MASS EXODUS! U.S. DOCTORS FLEEING MEDICINE


Mountains of Obamacare-related paperwork and the threats of severe fines for the slightest errors are forcing many doctors to retire and others to shut down their practices and work under the protection of hospitals, and all of it spells bad news for patients.

Galen Institute President Grace-Marie Turner says the exodus is alarming, as evidenced by a Physicians Foundation report showing the number of doctors who say they run an independent practice has dropped from 62 percent in 2008 to 35 percent in 2014. The survey of 20,000 physicians also shows only 17 percent in solo practice. Eighty-one percent of doctors are at full capacity or even overextended. Forty-six percent grade Obamacare as a D or an F. Just 25 percent give the law an A or a B.

For those greatly frustrated by the system, Turner said the government is making their lives miserable.

“The doctors cannot navigate this incredible bureaucracy,” she said. “They may see 40 patients during a day, and then they have mountains of paperwork to fill out. If they slip up and say something in carelessness or not understanding the rules and make a mistake, they could be subject to tens of thousands of dollars in fines. They just cannot expose themselves to that kind of jeopardy.”

Turner said there are two groups involved in shrinking the supply of doctors. First, she said experienced doctors are simply retiring rather than jumping through Obamacare’s bureaucratic hoops.

“Some of the more seasoned, experienced, established physicians are just taking down their shingle and saying, ‘We have had it. We cannot deal with this cookbook medicine. We cannot fight the rules and regulations and legal jeopardy we’re in.’”

She said the toll on health-care quality is sobering.

 (Photo: University of Wisconsin)

“They’re leaving practice early,” Turner said. “We’re losing decades of experience and medical expertise when doctors would otherwise be at the prime of their practice, leaving because they cannot deal with the bureaucracy or afford it.”

According to the Physicians Foundation study, doctors say they spend 20 percent of their time on non-clinical paperwork. Thirty-nine percent say they are accelerating retirement plans.

The other trend is doctors merging with hospitals and leaving independent practice.

“A number of physicians who are younger and still have bills to pay and families to support are selling their practices to hospitals, which mean that they basically become employees and have to do what the hospitals say,” Turner said.

The Physicians Foundation report finds that 53 percent of physicians describe themselves as hospital or medical group employees, up from 38 percent in 2008.

Turner said their logic makes sense.

“They really are buying the protection of these big hospital chains, which can hire an army of doctors and bureaucrats to try to help them navigate the bureaucracy,” she said. “The bureaucratization of American medicine is well underway and that does not bode well for patients.”

She says it’s bad for patients in two ways, first because of the realities of being a doctor employed by a hospital.

“Now they have to follow these very strict rules and regulations of these big hospital systems in order to treat a patient. If they don’t, they may either not be paid but they also could be penalized,” said Turner, who is also very worried that the notion of playing it safe is stifling innovation and preventing the development of better treatments.

“Both the doctors who stay in practice, and even more the medical students who apply and are accepted, are people who want to work a 40-hour week,” Turner said. “They’re perfectly happy to follow this cookbook medicine standardization and to not rock the boat by trying to do something innovative that might actually teach us something.”

Turner said increased government control of health care in other countries has consistently meant longer waiting times for treatment. She said cancer patients in Canada can wait up to 16 weeks or more for care after receiving a diagnosis, a span she acknowledges can be a “death sentence.”

In addition to losing good doctors, Turner said doctors are often brought in from other countries, and that can prove very challenging for patients as well.

“When you drive out the established physicians who are saying they are not willing to practice under these kinds of conditions, you still have to have physicians,” Turner said. “We do have many foreign medical graduates in this country, and patients complain that they have a physician who they really can’t communicate with.”

But while excoriating the mountain of rules and regulations Washington is piling onto physicians and others in the medical community, Turner said Americans should never doubt how much doctors and nurses want to help people.

“When you look at the nurses and the doctors that are still taking care of patients, it is so inspiring to see how much they continue to want to practice good medicine,” she said. “They are devoted to their patients. But they are so stressed in many cases and so frustrated, saying, ‘I got into this business to take care of patients, not to fill out all this paperwork and bureaucracy.’”

Source:wnd.com

PATIENTS ARE EXPERIMENTING WITH KETAMINE TO TREAT DEPRESSION


SEAN SPENCER WAS ready to give up. For two years, since suffering a major panic attack, the entrepreneur had been living under a cloud of depression. Nothing seemed to make it better. He took traditional antidepressants, but they made him “want to die.” Meditation gave him a fleeting sense of relief, but it wasn’t enough to get him through the day. Out of desperation, he finally traveled to a clinic to try a controversial new therapy: ketamine IV infusions.

Ketamine, first synthesized in 1962, has long been used as a clinical anesthetic and animal tranquilizer—but it’s also known as the hallucinogenic club drug Special K. Spencer remembers being afraid of having a bad trip. “The first time I was in this chair I was pretty nervous,” he says. “I certainly didn’t know what to expect.” As a low dosage of ketamine entered his bloodstream through the IV, he reclined back in the leather chair and his anxiety began to fade away.

When used correctly, ketamine is a cheap and effective pain killer. When abused, it can send users into what’s known as a K-hole, an out-of-body experience that’s been described as a kind of mental paralysis. But growing evidence shows that low doses given intravenously may be life-changing for patients with treatment-resistant depression. And dozens of clinics across the nation have embraced this new strategy in the fight against depression, as also reported in Los Angeles Magazine.

At the Ketamine Clinics of Los Angeles, anesthesiologist Steven Mandel has given more than 4,000 infusions over the past four years. “The other antidepressants take weeks to months to have an effect. Ketamine kicks in within hours,” he says. “It works on people that nothing else has worked on.” According to the National Institutes of Health, up to a third of those suffering from depression don’t respond to prescription antidepressants like selective serotonin reuptake inhibitors—and people like Spencer, desperate for new options, are seeking out ketamine clinics.

The infusions last 50 to 55 minutes and cause mild hallucinations. But it doesn’t come close to the intensity of the dreaded K-hole. “I don’t think anybody should be afraid of it, Spencer says. “You’re not getting handed pills at a club by somebody. You’re going to a professional and you’re in a space that’s safe.” Mandel monitors his patients throughout the procedure and adjusts the dosage accordingly. “After about five minutes you’re blasting off,” Spencer says. “When you get to the deepest part of it you feel ultimate peace.”

While Spencer says the treatment has been life-changing for him, it doesn’t come cheap. At the Ketamine Clinics of Los Angeles, infusions cost anywhere from $600 to $750 a pop. That’s unaffordable for many patients—so Mandel’s clinic mostly ends up serving professionals from the Los Angeles tech community known as “Silicon Beach.”

Spencer is the cofounder of a successful startup and he’s well aware of his advantages. “Objectively I know that I have a lot to be grateful for, and it seems like somebody looking at my life from the outside would think, ‘What does that guy have to be depressed about?’ but it doesn’t work like that,” Spencer says. “You have to look at your brain almost like an operating system, and if that system crashes it doesn’t matter if you have all the comforts of life. You’re still miserable.”

He isn’t alone. According to a 2015 study, entrepreneurs are twice as likely to suffer from depression. That may be due to a combination of work-related stress and higher rates of diagnosis thanks to better health care access. And it’s often a taboo subject in competitive industries like tech. “If you’re admitting to maybe having anxiety or being depressed, you’re giving the impression that you’re weak,” Spencer says.

Doctors still don’t fully understand how depression works, which makes studying and developing new treatments all the more challenging. “We don’t know how any of these meds work on the brain,” says Mandel. “We know about as much about ketamine as we do about any of the others. We do know that ketamine tends to cause new growth in the brain.”

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While the medical community is still waiting on the results from the first large scale clinical trials, proponents like Mandel are already convinced that the ketamine therapy works on patients with severe depression and suicidality. Out of more than 600 patients, he says he’s seen an improvement in 83 percent of them. And a growing number of studies support claims that ketamine is an effective antidepressant.

But many doctors don’t support the treatment. “The main critique is that it’s been rolled out into clinical usage too soon. There’s so much about the drug that we don’t know in terms of how to use it, who responds to it, what the long term consequences of taking the drug might be,” says Victor Reus, a practicing psychiatrist and professor at the UCSF School of Medicine. “We need to have more, larger, well controlled trials using this drug. We need to follow people over time.”

And there are other concerns. While Ketamine as an anesthetic is FDA approved, using it for depression is not. That means many insurance carriers don’t cover it, limiting its reach to lower income communities. Then there’s the risk of long term dependency on a treatment that some worry may prove to be addictive. “Ketamine is theoretically addictive based on what we see in individuals who are using ketamine recreationally and in street usage,” Reus says.

But talk to patients like Sean Spencer and the concerns melt away. “I hope in the future that it’s more accessible,” Spencer says. “I know people who have been on the brink of suicide and done it and it’s 180 changed their lives.”

A neuroscientist reveals the most important factor in changing your brain and improving your mood. 


Have you ever wondered if you can change your brain, even though you’re an adult?

Not too long ago, it was generally believed that once a human was fully developed, their brain remained fixed. This meant that we couldn’t grow new brain cells, nor could we change the structure of the brain.

But recent neuroscience has proven this wrong.

Coined as neuroplasticity, research has found that the neurons (nerve cells) in the brain change in response to new situations or to changes in their environment.

In this riveting TED talk, neuroscientist Sandrine Thuret explains how our brain produces 700 new neurons per day in the hippocampus.

While you might not think this is much, compared to the billions of neurons we have, by the time we turn 50, we will have exchanged the neurons we were born with in that structure with adult-born neurons.

According to Thuret, neurons are crucial for memory capacity and for the quality of those memories.

More interestingly, Thuret says that new research is showing a strong link between neurogenesis (the process of birth of neurons) and depression. In an animal model of depression, it has been found that there’s a lower level of neurogenesis.

 And by giving anti-depressants, it increases the production of these newborn neurons and decrease the symptoms of depression, establishing a clear link between neurogenesis and depression.

More importantly, if you block neurogenesis, then you block the efficacy of the anti-depressant.

In short, there’s enough evidence to suggest that neurogenesis is the target of choice if we want to improve memory, mood and even prevent the decline associated with aging.

Of course, the question we’re all wondering is: Can we control neurogenesis? The answer is yes we can. Watch the TED talk below to find out how:

For those of you who were too lazy to watch the video, here are the answers to increasing neurogensis:

– Constantly learn new things

 – Reduce Stress

– Have sex

– Get enough sleep

– Calorie restriction of 20-30 percent

– Intermittent fasting – spacing time between meals – will increase neurogenesis.

– Intake of flavanois, which are contained in dark chocolate and blueberries.

– Omega-3 fatty acids, present in fatty fish, like Salmon.

– A diet rich in saturated fat will have a negative impact on neurogenesis.

– Ethanol – intake of alcohol – will decrease neurogenesis.

– Resveratrol, contained in red wine, has been to shown to promote the survival of these new neurons.

Exposure to Ozone Kicks Up Chances of Autism 10-Fold in at-Risk Kids


“The increase in risk is striking.”

Having a higher number of copies of genes has been shown to raise the risk of a child developing autism, as has early exposure to various pollutants in the mother’s environment.

Researchers have now shown that when these two factors are combined, an individual has 10 times the chance of developing the condition, demonstrating the importance of stepping beyond the question of nature versus nurture and looking at the bigger picture.

The analysis by a team led by scientists from Pennsylvania State University is one of the first to examine genetic differences across the whole genome in conjunction with environmental factors surrounding an individual as it develops.

Autism Spectrum Disorder (ASD) covers a variety of behaviours involving social interactions and communications, presenting with degrees of severity.

“There are probably hundreds, if not thousands, of genes involved and up until now – with very few exceptions – these have been studied independently of the environmental contributors to autism, which are real,” says Penn State researcher Scott B. Selleck.

Those genes can affect numerous functions in the brain, potentially affecting a bunch of different neurological circuits that influence anything from social interactions to eye contact.

The question on just how heritable autism is has long been debated, with some early twin studies estimating as much as 90 percent of the condition is the result of genes passed down from parents.

Other researchers suggest the environment shares more of the blame, with the consensus now hovering around 50 percent genetics, 50 percent environment.

This new study shows how complicated the story just might be when it comes to such complex neurological conditions.

“Our team of researchers represents a merger of people with genetic expertise and environmental epidemiologists, allowing us for the first time to answer questions about how genetic and environmental risk factors for autism interact,” says Selleck.

Research involved 158 children with autism who were selected through a previous study, and 147 controls who were closely matched in age and demographic.

The team examined a feature called copy-number variations (CNVs); sequences that have been duplicated at least once to form repeats through the genome.

Previous research on individuals with ASD has already shown a higher tendency for their genomes to contain more CNVs than the rest of the population, and that the more of these repeats an individual has, the lower their measures of social and communication skills.

In addition to the subjects’ genetic variations, the team analysed their family’s residential history, comparing the addresses with data on air quality from the US Environmental Protection Agency (EPA) Air Quality System.

“This allowed us to examine differences between cases of autism and typically developing controls in both their prenatal pollutant exposure and their total load of extra or deleted genetic material,” says researcher Irva Hertz-Picciotto from University of California Davis.

Each risk factor on its own – larger numbers of CNV and high amounts of particulate in the air – was found to elevate the risk of autism, in line with previous research.

Once they started to combine the figures, one result in particular stood out.

Ozone, as one of the pollutants examined, hasn’t previously been considered a hugely significant risk factor for ASD.

The gas, consisting of three oxygen atoms, is formed from other pollutants such as nitrogen oxides and volatile organic compounds, which react in the presence of sunlight. Those molecules are generally released in vehicle exhaust, industrial processes, and electrical utilities.

The effect of ozone on those with high CVN numbers ramps up the chances of developing the condition, more than either would account for on their own.

Compared with those the bottom quarter of CNV numbers, and the bottom quarter of ozone exposure, there is a ten-fold risk of developing autism for those in the top quarter for both measures.

“This increase in risk is striking, but given what we know about the complexity of diseases like autism, perhaps not surprising,” says Selleck.

While the study didn’t analyse the cause, the researchers did speculate that ozone could increase the number of reactive oxygen species, such as peroxides, that are known to cause stress to cells and damage DNA.

It’s possible that having more variations of genes responsible for certain autism-related functions could open individuals to more oxidation damage.

The researchers acknowledge their sample size was relatively small, and since ozone occurs in conjunction with numerous other pollutants, there could be confounding factors that need to be pulled apart. It also doesn’t point at a single cause, instead hinting at one way a number of key genes could be affected by the environment.

Still, given the complexities of the condition, the study does show how variables we’ve previously dismissed might be working in combination.

“It demonstrates how important it is to consider different types of risk factors for disease together, even those with small individual effects,” says Selleck.

Inside a Killer Drug Epidemic: A Look at America’s Opioid Crisis


The opioid epidemic killed more than 33,000 people in 2015. What follows are stories of a national affliction that has swept the country, from cities on the West Coast to bedroom communities in the Northeast.

Opioid addiction is America’s 50-state epidemic. It courses along Interstate highways in the form of cheap smuggled heroin, and flows out of “pill mill” clinics where pain medicine is handed out like candy. It has ripped through New England towns, where people overdose in the aisles of dollar stores, and it has ravaged coal country, where addicts speed-dial the sole doctor in town licensed to prescribe a medication.

Public health officials have called the current opioid epidemic the worst drug crisis in American history, killing more than 33,000 people in 2015. Overdose deaths were nearly equal to the number of deaths from car crashes. In 2015, for the first time, deaths from heroin alone surpassed gun homicides.

And there’s no sign it’s letting up, a team of New York Times reporters found as they examined the epidemic on the ground in states across the country. From New England to “safe injection” areas in the Pacific Northwest, communities are searching for a way out of a problem that can feel inescapable.

 

Drug Deaths in America Are Rising Faster Than Ever


The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50.

Although the data is preliminary, the Times’s best estimate is that deaths rose 19 percent over the 52,404 recorded in 2015. And all evidence suggests the problem has continued to worsen in 2017.

 

Drug overdose deaths, 1980 to 2016
59,000 to65,000 peopledied from drugoverdoses in theU.S. in 2016*59,000 to65,000 peopledied from drugoverdoses in theU.S. in 2016*1980’85’90’95’00’05’10’1520,00030,00040,00050,00060,000Peak car crashdeaths (1972)Peak gundeaths (1993)Peak H.I.V.deaths (1995)10,000 deathsper year10,000 deathsper year
*Estimate based on preliminary data

Because drug deaths take a long time to certify, the Centers for DiseaseControl and Prevention will not be able to calculate final numbers until December. The Times compiled estimates for 2016 from hundreds of state health departments and county coroners and medical examiners. Together they represent data from states and counties that accounted for 76 percent of overdose deaths in 2015. They are a first look at the extent of the drug overdose epidemic last year, a detailed accounting of a modern plague.

The initial data points to large increases in drug overdose deaths in states along the East Coast, particularly Maryland, Florida, Pennsylvania and Maine. In Ohio, which filed a lawsuit last week accusing five drug companies of abetting the opioid epidemic, we estimate overdose deaths increased by more than 25 percent in 2016.

“Heroin is the devil’s drug, man. It is,” Cliff Parker said, sitting on a bench in Grace Park in Akron. Mr. Parker, 24, graduated from high school not too far from here, in nearby Copley, where he was a multisport athlete. In his senior year, he was a varsity wrestler and earned a scholarship to the University of Akron. Like his friends and teammates, he started using prescription painkillers at parties. It was fun, he said. By the time it stopped being fun, it was too late. Pills soon turned to heroin, and his life began slipping away from him.

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Mr. Parker’s story is familiar in the Akron area. From a distance, it would be easy to paint Akron — “Rubber Capital of the World” — as a stereotypical example of Rust Belt decay. But that’s far from a complete picture. While manufacturing jobs have declined and the recovery from the 2008 recession has been slow, unemployment in Summit County, where Akron sits, is roughly in line with the United States as a whole. The Goodyear factories have been retooled into technology centers for research and polymer science. The city has begun to rebuild. But deaths from drug overdose here have skyrocketed.

In 2016, Summit County had 312 drug deaths, according to Gary Guenther, the county medical examiner’s chief investigator — a 46 percent increase from 2015 and more than triple the 99 cases that went through the medical examiner’s office just two years before. There were so many last year, Mr. Guenther said, that on three separate occasions the county had to request refrigerated trailers to store the bodies because they’d run out of space in the morgue.

It’s not unique to Akron. Coroners’ offices throughout the state are being overwhelmed.

 

Drug overdose deaths in six Ohio counties, 2010 to 2017
’10’1720040060011130Warren Co.Warren Co.
’10’1761268ButlerButler
’10’1775290SummitSummit
’10’17154543HamiltonHamilton
’10’17267775CuyahogaCuyahoga
’10’17127800MontgomeryMontgomery
Totals for 2017 assume that overdose deaths continue at the same rate through the remainder of the year.Source: Butler County Coroner’s Office; Cuyahoga County Medical Examiner’s Office; Hamilton County Coroner; Montgomery County Alcohol, Drug Addiction & Mental Health Service; Montgomery County Sheriff’s Office; Summit County Department of the Medical Examiner

In some Ohio counties, deaths from heroin have virtually disappeared. Instead, the culprit is fentanyl or one of its many analogues. In Montgomery County, home to Dayton, of the 100 drug overdose deaths recorded in January and February, only three people tested positive for heroin; 99 tested positive for fentanyl or an analogue.

Fentanyl isn’t new. But over the past three years, it has been popping up in drug seizures across the country.

Drug seizures containing fentanyl
’01’02’03’04’05’06’07’08’09’10’11’12’13’14’15’165,00010,00015,00020,00025,00030,000A 2006 spike was tracedto a single lab in MexicoFentanyl reportsdoubled in 2016
Source: D.E.A. National Forensic Laboratory Information System

Most of the time, it’s sold on the street as heroin, or drug traffickers use it to make cheap counterfeit prescription opioids. Fentanyls are showing up in cocaine as well, contributing to an increase in cocaine-related overdoses.

The most deadly of the fentanyl analogues is carfentanil, an elephant tranquilizer 5,000 times stronger than heroin. An amount smaller than a few grains of salt can be a lethal dose.

“July 5th, 2016 — that’s the day carfentanilhit the streets of Akron,” said Capt. Michael Shearer, the commander of the Narcotics Unit for the Akron Police Department. On that day, 17 people overdosed and one person died in a span of nine hours. Over the next six months, the county medical examiner recorded 140 overdose deaths of people testing positive for carfentanil. Just three years earlier, there were fewer than a hundred drug overdose deaths of any kind for the entire year.

This exponential growth in overdose deaths in 2016 didn’t extend to all parts of the country. In some states in the western half of the U.S., our data suggests deaths may have leveled off or even declined. According to Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco, and an expert in heroin use in the United States, this geographic variation may reflect a historical divide in the nation’s heroin market between the powdered heroin generally found east of the Mississippi River and the Mexican black tar heroin found to the west.

This divide may have kept deaths down in the West for now, but according to Dr. Ciccarone, there is little evidence of differences in the severity of opioid addiction or heroin use. If drug traffickers begin to shift production and distribution in the West from black tar to powdered heroin in large quantities, fentanyl will most likely come along with it, and deaths will rise.

 

Drug overdose deaths in Philadelphia and San Francisco
Drug overdose deaths since 1980 have surged in Philadelphia despite a shrinking population; most heroin there is powdered. They have remained relatively flat in San Francisco, where most heroin is black tar.
1980’85’90’95’00’05’10’15100200300400500San FranciscoSan FranciscoPhiladelphiaPhiladelphia
Source: C.D.C. WONDER

First responders are finding that, with fentanyl and carfentanil, the overdoses can be so severe that multiple doses of naloxone — the anti-overdose medication that often goes by the brand name Narcan — are needed to pull people out. In Warren County in Ohio, Doyle Burke, the chief investigator at the county coroner’s office, has been watching the number of drug deaths rise as the effectiveness of Narcan falls. “E.M.S. crews are hitting them with 12, 13, 14 hits of Narcan with no effect,” said Mr. Burke, likening a shot of Narcan to “a squirt gun in a house fire.”

Early data from 2017 suggests that drug overdose deaths will continue to rise this year. It’s the only aspect of American health, said Dr. Tom Frieden, the former director of the C.D.C., that is getting significantly worse. Over two million Americans are estimated to be dependent on opioids, and an additional 95 million used prescription painkillers in the past year — more than used tobacco. “This epidemic, it’s got no face,” said Chris Eisele, the president of the Warren County Fire Chiefs’ Association and fire chief of Deerfield Township. The Narcotics Anonymous meetings here are populated by lawyers, accountants, young adults and teenagers who described comfortable middle-class upbringings.

Back in Akron, Mr. Parker has been clean for seven months, though he is still living on the streets. The ground of the park is littered with discarded needles, and many among the homeless here are current or former heroin users. Like most recovering from addiction, Mr. Parker needed several tries to get clean — six, by his count. The severity of opioid withdrawal means users rarely get clean unless they are determined and have treatment readily available. “No one wants their family to find them face down with a needle in their arm,” Mr. Parker said. “But no one stops until they’re ready.”

About the data

Our count of drug overdoses for 2016 is an estimate. A precise number of drug overdose deaths will not be available until December.

As the chief of the Mortality Statistics Branch of the National Center for Health Statistics at the C.D.C., Robert Anderson oversees the collection and codification of the nation’s mortality data. He noted that toxicology results, which are necessary to assign a cause of death, can take three to six months or longer. “It’s frustrating, because we really do want to track this stuff,” he said, describing how timely data on cause of death would let public health workers allocate resources in the right places.

 

To come up with our count, we contacted state health departments in all 50 states, in addition to the District of Columbia, asking for their statistics on drug overdose deaths among residents. In states that didn’t have numbers available, we turned to county medical examiners and coroners’ offices. In some cases, partial results were extrapolated through the end of the year to get estimates for 2016.

While noting the difficulty of making predictions, Mr. Anderson reviewed The Times’s estimates and said they seemed reasonable. The overdose death rate reported by the N.C.H.S. provisional estimates for the first half of 2016 would imply a total of 59,779 overdose deaths, if the death rate remains flat through the second half of the year. Based on our reporting, we believe this rate increased.

 

While the process in each state varies slightly, death certificates are usually first filled out by a coroner, medical examiner or attending physician. These death certificates are then collected by state health departments and sent to the N.C.H.S., which assigns what’s called an ICD-10 code to each death. This code specifies the underlying cause of death, and it’s what determines whether a death is classified as a drug overdose.

Sometimes, the cases are straightforward; other times, it’s not so easy. The people in charge of coding each death — called nosologists — have to differentiate between deaths due to drug overdose and those due to the long-term effects of drug abuse, which get a different code. (There were 2,573 such deaths in 2015.) When alcohol and drugs are both present, they must specify which of the two was the underlying cause. If it’s alcohol, it’s not a “drug overdose” under the commonly used definition. Ideally, every medical examiner, coroner and attending physician would fill out death certificates with perfect consistency, but there are often variations from jurisdiction to jurisdiction that can introduce inconsistencies to the data.

These inconsistencies are part of the reason there is a delay in drug death reporting, and among the reasons we can still only estimate the number of drug overdoses in 2016. Since we compiled our data from state health departments and county coroners and medical examiners directly, the deaths have not yet been assigned ICD-10 codes by the N.C.H.S. — that is, the official underlying cause of death has not yet been categorized. In addition, the mortality data in official statistics focuses on deaths among residents. But county coroners typically count up whichever deaths come through their office, regardless of residency. When there were large discrepancies between the 2015 counts from the C.D.C. and the state or county, we used the percent change from 2015 to calculate our 2016 estimate.

We can say with confidence that drug deaths rose a great deal in 2016, but it is hard to say precisely how many died or in which places drug deaths rose most steeply. Because of the delay associated with toxicology reports and inconsistencies in the reported data, our exact estimate — 62,497 total drug overdose deaths — could vary from the true number by several thousand.

Opioids, a Mass Killer We’re Meeting With a Shrug


About as many Americans are expected to die this year of drug overdoses as died in the Vietnam, Iraq and Afghanistan wars combined.

For more than 100 years, death rates have been dropping for Americans — but now, because of opioids, death rates are rising again. We as a nation are going backward, and drug overdoses are now the leading cause of death for Americans under 50.

“There’s no question that there’s an epidemic and that this is a national public health emergency,” Dr. Leana Wen, the health commissioner of Baltimore, told me. “The number of people overdosing is skyrocketing, and we have no indication that we’ve reached the peak.”

Yet our efforts to address this scourge are pathetic.

We responded to World War II with the storming of Normandy, and to Sputnik with our moon shot. Yet we answer this current national menace with … a Republican plan for health care that would deprive millions of insurance and lead to even more deaths!

More on President Trump’s fumbling of this problem in a moment. But it’s bizarre that Republicans should be complacent about opioids, because the toll is disproportionately in red states — and it affects everyone.

Mary Taylor, the Republican lieutenant governor of Ohio and now a candidate for governor, has acknowledged that both her sons, Joe and Michael, have struggled with opioid addiction, resulting in two overdoses at home, urgent calls for ambulances and failed drug rehab efforts. Good for her for speaking up.

It should be a national scandal that only 10 percent of Americans with opioid problems get treatment. This reflects our failed insistence on treating opioids as a criminal justice problem rather than as a public health crisis.

Times investigation published this month estimated that more than 59,000 Americans died in 2016 of drug overdoses, in the largest annual jump in such deaths ever recorded in the U.S. One reason is the spread of fentanyl, a synthetic opioid that is cheap and potent, leading to overdoses.

Another bad omen: As a nation, we’re still hooked on prescription painkillers. Last year, there were more than 236 million prescriptions written for opioids in the United States — that’s about one bottle of opioids for every American adult.

Even with all that’s at stake, there are three reasons to doubt that Trump will confront the problem.

First, Trump and Republicans in Congress seem determined to repeal Obamacare, which provides for addiction treatment, and slash Medicaid. The Congressional Budget Office estimated that the G.O.P. House plan would result in an additional 23 million Americans being uninsured in a decade — and thus less able to get drug treatment. Other, more technical elements of the G.O.P. plan would also result in less treatment.

Second, Tom Price, the secretary of health and human services, last month seemed to belittle the medication treatments for opioid addiction that have the best record, and Attorney General Jeff Sessions still seems to think we can jail our way out of the problem.

Third, Trump’s main step has been to appoint Gov. Chris Christie of New Jersey to lead a task force to investigate opioid addiction. But we needn’t waste more time investigating, for we know what to do — and in any case Christie talks a good game but bungled the issue in his home state.

Among experts, there’s overwhelming evidence of what works best: medication in conjunction with counseling. This doesn’t succeed in every case, but it does reduce deaths and improve lives. It also saves public money, because a result is fewer emergency room visits and inpatient hospital stays. So the question isn’t whether we can afford treatment for all people fighting addiction, but whether we can afford not to provide it.

The bottom line is that we need a major national public health initiative to treat as many Americans abusing drugs as possible, with treatment based on science and evidence. We also need to understand that drug overdoses are symptoms of deeper malaise — “deaths of despair,” in the words of Anne Case and Angus Deaton of Princeton University, stemming from economic woes — and seek to address the underlying issues.

Above all, let’s show compassion. Addiction is a disease, like diabetes and high blood pressure. We would never tell diabetics to forget medication and watch their diets and exercise more — and we would be aghast if only 10 percent of diabetics were getting lifesaving treatment.

Innumerable people with addictions whom I’ve interviewed haunt me. One was a nurse who became dependent on prescription painkillers and was fired when she was caught stealing painkillers from a hospital. She became homeless and survived by providing sex to strangers in exchange for money or drugs.

She wept as she told me her story, for she was disgusted with what she had become — but we as a society should be disgusted by our own collective complacency, by our refusal to help hundreds of thousands of neighbors who are sick and desperate for help.

Prescription painkiller tramadol ‘claiming more lives than any other drug’


For many, when given a prescription the assumption is that the drug they’re taking is safe. In the case of prescription painkiller Tramadol, however, that could hardly be further from the truth.

In fact, according to some experts, it may be claiming more lives than any other drug – including cocaine and heroine.

For instance, last year Tramadol was responsible for 33 deaths in Northern Ireland – including both a 16-year-old girl and a pensioner in his 70’s.

Tramadol is just one of many opiate-based painkillers on the market, and is illegal without a prescription. Like many other opiates, however, it’s easy for people to get hooked, and it’s becoming more widely available on the black market.

Rule-makers around the world are worried about what may happen as Tramadol becomes more widely available. Having seen the opiate crisis in the United States and elsewhere, it seems with good reason.

“I don’t think that people realise how potentially risky taking tramadol is.

I think it’s because it’s a prescription drug – people assume it’s safe.” – PROFESSOR JACK CRANE, STATE PATHOLOGIST FOR NI

The opiate-based drug used to treat moderate or severe pain should only be available on prescription – it was reclassified in 2014 making it an illegal Class C drug without prescription.

But anti-drug campaigners say more and more people are turning to the black market.

Professor Jack Crane has spoken out to say he fears more people will die unless urgent action is taken and he is calling for a crackdown on the illegal market.

He wants tramadol to be upgraded again, this time to Class A.

Professor Crane is now set to meet Northern Ireland’s Chief Medical Officer later this month to push for change.

 

National HIV Testing day. 


June 27 is National HIV Testing Day. This year’s theme, Test Your Way. Do It Today., is a call to get tested now and a reminder that there are more ways than ever to get an HIV test. In a clinic, from your health care provider, at a testing event, at home, from a local organization—get tested your way today!

Group of young adults taking selfie

About 1.1 million people in the United States have HIV, and 1 in 7 of them don’t know it. Young people are the most likely to be unaware of their HIV infection. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. But some people are more at risk of getting HIV than others and should be tested at least once a year. Sexually active gay and bisexual men may benefit from more frequent testing (for example, every 3 to 6 months).

I'm Doing It

Knowing your HIV status is important for your health. If you are living with HIV, you should start treatment as soon as possible. HIV medicine can keep you healthy for many years and greatly reduces your chance of transmitting the virus if you take it the right way every day. And if you’re HIV-negative, you can take steps to prevent HIV. For example, pre-exposure prophylaxis, or PrEP, is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected. PrEP can stop HIV from taking hold and spreading throughout your body.

Knowing your HIV status helps keep you and your partner healthy. Visit Doing It to learn more.

June 27 is National HIV Testing Day - Test Your Day, Do It Today

What Can You Do?

Get the FactsLearn about HIV, and share this lifesaving information with your family, friends, and community. Get an HIV test at least once as part of routine care if you are 13-64. Use CDC’s HIV Risk Reduction Tool (BETA) to get prevention information tailored to meet your needs.

Get Tested. Get tested for HIV or talk to your health care provider about HIV testing. Knowing your HIV status gives you powerful information to help keep you and your partner healthy. To find a testing site near you,

You can also use a home testing kit available in drugstores or online. Get Involved . CDC offers many resources to help you raise awareness about HIV testing in your community. Doing It is a national HIV testing and prevention campaign designed to motivate all adults to get tested for HIV and know their status. Join Doing It on FacebookInstagram, and Twitter, share videos of volunteers, community leaders, and celebrities explaining why they’re getting tested, and download posters and other materials.

Here are 11 ways to increase serotonin in the brain (naturally) 


What’s the key to improving your mental state and feeling good?

Some of us might say it’s healthy relationships or doing a job you love.

Spiritual gurus might say it’s living in the moment or positive thinking.

But isn’t it more interesting to find out what neuroscientists say? After all, they’re the ones studying our brains.

And despite what you’re led to believe, neuroscience has many things to say about our mental state and what works. According to several research studies, there’s one particular element to mental wellbeing that you might not be aware of.

It’s called serotonin, a neurotransmitter that can influence many things throughout your body like your mood, memory, sleep cycle, and even your sex drive.

 By increasing the serotonin in your body naturally, you can also enhance your mental state and your motivation. Here are 11 natural ways to boost your serotonin.

1. Eat Tryptophan.

Tryptophan is an amino acid that majorly helps in your body’s production of serotonin. Foods that include tryptophan include eggs, dairy, lean meats, nuts, and seeds.

2. Get a massage


Getting a massage can boost your mood no matter what, but did you know that it can reduce your cortisol levels? Cortisol is a stress hormone that is produced when you’re “under attack” or in stressful situations. When you have too much of this hormone in your body, it can block serotonin from being produced.

3. Increase your B Vitamins.

Especially B12 and B6 can help with serotonin production. There is even research suggesting that increasing your intake of these vitamins can help with depression. Most people can enhance their intake of B vitamins with 50-100 mg/day but check with your doctor to be sure.

4. Get some sun.

Unsurprisingly for those of us who live in the north, not getting sun can affect our mood. Sunshine can initiate serotonin production in our brains!

5. Increase your intake of Magnesium.

It’s thought that up to 75% of the American population is deficient in Magnesium. This mineral can help to control blood pressure, regulate nerve cell function enhance serotonin. Magnesium can be found in supplements and foods like dark greens, bananas, and fish.

6. Be positive.


Increasing serotonin isn’t just possible with external things. By changing your attitude, self-talk, and perspective, you can also influence your brain. When you do things that you enjoy, you feel better. These new patterns of positivity can help you create more serotonin.

7. Eat less sugar.

One of the symptoms you may feel when you’re low on serotonin is a craving for sugary foods. But by consuming these foods, you will feel a crash soon after. Be healthy and increase your serotonin in more natural ways.

8. Start a meditation practice.


Meditation raises an acid called 5-HIAA in the brain that is directly related to serotonin. By sitting in meditation every day you can reduce stress, and the production of cortisol and other stress hormones and also enhance the production of serotonin.

9. Exercise.

Any activity that gets your blood going and your heart pumping also contributes to the production of serotonin. Exercise also produces positive chemicals in the body like endorphins, which can enhance your mood right away.

10. Get lots of Vitamin.

Vitamin C is strongly connected to mood and also has antidepressant properties. One study even found people who took in an increase in vitamin C for a week felt happier. Vitamin C may not be directly related to serotonin but it definitely helps the brain to make other neurotransmitters like epinephrine and dopamine, which both make us feel great.

11. Reduce stress by taking care of yourself.


When you you’re stressed, do thing to prevent becoming overwhelmed. The best way to combat stress chemicals like cortisol is to do what you can to stay positive and take care of yourself.