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All Reason.com articles with the "Medicine" tag.



Published: Tue, 22 Aug 2017 00:00:00 -0400

Last Build Date: Tue, 22 Aug 2017 03:30:01 -0400

 



On Health Care, Private Sector May Show Congress the Way

Mon, 14 Aug 2017 16:15:00 -0400

Just because Congress can't fix health care doesn't mean it can't be done. That's the message from the Health Transformation Alliance, 41 big American companies that have banded together to try to save money and lives on their own, without waiting for Congress to pass a new law. The Alliance's chief executive, Robert Andrews, himself a former Democratic congressman from New Jersey, had a recent New York Times op-ed reporting on three steps being taken by the companies, which spend about $25 billion a year on covering about 6 million employees and retirees. One is using "big data" analysis to find patterns on which providers are delivering the best results. Another involves negotiating better deals with the medicine middlemen known as pharmacy benefit managers. A third will be setting up new medical networks in Dallas/Ft. Worth, Phoenix, and Chicago to treat back pain and diabetes and to provide knee and hip replacements. Andrews writes that the drug reforms alone "are projected to save participating companies, their workers and, in some cases, retirees at least $600 million over three years—while achieving the same or better results." Which raises one big question that he doesn't get into in the Times op-ed: if these savings are such a great idea and so easily achievable, why isn't the federal government doing these things? After all, government spends more than $1 trillion a year on Medicare and Medicaid. State budgets pick up some of the Medicaid costs, in ways that are threatening to crowd out other expenditures; in Massachusetts, for example, MassHealth consumes 40 percent of the state budget. In New York, Medicaid is one third of the state budget. At the federal level, Medicare, the health care program for the elderly, is about 15 percent of the total federal budget, about the same as what gets spent on defense. True, Medicaid reimbursement rates to doctors are already rock-bottom compared to private insurance. Some states are trying to save more money on the program. In Rhode Island, for example, where about 30 percent of the state budget is devoted to Medicaid, Governor Gina Raimondo, a Democrat, says she saved $75 million on Medicaid in 2016 and $120 million in 2017 "by reducing waste and increasing program efficiency and effectiveness." Even so, the private sector's leadership here highlights some structural differences between government and business that may help explain why progress by Congress has been so slow by comparison. One big difference is that what the private sector hails as "savings," in the public sector gets demagogued as "cuts." This is a bipartisan problem. Republican presidential candidate Mitt Romney repeatedly attacked Barack Obama and ObamaCare for having supposedly having "cut Medicare for current Medicare recipients." Romney described ObamaCare as a "Medicare-cutting monster." When President Trump proposed reductions in the rate of growth of health care spending, Hillary Clinton denounced Republicans as "the death party." Another big difference is the influence of interest groups, and their effect on incentives. If a CEO wants to save shareholders money by wringing better value from health care vendors, he or she is likely to be thanked with a bonus for increasing profits. Or the CEO's stock options will be worth more. When a politician tries to save taxpayers money by doing the same thing, big and powerful campaign donors and constituents and potential future employers—drug companies, doctors, their lobbyists, hospital board members, health care worker unions, medical device manufacturers, nursing home proprietors—push back hard in the other direction. The politician may decide the potential savings aren't worth the aggravation. What does that mean for health care cost and quality? A system in which government is the only buyer is likely to be more expensive. A system in which companies or groups of individuals are buyers may have more success in controlling costs without sacrificing quality. At the very least, the Health Transformation Alliance, a relatively new effort, bears watc[...]



Will All Seriously Ill Americans Be Granted the ‘Right to Try’ Experimental Meds?

Fri, 04 Aug 2017 13:01:00 -0400

(image) A state-level movement to allow Americans who are seriously and potentially terminally ill to access medication earlier in the approval process may successfully be going national.

The U.S. Senate has approved—by unanimous consent—Senate Bill 204, sponsored by Sen. Ron Johnson (R-Wisconsin) and pushed by the libertarian Arizona-based Goldwater Institute. It mimics legislation in 37 states that allows for people with life-threatening illnesses earlier access to medication being evaluated through the very lengthy Food and Drug Administration (FDA) approval process.

To be clear, this "right to try" legislation does not create a free-for-all when it comes to access to experimental medicine. The bill requires that a person have a life-threatening illness or disease and that the drug in question has already completed the first phase of clinical trials for the FDA.

Furthermore it does not require drug manufacturers or dispensers to provide access if they don't want to, and they cannot be held liable if they refuse (and they can't be held liable if the drug causes harm except in cases of misconduct or negligence). And as a compromise for critics worried about the ethics of letting people access drugs early, drug manufactures who do provide medicine as part of this process will need to report to the government any adverse effects.

The bill now heads to the House of Representatives, where two Republican congressmen have already introduced companion legislation. In a release praising the passage of Johnson's bill, the Goldwater Institute notes how state-level right-to-try laws actually help:

Right to Try is saving lives already. In Texas alone, Dr. Ebrahim Delpassand has helped nearly 100 patients under his state law, providing a treatment that has completed clinical trials but is not yet fully approved for advanced stage neuroendocrine cancer. Many of these patients were told they had only months to live but are still alive a year later, thanks to Right to Try.

Reason has been covering the "Right to Try" movement for years now. Below, watch a ReasonTV explanation video from 2015 about the efforts:

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Tired of High Health Care Costs? Look at Misbehaving Dentists and the Licenses That Enable Them

Tue, 18 Jul 2017 00:01:00 -0400

With memories of a certain scene from Marathon Man fading, it's likely that most Americans have a pretty positive view of dentists. They keep our choppers in decent working order despite a wide range of neglect and abuse of the pearly whites. But there is a darker side of the profession, which has developed a reputation for playing hardball in protecting its licensed practitioners from potential competition. It's an object lesson in the dangers of occupational licensing—a demonstration that letting any industry coopt the coercive power of government does little to help consumers, while protecting the paychecks and prerogatives of the licensed few. "Lawmakers from Maine to Alaska see a different side of dentists and their lobby, the American Dental Association, describing a political force so unified, so relentless and so thoroughly woven into American communities that its clout rivals that of the gun lobby," the Washington Post reported earlier this month. You know reporters are troubled by bad behavior when they compare it to "the gun lobby"—culturally parochial modern journalists' equivalent of invoking the devil. But what they report is truly troubling. The Post adds, "Critics say the ADA has worked to scuttle competition that could improve access to dental care in underserved areas and make routine checkups and fillings more affordable." The article goes on to detail efforts by organized dentists to intimidate lawmakers who consider allowing competition by dental therapists—non-dentist practitioners who can offer basic dental care at lower cost than dentists. It also discusses battles waged by the Federal Trade Commission against state dental boards—regulatory bodies run, as is the case with most licensing bodies, by and for the benefit of existing practitioners in the industry they oversee. "The Federal Trade Commission today announced a consent order settling charges brought in September 2003 that the South Carolina State Board of Dentistry unlawfully restrained competition in violation of Section 5 of the FTC Act by adopting a rule that required a dentist to examine every child before a dental hygienist could provide preventive care—such as cleanings—in schools," the FTC announced in 2007. "Today, the Supreme Court affirmed the Federal Trade Commission's position in recognizing that a state may not give private market participants unsupervised authority to suppress competition even if they act through a formally designated 'state agency'," the FTC reported in 2015. Yes, the scare quotes around "state agency" are original to the FTC press release—perhaps an acknowledgment by a federal regulatory body of the regulatory capture of the state body by the people it regulates, and its operation on their behalf (whether there's an implied lesson in there about all regulatory bodies I leave to readers' imaginations). So it's clear that dental licensing bodies function to protect dentists from competition, to the point that they've even had their hands slapped by the U.S. Supreme Court for their behavior. Is there any counter-balancing benefit to be had from licensing dentists? Not really, was the conclusion of a study performed by Morris M. Kleiner and Robert T. Kudrle, of the University of Minnesota and published in 1997. They compared regulatory regimes across the United States, from highly restrictive to permissive, and concluded that "increased licensing restrictiveness did not improve dental health, but did raise the prices of basic dental services." There's a lesson in here about creeping regulation over time, since "a state that changed from a low level of restrictiveness to one that was in the most restrictive grouping could expect to see an increase in the price of dental services of 14 to 16 percent." Those raised prices resulted not just in less accessible care, but also in a roughly 10 percent income boost for dentists in more highly regulated states. That means dentists have a built-in incentive to seek tighter regulation, resulting in stiffe[...]



Brickbat: The Waiting Is the Hardest Part

Wed, 12 Jul 2017 04:00:00 -0400

(image) The United Kingdom's National Health Service reports that 20 percent of those trying to schedule an appointment with a general practitioner cannot get one within seven days and 11.3 percent cannot get an appointment at all. Meanwhile, 27.8 percent said they had difficulty just reaching a doctor's office on the phone.




Meet the Doctor Who Refuses to Stop Prescribing Opioids to Pain Patients: New at Reason

Fri, 07 Jul 2017 12:45:00 -0400

src="https://www.youtube.com/embed/cR0QJxt5sI4" allowfullscreen="allowfullscreen" width="560" height="340" frameborder="0"> Pain patients from across the country are flocking to a boundary-pushing pain specialist in West Covina, California because they can't get the treatment they need in their home states. A growing "opioid epidemic" in the U.S. has led law enforcement agencies to crack down on so-called pill mills, leading to the arrest of several physicians. Last year, the Drug Enforcement Agency (DEA) clamped down on painkillers, reducing the allowed production of opioid medications by about 25 percent. Some states have filed lawsuits against pharmaceutical manufacturers, and, earlier this year, the Center for Disease Control (CDC) issued guidelines advising physicians against prescribing high doses of these drugs, which can be particularly lethal when combined with alcohol or anti-anxiety medications. Many doctors will only prescribe opioids as a last resort. Dr. Forest Tennant, 76, says this regulatory backlash is preventing chronic pain sufferers from getting the drugs they need to alleviate their conditions, and he refuses to go along. Critics have denounced his unapologetic style and unorthodox methods, but his patients depict him as one of the only physicians in America to put the needs of his patients first. "[Tennant was] the first doctor to say, 'our goal is to relieve your pain,'" says Kristen Ogden, whose husband Louis Ogden has suffered from chronic pain for decades. They travel to Dr. Tennant's office from Virginia for treatment every three months. "Every other doctor had said, 'our goal is to get you off any opioid medications.'" Many physicians have even begun to adjust the way that they think about pain. In a New England Journal of Medicine article, one of the pain specialists advising the CDC recommended that pain patients "use coping and acceptance strategies that primarily reduce the suffering associated with pain and only secondarily reduce pain intensity." That opioids are never an effective chronic pain treatment is quickly becoming conventional wisdom, and the American Medical Association (AMA) has even begun to advise physicians to abandon the pain rating scale when assessing patients. "I take the Hippocratic oath seriously, that my job is to relieve pain and suffering," says Dr. Tennant. "So when I see the AMA decide that they're not going to assess pain, I'm not with them." Tennant has run a pain clinic since the 1970s when he mostly treated patients with pain resulting from cancer and polio. He's never shied away from the public spotlight. In addition to serving as mayor of his city, he ran some of Los Angeles County's earliest methadone clinics to treat heroin addicts and in the late '80s served as a drug adviser for the NFL, NASCAR, and the Los Angeles Dodgers. Controversy swirled around him in many of these roles. He angered the NFL when he publicly disclosed plans to monitor several New England Patriots players for drug use. One NASCAR racer even accused him of colluding to falsify drug tests to target him. Tennant simply told the New York Times that "[n]o mistakes were ever made." Tennant says it's true that opioids were overprescribed in the past and should generally be a last resort for pain treatment. But he believes the media and government have now gone too far in demonizing them, and it's legitimate pain patients who are paying the price. Produced by Zach Weissmueller. Music by Kai Engel and Blue Dot Sessions. Subscribe to our YouTube channel. Like us on Facebook. Follow us on Twitter. Subscribe to our podcast at iTunes.[...]



Meet the Doctor Who Refuses to Stop Prescribing Opioids to Pain Patients

Fri, 07 Jul 2017 12:30:00 -0400

Pain patients from across the country are flocking to a boundary-pushing pain specialist in West Covina, California because they can't get the treatment they need in their home states. A growing "opioid epidemic" in the U.S. has led law enforcement agencies to crack down on so-called pill mills, leading to the arrest of several physicians. Last year, the Drug Enforcement Agency (DEA) clamped down on painkillers, reducing the allowed production of opioid medications by about 25 percent. Some states have filed lawsuits against pharmaceutical manufacturers, and, earlier this year, the Center for Disease Control (CDC) issued guidelines advising physicians against prescribing high doses of these drugs, which can be particularly lethal when combined with alcohol or anti-anxiety medications. Many doctors will only prescribe opioids as a last resort. Dr. Forest Tennant, 76, says this regulatory backlash is preventing chronic pain sufferers from getting the drugs they need to alleviate their conditions, and he refuses to go along. Critics have denounced his unapologetic style and unorthodox methods, but his patients depict him as one of the only physicians in America to put the needs of his patients first. "[Tennant was] the first doctor to say, 'our goal is to relieve your pain,'" says Kristen Ogden, whose husband Louis Ogden has suffered from chronic pain for decades. They travel to Dr. Tennant's office from Virginia for treatment every three months. "Every other doctor had said, 'our goal is to get you off any opioid medications.'" Many physicians have even begun to adjust the way that they think about pain. In a New England Journal of Medicine article, one of the pain specialists advising the CDC recommended that pain patients "use coping and acceptance strategies that primarily reduce the suffering associated with pain and only secondarily reduce pain intensity." That opioids are never an effective chronic pain treatment is quickly becoming conventional wisdom, and the American Medical Association (AMA) has even begun to advise physicians to abandon the pain rating scale when assessing patients. "I take the Hippocratic oath seriously, that my job is to relieve pain and suffering," says Dr. Tennant. "So when I see the AMA decide that they're not going to assess pain, I'm not with them." Tennant has run a pain clinic since the 1970s when he mostly treated patients with pain resulting from cancer and polio. He's never shied away from the public spotlight. In addition to serving as mayor of his city, he ran some of Los Angeles County's earliest methadone clinics to treat heroin addicts and in the late '80s served as a drug adviser for the NFL, NASCAR, and the Los Angeles Dodgers. Controversy swirled around him in many of these roles. He angered the NFL when he publicly disclosed plans to monitor several New England Patriots players for drug use. One NASCAR racer even accused him of colluding to falsify drug tests to target him. Tennant simply told the New York Times that "[n]o mistakes were ever made." Tennant says it's true that opioids were overprescribed in the past and should generally be a last resort for pain treatment. But he believes the media and government have now gone too far in demonizing them, and it's legitimate pain patients who are paying the price. Produced by Zach Weissmueller. Music by Kai Engel and Blue Dot Sessions. Subscribe to our YouTube channel. Like us on Facebook. Follow us on Twitter. Subscribe to our podcast at iTunes.[...]



Charlie Gard’s Case Shows Why Government Should Stay Out of End-of-Life Choices

Mon, 03 Jul 2017 14:30:00 -0400

In California, the government is documenting what happens when citizens can turn to medicine to end their own lives. In the United Kingdom, the government is forcing parents' hands in the case of an infant with a life-ending medical condition. Two news stories about the government's role in end-of-life issues highlight the potential slippery slope where a recognition of individual liberty transforms into a manifestation of official authority and control. California lawmakers passed right-to-die legislation in 2015. It permits doctors to prescribe life-ending medication to adults with terminal illnesses and likely less than six months to live. Now that the law is in place, the state is keeping track of who actually decides to end their own lives this way. Its first report, covering June to December of 2016, determined that 111 people committed assisted suicide in this fashion. The vast majority were over the age of 60 and receiving hospice care. In the United Kingdom, the government is deciding for itself when to pull the plug in a case sparking international news coverage and horrified responses. Charlie Gard, an infant with a serious and rare genetic condition and significant brain damage, is terminally ill. His parents would like to pursue an experimental treatment in the United States. Doctors, granted authority by the British government and their socialized medical system, have told them no. They are ordering that Gard's life support be shut down. The parents turned to the European Court of Human Rights for support and were rebuffed. Note that this is not a matter where the British government is being asked to bankroll Gard's experimental treatment. The parents themselves have raised the money to bring him to the United States. Rather, doctors and the British government are overruling the parents and deciding that they have the authority to an end the child's life and what they believe to be the child's suffering. While it seems unlikely that the treatment in the United States would change Gard's tragic fate, this case should nevertheless be seen as a dangerous assertion of authority disguised as mercy. For libertarians or anybody who supports an individual's right to end his or her own suffering, what's happening in the United Kingdom is an important and useful reminder of why some conservatives are wary about allowing this right. There is a slippery slope here: An individual's right to decide can transform into a government's insistence on making that call for those who aren't in a position to assert themselves. Western governments use their authority to override parents' decision-making in many areas, from schooling to vaccinations. But what's supposed to be a mechanism to shield children (who have little agency) from parental abuse becomes a method for paternalistic intervention. After all, what Gard's parents are doing is essentially the opposite of what should trigger government intervention. They are not abusing the child. They are doing what parents are supposed to do: everything they can to save him. And they should have the liberty to do so. It should not be difficult to avoid the slippery slope that transforms voluntary euthanasia into government-sanctioned termination. It's a matter of respecting the choice of the individual or those who are responsible for making those choices. Government intervention should be limited to situations where it can be shown that the private responsible parties are abusing or neglecting the patient, or where there are no private responsible parties. One other issue worth examining in the Gard case: The authorities have been quick to dismiss this experimental treatment because it probably won't work. They are probably right. But that's not where medicine and science ends. The development of treatment for an illness is an iterative process that includes many, many failures along the way to success. The fight between[...]



The GOP Health-Care Reform Plans Are Worse Than Useless: Nick Gillespie on Kennedy

Fri, 30 Jun 2017 14:05:00 -0400

(image)

I was on Fox Business' Kennedy to talk about the Senate Republicans' now-on-hold plans to reform Obamacare. The eponymous host started out by talking about an excellent letter from Sen. Rand Paul outlining the Kentucky Republican's opposition to his own colleagues' plan. Among other things, Paul objected to the plan's refundable tax credits, which he convincingly argues create a new entitlement. What is wrong with politicians that they will do anything but talk seriously about bring market forces and price signals into health care?

Watch above for our discussion. And click below to learn why the reforms being pushed by House and Senate Republicans represent not just a failure of nerve but a failure of vision about how best to actually "repeal and replace" Obamacare. The GOP currently runs the House, the Senate, and the White House. If they're not up to the task of creating a system that increases the quantity and quality of health care now, they never will be.

src="https://www.youtube.com/embed/SvuayBHV7Js" allowfullscreen="allowfullscreen" width="560" height="340" frameborder="0">

Read Reason's coverage of health-care reform here.




Scott Gottlieb Confirmed as New FDA Commissioner

Tue, 09 May 2017 18:05:00 -0400

(image) Physician, venture investor, and drug industry consultant Scott Gottlieb has been confirmed by the Senate as the new Commissioner of the Food and Drug Administration. Gottlieb takes the helm of the agency that regulates products accounting for about 20 cents of every dollar of annual spending by U.S. consumers, that is, about $2.4 trillion in annual consumption that includes medical products, food and tobacco. The agency regulates medicines, diagnostic tests, medical devices, food safety including those made from modern biotech crops and livestock, food labeling, and tobacco and nicotine products. What the agency's bureaucrats decide has signifcant impact on U.S. economic growth and the livelihoods of Americans.

Gottlieb has long been a critic of the FDA's slow and protracted drug and medical device approval processes. Researchers at the Tufts University Center for the Study of Drug Development have estimated that in 1991 it cost $412 million (2013 dollars) to develop and obtain approval for a new pharmaceutical. Last year, they calculated that it now takes more than $2.5 billion, a six-fold increase.

In an email, Union of Concerned Scientists spokesperson Seth Michaels warned that Gottlieb's confirmation is "yet another example of an appointee whose record raises questions about whether they'll respect science and the public interest." On the other hand, Paul Howard, Senior Fellow and Director, Health Policy at the market-friendly Manhattan Institute issued a statement applauding the appointment. "At a time of both unprecedented scientific opportunity and rapidly evolving public health challenges, Dr. Gottlieb provides the FDA with principled and pragmatic leadership," declared Howard. "His experience as a regulator, practicing physician, cancer survivor, and innovator will help the agency navigate the scientific challenges surrounding drug and medical device development and approval without losing sight of the real-world implications of the agency's decisions for patients struggling with potentially life threatening conditions."

I earlier noted, "While not a radical reformer, Gottlieb clearly has a good understanding of how over-regulation has been slowing down innovation in medicines and foods." Good luck to him as he tries to reform the agency's excessively cautious regulatory culture.




CRISPR and the Dawn of the New Biotech Revolution

Wed, 03 May 2017 12:15:00 -0400

(image) CRISPR genome editing will transform biotechnology and our lives in the next decade making possible (and cheap*) all kinds of new cures, new crops, new livestock, new industrial processes, and new ways to manage the environmental commons. Just two years ago, Science hailed CRISPR as the scientific breakthrough of 2015 noting, "It's only slightly hyperbolic to say that if scientists can dream of a genetic manipulation, CRISPR can now make it happen." Researchers have tweaked CRISPR so that it can find and cut and, if desired, replace essentially any DNA sequence in an organism's set of genes, including those in human beings.

With regard to new cures, researchers at the Lewis Katz School of Medicine at Temple University and the University of Pittsburgh have just published results in which they used CRISPR to almost entirely eliminate HIV, the virus that causes AIDS, from living experimental animals. Basically, the researchers targeted segments of HIV genes using CRISPR loaded into a viral delivery system that inactivated the HIV genes. Temple University researcher Kamel Khalili said, "Our eventual goal is a clinical trial in human patients."

(image)

Another group of researchers announced last week that they are developing a pill that would use CRISPR to target specific microbial pathogens. The idea is that a CRISPR antibiotic pill would instruct harmful bacteria to shred their own genes to bits. The researchers have engineered CRISPR to contain bits of genomic DNA of Clostridium difficile into bacteria-killing viruses called bacteriophages. The next step is to package the engineered phages into Lactobacillus bacteria. Found in yogurt, Lactobacillus would survive passage through the human digestive tract while shedding CRISPR phages that infect and then destroy the targeted pathogens. Unlike current antibiotics, CRISPR pills would kill only the targeted pathogens, leaving benign microorganisms alone.

*Cheap, if the Food and Drug Administration regulators don't stand in the way. The initial signs are not good.




Should You Be Compensated for Your Medical Waste?

Fri, 21 Apr 2017 16:00:00 -0400

The right answer is: No. Why bring this issue up? HBO will be showing a movie based on the 2010 bestseller The Immortal Life of Henrietta Lacks tomorrow starring Oprah Winfrey. In 1951, black Baltimorean Henrietta Lacks had surgery to remove a cervical cancer tumor. Her physician took some cells from the tumor which he turned into the first immortal line human cell line. The HeLa cell line has been subsequently used in thousands of biomedical research projects. Lacks died later that year of her cancer, and her family was not told about the HeLa cell line. One of the central themes of the book was whether or not Lacks' physician should have asked for consent and provided compensation for the use of her cells. Spurred by the controversy engendered by the book, the U.S. Department of Health and Human Services proposed revisions to the Common Rule that protects people who volunteer for federally funded research studies. The proposed revisions would have substantially increased the burden on researchers with regard to obtaining consent from patients for the subsequent use of their medical wastes, uh, biospecimens. I am happy to report that in their op/ed, "Science Needs Your Cells," in today's New York Times two bioethicists agree with me that such requirements are largely useless and would substantially slow down medical progress. From the op/ed: First, no one is taking biospecimens from patients' bodies without their permission. Patients have consented to the clinical procedure as important to their medical care. What harm could come from using leftover materials, which would otherwise be thrown away, for research? Perhaps we should be concerned about risks to a patient's privacy, but that is why we remove the identifying information. Although researchers have shown that it is possible to "de-anonymize" specimens — using clues to link them back to individuals — there have been no reports of anyone doing this for nefarious reasons. And even if there were, the answer would be to sanction the culprit through fines or criminal charges, not to make it harder for researchers to get these samples in the first place. What is left, then, is our claim to autonomy: Many of us intuitively feel we should be able to control how biospecimens derived from our bodies are used. But leftover biospecimens are just medical waste to most of us, as we lack the expertise to imbue them with scientific value. Nor have we done anything to make them valuable, other than being born with a particular genetic variant or afflicted with a particular malignancy. This is why calls to pay patients are misplaced. In addition, unlike HeLa, in which one patient's biospecimens led to dramatic advancements, most developments come from studying materials from many patients — each biospecimen contributes only marginally to the result. These relatively weak claims to control and compensation do not justify the demands more restrictions would place on biospecimen research. Hindering this research is worrisome because its benefits are so great. Among many examples, they include the identification of mutations in tumors (lung, skin and others) that can be targeted with drugs that markedly improve quality of life and survival. Requiring consent might not seem like a big deal. But it is. Consent might require tracking patients down later, whenever a study is proposed, which can be difficult or impossible. Alternately, it might involve asking patients to agree generally to any future research at the time blood is drawn or a biopsy is taken. Either way, it can be a costly, bureaucratic headache. Which patients said yes, which said no, and to what, exactly? They are correct. And the good news is that most the proposed consent revisions to the Common Rule have been dropped. With regard to compensati[...]



Is the Cure for Aging Just Around the Corner?

Fri, 31 Mar 2017 13:30:00 -0400

"In this world nothing can be said to be certain, except death and taxes," quipped Benjamin Franklin. For now both remain inevitable, but two exciting new studies suggest that the grim reaper might be put off by novel treatments that can slow and even reverse aging. Peter de Keizer, a molecular geneticist at Erasmus University, reports in the journal Cell that he and his colleagues have developed a technique that kills off senescent cells. Our bodies have two ways of preventing damaged cells from becoming cancerous: kill them off, or cause them to cease replication and thus become senescent. Senescent cells accumulate as we grow older, secreting inflammatory substances that harm neighboring cells and contribute to many age-related diseases, including atherosclerorsis and diabetes. De Keizer and his colleagues have developed a treatment in mice that selectively kills senescent cells while leaving healthy normal cells alone. They discovered that old or damaged cells become senescent rather than die when the FOXO4 protein binds to the tumor suppressor gene p53. They have designed another protein that interferes with the ability of FOXO4 to halt p53 from causing cells to die. De Keizer's team administered the new protein to both fast-aging and normally aged mice. The treatment worked as they had hoped, jumpstarting the ability of p53 to make senescent cells commit suicide. Eliminating senescent cells restored stamina, fur density, and kidney function in both strains of mice. The researchers report that they are continuing to study the rodents to see if the treatment extends their lifespans. They plan to try the treatment to stop brain cancer in human beings, but the ultimate goal is to treat aging as a disease. "Maybe when you get to 65 you'll go every five years for your anti-senescence shot in the clinic. You'll go for your rejuvenation shot," de Keizer told the Tech Times. In the same week, another group of Harvard researchers led by molecular biologist David Sinclair reported in Science about experiments in mice that thwart DNA damage associated with aging and exposure to radiation. As we age, our cells lose their ability to repair the damage to the DNA that makes up our genes. The repair process is orchestrated by the SIRT1 and PARP1 proteins. Both proteins consume the ubiquitous coenzyme nicotinamide adenine dinucleotide (NAD) to operate. As we grow older, the amount of NAD in our cells declines, thus allowing another protein, DBC1, to inhibit the DNA repair activity of both SIRT1 and PARP1. In their new research, the scientists fed the NAD precursor nicotinamide mononucleotide (NMN) to mice that were equivalent in age to an 80-year-old person. They also gave it to mice whose DNA had been damaged by radiation. The compound boosted NAD back to youthful levels and restored their ability to repair the DNA damage in both the old and irradiated cells. Sinclair said, "The cells of the old mice were indistinguishable from the young mice, after just one week of treatment." In addition, dosing astronauts traveling to Mars with NMN could counteract the damage that radiation in deep space would cause them. In an earlier experiment by Sinclair and his associates, the muscles of two-year-old mice fed NMN resembled those of six-month-old mice with respect to insulin resistance, inflammation, muscle wasting, and other important markers. Sinclair says that his group plans to launch human NMN trials in the next six months. Other groups have already started and completed safety trials of other NAD precursors in human beings. Leonard Guarente, director of the Massachusetts Institute of Technology's Glenn Laboratory for the Science of Aging, reported the results in December of a clinical trial involving 120 people who took the NAD precursor ni[...]



Rejuvenation By Killing Off Senescent Cells and by Boosting DNA Repair: New at Reason

Fri, 31 Mar 2017 13:30:00 -0400

(image) "In this world nothing can be said to be certain, except death and taxes," quipped Benjamin Franklin. For now both remain inevitable, but two exciting new studies suggest that the grim reaper might be put off by novel treatments that can slow and even reverse aging.

Senescent cells accumulate as we grow older, secreting inflammatory substances that harm neighboring cells and contribute to many age-related diseases, including atherosclerorsis and diabetes. Researchers associated with Erasmus University report that they have developed a compound that selectively kills off senescent cells while leaving healthy ones alone. Eliminating senescent cells restored stamina, fur density, and kidney function in aged mice. The researchers report that they are continuing to study the rodents to see if the treatment extends their lifespans. "Maybe when you get to 65 you'll go every five years for your anti-senescence shot in the clinic. You'll go for your rejuvenation shot," speculated one researcher.

As we age, our cells lose their ability to repair the damage to the DNA that makes up our genes. Another team of researchers associated with Harvard University are reporting experiments that increase levels of a compound that restores DNA repair activity back to youthful levels.




Can the Free Market Fix Health Care? Listen to Michael Cannon vs. Jonathan Cohn at the Soho Forum (Reason Podcast)

Wed, 15 Mar 2017 12:55:00 -0400

"The U.S. [health care system] is what you get when you let government run rampant," says Michael F. Cannon, who's the Cato Institute's director of health policy studies. "The government controls half of our health care spending directly and the other half indirectly." He elaborated:

The government tightly controls who can practice medicine, what education they must have, what tasks they can perform, where they can practice medicine, who can open a medical facility, who can purchase expensive medical equipment, where we can purchase our medical insurance, what our insurance covers, the prices we pay for insurance, how we obtain health care in retirement, what treatments doctors can describe, what manufacturers can say about those treatments and their products, the organization structure of health care providers, how health providers get paid, how much they get paid, how much we spend on health care, [and] how we help the poor obtain health care.

(image) Would Americans be better off if the government pulled back and let markets function? That was the topic of a debate held Monday night at the Soho Forum, a monthly Oxford-style debate series that "features topics of special interest to libertarians" and "aims to enhance social and professional ties within the New York City libertarian community." (An archive of past Soho Forum events.)

Cannon's debating partner was The Huffington Post's Jonathan Cohn, author of the 2007 book, Sick: The Untold Story of America's Health Care Crisis—and the People Who Pay the Price.

Cohn and Cannon debated the following resolution: "A market system for medical care would save more people from suffering inadequate care than any other system." At the beginning of the event, attendees voted "yes," "no," or "undecided." After Cannon and Cohn had their say, the audience voted again.

Cohn won the debate, convincing two percent of "yes" votes and 16 percent of the undecideds to switch to his side. The results are here.

Listen to the debate on SoundCloud below. Better yet, subscribe to the Reason podcast at iTunes.

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NRA-Backed Law Violates the First Amendment in the Name of Protecting the Second

Wed, 22 Feb 2017 08:00:00 -0500

Last week the U.S. Court of Appeals for the 11th Circuit overturned a censorious Florida law that tried to stop doctors from pestering their patients about guns, sacrificing the First Amendment in the name of protecting the Second. Such laws, which the National Rifle Association supports, show how fake rights—in this case, an overbroad understanding of the right to armed self-defense—endanger real ones. Florida's Firearm Owners' Privacy Act, enacted in 2011, was a response to complaints that pediatricians and family practitioners had become excessively nosy about guns in the homes of their patients. The American Medical Association, the American Academy of Pediatrics, and the American Academy of Family Physicians encourage their members to ask parents about guns, treating them as hazards analogous to alcohol, swimming pools, and poisonous household chemicals. Sometimes gun owners object to such inquiries, especially if they seem to be colored by a moralistic anti-gun ideology. The 11th Circuit's decision describes half a dozen examples that influenced Florida's legislators: A pediatrician in Ocala had reportedly told a mother that she would have to find a new physician for her child due to her refusal to disclose information about firearm ownership in the family home. A state representative said that his daughter's pediatrician inquired if he owned a firearm, and then asked him to remove the firearm from the home. An email described how a mother "was separated from her children while medical personnel...interrogated" them about firearm ownership and put information about such ownership in their medical records. One doctor refused to treat a child because he wanted to know if there were firearms in the home. A patient, according to a state senator, was told that disclosing firearm ownership was a Medicaid requirement. And another patient was informed that Medicaid does not pay for care if patients refuse to answer firearm-ownership questions. A representative of the National Rifle Association reported that a child would not be examined if the parent refused to answer questions about firearms in the home. Assuming these accounts are accurate, the behavior of these doctors may have been unreasonable or even (when they misrepresented Medicaid requirements) unethical. But their requests for information about guns were not unconstitutional, since the Second Amendment applies only to the government. The law passed in response to these anecdotes nevertheless purported to protect the Second Amendment rights of Floridians by regulating what doctors say to their patients. As the 11th Circuit notes, that makes no sense (citations omitted, emphasis added): There was no evidence whatsoever before the Florida Legislature that any doctors or medical professionals have taken away patients' firearms or otherwise infringed on patients' Second Amendment rights. This evidentiary void is not surprising because doctors and medical professionals, as private actors, do not have any authority (legal or otherwise) to restrict the ownership or possession of firearms by patients (or by anyone else for that matter). The Second Amendment right to own and possess firearms does not preclude questions about, commentary on, or criticism for the exercise of that right. So, as the district court aptly noted, there is no actual conflict between the First Amendment rights of doctors and medical professionals and the Second Amendment rights of patients that justifies [the law's] speaker-focused and content-based restrictions on speech. In addition to prohibiting doctors from discriminating against gun owners (a provision the appeals court upheld), the Firearm Owners' Privacy A[...]