Health & healthcare/ September 2019 –

Written by  //  June 29, 2020  //  Health & Health care  //  No comments

Brookings Topic Page on Marijuana
European Centre for Disease Prevention and Control
World Health Organization (WHO)
China: government and governance 2016-20
Stephen Colbert: Beware The Elderly Antifa!
They’re old, and they’re coming for us all

Although focused on the U.S. situation, many of the problems raised pertain equally to Canada and other nations
The Coronavirus Pandemic’s Wider Health-Care’s Crisis
The pandemic has shaken the industry’s unsteady foundation, siphoning attention and resources away from patients who need other types of care.
COVID-19 has disrupted patient care and hospital finances—and the problems could deepen as the disease spreads..
By Dhruv Khullar
(The New Yorker) …the coronavirus has shaken [American health care’s] unsteady foundation, siphoning attention and resources away from patients who need other types of care. We tend to follow the virus’s toll narrowly—cases, hospitalizations, deaths—but the damage to public health is also vast, and the longer the pandemic persists, the larger it will grow. Children go unvaccinated; blood pressure is left uncontrolled; cancer survivors miss their checkups. The extent of the collateral damage won’t be known for years, if ever
During the pandemic, … [s]ome people with chronic illnesses, fearful of entering a medical setting or even venturing outside, have stopped seeing doctors altogether. Others have tried to make appointments but found clinics closed and routine care suspended. At many hospitals, non-urgent or “elective” care has been postponed for months. It’s difficult to say for sure what the effects of such postponements have been and will be. But statistics show that, across the United States, so-called excess deaths—deaths beyond those that are historically typical—have surged. Although many of these deaths can be attributed to COVID-19, delayed or cancelled care is probably a contributing factor, too. An analysis of death certificates shows that a fifth of the twenty-four thousand excess deaths that occurred in New York City between March 11th and May 2nd were caused by factors other than COVID-19; according to a study currently in pre-publication review, hospitals saw a thirty-eight-per-cent drop in serious heart-attack cases in March alone, suggesting that even people with acute, life-threatening illnesses have been avoiding medical visits. (The American College of Cardiology has gone so far as to issue a statement urging people to seek medical attention if they’re having cardiac symptoms.) A nationwide survey conducted in April found that a quarter of cancer patients receiving active treatment had seen their care delayed. Ultimately, it’s not just people with COVID-19 who are suffering; those with other illnesses are affected by the pandemic, too.
On May 28th, the United States reached a sombre milestone: a hundred thousand COVID-19 deaths. In the days since, twenty-two thousand more people have died. And yet the virus’s harm extends to individuals whose lungs it never reaches, and who aren’t included in those grim totals: patients with diabetes, depression, cancer, and high blood pressure; people suffering heart attacks and strokes; families who can’t hold their dying loved ones, and the nurses who must hold the phones through which people say goodbye. There are doctors who can’t keep their COVID-19 patients alive, and others who can’t keep their practices open.

26 June

The American Nursing Home Is a Design Failure

(New York) … David Grabowski, a professor of health-care policy at Harvard Medical School, and a team of researchers analyzed the spread of COVID-19 in nursing homes, and concluded that it didn’t matter whether they were well or shoddily managed, or if the population was rich or poor; if the virus was circulating outside the doors, staff almost invariably brought it inside. This wasn’t a bad-apples problem; it was systemic dysfunction.
… Grabowski’s analysis revealed one variable in operation and design that afforded some protection from coronavirus: Intimate facilities fared far better than large ones. Fortunately, the country has a growing network of miniature nursing homes, certified by the Maryland organization the Green House Project. Typically, this is a cross between a graduate student house-share and a suburban development. Ten or 12 residents, each with a private room, share a sprawling ranch house. They take their meals together, at a long communal table, sharing their lives with a handful of staffers. “The kitchen is open, so you can see the food being prepared and smell it as it’s cooking,” says Green House’s senior director Susan Ryan. Daylight flows into the common areas and a few steps lead outdoors to a garden or patio.
… The goal is to make people feel like they are able to continue the life they have lived for decades, rather than be suddenly transformed into superannuated livestock. “You want a place to feel normal, which is the opposite of institutional,” says Martin Siefering, an architect at the firm Perkins Eastman. “Shiny vinyl floors are not normal. Loud mechanical systems, having meals served to you on a tray — these things aren’t normal.”
… The Danish architecture firm CF Møller and the landscape firm Tredje Natur (Third Nature) won a 2016 competition to reimagine a complex of nursing homes in the Norrebro neighborhood of Copenhagen. … A series of three linked courtyards is crisscrossed by paths and lined with stores, clinics, and social services. The goal is to fuse the complex with the city, to mix populations, and stimulate casual contact.
… In a segmented industry where the interests of nursing-home and assisted-living operators compete for meager government funds, reforming the system will involve rewriting rules and spending more. “If the government put $300 billion into elder care, they could transform it,” Reingold says. “That’s an investment, not an expense. Spending more on quality long-term care would save a fortune in hospital stays.” A night in a nursing home costs Medicaid $200 to $300, depending on the state, while a night in a hospital can cost ten times that much.

22 June
The Promise and the Peril of Virtual Health Care
During the coronavirus pandemic, telemedicine looks like the future of health care. Is it a future that we want?
By John Seabroo
Telemedicine and telehealth involve a myriad of remote-health-care technologies and services collectively known as “virtual care.” For years, virtual care played a minor role in the United States’ $3.6-trillion health-care industry; now, with the COVID-19 pandemic, millions of people are discovering its benefits and its shortcomings for the first time. If virtual care is the future of health care, is it a future that we want?
In a narrow sense, the word “telemedicine” can mean the type of hardwired hospital-to-clinic setup that allows workers in a large hub hospital to assist in complex emergency procedures in distant spokes. This approach is descended from NASA’s pioneering research, in the nineteen-sixties and seventies, into satellite communications and methods of monitoring astronauts’ well-being in space.
… Telehealth providers typically offer virtual urgent care for non-emergencies. And patients suffering from chronic conditions, such as diabetes and colitis, can conduct routine follow-ups online. Proponents of telehealth have long argued that fifty to seventy per cent of visits to the doctor’s office could be replaced by remote monitoring and checkups. But, until the pandemic, most Americans weren’t interested.
Many rural clinics and community hospitals in small American towns fear that their already meagre medical staffing, and the revenues generated from procedures that can be performed on-site, will be further hollowed out by remote medicine. And often the patients who need care the most—the old and the poor—don’t have smartphones or broadband connectivity, or can’t afford extra minutes on their wireless plans, placing one of telehealth’s greatest promises, of allowing old people to “age in place,” out of reach.

16 February
How bilingualism can hold back a flood of Alzheimer’s symptoms
A new study has found that while bilingualism can hold back the symptoms of Alzheimer’s disease, it can also lead to a faster decline down the track
(New Atlas) A long line of research projects have found a range of benefits of bilingualism when it comes to the brain, from shortening recovery times from stroke to staving off the cognitive decline associated with dementia and Alzheimer’s. Scientists looking into the latter have uncovered some interesting new insights, finding that while knowing a second language can delay the onset of the disease, it can also significantly accelerate the deterioration into severe Alzheimer’s thereafter.
The research was carried out at Canada’s York University, where scientists in the Department of Psychology set out to investigate how bilingualism can boost what is known as our cognitive reserve, and what that means for Alzheimer’s. This refers to the brain’s resilience to neurological damage, with previous studies finding that a greater cognitive reserve can, at least temporarily, mitigate the impacts of Alzheimer’s in our later years.
The research was published in the journal Alzheimer Disease and Associated Disorders.

3 February
Viral connectivity means we all have to accept the threat of disease and disaster
(SCMP) In an increasingly interconnected world, those of us who enjoy the fruits of globalisation must also bear its risks: climate crisis, drug resistance and emerging epidemics. As the Wuhan outbreak shows, we must work together
There is considerable fear and misinformation about viral pandemics. To put things in perspective, the current Ebola outbreak in West Africa has more than 3,000 confirmed infections and a mortality rate of about 66 per cent, compared to around 2 per cent for the Wuhan coronavirus.

The New Coronavirus Is a Truly Modern Epidemic
New diseases are mirrors that reflect how a society works—and where it fails.
…the World Health Organization recently declared a “public-health emergency of international concern” (PHEIC)—a designation that it has used on five previous occasions, for epidemics of H1N1 swine flu, polio, Ebola, Zika, and Ebola again. The invocation of a PHEIC is a sign that the new coronavirus should be taken seriously—and as the sixth such invocation in a little more than a decade, it is a reminder that we live in an age of epidemics.
Each new crisis follows a familiar playbook, as scientists, epidemiologists, health-care workers, and politicians race to characterize and contain the new threat. Each epidemic is also different, and each is a mirror that reflects the society it affects. In the new coronavirus, we see a world that is more connected than ever by international travel, but that has also succumbed to growing isolationism and xenophobia. We see a time when scientific research and the demand for news, the spread of misinformation and the spread of a virus, all happen at a relentless, blistering pace.

28 January
We Made the Coronavirus Epidemic
It may have started with a bat in a cave, but human activity set it loose.
By David Quammen, author of “Spillover: Animal Infections and the Next Human Pandemic.”
(NYT) Long term: We must remember, when the dust settles, that nCoV-2019 was not a novel event or a misfortune that befell us. It was — it is — part of a pattern of choices that we humans are making.

11-13 January
CBC The Current “neuroscientist Dan Levitin gives us his tips on how to age well, and why he thinks old age is a stage of life where we can still grow.”
A neuroscientist lays out the keys to aging well -complete transcript
(PBS) Daniel Levitin — a neuroscientist and professor emeritus of psychology at McGill University– has written extensively about the brain. Also a musician, he has written bestselling books examining the effect of music on the brain, as well as about how to think “straight” in an age of information overload. In Levitin’s latest book, “Successful Aging” he explores the questions: what happens in the brain as we age and what are the keys to aging well?

1 January
AI system outperforms experts in spotting breast cancer
(The Guardian) An artificial intelligence program has been developed that is better at spotting breast cancer in mammograms than expert radiologists.
The AI outperformed the specialists by detecting cancers that the radiologists missed in the images, while ignoring features they falsely flagged as possible tumours.
If the program proves its worth in clinical trials, the software, developed by Google Health, could make breast screening more effective and ease the burden on health services such as the NHS where radiologists are in short supply.
“This is a great demonstration of how these technologies can enable and augment the human expert,” said Dominic King, the UK lead at Google Health. “The AI system is saying ‘I think there may be an issue here, do you want to check?’”


16 November
The most remote emergency room: Life and death in rural America
If anything defines the growing health gap between rural and urban America, it’s the rise of emergency telemedicine in the poorest, sickest, and most remote parts of the country, where the choice is increasingly to have a doctor on screen or no doctor at all.
(WaPo) As hospitals and physicians continue to disappear from rural America at record rates, here is the latest attempt to fill a widening void: a telemedicine center that provides remote emergency care for 179 hospitals across 30 states. Physicians for Avera eCare work out of high-tech cubicles instead of exam rooms. They wear scrubs to look the part of traditional doctors on camera, even though they never directly see or touch their patients. They respond to more than 15,000 emergencies each year by using remote-controlled cameras and computer screens at what has become rural America’s busiest emergency room, which is in fact a virtual ER located in a suburban industrial park.

2 October
Chronically Simple helping manage the chaos of living with chronic disease
The Chronic Disease Prevention Alliance of Canada puts the number of Canadian adults living with chronic disease at 60 per cent. According to Statistics Canada, 6.2 million Canadians over the age of 15 live with one or more disabilities. And nearly half of Canadians have cared for an aging, ill, or disabled family member or friend, according to the agency’s latest data. …
The result was the August 2018 launch of Chronically Simple, a cloud-based app that helps patients and caregivers manage the day-to-day logistics around living with chronic disease or disability, from medication and appointment tracking, to accounting and note taking, to lab results and medical records storage. … Among its many secure features, Chronically Simple offers appointment and scheduling functions, as well as medication and prescription tracking. It’s programmed to send reminders and connect appointment, doctor and prescription details. It also allows the patient to store their own medical records and keep copies of important test results. Users can store important incidentals like tax-deductible parking, travel, equipment, and prescription receipts by taking photos of the receipts. They can also enter appointment notes, manually or via talk-to-text, to be indexed for easy searching by the patient or healthcare provider.

23 September
Liberals, NDP promise increased health care spending
(Globe & Mail) Justin Trudeau promised a re-elected Liberal government would spend an additional $6-billion over four years on health care, describing the promise as a “down payment” to launch negotiations with provinces on pharmacare.
At an announcement in Hamilton, Mr. Trudeau said the increased funding would ensure that every Canadian can “easily” find a family doctor or primary-care team. He said the money would also lead to clear national standards for access to mental-health services, improve home care and implement a rare-disease drug strategy.
Mr. Trudeau gave very few details on the plans for a universal pharmacare system beyond interim measures that were announced in this year’s budget. He did not release a costing for the proposed plan, nor did he say when it would be implemented. Not to be outdone, Greens’ Elizabeth May commits to funding mental health, which she says is affected by the climate crisis
Federal leader outlines her health platform, which includes reducing wait times for assistance programs and putting more money into mental-health services in rural and remote areas.

19 September
Take down the barriers to telemedicine
By Patrick Déry, senior associate analyst at the Montreal Economic Institute.
Given that the technologies behind telemedicine exist and are proven, why do Canada’s health-care systems remain stuck in the past?
(Opinion Montreal Gazette) Because our governments, consciously or not, allow all sorts of obstacles to complicate the lives of patients.
For example, a doctor who provides care to people located in a certain province must hold a licence to practise in that province, even if he or she already holds a licence from another province. This outdated requirement prevents a better allocation of medical resources. If doctors are available to lend a hand in our part of the country, even just temporarily, why not welcome them with open arms?
In the case of telemedicine, the maintenance of this same requirement by the majority of provinces is completely ridiculous. More and more Canadian companies are offering their employees access to virtual consultations through their group insurance plans. A doctor who provides such a consultation could renew a prescription for an Alberta patient, then follow up with another from Manitoba suffering from a chronic illness, direct a Quebec patient to a consultation with a specialist, and give advice to a New Brunswick patient, all without leaving his or her office.
Why force this doctor to hold and renew a licence to practise in each of these places? The anatomy of Canadians does not vary a lot from province to province!
The provincial governments have also set out all sorts of conditions that restrict access to telemedicine within the public systems. It is often reserved for patients who live in remote regions or who suffer from particular conditions. Sometimes, the government even requires the patient or the doctor to go to an authorized health facility to receive or provide virtual care. This defeats at least some of the purpose of telemedicine!
The way we pay doctors doesn’t help, either. Fee-for-service payments, which represent around three-quarters of Canadian doctors’ incomes, do not encourage them to carry out actions for which there will be no payment. Unsurprisingly, the very large majority of our doctors are hesitant to write an email or pick up a phone to contact us, let alone have a smartphone consultation.
Finally, our health-care systems are still often far too centred on doctors. While their expertise is sometimes indispensable, there are many situations in which nurses and pharmacists can lend a hand. Allowing them to do more would liberate doctors, a scarce resource, to do other things.

18 September
Factbox: India becomes latest country to ban sale of e-cigarettes
(Reuters) – India became the latest country after Brazil and Thailand to ban the sale of e-cigarettes in what could potentially be the biggest move against vaping globally over growing health concerns.

6 September
Three more deaths and at least 450 illnesses linked to vaping nationwide
The Centers for Disease Control (CDC) said some type of chemical exposure is likely associated with the illnesses, but more information is needed to determine the exact cause. Many of those hospitalized reported recently vaping a THC product with chemicals from marijuana, while a smaller group reported using regular e-cigarettes.
The CDC did not identify any particular brand of e-cigarette, but expressed concern about any product sold on the street or tampered with by users.
“They’re really concerned about unknown substances people are buying on the street,” LaPook said. “They think it’s not an infection, it’s a probably some chemical irritation. When you think about it, these e-cigarette devices are really like chemistry sets. You put in this liquid, you lick it, you heat it up – there’s some kind of chemical reaction. You’re creating all these different chemicals. You’re not entirely sure what these chemicals are, but we are sure of one thing: You are sucking a lot of them.”

Ebola outbreak in the Democratic Republic of the Congo
(European Centre for Disease Prevention and Control) The 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) has been ongoing since August 2018. This is the largest-ever outbreak reported in the country and the world’s second largest in history. It has been declared a Public Health Emergency of International Concern on 17 July 2019.

4 September
Malaria breakthrough as scientists find ‘highly effective’ way to kill parasite
Drugs derived from Ivermectin, which makes human blood deadly to mosquitoes, could be available within two years

24 June
A vaccine for Alzheimer’s is on the verge of becoming a reality
For decades, research into Alzheimer’s has made slow progress, but now a mother and daughter team think they have finally found a solution – a vaccine that could inoculate potential sufferers
(Wired UK) Half the deaths in the US in 1900 were from infectious disease. By 2010, mortality related to infectious disease had been all but wiped out, leaving the two biggest killers as cancer and heart disease. Over the last 15 years, UK mortality statistics have shown a steady decline in deaths from heart disease, strokes and most major cancers – for men and women.
Over the same period the death rate from dementia – of which Alzheimer’s is the most common cause – has doubled: in part because lifespans have increased, and the effects of the disease increase with age. In the UK, there are currently 850,000 people living with dementia, and 500,000 – perhaps as many as two-thirds – have Alzheimer’s. In the UK, the Alzheimer’s Society expects dementia sufferers to exceed a million by 2025, with an unknown quantity of carers and family members affected.
A total of five drugs are available to relieve symptoms, but they cannot slow or stop the progression of the disease.
In the last ten years, over 100 anti-Alzheimer’s drugs have been abandoned in development or during clinical trials.
… researchers aren’t sure if high levels of beta-amyloid and tau cause Alzheimer’s or are symptoms of the condition. Both damaged versions of the proteins can cause neighbouring beta-amyloid and tau molecules to misfold as well – spreading the damaging tangles to other cells, breaking nerve cell connections with other neurons and slowly starving neurons to death.
The risks generally increase with age, but an inheritable form of the disease – early-onset Alzheimer’s – can affect people as young as 30. …  Some medications can reduce memory loss and aid concentration, but these just boost the performance of unaffected neurons, doing nothing to stop the kill-off of brain cells.
Chang Yi’s vaccine – UB-311 – couples a synthetic imitation of a common disease with a specific sequence of amino acids that are present only in the damaged beta-amyloid protein, and absent in the healthy form. This provokes an antibody response, clearing the tangled proteins away without provoking potentially damaging inflammation.
In January 2019, the company announced the first results from a phase IIa clinical trial in 42 human patients. “We were able to generate some antibodies in all patients, which is unusual for vaccines,” Chang Yi explains with a huge grin. “We’re talking about almost a 100 per cent response rate. So far, we have seen an improvement in three out of three measurements of cognitive performance for patients with mild Alzheimer’s disease.”
Because phase II trials are so small, there’s no statistically valid evidence yet that UB-311 has an impact on cognition and memory, but the lack of serious side-effects is a big step forward.

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