Dood you can't blame MJ on Trump, get with the sub
Obama did shit for the opioid crisis too.
Yea, he did shit. . . like getting millions of addicts healthcare so they can obtain treatment, and requiring that mental ailments be treated the same as physical ailments by insurance companies so they couldn’t be denied for treatment.
Go read about what it was like for an addict trying to find treatment before Obamacare. I dare you.
Look at the number of people who died of overdose during his presidency. Whatever he did was not nearly enough.
Maybe it's not directly on topic but I decided to check foxnews to see if they really are that biased.
They framed their article in such a way it blamed the democrats...
I'm not sure why this is legal in the states?
Both sides bear some responsibility here. No matter how much the Democrats try to avoid taking any blame, an appropriations bill like this needs 60 votes. Dems didn’t support it. Now you can debate whether they were justified in not supporting it. But by not supporting it they contributed to the shutdown.
Wouldn't it make sense to target well known oncogenes like BRCA1/2, where point mutations can lead to cancer?
But how would you go about doing that?
Would you screen for women with the mutations, and then give the Crispr prophylactically? I doubt that would work well (remember most gene therapies actually only modify a small portion of the cells in a tissue), let alone be cost effective.
If you wait until they develop a tumor, targeting BRCA won't do much, and again, you run into the problem of needing to modify the genomes of all the cells in the tumor, which just isn't feasible, unfortunately.
Would you screen for women with the mutations, and then give the Crispr prophylactically?
Well, I'm not a PhD, but it seems to me it's either that or germ line editing to prevent inheritance by the kids. Even if you are only able to get CRISPR into 10% of the BRCA expressing cells, you've helped to ensure that those cells aren't the ones that will develop into cancer. I would imagine that there's a lot of research being done into making sure that CRISPR can modify a much larger percentage of cells than it can right now.
Ah. At the germline level, you could definitely do that. Although, it is still probably easier and cheaper to just select an embryo that doesn't have a BRCA mutation (assuming the woman is heterozygous for the allele).
Yes, by promoting their alternative medicine services, they do weaken the credibility of the hospital among scientific literate folks, skeptics, etc. And, if they go one step further and promote their services as cures or something not evidenced based - I think they would have committed false advertising and should be sued.
However, I do get that when a hospital opens up a service, it needs to promote them to make them commercially viable and hence the advertisements. I am personally uncomfortable with this but I know my patients would benefit from this - they will seek licensed practitioners, they don't need to travel to multiple places, I have a better relationship with them, they are more likely to stick with treatments that actually work, they are more likely to stick to follow up clinic visits and treatments.
In the practice of medicine, it is also important to realize that conservative measures play a very important role in the treatment of our patients - especially in conditions like chronic pain. As far as possible, we try to avoid prescribing treatments or doing surgery for our patients. Each intervention comes with its own risks. A lot of diseases such as chronic pain has a functional overlay which could either be overcome by actual medications or it could be treated conservatively. By keeping a patient on conservative treatments longer, you can avoid the risks of prescribing certain medications - especially if they have certain co-morbids that predispose them to complications.
Furthermore, it is not true that the hospital only allow evidence-based activities. We allow religious leaders to come in to pray or perform rituals for patients - based on their beliefs - not because we think it helps. But we do it because we care for our patients even if it may seem like the hospital promotes religious healing
I think for most of us, it is really easy to see that this is a step backward for the fight in squashing quackery, in our fight to educate our public against ridiculous practices like "raw water" in the name of health.
But its harder for most people to see and quantify the benefits to our patients when something like this is implemented. Healthcare, and our patients are incredibly complicated with multiple competing interests. So its important to take a big picture approach, its important to identify what your main role as a health provider is.
Is it to educate your patients and protect them from swindlers and snake oil salesmen? Or is it to ensure our patient's conditions are managed well, and they get the best available treatment?
During my pre-clinical years as a medical student/researcher, I used to think both aims were inseparable, but the reality of practice is that, in this day and age, you can't have your cake and eat it.
This trend is disturbing, but in this current environment, this might be the lesser of two evils
Appreciate your thoughts, but I doubt we will agree on this. For me the line is crossed once the hospital starts marketing and charging for alternative therapies.
You mention the example of religious leaders - I would be equally appalled if hospitals were to start trying to differentiate themselves on the basis of their religious leaders or were charging per prayer.
Frankly, in my mind, the way forward for alternative medicines has to be the same path as other medicines - there needs to be evidence that it works (and in some cases there is). Until that is demonstrated, though, I find it unethical for hospitals to engage in the practices described in the article.
Yup I don't think we will agree especially if you haven't had the opportunity to manage the patients in this environment. I used to have the same hardline stance and have been one of the most outspoken voices in medical school against such practices. But the moment you're responsible for someone's life, these things take a backseat. These unethical injustices will always be secondary when it comes to somebody's life.
An alluring trap that people fall into, though, is thinking that things that make patients happier make them better.
Need evidence to support broad uptake of hospital-sponsored alternative therapies beyond it makes patients happier/less likely to seek out incrementally sketchier alternative therapies. Not making them worse is a poor justification for taking their money.
Luckily, these types of questions are testable. I wish hospitals had been more data-driven in their approach. Now, I suspect, we will have to wait a few years and try to scratch an interpretation out of retrospective cohorts for assessing how the availability of hospital-sponsored alternative therapies impacted outcomes.
I think the article's author has missed the point: The patients who want to try the experimental drugs are terminal!! They are going to be dead within six months no matter what drugs or therapies they use. Even if we all agree that experimental treatments don't work, at least the patient and family feel they're doing something constructive.
When doctor-assisted suicide is prohibited in most states and self-administered suicide produces uncertain results, patients are understandably reluctant to lie back and let "nature" take over. Nature is notoriously cruel, especially to those relying on public assistance. Plus, pain control depends far too often on the whims and religious beliefs of medical administrators and hospice care providers' schedules.
When your "days dwindle down to a precious few", patient autonomy can be as essential as air. Or does "terminal" not mean what it used to?
Even if we all agree that experimental treatments don't work, at least the patient and family feel they're doing something constructive.
I disagree with this sentiment as a means for justifying a right-to-try. If nothing else, it is burdening the patient with additional drug-related toxicities. Not to mention the financial costs and time costs.
That said, I think patients should have a right-to-try (provided the law is well crafted and protects patients, drug manufacturers and doctors). And that is because sometimes the drugs do work. I was speaking recently with someone who got a Parp-inhibitor for compassionate use in their BRCAmut+ prostate cancer. The drug really helped.
I would much rather terminal patients - with appropriate guidance and protection - pursue these types of avenues than waste money and time on alternative medicines. And that's what does happen if they can't access promising, but not yet properly evaluated drugs.
Something along the lines of:
Eternal peace to Cecilia Gaetani dell'Aquila d'Aragona, daughter of Nicolo' dell'Aquila d'Aragona, duke of Laurenzana, and of Aurora Sanseverino del Principe di Bisignano, perfect wife of the duke of Torremaggiore di Sangro, who shined for her habits, elegance, intelligence, piousness, religiosity and faith, so much to be equal to the most noble and virtuous women of all time. She lived 20 years and died on Jan 7th 1711. Her son, Raimondo di Sangro, so that her merits would be even more noble, with a heart full of gratitude and love arranged for this monument and the construction of the tomb for his uncomparable mother in the year of our Lord 1752
Thanks! I knew reddit would deliver.
I always found the Jesus one a bit funny. They all believe Jesus will be comming back some day but if a man who embraced the poor, fed the hungry, denounced wealth, was middle eastern and claimed to be god showed up, they would try to have him deported.
The miracle thing might grab their attention.
What is the normal ratio?
It should always be approximately 1:1, its called "Fisher's principle".
Basically if there are more males than females that means females on average or more likely to pass on their genes than males. Therefore genes that predispose people to having female children are more likely to be passed on. This will happen until the sex ratio reaches 1:1.
It's hard to say what the "normal" ratio is. But in areas where climate change have not been as impactful on the local ecology, the ratio of females:males is ~2:1.
If you want to make this a bit more readable:
What the authors show is that there is a neuronal gene, Arc,
which that forms virus like virus-like capsids. In the body, endogenous Arc protein forms capsules which that contain mRNA, and these capsules are transferred to nearby neurons. This mRNA actually gets turned into protein in the receiving cells.
We know that dysfunction in the production of Arc protein has been implicated
as an important factor in understanding of in various neurological conditions, including amnesia, Alzheimer's disease, autism spectrum disorders, and Fragile X syndrome. Is this related to the RNA-transferring activity of the protein?
What is the point of transferring mRNA this way? Presumably the receiving cells have the same genome and could make the mRNA themselves. And protein-based transduction signals are far better characterized methods for cell-cell signaling. Is there anything special about transferring information this way?
What about other organ systems? Are there similar examples of this type of cell-cell communication? The
closes closest I could think of was the example of mutant EGFRvIII protein, which can form membrane-based blebs and trasfer from one cancerous cell to nearby cells, and inform oncogenic signaling. But this mostly happens in the brain too (glioblastoma).
Explanation: "which" gives extra information about something that's already specified. "that" is restrictive-- it specifies one thing out of a group. Semicolons (;) join independent clauses. You need an independent clause before a colon (:). Use a comma before BOAS (But Or And So) only if they join two independent clauses or form items in a list. Never put a comma after them.
P.S. thank you for the awesome summary.
Cheers - thanks for the copy-edits. I'll update my post if you don't mind :)
Reach goal: to one day understand when to use which vs. that.
Could this be used to improve the effectiveness of gene therapy?
That’s an interesting thought. A big challenge with gene therapy is pre-existing adaptive immunity against the AAV (and recently, we learned, the Cas9 protein of CRISPR).
Presumably humans are tolerized to Arc capsules, getting around this particular hurdle.
I’d want to know more about 1) how much DNA/RNA can be fit into an Arc capsule and 2) what are the mechanisms that determine which cells can internalize these capsules before I got too excited. It’s a neat thought, though!
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2017 was a pretty exciting year for gene therapy. Depending on how you count, the FDA approved 1-3 new gene therapy drugs.
The first two were Kymriah and Yescarta. I really consider these more cell therapies than gene therapies. The way they work is T-cells are extracted from a B-cell leukemia/lymphoma patient and then transfixed with gene that enables them to hunt down the cancerous B-cells (and healthy ones too). So there is an element of genetic engineering, but it occurs ex vivo.
Additionally, the FDA approved Luxturna, a gene therapy for a certain form of blindness. This gene therapy works by having virus’s encoding a functional RPE65 gene (this is the gene which is mutated in these patients) injected into the patient’s eye
Gene therapies we might see approved in the next few years: hemophilia A and B, multiple myeloma, a number of neurological conditions (ranging from Parkinson’s to Huntington’s to ALS), forms of deafness, and handful of liver disorders. That’s just off the top of my head.
Things to watch out for: how to pay for these therapies (the first three cost between 375k and 875k), long-term safety and how daring will researchers be in using gene therapy to come up with novel ideas for treating disease (expanding past the replace the broken gene model).
Interesting. Is there any particular reason for the high price? Most gene therapies don't strike me as particularly expensive to manufacture and apply. Is this perception wrong? Is it due to extremely high barrier of entry due to current regulations banning most of them/the fact they're in early trials?
Mostly a combination of small pools of treatable patients and high development costs. The money has to be recouped somehow or drugs for rare diseases will never be developed - this is actually a topic of debate in public health circles.
It's the same thing. It's just that Trumpism is making them take their 'grantsmanship' to another, stupid, level.
This isn't business as usual, or it would have happened decades ago. It's a new level of baloney.
What I would be curious to see is a CDC budget justification from Obama-years and compare it to the one that was submitted this year by CDC. I think that would help untangle some of the uncertainty about whether the agency was letting politics take precedence over science.
Awesome - thanks!
I wasn’t so much interested in the usage counts (if they didn’t go down, that would say a lot about the influence of CDC leadership), but rather a more qualitative assessment of how the change in language reflects (if at all) a CDC change in mission and approach to science. I’ll try to skim through some of the reports later.
To induce hyperlipidemia/ hypercholesterolemia female mice were fed a Western diet (Teklad 88137) consisting of 17.3% protein, 21.2% fat (saturated fat 12.8%, monounsaturated fat 5.6%, polyunsaturated fat 1%) and 48.5% carbohydrates.
Chow diet (Prolab Isopro RMH 30; LabDiet) consisted of 25% protein, 14% fat (ether extract) and 60% carbohydrates.
So actually, it looks like the "healthier" diet here is lighter in carbohydrates but higher in protein.
I think you read that wrong; the "chow diet" is 60% carbs, while the "Western diet" is 48.5% carbs. Carb percentage goes up.
The thing that goes down in the "chow diet" is fat: from 21% fat to 14%.
Right you are - I typed that wrong. Which is funny because I was actually surprised by the fact that the Western diet had fewer carbs than the control diet and had to re-read it a few times to be sure.
Good catch! I'll edit my post.
The scientists placed mice for a month on a so-called “Western diet”: high in fat, high in sugar, and low in fiber. The animals consequently developed a strong inflammatory response throughout the body, almost like after infection with dangerous bacteria.
wow - a whole month and they didn't bother to eliminate any aspect like sugar/carbs or fats to narrow down things to the real cause... good thorough job there science!
I don't know. I think it is pretty interesting that they are able to show that certain diets "prime" the immune system to respond more vigorously to stimulation than it should. Definitely suggests an interesting paradigm for thinking about diseases with an inflammatory component.
It would be interesting to do more research to tease out what molecules exactly are doing this. Especially if we could find ways to modulate the underlying biological process.
Except most on Medicaid do work but don't have insurance benefits or can't afford it. It is just feeding the 'we hate welfare' rhetoric that people just eat up.
No. Most people on who enrolled via Medicaid expansion do not work.
About 50% have some form of permanent disability; 30% have jobs or are in school; 10% are caring for loved ones; 5% are looking for jobs.
The proposed regulation would only really apply to the last 5%. There is valid concern, I think, about how the law would be written and enforced. But the narrative that Trump wants to make everyone on Medicaid get a job or get cut is incorrect.
I feel like the push for universal healthcare should be easier than it is. To convince more conservative Christians all we need to say is that we are moving towards the Jesus Christ model of health care. How much money did it cost Lazarus to be raised from the dead? For the blind to gain their sight? For the leppers to be cured? Nothing. Not a single coin was taken by Jesus. WWJD? He would heal the sick without any thought of cost.
EDIT: I feel like most people are missing the point. My comment shows that we can use hand picked bible verses to support many ideas. In this case it supports the fact the bible tells us to love each other as god has loved us. I am willing to give of my need/excess in order to provide aid to every citizen.
As a side note, I feel the deeper rooted cause of the healthcare debate is the cost of treatment. We have seen in the last year or so drug prices skyrocket uncontrollably for no other reason besides money and one CEO is in jail for that. This is just an offhand comment about how I personally view my ideas about government to being raised in the Catholic Church. Take it as you will.
The government is Jesus in this analogy. And that is the problem. The idea would be a lot more credible if we could trust the government to effectively run a large-scale program like this. I don't think we can, though.
Would you trust your healthare to a program run by President Trump or his political appointee? Or Mike Pence and his appointee? That's a pass from me.
Academic medical centers (AMCs) are widely perceived as providing the highest-quality medical care. To investigate disparities in access to such care, we studied the racial/ethnic and payer mixes at private AMCs of New York City (NYC) and Boston, two cities where these prestigious institutions play a dominant role in the health care system. We used individual-level inpatient discharge data for acute care hospitals to examine the degree of hospital racial/ethnic and insurance segregation in both cities using the Index of Dissimilarity, together with recent changes in patterns of care in NYC. In multivariable logistic regression analyses, black patients in NYC were two to three times less likely than whites, and uninsured patients approximately five times less likely than privately insured patients, to be discharged from AMCs. In Boston, minorities were overrepresented at AMCs relative to other hospitals. NYC hospitals were more segregated overall according to race/ethnicity and insurance than Boston hospitals, and insurance segregation became more pronounced in NYC after the Affordable Care Act. Although health reform improved access to insurance, access to AMCs remains limited for disadvantaged populations, which may undermine the quality of care available to these groups.