publishedmedium:the new england journal of medicine

  • Cory Doctorow: Fake News Is an Oracle – Locus Online

    In the same way, science fiction responds to our societal ideomotor responses. First, the authors write the stories about the futures they fear and rel­ish. These futures are not drawn from a wide-open field; rather, they make use of the writer’s (and audience’s) existing vocabulary of futuristic ideas: robots, internets and AIs, spaceships and surveil­lance devices. Writers can only get away with so much exposition in their fiction (though I’ve been known to push the limits) and so the imaginative leaps of a work of fiction are constrained by the base knowledge the writer feels safe in assuming their readers share.

    So the writers write the stories. Then the editors choose some of those stories to publish (or the writers publish them themselves). Then readers choose some of those stories to elevate to the discourse, making them popular and integrating them into our vocabulary about possible futures, good and bad. The process of elevation is complicated and has a lot of randomness in it (lucky breaks, skilled agents, PR wins, a prominent reviewer’s favor), but the single incontrovertible fact about a SF work’s popularity is that it has captured the public’s imagination. The warning in the tale is a warning that resonates with our current anxieties; the tale’s inspiration thrums with our own aspirations for the future.

    Reading a writer’s fiction tells you a lot about that writer’s fears and aspira­tions. Looking at the awards ballots and bestseller lists tells you even more about our societal fears and aspirations for the future. The system of writers and readers and editors and critics and booksellers and reviewers act as a kind of oracle, a societal planchette that our hands rest lightly upon, whose movements reveal secrets we didn’t even know we were keeping.

    Which brings me to “fake news.”

    “Fake news” is a nearly useless term, encompassing hoaxes, conspiracy theories, unfalsifiable statements, true facts spoken by people who are seek­ing to deceive audiences about the identity of the speaker, and as a catch-all meaning, “I read a thing on the internet that I disagree with.”

    But for all that, “fake news” is useful in one regard: the spread of a given hoax, or unfalsifiable statement, or truth delivered under color of falsehood, or conspiracy, or objectionable idea undeniably tells you that the idea has caught the public imagination. The fake news that doesn’t catch on may have simply been mishandled, but the fake news that does catch on has some plausibility that tells you an awful lot about the world we live in and how our fellow humans perceive that world.

    The anti-vaxers have a point. Not about the safety of vaccines. I believe they are 100% wrong about vaccines and that everyone who can should get a full schedule of vaccines for themselves and their children.

    But anti-vaxers have a point about the process.

    About 20 years ago, Purdue Pharma introduced a new blockbuster pain­killer to replace its existing flagship product, MS Contin, whose patent had expired. The new drug, Oxycontin, was said to be safe and long-lasting, with effects that would last an incredible 12 hours, without provoking the fast adaptation response characteristic of other opioids, which drives users to take higher and higher doses. What’s more, the company claimed that the addictive potential of opioids was vastly overstated, citing a one-paragraph letter to the New England Journal of Medicine penned by Boston University Medical Center’s Dr. Hershel Jick, who claimed that an internal, un-reviewed study showed that opioids could be safely given at higher doses, for longer times, than had been previously thought.

    Purdue Pharma weaponized the “Jick Letter,” making it one of the most-cited references in medical research history, the five most consequential sentences in the history of NEJM. Through a cluster of deceptive tactics – only coming to light now through a string of state lawsuits – Purdue cre­ated the opioid epidemic, which has killed more than 200,000 Americans and counting, more than died in the Vietnam War. Purdue made $31 billion. The Sackler family, owners of Purdue, are now richer than the Rockefellers.

    The regulators had every reason to know something terrible was going on, from the small town pharmacies ordering millions of pills to the dead piling up on the streets of American cities and towns. The only way they could miss the opioid crisis and its roots in junk science was if they were actively seeking not to learn about it – and no surprise, given how many top regulators come from industry, and have worked at an opioid giant (and more: they are often married to pharma execs, they’re godparents to other pharma execs’ kids, they’re executors of pharma execs’ estates – all the normal, tight social bonds from the top players in concentrated industries).

    Ten years ago, if you came home from the doctor’s with a prescription for oxy, and advice that they were not to be feared for their addictive potential, and an admonition that pain was “the fourth vital sign,” and its under-treatment was a great societal cruelty, you might have met someone who said that this was all bullshit, that you were being set up to be murdered by a family of ruthless billionaires whose watchdog had switched sides.

    You might have called that person an “opioid denier.”

    #Fake_news #Cory_Doctorow #Science_fiction #Vaccins #Opioides

  • Harvard study estimates 4,645 people died in Puerto Rico due to Hurricane Maria. The official toll is 64. - Baltimore Sun

    At least 4,645 people died as a result of Hurricane Maria and its devastation across Puerto Rico last year, according to a new Harvard study released Tuesday, an estimate that far exceeds the official government death toll, which stands at 64.

    The study, published in the New England Journal of Medicine, found that health-care disruption for the elderly and the loss of basic utility services for the chronically ill had significant impacts across the U.S. territory, which was thrown into chaos after the September hurricane wiped out the electrical grid and had widespread impacts on infrastructure. Some communities were entirely cut off for weeks amid road closures and communications failures.


  • America’s opioid epidemic began more than a century ago – with the civil war | Science | The Guardian

    An estimated two million people abused opiates during the war, after using drugs disseminated by healthcare providers, doctors and nurses to stem pain

    For many Americans, it was the prescription of a well-meaning physician that sent them down the dark road.

    Aggressive marketing and over-prescribing of painkillers touched off a scourge of opiate addiction and Congress, pushed by the destruction it had wrought, introduced a new law to reform painkiller prescribing.

    It was 1915 and Congress was considering what would become the first law to criminalize drug use, the Harrison Narcotic Act. By this time, addiction had already touched middle-class housewives, immigrants, veterans and even physicians hoping to soothe their own aches and pains. Between the 1870s and 1880s, America’s per capita consumption of opiates had tripled.

    More than a century later, Americans are fighting some of the same demons.

    Since 1999, more than half a million Americans have died of drug overdoses. Recent data shows the trend accelerated in 2016, when 63,600 people were killed by overdoses and the rate of Americans dying increased by 21%.

    “There was a massive opioid epidemic after the civil war,” said Robert Heimer, a professor of epidemiology and pharmacology at Yale University School of Public Health. “Except is wasn’t a black market – it was a perfectly legal market filled with patent medicines that contained not just cocaine and opiates, morphine mostly, but also alcohol.”

    Laudanum, Heimer said, “was commonly taken as a relief of colds, coughs, and in stronger form was particularly good for lung diseases such as tuberculosis, which was common at the time, in addition to being widely used in combat situations to facilitate amputations”.

    Where Purdue Pharma marketed Oxycontin to doctors as a “continuous around-the-clock analgesic” formulation of semi-synthetic oxycodone great for chronic pain, Mrs Winslow’s Soothing Syrup marketed morphine and alcohol to parents as a “perfectly harmless and pleasant” way to produce “quiet sleep, by relieving the child from pain”.

    History, Courtwright said, offers some “grounds for optimism”. Beginning in the 1890s, physicians began to criticize colleagues who reached for the prescription pad when patients had aches and pains; pharmacists refused to sell heroin or cocaine (then both legal); and in 1906 muckraking journalists and campaigners successfully argued for reforms to end the sale of patent medicines.

    By 1915, Courtwright argues in the New England Journal of Medicine, “the Harrison Act closed the barn door after the horse was back in”. Problematically, the Harrison Act also became the first law to criminalize drug use and opiate maintenance therapies, such as methadone and buprenorphine.

    #Opioides #Histoire #Addiction #Laudanum

  • How Big Pharma Is Corrupting the Truth About the Drugs It Sells Us | Alternet

    Remember how appalled we felt as a society when we discovered that, for so long, we had been mistakenly taking Big Tobacco’s word that cigarettes are harmless? Rinse and repeat with lobbyists for Big Alcohol fear-mongering about legal weed. And again and again with a panoply of consumer-level commodities and goods.

    Nowadays we have all these familiar worries, but about our drugs and medications instead. It’s become so bad that there’s now reason to believe Big Pharma is also colluding to poison the well of scientific inquiry.

    The truth is, there are many examples of private industry paying for positive press from the scientific community. When you look closer at our spending priorities as a nation, it’s not entirely difficult to see why. As public funding for the sciences has fallen away, many scientists have had to pivot toward more consistent—and ethically fraught—sources of funding and stability as surely as politicians who, for want of public election funding, get buoyed by billionaires at $100,000-per-plate fundraising dinners.

    The Fall of Accountable Science

    Between 2011 and 2012, the New England Journal of Medicine published more than 70 “original studies” of newly FDA-approved and experimental drugs. Of these 70-plus reports:

    Sixty received direct pharmaceutical company funding.
    Fifty were written or co-written by a current employee of a pharmaceutical company.
    Thirty-seven had lead writers who had, at some point, received speaking fees or other compensation from the subject of the study.

    Up until about the 1980s, the federal government was the primary financier of scientific research in the world of medicine. In the ’60s and ’70s, the federal government had a 70 percent share of scientific research. In 2013, that number finally dropped below the 50 percent mark.

    #Conflit_intérêt #Big_Pharma #Pubications

  • These Pharmaceutical Companies Are Making a Killing Off the Opioid Crisis | The Nation

    Profitant du pic de #mortalité aux #opiacés, #pharma augmente le prix du naloxone, leur antidote.

    Amphastar Pharmaceuticals, for instance, raised the average wholesale price of its naloxone, which can be injected or outfitted off-label with an atomizer for intranasal use, from $20.34 to $39.60, according to a December 2016 paper in The New England Journal of Medicine. The price of the popular Narcan nasal spray, manufactured by Adapt Pharma and approved in 2015, has not been raised, but it came on the market in 2015 at a high average wholesale price of $150. The largest price hike was for Evzio, an auto-injector device designed for easy use by laypersons. In 2014, a two-dose package of Evzio, manufactured by kaléo, cost $690. As of 2016, it cost $4,500. That’s more than a 500 percent increase.

    #sans_vergogne #profit #états-unis « #nos_valeurs »

  • Trump’s New CDC Chief Championed Partnership with Coca-Cola to Solve Childhood Obesity

    The new chief of the Centers for Disease Control and Prevention, which monitors significant public health concerns, including the impact of sugary beverages on obesity and heart disease, will be led by Brenda Fitzgerald, a Georgia physician whose signature childhood obesity project was underwritten by Coca-Cola.

    Coca-Cola was so fond of Fitzgerald’s approach to obesity issues that an opinion column authored by Fitzgerald is featured prominently on Coca-Cola’s website.

    Public health officials around the country have made obesity a top issue of concern. The United States has the distinction of having the highest rate of childhood obesity in the world, according to a recent report from the New England Journal of Medicine. And multiple reports have found that regular consumption of sugary beverages is a leading driver of obesity, which is linked to heart disease, diabetes, kidney diseases, cancers and hypertension.

    More exercise, of course, is a good thing, but the Georgia SHAPE program notably eschewed another well-known step toward healthier living: curbing sugary beverage consumption

    The CDC in particular has also been targeted by Coca-Cola, which has long disclosed attempts to lobby the agency to influence public health policy.

    Emails obtained by U.S. Right to Know revealed that executives from Coca-Cola and the International Life Sciences Institute — an organization founded with support from Coca-Cola — had pressured the agency to partner with the soda giant and allow it to weigh in on debates over sugary soft drinks. In one particular email chain with a CDC official, a former Coca-Cola executive discussed strategies for influencing the World Health Organization’s call for greater regulation of soft drinks. The former Coca-Cola executive called the WHO’s efforts a “threat to our business,” and invited the CDC official out for dinner to further discuss ways to sway decisions at the international body. Clyde Tuggle, the former Coca-Cola executive, was included in the email chain.

    #alimentation #conflits_intérêt #boissons_sucrées #obésité

  • Gates Foundation research can’t be published in top journals : Nature News & Comment

    Scientists who do research funded by the Bill & Melinda Gates Foundation are not — for the moment — allowed to publish papers about that work in journals that include Nature, Science, the New England Journal of Medicine (NEJM) and the Proceedings of the National Academy of Sciences (PNAS).

    #open_access #bill_gates (cette fois du bon côté !)

  • Stunning discovery is huge relief for African-Americans

    Scientists have just published new research that indicates that a genetic trait that primarily affects African-Americans aren’t at as high of a risk of dying as had been thought. The findings, which were published in the New England Journal of Medicine, found that those who carry the gene for #sickle_cell_disease may not have an elevated risk of death, according to a Stanford University Medical Center statement.

    Sickle cell isn’t exclusive to African-Americans, but they do make up the majority of sickle-cell sufferers, which is when blood cells become misshapen due to a genetic disorder, resulting in reduced life spans and chronic pain. About one in every 365 black people born in America will get sickle cell disease, which is when they have two copies of this particular gene, and about one in 13 African-Americans have the sickle cell trait, which is when they have just one copy of the gene.

    Previously, scientists thought that those with just the sickle cell trait and not the disease itself were still at an elevated risk of death, and this was backed up by an earlier study. But this new study says otherwise, although it does indicate that those with the trait are more likely to develop a condition where strenuous exercise can cause the skeletal tissue to break down.


    La drépanocytose (du grec drepanon, faucille), également appelée hémoglobinose S, sicklémie ou anémie à cellules falciformes, est une maladie héréditaire qui se caractérise par l’altération de l’hémoglobine, la protéine assurant le transport du dioxygène dans le sang.

    La drépanocytose est une maladie répandue. Elle est particulièrement fréquente dans les populations d’origine africaine subsaharienne, des Antilles, d’Inde, du Moyen-Orient et du bassin méditerranéen particulièrement en Grèce et en Italie. On estime que 50 millions d’individus en sont atteints dans le monde. C’est la première maladie génétique en France, et probablement dans le monde.

  • It’s official: #Zika causes fetal defects - POLITICO

    A CDC study published in the New England Journal of Medicine definitely links the Zika virus with microcephaly and a range of other serious brain defects in infants, confirming what has been suspected for months.

    — Tom Frieden: “There is no longer any doubt” that the virus is leading to an outbreak of brain problems in infants across South America, Central America and the Caribbean. The CDC director added that “never before in history has there been a situation where a bite from a mosquito could result in a devastating malformation.

    — What’s still unclear: CDC pointed out that it’s still learning when during pregnancy the virus poses the greatest risk to the fetus, what other types of birth defects Zika causes, and what percentage of Zika-infected women give birth to affected children.

    • article accessible

      Zika Virus and Birth Defects — Reviewing the Evidence for Causality — NEJM

      The Zika virus has spread rapidly in the Americas since its first identification in Brazil in early 2015. Prenatal Zika virus infection has been linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain anomalies. To determine whether Zika virus infection during pregnancy causes these adverse outcomes, we evaluated available data using criteria that have been proposed for the assessment of potential teratogens. On the basis of this review, we conclude that a causal relationship exists between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Evidence that was used to support this causal relationship included Zika virus infection at times during prenatal development that were consistent with the defects observed; a specific, rare phenotype involving microcephaly and associated brain anomalies in fetuses or infants with presumed or confirmed congenital Zika virus infection; and data that strongly support biologic plausibility, including the identification of Zika virus in the brain tissue of affected fetuses and infants. Given the recognition of this causal relationship, we need to intensify our efforts toward the prevention of adverse outcomes caused by congenital Zika virus infection. However, many questions that are critical to our prevention efforts remain, including the spectrum of defects caused by prenatal Zika virus infection, the degree of relative and absolute risks of adverse outcomes among fetuses whose mothers were infected at different times during pregnancy, and factors that might affect a woman’s risk of adverse pregnancy or birth outcomes. Addressing these questions will improve our ability to reduce the burden of the effects of Zika virus infection during pregnancy.

  • Training to prevent sexual assault halves risk of rape on campus: study | Reuters

    Training female college students to recognize and fend off unwanted sexual advances can halve the risk of rape, experts said following a trial program in Canada.

    The risk of rape for first-year students who took the 12-hour training course was about 5 percent versus nearly 10 percent for a control group who were given brochures and brief information sessions instead.

    The risk of attempted rape was even lower, 3.4 percent, compared to 9.3 percent for students who didn’t receive training, according to the study published this week in the New England Journal of Medicine.

    What this means in practical terms is that enrolling 22 women in the ... resistance program would prevent one additional rape from occurring,” said Charlene Senn, author of the study and a professor at Windsor University in Canada.

    She added that nine out of 10 sexual attacks on campuses were by someone known to the victim.

    Almost 900 students took part in the two-year trial at three Canadian universities.

    Students in the non-control group were given four sessions on assessing the risk of assault and learning self-defense techniques — both verbal and physical.

    A study last month found sexual violence on U.S. campuses had hit “epidemic levels” with more than 18 percent of female students at one university reporting rapes or attempted rapes in their first year.

  • About Nobel laureates and chocolate, correlations and unreliable data

    Is the number of Nobel laureates by country correlated with chocolate consumption? This chart has quickly become very popular on the internet since its publication in 2012 in the New England Journal of Medicine. Visually, the little flags seem to be aligned on an imaginary line showing the amazing correlation between the number of Nobel laureates for 10M inhabitants and chocolate consumption in these countries.
    #cartographie #Nobel #chocolat #corrélation

  • #Resistance Taking Sting Out of Top #Malaria Drug - WSJ

    Resistance to the world’s most effective drug against malaria is becoming widespread in Southeast Asia, a recurrent pattern that threatens global efforts to control the mosquito-borne infectious disease, a new study shows.

    Resistance to the drug, #artemisinin, in the most deadly form of malaria-causing parasite, #Plasmodium falciparum, is established in northern and western Cambodia, Thailand, Vietnam and eastern Myanmar, according to the study published Thursday in the New England Journal of Medicine.

    The research, coordinated by the Mahidol Oxford Tropical Medicine Research Unit in Bangkok, analyzed blood samples from 1,241 malaria patients in 10 Asian and African countries between 2011 and 2013.

    Fear is growing that resistance would spread from Asia to Africa—where progress has been made in reducing deaths from malaria—in a way that neutered previous treatments. So far, three African sites included in the study—in Kenya, Nigeria and Congo—showed no signs of resistance.

    This is the third time that the malaria parasite has developed resistance to drugs. Each time previously it emerged from the Cambodian-Thailand border and spread to other countries, including in Africa.

    Resistance to chloroquine spread from the late 1950s into the 1970s, resulting in a resurgence of malaria infections and millions of deaths. Then, sulphadoxine-pyrimethamine was introduced before a resistance emerged. It was replaced by artemisinin combination therapies.

    Resistance to artemisinin has been driven by the misuse of the drug eroding its efficacy. It takes six days of treatment to clear parasites in patients on the Thai-Cambodian border instead of the standard three, the study found.

    Researchers found that patients whose infections were slow to clear were also more likely to transmit their drug-resistant strain to others.

    Mr. White urged more radical action, such as targeted malaria elimination, to prevent the spread of resistance. The approach would require officials to identify people who are healthy but carry malarial parasites, especially on western border of Myanmar.

    “The artemisinin drugs are arguably the best antimalarials we have ever had. We need to conserve them in areas where they are still working well,” said Elizabeth Ashley, the lead scientist of the study.

    New antimalarial medicines are being developed and have shown some promise, but are unlikely to be available for distribution for several years, another paper published in the New England Journal of Medicine showed.

    #paludisme #moustique

  • Prostate surgery edges slightly ahead of ’watchful waiting’ in study -

    When it comes to prostate cancer, aggressive surgery saves lives and leads to a better quality of life, according to a new study that could inflame the debate over how best to treat the disease — and in some cases, whether to treat it at all.
    The paper, published in the New England Journal of Medicine, is an update on a study that was launched in Sweden, Finland and Iceland a quarter-century ago. Nearly 700 men newly diagnosed with prostate cancer were split into two groups: half had their prostate gland fully removed — a radical prostatectomy — and half were followed through a protocol of “watchful waiting,” where doctors only treated them if symptoms progressed.
    On average, men who underwent immediate surgery lived longer, were less likely to see the cancer spread and had fewer complications from the disease. The longevity benefit was greatest for men in their 50s and early 60s, where over an 18-year period, surgery cut the death rate by more than a third.

    Le papier d’origine #paywall
    Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer — NEJM

    During 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P=0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical prostatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P=0.04).
    Extended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment.

    La suite de l’article de CNN rend la lecture plus confuse, car il donne la parole à des spécialistes non signataires de l’étude qui donnent leurs points de vue. Essentiellement,

    Carroll agrees that mortality is only part of the picture and says the new study underscores a need to better differentiate between high- and low-risk cancers.


  • Maps: The Mysterious Link Between Antibiotics and Obesity | Mother Jones

    via Olivier Pironet

    Lately, I’ve been fascinated by a study on antibiotic prescription rates across the United States that was recently published in the New England Journal of Medicine. The researchers found a surprisingly wide variation among the states, and the rates—expressed in terms of prescriptions per 1,000 people—seemed to follow a geographical pattern: The Southeast had the highest rates, while the West’s were lower. West Virginia had the most prescriptions, and Alaska had the fewest. The rest of the country fell somewhere in between. Here’s a map of the findings:

    #états-unis #santé #obésité #alimentation

  • Eat French fries, gain weight? by Marion Nestle - Food Politics

    The study, which came out in the New England Journal of Medicine last week, looked at the weight gained by more than 100,000 people who had filled out diet questionnaires in 1986 or later. It correlates what people said they ate with weight gained over periods of 4 years:

    The results show that people who said they habitually ate potato chips, potatoes, or fries—as well as the the other foods in the top part of the diagram—were more likely to gain weight.

    (...) What fun! The study assigns pounds of weight gained or lost to specific foods.

    #data #graphique #représentation #nutrition #santé