Medicine and Health

Subterms

    Latest story

    163 Shares24 Views

    Hilary Cass Says U.S. Doctors Are ‘Out of Date’ on Youth Gender Medicine

    by

    Dr. Hilary Cass published a landmark report that led to restrictions on youth gender care in Britain. U.S. health groups said it did not change their support of the care.After 30 years as one of England’s top pediatricians, Dr. Hilary Cass was hoping to begin her retirement by learning to play the saxophone.Instead, she took on a project that would throw her into an international fire: reviewing England’s treatment guidelines for the rapidly rising number of children with gender distress, known as dysphoria.At the time, in 2020, England’s sole youth gender clinic was in disarray. The waiting list had swelled, leaving many young patients waiting years for an appointment. Staff members who said they felt pressure to approve children for puberty-blocking drugs had filed whistle-blower complaints that had spilled into public view. And a former patient had sued the clinic, claiming that she had transitioned as a teenager “after a series of superficial conversations with social workers.”The National Health Service asked Dr. Cass, who had never treated children with gender dysphoria but had served as the president of the Royal College of Pediatrics and Child Health, to independently evaluate how the agency should proceed.Over the next four years, Dr. Cass commissioned systematic reviews of scientific studies on youth gender treatments and international guidelines of care. She also met with young patients and their families, transgender adults, people who had detransitioned, advocacy groups and clinicians.Her final report, published last month, concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.” On her recommendation, the N.H.S. will no longer prescribe puberty blockers outside of clinical trials. Dr. Cass also recommended that testosterone and estrogen, which allow young people to develop the physical characteristics of the opposite sex, be prescribed with “extreme caution.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

    More stories

    • 75 Shares130 Views

      in Elections

      Maximizing Profits at the Patients’ Expense

      by

      More from our inbox:The Brave Trump JurorsBlack Voters ‘Want to Be Courted’ by DemocratsBetter Than Debates NATo the Editor:Re “Patients Hit With Big Bills While Insurers Reap Fees” (front page, April 7):Chris Hamby’s investigation uncovers the hard truth for patients who receive care from providers outside their insurance network. While most of us try to save out-of-pocket costs by using in-network health professionals and hospitals, it’s not always possible. And there’s no way to determine what we’ll owe until after we get that care — when it’s too late to reconsider based on the costs we’ve incurred.So, it’s more important than ever for the government to swiftly implement an essential element of the No Surprises Act: Providers should have to give patients an advance explanation of benefits so patients can estimate their financial burden before they get treatment, in or out of network.Health price transparency is improving, but it’s outrageous that even two years after the No Surprises Act passed, everyone except the patient knows the price of a procedure or doctor’s visit in advance, leaving patients unpleasantly surprised.Patricia KelmarAlexandria, Va.The writer is senior director of Health Care Campaigns for U.S. PIRG.To the Editor:This is just the latest example of the schemes deployed by insurers to maximize profits by cutting reimbursements to physicians and shifting medically necessary health care costs onto patients.Whether it’s through third-party entities like MultiPlan or using tactics such as narrowing provider networks and restrictive prior authorization policies, insurers have the perverse incentive to boost revenue over offering adequate payment for quality patient care under the guise of “controlling costs.”More and more patients are being forced to decide whether they should forgo treatment because their insurer won’t pay the bill.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

    • 125 Shares143 Views

      in Elections

      Heat Wave in Gaza Challenges Pharmacists Ability to Store Medicine

      by

      A heat wave in the Gaza Strip this week, with temperatures soaring above 100 degrees Fahrenheit the past few days, has not only made life intolerable for the hundreds of thousands of displaced people trying to rebuild their lives in tent cities but has made it hard for some businesses to operate.By Saturday, the heat had significantly eased and the forecast was for more moderate temperatures in coming days. But the recent highs offered a vision of what the summer likely holds.“This hot weather is a challenge for us,” said Mohammed Fayyad, a displaced pharmacist who started selling medications from a tent he built out of wooden slabs, curtains and metal scraps at a camp for displaced people in Al-Mawasi.With no electricity or alternative sources of power, Mr. Fayyad, 32, said that he could not keep the medicines — which he buys from pharmacies that have had to shut down — stored at cool enough temperatures to keep them from being damaged.“Fifty percent of the medicines for chronic diseases are not available because we do not have any source of power to keep them cool,” said Mr. Fayyad, speaking from his makeshift pharmacy that he named after his 3-year-old daughter Julia.Mr. Fayyad is trying to find ways to generate power for a refrigerator to store medication.“I hope I can find those solar panels, which are very expensive, to make the options wider for the displaced people,” he said.Mr. Fayyad was displaced with his wife and only daughter from Khan Younis, where they lived and owned a pharmacy. They have been in Al-Mawasi for more than two months. When they recently went back to Khan Younis after the Israeli military withdrew from the area, he found his pharmacy had been burned and looted.Nearly two million Palestinians in Gaza were forced to flee their homes under Israeli bombardment and military evacuation orders. Many had to live in tents that provided little protection from the cold and rainy months earlier in the war and that offer them no protection against the scalding heat and humid weather now.Parents across the Gaza Strip are relying on water to keep their children cool when it is already not easy to get. The hot weather is also bringing insects that help spread disease.“My children were stung by insects and mosquitoes because there is no sanitation around, and sewage is leaking almost everywhere,” said Mohammed Abu Hatab, a father of four, including a 7-month-old. His family has been spending their days outside, under the shade of nylon tents, which trap heat and make the tents more unbearable.“I had to undress my children to their underwear only,” said Mr. Abu Hatab, 33. He added: “The tent, the heat wave, and the horror of this war are all a nightmare. How can my children live healthily and safely?” More

    • 113 Shares166 Views

      in Elections

      Ozempic and Wegovy Have Health Benefits Beyond Weight Loss

      by

      Last year was called the year of Ozempic, though it was also a year of Ozempic backlash and Ozempic shortages, which could persist for years. Even so, we appear very far from a peak for GLP-1 drugs, like Ozempic and Wegovy, which are powered by a molecule called semaglutide, and Mounjaro, which uses its cousin tirzepatide. It seems possible to imagine a future in which almost everyone is taking some variety of GLP-1 drug, and with a pretty good reason to do so.Probably, you have heard about the game-changing impact of such drugs on obesity, a condition that affects 40 percent of Americans and increases the risk of heart disease, stroke and hundreds of other comorbidities. Patients on Ozempic and Wegovy can lose 15 to 20 percent or more of their weight in a little over a year, and if they stay on the drugs, the weight tends to stay off. That may not sound like a monumental effect, but consider that on average, an obese 210-pound man who loses 20 percent of his body mass generally passes quickly through the overweight stage all the way to a normal weight.If anything, though, we’ve probably talked too much about cosmetic weight loss and Hollywood vanity — and certainly made too many comparisons to fen-phen, Botox and Viagra. The GLP-1 drugs have been shown to cut risk of heart attacks, strokes and death from coronary disease by 20 percent among overweight and obese patients, presumably through the salubrious effect of weight loss, though the researchers can’t yet say for sure. Semaglutide has been shown to eliminate or reduce the need for insulin among those with recent-onset Type 1 diabetes. In a clinical trial of people with Type 2 diabetes and moderate to severe kidney disease, the drug reduced the risk of kidney disease progression and cut the death rate from cardiovascular and kidney-related causes by 24 percent — such a clear result that the trial was ended early. Semaglutide has reduced fatty liver deposits in patients with H.I.V. and nonalcoholic steatotic liver disease. It has normalized the menstrual cycles of those with polycystic ovary syndrome. (It has also, somewhat mysteriously, seemed to produce a wave of unintended pregnancies among women taking birth control, at least if TikTok videos are to be trusted.)Studies have shown promise in treating Alzheimer’s and Parkinson’s with GLP-1 drugs, perhaps by regulating insulin levels and reducing inflammation, and the drugs may yet prove useful in treating many other conditions made worse by chronic inflammation. Some studies have found large decreases in the risk of depression and anxiety; others found smaller but still positive effects. There are potential applications for schizophrenia and neurological dysfunction, thanks to the role that insulinlike hormones like GLP-1 play in the development of the central nervous system and the way semaglutide reshapes the brain’s chemical reward system. It seems to bend the curve on alcoholism and drug addiction and curb other addictive behaviors, as well — compulsive shopping and sex addiction, gambling and nail biting, smoking and skin picking. A compulsive nation has stumbled into what looks like a treatment for compulsion and one that happens to protect against some of the country’s biggest killers and curb some of its most pervasive pathologies and inner demons.Americans love to dream of miracle drugs, but hardly anything ever seems to fill the bill. True, semaglutide has arrived with real questions trailing like bunting: Much of the weight loss is from lean muscle mass, which isn’t ideal, and there are reasons to worry over the possibility of thyroid problems, loss of bone density and sarcopenia, a weakness disorder associated with aging. There are potentially other serious long-term side effects, though millions of Americans have been taking Ozempic for Type 2 diabetes for years without serious issues. (Some of them do report more familiar side effects, like nausea.) The GLP-1 drugs aren’t a permanent fix in a single shot — whether the thing being addressed is body mass index or cardiac risk or the progression of Alzheimer’s — but a permanent disease-management program. They also haven’t exactly cured cancer, although more than a dozen cancers are linked to obesity, and in at least one case, colorectal cancer, there is reason to believe GLP-1 drugs may directly cut the chances of developing the disease.All that means that semaglutide isn’t exactly a cure-all, in the vernacular sense. But it seems to be about as close as we’ve gotten, even in a time of racing biomedical progress, to that old science-fiction proposition — one pill for almost everything and almost everyone forever.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

    • 163 Shares195 Views

      in Elections

      Millions of Girls in Africa Will Miss HPV Shots After Merck Production Problem

      by

      The company has told countries that it can supply only 18.8 million of the 29.6 million doses it was contracted to deliver this year.Nearly 1.5 million teenage girls in some of the world’s poorest countries will miss the chance to be protected from cervical cancer because the drugmaker Merck has said it will not be able to deliver millions of promised doses of the HPV vaccine this year.Merck has notified Gavi, the international organization that helps low- and middle-income countries deliver lifesaving immunizations, and UNICEF, which procures the vaccines, that it will deliver only 18.8 million of the 29.6 million doses it was contracted to deliver in 2024, Gavi said.That means that more than 10 million girls will not receive their expected HPV shots this year — and 1.5 million of them most likely will never get them because they will be too old to qualify for the vaccine in subsequent years.Patrick Ryan, a spokesman for Merck, said the company “experienced a manufacturing disruption” that required it to hold and reinspect many doses by hand. He declined to give further details about the cause of the delay.“We are acting with urgency and rigor to deploy additional personnel and resources to resolve this matter as soon as possible,” he said.Mr. Ryan said that Merck would deliver the delayed doses in 2025. He also said the company would ship 30 million doses of the vaccine to Gavi-supported countries this year. However, about a third of these are doses that were supposed to have been sent in 2023, leaving Gavi with the 10.7 million dose shortfall.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

    • 113 Shares199 Views

      in Elections

      Large Scientific Review Confirms the Benefits of Physical Touch

      by

      Premature babies especially benefited from skin-to-skin contact, and women tended to respond more strongly than men did.A hug, a handshake, a therapeutic massage. A newborn lying on a mother’s bare chest.Physical touch can buoy well-being and lessen pain, depression and anxiety, according to a large new analysis of published research released on Monday in the journal Nature Human Behaviour.Researchers from Germany and the Netherlands systematically reviewed years of research on touch, strokes, hugs and rubs. They also combined data from 137 studies, which included nearly 13,000 adults, children and infants. Each study compared individuals who had been physically touched in some way over the course of an experiment — or had touched an object like a fuzzy stuffed toy — to similar individuals who had not.For example, one study showed that daily 20-minute gentle massages for six weeks in older people with dementia decreased aggressiveness and reduced the levels of a stress marker in the blood. Another found that massages boosted the mood of breast cancer patients. One study even showed that healthy young adults who caressed a robotic baby seal were happier, and felt less pain from a mild heat stimulus, than those who read an article about an astronomer.Positive effects were particularly noticeable in premature babies, who “massively improve” with skin-to-skin contact, said Frédéric Michon, a researcher at the Netherlands Institute for Neuroscience and one of the study’s authors.“There have been a lot of claims that touch is good, touch is healthy, touch is something that we all need,” said Rebecca Boehme, a neuroscientist at Linkoping University in Sweden, who reviewed the study for the journal. “But actually, nobody had looked at it from this broad, bird’s eye perspective.”The analysis revealed some interesting and sometimes mysterious patterns. Among adults, sick people showed greater mental health benefits from touch than healthy people did. Who was doing the touching — a familiar person or a health care worker — didn’t matter. But the source of the touch did matter to newborns.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

    • 125 Shares119 Views

      in Elections

      New England Journal of Medicine Ignored Nazi Atrocities, Historians Find

      by

      The New England Journal of Medicine published an article condemning its own record during World War II.A new article in the New England Journal of Medicine, one of the oldest and most esteemed publications for medical research, criticizes the journal for paying only “superficial and idiosyncratic attention” to the atrocities perpetrated in the name of medical science by the Nazis.The journal was “an outlier in its sporadic coverage of the rise of Nazi Germany,” wrote the article’s authors, Allan Brandt and Joelle Abi-Rached, both medical historians at Harvard. Often, the journal simply ignored the Nazis’ medical depredations, such as the horrific experiments conducted on twins at Auschwitz, which were based largely on Adolf Hitler’s spurious “racial science.”In contrast, two other leading science journals — Science and the Journal of the American Medical Association — covered the Nazis’ discriminatory policies throughout Hitler’s tenure, the historians noted. The New England journal did not publish an article “explicitly damning” the Nazis’ medical atrocities until 1949, four years after World War II ended.The new article, published in this week’s issue of the journal, is part of a series started last year to address racism and other forms of prejudice in the medical establishment. Another recent article described the journal’s enthusiastic coverage of eugenics throughout the 1930s and ’40s.“Learning from our past mistakes can help us going forward,” said the journal’s editor, Dr. Eric Rubin, an infectious disease expert at Harvard. “What can we do to ensure that we don’t fall into the same sorts of objectionable ideas in the future?”In the publication’s archives, Dr. Abi-Rached discovered a paper endorsing Nazi medical practices: “Recent changes in German health insurance under the Hitler government,” a 1935 treatise written by Michael Davis, an influential figure in health care, and Gertrud Kroeger, a nurse from Germany. The article praised the Nazis’ emphasis on public health, which was infused with dubious ideas about Germans’ innate superiority.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

    • 88 Shares129 Views

      in Elections

      Insurance Companies and the Prior Authorization Maze

      by

      More from our inbox:Elect the U.S. Attorney GeneralFriendship MemoriesA Leadership GapInsurance companies have weaponized a seemingly benign process to protect their profits, and it’s putting patients at risk.To the Editor:Re “‘What’s My Life Worth?’ The Big Business of Denying Medical Care,” by Alexander Stockton (Opinion video, March 14), about prior authorization:Mr. Stockton’s video captures a current snapshot of an important truth about medical insurance in our country and in doing so does a service to all citizens by making them aware of this threat to themselves and their families.The immediate truth is that medical insurance companies are inadequately regulated, monitored and punished for their greed. In their current iteration they are bastions of greed, power and money. They need to be reined in.But there are other truths as well. Some physicians, just like some pharmaceutical companies, are unable to contain their greed and allow avarice to cloud their judgment, compromise their ethics and in some cases cross the line to Medicare fraud or other illegal activity.Medical care in our country is very big business involving billions of dollars. Without proper controls, regulation and monitoring, malfeasance follows. The challenge in such a complex and multifaceted context is how to implement such controls and monitoring without making things worse.Ross A. AbramsJerusalemThe writer, a retired radiation oncologist, is professor emeritus at Rush University Medical Center in Chicago.To the Editor:The Times’s video exploits tragic outcomes and does not mention basic important facts about the limited yet key role of prior authorization in ensuring that patients receive evidence-based, affordable care.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

    • 138 Shares189 Views

      in Elections

      Gang Violence Pushes Haiti’s Health System to the Brink of Collapse

      by

      Many hospitals in Haiti’s capital have been looted by gangs or abandoned by their staffs amid the violence. Some are open, but too dangerous for people in need of care to reach.Taïna Cenatus, a 29-year-old culinary student in Haiti, lost her balance at school one day this month and toppled over, but it was not until she hit the ground that she realized she had been hit in the face by a stray bullet.It left a small hole in her cheek, just missing her jawbone and teeth.Unlike many Haitians wounded by gunfire in the middle of a vicious gang takeover of the capital, Port-au-Prince, Ms. Cenatus was actually lucky that day — she made it to a clinic. But she is still in pain, her wound swelling, and she cannot get any relief, with more and more hospitals and clinics abandoned by staff or looted by gangs.“My teeth hurt,” she said. “I can feel something is wrong.”A gang assault on Haiti’s capital has left an already weak health care system in tatters.More than half of the medical facilities in Port-au-Prince and a large rural region called Artibonite are closed or not operating at full capacity, experts said, because they are too dangerous to reach or their medicine and other supplies have been stolen.In a country where the United Nations estimates that up to one million people are facing the threat of famine, the unraveling of the medical infrastructure threatens to put thousands more lives at risk.Even in periods of less upheaval, the public health system was already in shambles, but now hospitals run by humanitarian groups and churches that many Haitians depend on are closing one by one.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More