states to determine how settlement money is spent.

“We’re not going to allow that to happen this time,” he said. “We can’t afford to allow it to happen this time.”

This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News.

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