Mosquitoes don’t bug rich tourists on Marlon Brando’s island. Here’s why that matters

first_img“All of this happens because of mosquitoes,” said Bossin. In the LabMosquitoes don’t bug rich tourists on Marlon Brando’s island. Here’s why that matters Related: By Karen Weintraub March 3, 2016 Reprints Karen Weintraub None of hundreds of studies has seen any negative consequences from infecting mosquitoes with Wolbachia — because the bacteria are already present in the environment and are not transmitted to predators, said Steven Sinkins, a Wolbachia expert at Lancaster University in the United Kingdom. The work does not require genetic engineering, he said, quieting concerns about tinkering too much with nature.Wolbachia also acts in several ways to keep mosquitoes from passing on disease, Sinkins said, so it is unlikely that the insects can evolve to become less vulnerable to it.Sinkins is getting ready to release Wolbachia-infected mosquitoes in Malaysia as part of a research project, and is optimistic that studies like his will show that such mosquitoes can be a safe, effective way of preventing mosquito-borne diseases.“I hope very much that this will be Wolbachia’s decade,” Sinkins said.Lorenzo Hoga, far left, Hereiti Petit and Hutia Barff prepare mosquito pupae to be sorted by gender. The male mosquitoes, which are sterile, will be released on an islet 20 miles away in an attempt to eradicate the mosquito population there. Gregory Boissy for STATAn unwelcome visitorThe experiment on Tetiaroa is one of the first to test whether releasing sterile, Wolbachia-infested male mosquitoes can completely and safely erase mosquitoes from an ecosystem. Bossin is starting with one island, and then will expand to the whole atoll. Eventually, he wants to protect the entire Polynesian archipelago.“Our goal is not to remove [polynesiensis mosquitoes] from the earth,” Bossin said. “It’s to make sure that on populated islands, we are no longer exposed.”Every Monday and Tuesday morning in his Tahati lab, a technician takes Wolbachia-infected mosquito pupae and gently drops them between two tilted glass plates. Like in a coin sorter, the smaller male pupae slip further down between the plates, while the bigger females get stuck closer to the top, enabling relatively easy gender separation.On Tuesdays at midday, the pupae are packaged and flown on a small plane to Tetiaroa’s research station where they will spend another day maturing, 650 to a white plastic tub.Thursday mornings, Manea Brando stacks dozens of tubs in a golf cart and drives around the islet, opening them one at a time in different spots. Tens of thousands of sterile males fly off in search of mates, hopefully ending the family tree of Onetahi’s polynesiensis.So far, Bossin said he’s seen no downside to the elimination. There are no bats or frogs in French Polynesia to feast on mosquitoes, and no insect-eating bugs on the atoll. Spiders have plenty of other options.Aedes polynesiensis was introduced to Polynesia 1,000 years ago, as people from Fiji began to populate the Polynesian archipelagos. “It was an introduced, invasive species that does not sustain other species,” Bossin said.Aedes aegypti arrived in the South Pacific about 200 years ago, aboard boats from Africa. It spread widely throughout French Polynesia only after World War II, with the urbanization of atolls across the territory.“It could never have come here without the presence of humans,” Bossin said. Although climate change likely plays a role in the expansion of mosquito habitats worldwide, he said, “the population genetics of mosquitoes exactly maps the movement of people.”Research assistant Hereiti Petit prepares mosquito pupae to be sorted by gender at the Institut Louis Malardé. Gregory Boissy for STATBossin plans to monitor the mosquito population to ensure the population doesn’t rebound. He may need to release more sterile males, he said, but it’s too soon to know.Walking through the densest area of Onetahi, Bossin paused to marvel at his own success. Just a few years ago, the workers who built the guest villas on the islet were constantly complaining about the mosquitoes. “It feels incredibly comfortable here now,” he said. “Elimination is within reach.”Returning from Tetiaroa to Tahiti takes 2 1/2 hours by boat or 20 minutes by a six-seat airplane. On one recent trip, as the five passengers scrambled aboard, a stowaway came along, too. A fly buzzed around the cabin during the flight and disappeared on landing.It wasn’t a mosquito, but its presence showed just how easily people can transport insects from one place to another, and what Bossin and other scientists are up against, as they try to stop this invasive creature and the disease and misery it spreads. Gene drive gives scientists power to hijack evolution Biologists: Let’s sic ‘gene drive’ on Zika-carrying mosquitoes About the Author Reprints Malaria kills a half-million Africans a year. Gene-edited mosquitoes might stop it TETIAROA, French Polynesia — On this remote South Pacific atoll owned by Marlon Brando’s family, a French biologist is undertaking an ambitious experiment that could help change how we fight mosquitoes — and the diseases they spread.Hervé Bossin and his team have released more than 1 million sterile male mosquitoes since September, triggering a hundredfold drop in the mosquito population on one islet of Tetiaroa, formerly a retreat for Polynesian royalty.Mosquitoes cause more human illness than any other creature on earth, killing 800,000 children a year, on average. The biting females carry malaria, dengue, yellow fever, and — most recently — Zika, which is suspected of triggering birth defects and neurological damage in some patients.advertisementcenter_img Related: Related: Zika struck this part of the South Pacific in 2013-2014 before jumping to the Americas last year, where it has swept through two-dozen countries. Bossin didn’t catch Zika, but several colleagues did, as did an estimated 60 percent of the population of French Polynesia, a collection of five archipelagos just east of the international date line and 2,600 miles south of Hawaii.advertisement Senior technician Michel Cheong Sang prepares mosquito pupae to be sorted by gender at Institut Louis Malardé in Tahiti. Gregory Boissy for STAT Mosquito control usually involves spraying chemicals and asking people to clean up sources of standing water in their yards.But these traditional methods won’t halt the global spread of disease, said Bossin, who heads the mosquito lab at the Institut Louis Malardé in Tahiti, the largest of the Polynesian islands. Spraying insecticide can be toxic to other creatures. People too easily slip back into habits that allow the insects to flourish; they leave standing water in trash piles, flower pots, pet bowls, and backyard pools. Mosquitoes lay eggs unseen in ship’s hulls and inside packing crates and airplanes, allowing them to spread to new habitats. And people carry diseases from one time zone to another — once bitten by a mosquito, their sickness can be transmitted to others.“Response is a losing battle,” Bossin said, urging more aggressive steps to thwart disease outbreaks before they can start. “All we can do is prevention.”Hervé Bossin and Margaux Jourdainne turn on traps used to capture mosquitoes in Tetiaroa. Karen Weintraub for STATAn ideal natural laboratoryBossin stood outside a research station on Tetiaroa’s main islet one muggy day last month. “A year ago, if you were here during the day, you would have been surrounded by mosquitoes and bitten,” he said. On this day, none was in sight.The tiny island is one of 12 surrounding a turquoise lagoon. The atoll grabbed global headlines when Marlon Brando bought it in 1967. He fell in love with the place while filming “Mutiny on the Bounty” in nearby Tahiti. He also fell in love with his Polynesian costar, Tarita Teri’ipaia, who became his third wife.Several of their grandchildren still live in Tetiaroa; one, Manea, who inherited his grandfather’s jawline, helps Bossin with his research. They share the atoll with an ultra-exclusive, environmentally friendly resort called The Brando, where couples can stay for $2,600 a night; and a research station run by the Tetiaroa Society, a nonprofit dedicated to scientific research that promotes sustainable interdependence between people and nature.Bossin, a medical entomologist, estimates that there were tens of thousands of biting mosquitoes on Tetiaroa’s main islet, Onetahi, when he began releasing sterile males there in September. At the peak of last year’s rainy season, each of the 20 traps he set collected an average of 16 biting females a day. (Only the females suck blood, when they need extra energy to lay eggs.) Now, he’s hard-pressed to find more than a dozen across the whole islet. Are you at risk of contracting Zika virus?Volume 90%Press shift question mark to access a list of keyboard shortcutsKeyboard ShortcutsEnabledDisabledPlay/PauseSPACEIncrease Volume↑Decrease Volume↓Seek Forward→Seek Backward←Captions On/OffcFullscreen/Exit FullscreenfMute/UnmutemSeek %0-9 facebook twitter Email Linkhttps://www.statnews.com/2016/03/03/marlon-brando-mosquitoes/?jwsource=clCopied EmbedCopiedLive00:0001:3301:33  Are you at risk for contracting Zika virus? Your level of risk depends in part on your living conditions. Alex Hogan/STAT Islands, Bossin said, are “ideal settings” for doing this kind of work. They are natural laboratories, a way to start simply, get a clear picture of causes and effects, and then move on to more complex systems, he said.His research is time-consuming and expensive, running about $300,000, half paid by the local and the French governments, and half coming from in-kind contributions from the Tetiaroa Society and the resort. For now, his work is designed to keep mosquitoes away from the tourists, who come to Tetiaroa to fish, snorkel, take in the incredible views, and maybe learn a little science. Bossin is happy to explain his work to anyone who is interested, figuring it can’t hurt for wealthy people to learn about what he does.Some might object to the effort he spends protecting mostly white, rich people. But Bossin, who earned an MBA in addition to his PhD, knows that there will be no jobs for locals if mosquitoes scare off Polynesian pleasure-seekers.If the approach works here, he plans to export it to other resorts across the South Pacific, and maybe the world.“Other resorts and private islands have already expressed interest and are waiting to see the results of our Tetiaroa operation,” he said in an email.On a sweaty, overcast morning last month, Bossin set off in a motorboat steered by Manea Brando to the far side of the lagoon, to two islets he uses as experimental controls — where he hasn’t released sterile mosquitoes.As they eased between sandbars and chunks of coral, young black-tipped and yellow sharks zigzagged by, rays sped just below the water’s surface, and a sea turtle crossed their path.Wading ashore onto the first islet, Bossin and graduate student Margaux Jourdainne headed into the dense coconut groves planted a half-century earlier to boost coconut oil exports.Bossin hurriedly slipped the protective green trash bag off a mosquito trap. He linked the wires of a battery and checked that the tiny fan whirred, sending out an aroma to lure in the insects. He stretched netting over the top to prevent escape and moved on.His motions were fluid and fast. To show why, he stood still for 30 seconds, bare arm outstretched. A mosquito landed and prepared to dine.Bossin could easily have crushed the bug. But he is not that kind of man. He shooed it away instead.Mosquito pupae at the Institut Louis Malardé in Tahiti. Gregory Boissy for STATHumbled by mosquitoesBossin, who spent childhood afternoons absorbed by the insects in his suburban Paris backyard, finds mosquitoes fascinating.There are 3,500 named species of mosquitoes across the world, but only about 200 are a nuisance to humans. In French Polynesia, of the 15 local species, only three – Aedes aegypti, Aedes polynesiensis, and Culex quinquefasciatus – threaten human health.He’s impressed that mosquitoes can survive in so many parts of the world.“Even though I’m working to reduce the damage they do to us, I’m still very humble in the face of such species — such a level of adaptation to the environment,” he said.Bossin was originally headed for life as a “lab rat” studying genetics, he said, but his early work left him feeling he wasn’t making enough of a difference in the world.After earning a PhD in France, he did postdoctoral research for the US Department of Agriculture in Gainesville, Fla., for three years, where he learned to fluently speak the kind of American English that quickly endears him to tourists and foreign colleagues.Bossin greets everyone from hotel staff to scientists by first name and with the French-style quick kiss on each cheek.He worked for the United Nations in Vienna studying mosquito-borne diseases, and in 2005 attended a public health conference in French Polynesia, where he met the head of the Institut Louis Malardé’s mosquito lab. He helped the institute run a field study, and, he said, “a couple of years later, I was the one running the show.”Harnessing bacteria that infect mosquitoesIn a sort of ironic twist, Bossin hopes to stop mosquitoes by infecting them.He’s taking a two-pronged approach: In one, he wants to prevent mosquitoes from spreading disease in populated areas, and in the other, intended for resorts, he aims to get rid of mosquitoes entirely.A bacterium called Wolbachia is his weapon of choice for both. Wolbachia live inside many insect species, including numerous mosquitoes. Infect the Aedes aegypti mosquito with Wolbachia, and the mosquito responsible for spreading dengue, chikungunya, West Nile and other viruses can no longer pass these diseases on to people, a handful of scientific teams around the world have shown.Although this approach still has to be proven effective against Zika, its broad effectiveness suggests it will be. “We have every expectation that they’ll also be resistant to Zika,” said Cameron Simmons, a Wolbachia expert and professor at the University of Melbourne in Australia.Simmons and his colleagues have been testing Wolbachia-infested mosquitoes in field trials for the last five years in Australia, and they are now scaling up their work into larger cities in Vietnam and Java.When a Wolbachia-infested male inseminates an uninfected female, she will never be able to lay viable eggs. But when infested females mate — regardless of the status of the male — their offspring inherit the Wolbachia. This means that over just a few generations, all the mosquitoes in a population will be infested — and apparently unable to spread disease.Simmons anticipates it will cost under $1 per person to release enough infested females to block mosquitoes from passing on dengue. That is far less than spraying or genetically engineering mosquitoes — an approach being tried by other scientists — although he says that a variety of complementary approaches will be needed to contain disease. Karen Weintraub is an independenthealth/sciencejournalist, journalism teacher, and bookauthor. @kweintraub Tags infectious diseasemosquitoesZika Viruslast_img read more

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Pharma and biotech companies: Don’t just merge, innovate

first_img By Patrick Skerrett April 20, 2016 Reprints @PJSkerrett Tags innovationmergerspharmaceutical industry Editor, First Opinion Patrick Skerrett is the editor of First Opinion, STAT’s platform for perspective and opinion on the life sciences writ large, and the host of the First Opinion Podcast. [email protected] First OpinionPharma and biotech companies: Don’t just merge, innovate center_img About the Author Reprints APStock Patrick Skerrett Editor’s note: This article was mistakenly published. It has been removed from the website.last_img

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WHO expands list of possible Zika-related birth defects

first_img By Helen Branswell June 3, 2016 Reprints Senior Writer, Infectious Disease Helen covers issues broadly related to infectious diseases, including outbreaks, preparedness, research, and vaccine development. @HelenBranswell HealthWHO expands list of possible Zika-related birth defects Does getting Zika raise a woman’s risk of birth defects in future pregnancies? The damage the Zika virus can do to a developing fetus appears to be even greater than has been previously understood, the World Health Organization said Friday.The birth defect most commonly associated with Zika has been microcephaly, in which babies are born with abnormally small heads. Citing unpublished findings from Colombia and Panama, however, WHO scientists warned in an editorial that the cardiac, digestive, and genitourinary systems of affected infants can also sustain damage.Some babies born to mothers infected with Zika have also been found to have neurological problems.advertisement Tags microcephalyWHOZika Virus “Most data related to congenital manifestations of Zika infection remain unpublished,” WHO scientists said in the editorial, published in the Bulletin of the World Health Organization.advertisementcenter_img Helen Branswell About the Author Reprints “Further analysis of data from cohorts of pregnant women with Zika virus infection are needed to understand all outcomes of Zika virus infection in pregnancy,” they added.For awhile now, experts studying the babies born to women who were infected with Zika in pregnancy have warned that microcephaly appears to be the tip of a much larger iceberg.Some studies have suggested that as few as 1 in 100 women infected in pregnancy might go on to have a child with microcephaly — though one of those papers said the figure might be as high as 13 percent.But scientists following a group of pregnant women in Brazil who were infected reported that 29 percent of the babies born had birth defects ranging from microcephaly to brain damage to eye problems. Other studies have reported hearing problems in babies born to women infected in pregnancy.The definition of congenital Zika syndrome is expected to expand over time, the WHO scientists said, as more information is received and as follow-up studies of affected children reveal whether they experience additional developmental problems. Related: A mother in Brazil holding her daughter born with microcephaly. Mario Tama/Getty Images The Geneva-based global health agency made a plea to doctors and scientists studying infants born to women who were infected in pregnancy to share more data on their findings, so that that the WHO can better define what is coming to be known as congenital Zika syndrome.last_img read more

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How boxes of infant skulls helped solve a 19th-century medical mystery

first_img WATCH: This operating room changed medical history Every part of the transaction was secret.The grieving mothers couldn’t afford to bury their dead infants, so they sold the tiny bodies. The doctors buying the corpses knew the arrangements were illicit and left no paper trail.These hushed transactions helped build the foundation of anatomy as medical students now learn it.advertisement University of Cambridge Leave this field empty if you’re human: “We found that the anatomists were dissecting them in a completely different way because they are so special. They would dissect them very gently and keep their bodies in the lab for generations to come, instead of reburying them as they did for adults,” said Dr. Piers Mitchell, a biological anthropologist, historian, and pediatric orthopedic surgeon at Cambridge, who coauthored the study.The finding begins to solve a long-standing medical mystery. Historians knew that some anatomists used emaciated young bodies to show their students vasculature and the nervous system, as well as the stages of development. But until now, there was almost no archeological evidence that these infant dissections had ever taken place.Selling cadavers by the inchIn the 18th and 19th centuries, trying to understand the human body at any age often meant breaking the law.In 1752, the British government passed the Murder Act, which allowed the bodies of criminals who had been hanged to be taken by medical professors, but that only provided an average of 77 corpses a year — and some medical schools used as many as 500.So the doctors relied on what they called “resurrectionists”: gangs who stole fresh corpses from graveyards and grieving households. Anatomists also occasionally purchased bodies from impoverished mothers after a stillbirth, an infant death, or, in some desperate cases, infanticide. This illicit trade in corpses was so strong that it continued even after poorhouses began to donate their unclaimed dead. @ericboodman Related: Please enter a valid email address. About the Author Reprints General Assignment Reporter Eric focuses on narrative features, exploring the startling ways that science and medicine affect people’s lives. Related: [email protected] Many of the historical details have been lost — but a paper published Thursday in the Journal of Anatomy reveals the story behind 54 skulls of infants and fetuses stashed away in the University of Cambridge’s department of archeology and anthropology. The earliest was from 1768, the most modern from around 1913.The researchers who discovered the skulls could trace every move the 18th- and 19th-century anatomists made as they studied the small corpses. Instead of the huge incisions often made on adult cadavers, all but one of these skulls showed tiny cuts from knives that were used to delicately divide the skin. There were also grooves left by brushes used to remove soft tissues.advertisement Newsletters Sign up for Daily Recap A roundup of STAT’s top stories of the day. Eric Boodman “It’s such a hidden history,” said Elizabeth Hurren, a historian of medicine at the University of Leicester in England, who has written extensively about dissections in the 18th and 19th centuries.She has looked at more than 30,000 cases of historical dissection and found that doctors always performed a Christian burial when they were done with the cadavers, even if the ceremony had to be held in secret, at night, with a trusted, tight-lipped clergyman from the Church of England.The skulls tucked away in those boxes do not seem to fit that pattern. But to Hurren, this study opens another small window onto a part of medical history that is largely unknown.“It’s a contribution that the poorest have made to medical research,” she said. “We owe the poor … the most tremendous debt in the medical world.” Four horrifying medical procedures we’re glad history forgot By Eric Boodman June 30, 2016 Reprints Tags medical educationmedical research Privacy Policy The mystery of the dissected children emerged, in part, from remains unearthed in old English graveyards. Archeologists found plenty of bodies that bore the scars of dissection — the tops of skulls sawn off, rib cages broken apart — but they were almost all adult men.“People had presumed that they didn’t dissect kids and they just dissected adult males, because we just kept finding adult males in cemeteries who had had their ribs and their skulls cut open,” Mitchell said.Yet there were accounts from grave robbers about selling “smalls” — infant corpses, priced by the inch. And 19th-century English doctors learned and published a lot about the anatomy of the child. Mitchell uses some of that knowledge even today when operating on children.“This was the time [when] people found the structure of the child. All this kind of stuff we only know because of dissections back in the 1800s,” he said.He was curious. So he and his collaborator Jenna Dittmar headed into the anatomic collections at Cambridge, where centuries’ worth of bones are kept in acid-free cardboard boxes. As they zeroed in on the infant skulls, small enough to fit in the palm of a hand, they could pick out the scratch marks left by the dissections and figure out how they were made.Those traces of a gentler dissection technique can explain why archaeologists weren’t finding the sawed-off skulls of children in hospital graveyards. But much about the practice remains mysterious. In the LabHow boxes of infant skulls helped solve a 19th-century medical mystery last_img read more

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Are your doctors lying about how long they worked today?

first_imgFirst OpinionAre your doctors lying about how long they worked today? Christopher Lee Bennett By Christopher Lee Bennett Feb. 1, 2017 Reprints Under controversial rule, first-year medical residents could work longer hours again About the Author Reprints The rules were created for good reasons. Studies have shown that tired young doctors working long hours are more prone to make mistakes. Hoping to reduce these errors and increase safety for both physicians and patients, the ACGME first enacted work hour limits in 2003, and revised them in 2011. Now the organization proposes to change them once again.In spite of these rules, many residents work longer than they should — but keep it to themselves. I see it happen all too often. And though I’ve felt the pressure to work past the limit, I have never done that — and I’m a critic of the practice of under-reporting hours.advertisement [email protected] Why should you care about what looks like an internal matter among medical educators? There is already significant evidence that working long hours puts patients — and providers — at risk for serious medical errors.Instead of addressing underreporting or the culture of guilt and coercion within residency training that drives residents to lie about how long they work, the medical community simply seems to be saying: work longer. The ACGME proposal to boost shift lengths falls short and misses an opportunity to address why residents feel pressured to lie about their hours, an issue that has been ignored for far too long.When we have evidence that residents make fewer mistakes when they work shorter shifts, evidence from the FIRST Trial that longer hours don’t have “worse” outcomes on patients, and evidence of widespread depression and burnout among residents, the default shouldn’t be to ask doctors to work longer. At least not when we also have evidence suggesting that doctors are already working longer than they are supposed to because of guilt and pressure in residency training. Instead, we need to first address the guilt and external pressures in residency programs that already drive residents to work longer hours than they should.If for some reason you find yourself spending some time as a patient in a teaching hospital, ask the residents treating you how many hours straight they have been working. You may get the truth and you may not. If they fess up that they have worked longer than they should have, or if they’ve done that but aren’t telling you, are you OK with that? I know I’m not.Christopher Lee Bennett, MD, is an emergency medicine resident at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston. Why not be truthful about working an extra hour (or 10) each week? When a resident works longer than allowed, his or her residency program gets a “work hour violation.” Too many violations can lead to a warning from the ACGME. In extreme situations, they can be grounds for a residency program losing its accreditation. That can mean losing out on education funds from the Center for Medicare and Medicaid Services; graduates from unaccredited programs can also face trouble getting their medical licenses. Many residents underreport extra hours to avoid these violations.It’s important to ask why residents are working beyond their limits in the first place. Studies of resident work hours show that they exceed their limits to take care of you and your loved ones, to finish adding their notes and other information in patients’ charts, and to complete other tasks.Several colleagues and I recently reported in the New England Journal of Medicine that a significant number of residents exceed the work hour limit because of external pressure from authority figures. Others blame it on internal pressures, such as guilt about leaving the hospital or feeling they are expected to work beyond their limits. These internal and external pressures are alarming given the high rates of burnout, depression, substance abuse, and suicide among resident physicians across the country.We aren’t talking about a few residents underreporting here and a few there. Most do it. National surveys have found that around 60 percent of respondents falsify how long they actually work. Our study found that more than 70 percent worked longer than they should have at least once without reporting it. More worrisome, 60 percent of that group reported routinely exceeding their work hours on an average week.Many in the medical community oppose the current work hour policies. Critics argue that the reforms harm the education of residents by making it difficult for them to follow the care of their patients. They also say that work hour limits increase transitions of care between providers. Many call for a relaxation of these policies, even though a report from the Institute of Medicine offered considerable evidence that long shift lengths place both physicians and their patients at risk.The most recent research on resident work hours comes from a clinical trial of general surgery residents enrolled in the highly influential FIRST Trial. It showed that less-restrictive work hour policies, compared to the current more-restrictive ones, did not result in worse patient outcomes. A soon-to-be-published report in the Journal of the American College of Surgeons by the same authors of the FIRST Trial shows that many physicians at all stages of training violate their work hour limits and are working longer than they should.The ACGME is now proposing multiple revisions to current work hour policies. Among them is replacing the current 16-hour maximum shift length for interns with shifts that could last up to 28-hours without sleep. The weekly limit will remain capped at 80 hours, at least for the moment.center_img America’s resident physicians have strict limits on how many hours they can work in the hospital. Many break that limit and keep quiet about it. Others lie.Resident physicians are the doctors-in-training that millions of Americans come into contact with at teaching hospitals across the country. We work for three to seven years (it depends on the medical specialty) under the supervision of attending physicians. From admission to discharge, we are the often-tired, ever-present doctors who likely take part in your hospital care.We are supposed to follow rules that specify how many hours we are able to work in a single stretch and over the course of a week. As an intern (a first-year resident), I’m not supposed to work more than 16 hours a day and no more than 80 hours a week (averaged over a four-week period). More senior residents can work for 24 hours straight but still can’t work more than an average of 80 hours a week. These limits are dictated by the Accreditation Council for Graduate Medical Education (ACGME).advertisement Related: APStock @cleebennett Fighting the silent crisis of physician burnout Related: Tags educationphysicianslast_img read more

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The truth about ‘man flu’: Does influenza make men more miserable than women?

first_img [email protected] @sxbegle Gut Check looks at health claims made by studies, newsmakers, or conventional wisdom. We ask: Should you believe this?The claim:Men’s flu symptoms are worse than women’s, so when they complain about how much they’re suffering it’s not (just) because they’re big babies.Tell me more:“Man flu” has become an internet meme, complete with its own tongue-in-cheek website dedicated to the proposition that when men catch even a simple cold their symptoms are as bad as if they had influenza, and when they contract actual flu their symptoms are way worse than women’s.A recent study tested that hypothesis. Researchers at the University of Ottawa injected lab mice with molecules from bacteria, which mimic infection with E. coli, salmonella, legionella, and related bugs. They found “an important sex difference” in how the mice’s body temperatures responded, they reported in the journal Brain, Behavior, and Immunity: At the onset of infection, males’ body temperature fell more than females’ did. That would seem to fit with the “man flu” idea that identical infections make males more miserable — in this case, chilled — than females. The male mice’s signs of inflammation were also worse than females’, and they seemed to huddle together more and have droopier eyelids.advertisement The mouse results, however, fall short of proving that men’s flu symptoms are worse than women’s, or that men’s mild infections are as bad as women’s serious ones. For one thing, the experiment used bacteria, not viruses; only the latter cause cold and flu, and bacterial infections are imperfect proxies for viral ones. Also, results in a few dozen mice, while a good start, don’t necessarily reveal much about human biology.More extensive evidence undercuts the notion of man flu. The most important is that immune organs such as the thymus as well as immune cells such as macrophages all have receptors for testosterone and estrogens, so those sex hormones can affect the immune system. In general, testosterone suppresses it slightly while estrogens rev it up, including by increasing the production of microbe-killing antibodies and inflammation-causing proteins. Result: When women catch a virus, their immune systems flood the zone. Related: About the Author Reprints Senior Writer, Science and Discovery (1956-2021) Sharon covered science and discovery. By Sharon Begley March 2, 2017 Reprints There’s no such thing as a male or female brain, study finds That might suggest that men are doomed to be more miserable when they have a flu or other viral infection, as their immune systems take a lackadaisical approach to fighting it. But no. “People think that when we get sick it’s the virus that causes our symptoms, but often those symptoms are from the immune response,” said biologist Sabra Klein of Johns Hopkins Bloomberg School of Public Health. “Cells clogging our airways, proteins causing inflammation, fever, and chills — that’s all immune response to a flu virus. And it is more common in females than males for those responses to go on too long and to be too intense. Testosterone [tamps down] the immune response, so you don’t get the exaggerated response” that intensifies symptoms.The upside of females’ more vigorous immune response is that they generally recover from infections faster than males. Might man flu be more about how long a sufferer suffers, with psychological resilience eventually crumpling in the face of day-after-day symptoms? (The male mice in the Ottawa study took an average of 48 hours to recover, compared to 24 hours for the females.)In the absence of strong physiological data supporting the notion of man flu, “you can look at psychological differences,” said immunologist Laura Haynes of the University of Connecticut, who studies age and sex differences in response to infection. “Maybe men just get whinier.”The verdict:Believers in man flu do not have physiology on their side.center_img Can a flu shot wear off if you get it too early? Perhaps, scientists say Really?Joking aside, sex and gender differences in response to infection is a lively area of research, in part because until a few years ago neither women nor female lab animals were regularly included in biomedical studies.advertisement “My data supports the idea that the man flu isn’t just a myth,” Ottawa psychology professor Nafissa Ismail said in an interview. The findings, moreover, are consistent with animal studies going back to the 1990s finding that “the intensity of infections tends to be lower in females than in males,” Ismail and colleagues wrote, possibly because of how sex hormones — testosterone in males and estrogen in females — affect the immune system. APStock Related: Gut CheckThe truth about ‘man flu’: Does influenza make men more miserable than women? Sharon Begley Tags infectious diseasemen’s healthwomen’s healthlast_img read more

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My work-life balance is tilting toward work. I’m trying to tilt it back

first_img “What’s hot for the weekend?”For graduate students like me, this is a loaded question.It’s asking, however friendly the intent, “What will you prioritize this weekend? Churning out data, or working on your tan?”advertisement In science and medicine, diversity shouldn’t be optional Related: [email protected] Different work styles make the scientific field a richer place, but it doesn’t make the task of setting personal priorities any easier. Like every other scientist, I have to decide how much work I need to do to meet not only the external pressure to publish, but also to satisfy my internal curiosity. I have to figure out what balance of lab time and time spent with my family and friends will maximize my contribution to society and personal happiness. I have to recognize that I will work long hours in blocks, and I will occasionally take days or weekends off.Right now, I have no idea where this balance lies. As the weeks pass, I’m tweaking my schedule; I don’t know if it’s possible to arrive at perfection. But I do know this: If you ask me what’s hot for my weekend, I’ll tell you — it’s the pancakes I’m cookin’, the date I’m going on, or the river I’m lounging by.And I’m not ashamed of that. Newsletters Sign up for Weekend Reads Our top picks for great reads, delivered to your inbox each weekend. Please enter a valid email address. Mike Reddy for STAT Sara Whitlock The bread and butter of biomedical research is publishing research papers to get grants to publish more research papers to get more grants. This means hundreds, if not thousands, of hours of work, of timed experiments that don’t skip weekends, and of model organisms that need to be fed and looked after, even if it’s Friday night.It’s competitive, meaning 10- or 12-hour days are totally normal and expected, even on weekends. And given the ideal — the researcher who works night and day in pursuit of life’s big answers, it’s easy to feel guilty if, like me, your weekend plans often involve more sunglasses than safety glasses.advertisement One reason young people don’t go into science? We don’t fail well Could it be the perception that we’re not curious enough if we leave before dinnertime? That we’re not driven enough if we don’t run the clock out on each and every day? Burning curiosity is a powerful force. It’s the pursuit of that moment when confusing results finally make sense, or realizing after a year of trying that you have figured out how a bacterium infects or a protein folds. That passion for answers doesn’t take breaks for the weekend.For some of us, this kind of drive is harder to manage, because like a carrot dangling off a string, our goal, that answer, that satisfied curiosity is within reach — if we work a little longer, a little harder, just one more hour, or one more experiment. When do we walk away? There aren’t any fixed benchmarks for satisfying curiosity. It’s deeply personal. But over time, the image it creates has become universal.The model scientist has no hobbies, no relationships, and they are consumed by the desire to answer the next question about our inner workings. My classmate is one of them. She recently asked me, “What am I supposed to do, just stop doing my work on Friday and wait until Monday to start again? I’d get bored!” Most scientists have points in their career where they share this feeling — it’s why we take on a profession built on failure.But the realities of life — children or elderly parents, school plays, or even a promising date means many of us can’t spend every waking moment in the lab. Some need to recharge with a novel, cooking, or going on a long run. Without those breaks, they wouldn’t have the energy to keep going in the face of the failures inevitable in scientific research. I’d like to think that all of these work styles have a place in science, and that taking some time off shouldn’t be a cause for guilt. Tags educationresearch Related: Under the MicroscopeMy work-life balance is tilting toward work. I’m trying to tilt it back By Sara Whitlock July 7, 2017 Reprints About the Author Reprints Leave this field empty if you’re human: As I start my second year of graduate school, the enormity of the (hopefully) four-year-long project necessary get my Ph.D. is sinking in. The stack of papers I have to read to learn about my field is ever-growing and the number of experiments I need to design and perform, then troubleshoot and try again when they fail, is overwhelming.My work-life balance ends up tilting toward work, often with a thud, and it’s not easy to tilt it back toward the middle. But I’m trying. After four years of a near-cloistered existence in college, I don’t want to be as exhausted and apathetic as I was when I graduated. I think I’ll be a better scientist in the long run if I can walk away, even for a day, and come back refreshed.I’m not alone.It is possible to fit the work you need to do into a 40- or 50-hour work week. A recent article from Nature presents convincing examples of scientists who limit their time in the lab without hindering their careers. Although they didn’t work the 80-hour weeks many scientists think necessary, these researchers managed to not only publish papers and get funding, they also won awards and excelled beyond colleagues who presumably put in more hours of work.Even knowing this, I still feel twinges of shame if I leave the lab for the evening and don’t plan to read research papers or work on analyzing the data I’ve collected from the day’s experiments. My coworkers stress about taking time away from the lab to spend with family and friends. If it’s possible to accomplish enough to meet the external requirements — getting enough data for papers and winning funding — why do we still feel guilty? Privacy Policylast_img read more

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Hospitals that act as modern-day debtor prisons deny rights and dignity

first_imgFirst OpinionHospitals that act as modern-day debtor prisons deny rights and dignity By Robert Yates Dec. 5, 2017 Reprints @yates_rob Privacy Policy In Nigeria, there are frequent reports of hospitals detaining poor and vulnerable patients, including newborn babies. Two stories were recently reported in local media. One involved a mother and baby being detained for four months at the God Cures Hospital in Lagos after a caesarean section. Another story involved an aspiring politician visiting a public hospital in Osun State in the run-up to a local election and paying the bills of elated patients who had been detained for many months.Hospital detentions are so common in Nigeria and Ghana that there are many stories of politicians releasing medical detainees in the run-up to elections — a gesture which provides an excellent public relations opportunity. In one bizarre example, the wife of a state governor in Nigeria was heralded as a savior for releasing patients from a hospital governed by her spouse.advertisement Around the world, human-rights activists fight on behalf of people imprisoned in unsanitary jails and denied a fair trial. These victims often suffer the double indignity of being mistreated by their captors and deprived of basic services. In many countries, these abuses are not only taking places in prisons, but in hospitals, too.A new Chatham House paper that I co-authored with Tom Brookes and Eloise Whitaker shows that up to hundreds of thousands of people are detained in hospitals against their will each year. Their crime? Being too poor to pay their medical bills. This phenomenon is particularly prevalent in several sub-Saharan African countries, notably Nigeria, Democratic Republic of Congo, Ghana, Cameroon, Zimbabwe, and Kenya, but there is also evidence of it in India and Indonesia.The practice of medical detentions is particularly rife in Democratic Republic of Congo. In one study of a health facility over a six-week period in 2016, 54 percent of women who had given birth and were eligible for discharge were detained for the nonpayment of user fees. In many cases, women and babies are held for months and are denied ongoing health care until their bills can be settled.advertisement Our research shows that in addition to depriving victims of their liberty, these detentions are often accompanied by the denial of medical care and food, and sometimes also by physical and sexual abuse. In another example from Nigeria, a woman spent her hospital detention chained to a urinal pipe. In Nairobi, Kenya, patients at Kenyatta National Hospital claimed in 2015 that they had been pressured into having sex with hospital staff in exchange for cash to help pay their bills.These detentions and associated abuses contravene many international laws and represent a gross violation of human rights. What is particularly shocking is that they take place in health facilities, which are supposed to protect and improve the welfare of vulnerable people.There are two practical steps that every country can take to eliminate this abhorrent practice.The first is straightforward and should be taken immediately by national leaders: ensure that the practice is banned by domestic law, and prosecute hospitals that continue to imprison their patients. There is no legal or moral justification for health facilities to detain people on their premises, in effect holding them hostage until their families settle their bills. A United Nations or World Health Assembly resolution might prove an effective way for countries to outlaw this practice.The second action is more long term and addresses the root cause of this problem: reforming health financing systems so people are not presented with unaffordable medical bills. This requires reducing the use of direct charges to pay for health services and instead moving towards prepaid financing mechanisms that pool contributions from across society. In essence, that means launching publicly financed universal health coverage reforms that ensure everyone can access the services they need without financial hardship. Medical debt is crushing many Americans. States can help fix that Albertine, 19, tends to her twins in the maternity ward at Roi Baudoin Hospital in Kinshasa, Democratic Republic of Congo, which detained her for non-payment of medical fees. Junior D. Kannah/AFP/Getty Images Please enter a valid email address. Leave this field empty if you’re human: Although this plan may seem utopian, in the last decade Turkey and Burundi have succeeded in implementing this dual strategy of banning medical detentions and simultaneously launching successful health financing reforms that have removed user fees for vital services.The example of Burundi, one of the poorest countries in the world, is particularly striking. Following a damning Human Rights Watch report in 2005, President Pierre Nkurunziza realized that the nation’s hospitals had become debtor prisons and released all mothers and babies from detention. But Nkurunziza’s government also recognized the importance of reforming the health financing system. By channeling public funding, including aid, to hospitals, the government was able to remove fees and provide free maternity services. As a result, deliveries in health units quadrupled and, in the following five years, infant mortality declined by 43 percent.If Burundi’s neighbors, Democratic Republic of Congo and Nigeria, which together represent 20 percent of Africa’s population, followed this strategy, the impact on the continent’s maternal and infant mortality rates would be immense. Moreover, tens of millions of women would be free of the fear that their lifesaving hospital maternity care might condemn them and their babies to months of incarceration in a debtor prison.Robert Yates is the project director of the Universal Health Coverage Policy Forum, which is part of the Center on Global Health Security at Chatham House. Related: [email protected] About the Author Reprints Tags hospitalspatients Newsletters Sign up for First Opinion A weekly digest of our opinion column, with insight from industry experts. Robert Yateslast_img read more

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Philippines threatens to sue Sanofi for refusing to issue refunds for unused dengue vaccine

first_img Alex Hogan/STAT Ed Silverman About the Author Reprints Log In | Learn More The Philippine government is not taking ‘No’ for an answer.The health minister is threatening to file a civil lawsuit against Sanofi after the company twice refused to issue a full refund for all dengue vaccine that was used during a recent immunization campaign. The government ended the program last month after learning that Dengvaxia could worsen — rather than prevent — future cases of the mosquito-borne virus in people who had not previously been infected. What is it? STAT+ is STAT’s premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. [email protected] By Ed Silverman Feb. 19, 2018 Reprints Pharmalot center_img Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr. @Pharmalot GET STARTED Philippines threatens to sue Sanofi for refusing to issue refunds for unused dengue vaccine Unlock this article — plus daily coverage and analysis of the pharma industry — by subscribing to STAT+. First 30 days free. GET STARTED Pharmalot Columnist, Senior Writer Ed covers the pharmaceutical industry. What’s included? Tags pharmaceuticalsSTAT+Vaccineslast_img read more

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Oregon legislature passes a drug price transparency bill as more states seek relief

first_imgPharmalot Ed Silverman STAT+ is STAT’s premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. APStock About the Author Reprints By Ed Silverman March 5, 2018 Reprints You may soon be able to add Oregon to the growing number of states with laws that require drug makers to report and justify price hikes for some medicines.In a bipartisan vote late Friday, the Oregon Senate overwhelmingly passed such a bill, 25-to-4, just a few days after the same legislation was approved by the House. The legislation, called the Prescription Drug Price Transparency Act, now goes to Gov. Kate Brown, who is expected to sign it. Oregon legislature passes a drug price transparency bill as more states seek relief Log In | Learn More What’s included?center_img GET STARTED Tags diabetesdrug pricinglegalpharmaceuticalsSTAT+ [email protected] Unlock this article by subscribing to STAT+ and enjoy your first 30 days free! GET STARTED What is it? Pharmalot Columnist, Senior Writer Ed covers the pharmaceutical industry. @Pharmalot Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.last_img read more

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