Newer Epilepsy Drugs Haven't Boosted Seizure Control

Despite the arrival of newer anti-epileptic drugs (AEDs), seizure control hasn't improved in the last several decades, researchers found.

Throughout the trial, there was a marked increase in the use of newer AEDs: the first decade was dominated by carbamazepine, valproate, and phenytoin as initial therapy, while the latter decade was dominated by valproate, levetiracetam, and lamotrigine as initial monotherapy.

"While some modern AEDs have novel anti-seizure mechanisms, their increasing use did not seem to have improved overall long-term seizure control," the authors wrote. "This may be attributed to deficiencies in the preclinical and clinical strategies of AED development," such as enrollees being required to have established epilepsy and a high frequency of seizures.

"The results of this study suggest that the advent of new pharmacological therapies has had little impact on the proportion of newly diagnosed people rendered seizure-free" -- a finding that "is not new and should not be surprising."

Even with the best management, Hauser wrote, "only about two-thirds of people with newly diagnosed epilepsy will be successfully treated ... Resources need to be dedicated to developing anti-epilepsy therapies that interfere with or reverse the underlying disease process, rather than merely identifying agents that suppress seizures."

People Are Taking Ubers to Avoid Ambulance Fees

Using an ambulance to travel to the hospital in an emergency can cost upwards of $1,000 USD. Now research demonstrates that a significant number of people are instead choosing Uber to perform the same service.

The paper – currently being peer reviewed – examines the effect on ambulance usage as Uber was introduced to 766 cities across 43 states. According its findings, even the most conservative estimate shows a seven percent reduction in people traveling via ambulance where the service is available.

“I think it’s, in general, a good thing,” said co-author David Slusky, an assistant professor of economics at the University of Kansas, speaking to Futurism over the phone. “Certainly, we can think of cases where it’s a worrying trend, but in general, it’s a good thing.” Slusky went on to acknowledge the importance of “bending the cost curve” for healthcare in the U.S., given that residents spend more per capita on healthcare than anywhere else in the world.

Of course, it’s crucial that people are only using Uber drivers as an impromptu ambulance when it’s safe to do so. While in some cases it makes sense to save money using this strategy, there are certain situations when it would be ineffective or even downright dangerous to do so.

For example, you may end up in the wrong hospital, said Marc Eckstein, the Los Angeles City Fire Department’s medical director, speaking with CBS.

Not all hospitals offer the same services, so if you get a ride to the nearest one which is not equipped to treat your problem, that hospital will then call 911 and move you to the right facility. “That difference of 30 minutes or more could mean the difference between life and death,” Eckstein said.


The fact that the cost of taking an ambulance to the hospital is inaccessible for a lot of people in the U.S. is a big problem, and the use of ride-sharing services is a workaround at best. However, there are certain advantages to the idea of people taking an Uber when an ambulance isn’t necessary.

“If ambulances aren’t used when they’re less needed, that improves response time when they are needed,” explained Slusky. Again, it’s troubling to think that people might have to weigh the financial repercussions of getting to the hospital in an emergency, but there could be a benefit to giving people a less expensive alternative in non-emergency situations.

Slusky argues that educating the public about what sort of conditions need immediate treatment, as well as an effective method of remote triage before the patient ever reaches the hospital, could help modernize our emergency healthcare. Some kind of sanctioned ride-sharing service could play a role, with ambulances serving as one component of a broader fleet of vehicles with various levels of specialization.

Technology is poised to revolutionize the healthcare industry as we know it, and the current experience of heading to the hospital could be unrecognizable in a few years time. When it comes to emergency services, the biggest problem is re-educating the public. People know the established process for emergency care, and ingraining a new approach will take time and effort.

Should More EMS Responders Be Allowed to Give Glucagon?

For the treatment of hypoglycemia, glucagon may be underused in outpatient settings, researchers argued.

In a nationwide analysis, most states only permit paramedics to carry and administer glucagon for a severe hypoglycemia event -- leaving around 76% of all emergency medical service providers unable to give the agent, reported Peter A. Kahn, MD, of Yale School of Medicine in New Haven, Connecticut, and colleagues.

In some states, emergency medical service responders aren't even permitted to check blood glucose levels, according to a research letter online in Annals of Internal Medicine.

"Patients receiving insulin or certain oral hypoglycemic agents are at increased risk for hypoglycemia, which results in more than 100,000 emergency department visits incurring approximately $120 million in costs annually," Kahn's group wrote, adding that family members often routinely administer glucagon.

The analysis included cases of glucagon administration from the National EMS Information System between 2013 to 2015, as well as prescriptions of glucagon from 2014 Medicare Part D data.

Within this time frame, glucagon was administered in only 89,263 cases in a prehospital setting. Among such instances where glucagon was administered, the average response time to calls for emergency medical services was 15.34 minutes (SD 11.50). Of these, only 3,944 patients reported having any adverse events due to glucagon.

"Emergency medical service response times to episodes of hypoglycemia are crucial in the diabetes chain of survival," the group wrote. "The average response time of more than 15 minutes suggests that policy changes may be needed, because such a delay coupled with policies preventing basic emergency medicine providers from administering glucagon may increase patients' risk for neurologic sequelae, death, or both."

Everything you know about toxic shock syndrome is probably wrong

First off, it’s not just a tampon thing.

TSS is back in the news because a model — who lost her leg to the disease in 2012 — is on an awareness campaign to teach young girls about the dangers of tamponsHer story is horrifying, and is only more depressing now that she may have to have a second leg amputated. It seems all the scarier when you realize that she hadn’t even left the offending tampon in for very long (in fact, based on her telling of it, she felt ill before she put one in).

Every woman I know heard these tales as a kid and had one takeaway: we were all definitely going to get TSS if we left a tampon in for even a minute longer than the prescribed eight hours. In 9th grade I accidentally left one in for 12 hours and genuinely thought I’d narrowly escaped death. But it turns out almost everything that I and other girls my age believed about TSS is flat-out wrong. Let’s clear up a few misconceptions, starting with the basics.

Could you remind me ahem, my friend what TSS actually is?

Don’t be embarrassed. I would venture a guess that most folks don’t really know what TSS is, besides “a horrifying disease that you get from tampons.”

Toxic shock syndrome isn’t really a disease in and of itself. It’s a complication of a bacterial infection. There are two kinds of bacteria, staphylococcus aureus and group A streptococcus, that can produce a toxin called TSST-1 (toxic shock syndrome toxin 1). TSST-1 is a superantigen, which means it prompts the immune system to massively overreact to an infection. The resulting storm of immune cells causes the body to go into shock as inflammation spreads and a fever rises, and if left unchecked will eventually cause multi-organ failure. And the toxin can enter the bloodstream even if the bacteria are isolated to one area, so an infection in a single part of the body can end up killing you. Other toxins can also cause TSS, but TSST-1 is the most common one for tampon-related cases.

TSS is actually really rare

In 2016, the CDC reported a grand total of 323 cases. That’s not insignificant, but is pretty tiny when you consider that there are roughly 63 million women between the ages of 15 and 44 in the United States. That’s a rate of 0.0005 percent. Even fewer people died of it that year — just 26 men and women. This isn’t to minimize those losses, because for the victims and their families, TSS was devastating. But on the spectrum of possible causes of death to worry about, toxic shock syndrome is exceedingly unlikely.

And for all you youths out there who are terrified to leave a tampon in for more than a few hours, rest assured that millions of adults regularly fail to remove tampons in a timely fashion. It’s generally not a problem, and TSS doesn’t often have much to do with tampons anyhow.

A third of all TSS cases happen in men

That’s right — men. Do you know who is arguably the most famous person to die from TSS? Jim Henson, the creator of The Muppets.

Toxic shock syndrome isn’t unique to tampon use, it’s just more common in the tampon-using population. Less than half of all cases involve a tampon, however. The rest of the women have an infected wound of some kind, like a surgical incision from a c-section.

Regular Aspirin Use May Slow COPD Progression

This is startlingly good news.....

Analysis showed 50% reduction in emphysema progression.

Regular aspirin use was associated with a more than 50% reduction in emphysema/chronic obstructive pulmonary disease (COPD) progression in an elderly cohort over a decade in a longitudinal analysis of data from a large lung study.

The association was seen across aspirin doses and was greatest in older study participants with significant airflow obstruction.

Results were similar in ever-smokers and for doses of 81 mg and 300-325 mg. A greater magnitude effect was seen among participants with airflow limitations.

Antidepressant May Help Combat the Course of Multiple Sclerosis

The antidepressant clomipramine may also alleviate symptoms of multiple sclerosis (MS), specifically in its progressive form, i.e. when it occurs without relapses or remissions. As yet, drugs for this type of MS have been virtually non-existent. Researchers collaborating with Prof V. Wee Yong, PhD, from the University of Calgary and Dr Simon Faissner from Ruhr-Universität Bochum screened 1,040 generic therapeutics and, based on preclinical studies, identified one that is suitable for the treatment of multiple sclerosis. They published their results in the journal Nature Communications from December 19, 2017.

Today, twelve drugs have been approved for the treatment of relapsing-remitting multiple sclerosis; for the progressive types, on the other hand, only a few therapy approaches exist. “The mechanisms causing damage in progressive MS are not always the same as in relapsing-remitting MS. This is why the latter requires different therapeutic approaches,” says Simon Faissner. As postdoctoral researcher of the Department of Neurology at St Josef-Hospital in Bochum, he contributed to a study carried out at the Cumming School of Medicine, University of Calgary as a visiting scholar, funded by the grant for medical research awarded by the Ruhr-Universität’s Faculty of Medicine.

Potential side effects already well-documented

The team worked with approved drugs, the side effects of which have already been amply documented. From among those drugs, the researchers selected 249 well-tolerated therapeutics that enter the nervous system safely; this is where chronic inflammation occurs in progressive MS. Using cell cultures, they tested which of the 249 substances are capable of protecting nerve cells from the damaging influence of iron. In MS patients, iron is released due to cell damage, damaging nerve cells in turn.

Following those tests, 35 potential candidates were identified; the researchers subsequently analysed them with regard to additional properties: investigating, for example, if they can reduce damage to mitochondria – the powerhouses of the cells – or if they minimise the activity of leucocytes that attack the insulation of nerve cells in MS patients. In the process, the drug clomipramine proved promising.

Positive results in preclinical studies

In the next step, the researchers analysed the substance in mice suffering from a disease comparable with relapsing-remitting multiple sclerosis in humans. The therapy suppressed the neurological disturbances completely; as a result, damages to the nerve cells and inflammation were minimised.

In a subsequent test, they treated mice with a disease that resembles progressive MS in humans. Here, too, the therapy proved effective, provided the researchers applied it immediately after the first clinical symptoms became apparent. Symptoms such as paralysis were thus reduced – unlike in control animals that were treated with placebo drugs.

Patients Legally Using Cannabis Stopped Or Used Less Opioids & Dangerous Prescription Drugs

Our elected officials and health care providers may hope to curb the opioid epidemic through traditional addiction recovery programs and criminalization, but it’s time for them to consider the potential that medical cannabis has to offer in this effort.

All year, researchers from all over the country have been publishing concrete evidence proving that the legalization of medical marijuana leads to happier, healthier patients. Another study, released this week, has found that patients are replacing their prescription drugs with medical marijuana.

Published in the Journal of the American Medical Directors Association, the study concluded that chronic pain sufferers who were legally able to use medical cannabis eventually ended up using fewer opioids and other dangerous prescription drugs.

By the 10-month mark of being enrolled in the New Mexico Medical Cannabis Program (MCP), patients with chronic back pain, arthritis, chronic headaches, fibromyalgia, and other chronic musculoskeletal conditions significantly reduced their prescription drug use. Over a third of the patients enrolled in the MCP stopped using prescription drugs altogether, compared to only two percent of the non-enrolled participants.

Booming Boise Picks a Fight With CVS

CVS Health, the largest retail pharmacy chain in America, announced early this month that it planned to purchase Aetna, one of the largest health insurance companies. It was a move analysts say was meant to keep the brick-and-mortar pharmacy juggernaut competitive as e-tailer Amazon moves in to disrupt the prescription drug industry.

Over the last few years, CVS has become all-but-synonymous with “drug store” for much of the U.S., wiping out independent pharmacists as its outlets have marched through cities coast-to-coast. CVS has been on a tear during the last decade, with stores in 49 states, Washington, D.C., Puerto Rico, and Brazil. The number of CVS storesgrew more than 30 percent to more than 9,700 from 2012 to 2017. More than 1,600 are located inside Target stores, which in 2015 sold its pharmacies to CVS for $1.9 billion.

The state of Idaho, however, has only two lonely CVS outposts. Both are inside Targets, and neither is in Boise, the fast-growing high-desert capital city of 223,000. The company has been trying to remedy that situation: In October, a developer filed an application to build a single-floor 12,000-square-foot CVS retail pharmacy on Boise’s West State Street, an urban gateway that links multiple neighborhoods to the city’s downtown.

To make space for the store and its parking lot—which would have occupied nearly a city block—the developer planned to demolish three homes and a building with 23 low-income residences, at a time when the city’s downtown is quickly gentrifying and concerns about low-income residents being pushed out are intensifying.

But CVS ran into a chorus of community opposition, triggering a land-use battle that pits the pharmacy chain against a cadre of spirited smart-growth advocates who say that the drug goliath threatens the town’s essential character. Boise has been welcoming an influx of new residents lately—many from high-cost cities in California and the Pacific Northwest—drawn by the relatively inexpensive housing and laid-back outdoorsy vibe. (Boise’s local ski hill, Bogus Basin, is a nonprofit.) Longtime Boise residents don’t want the development that’s coming along with these newcomers to turn Boise into a city indistinguishable from the places they left.

Net neutrality repeal may diminish telemedicine access, harm small practices

“If I can do that, that would be a very healing experience,” he said. “Well, repealing net neutrality may screw that up. They may charge those patients a zillion dollars for the necessary bandwidth I need to communicate and to do my job better.”

Cyber protection, competition

Another hurdle to telemedicine if net neutrality is repealed involves encryption. Everything that is transmitted through telemedicine portals has tomust be encrypted to meet HIPAA laws.

“Say an ISP decides they no longer want encrypted traffic to go across their network because they want visibility into everything that goes across their line. At that point we’re just hoping that they’re going to continue to pass that traffic,” Greg Hall, IT director for the Center for Telehealth at the University of Mississippi Medical Center, told “If they decide they don't want to or want us to pay them additional fees to have the traffic that is encrypted then suddenly we’re stuck. They could very easily block it all and we can no longer do a telehealth encounter because we can’t pass our traffic over our networks. Our business is completely stopped because one ISP somewhere on the chain has decided that they don't like that kind of traffic.”

Even if major ISP providers such as AT&T, Verizon and Sprint continue to operate under the guidelines of net neutrality and do not restrict access, there still could be hurdles to telemedicine, Hall said.

“You have a small rural ISP that decides, ‘Hey, no we don’t want to play all those games, we want to charge a certain fee for certain traffic’ and say that happens to be the video traffic that we push across the internet at some point. All of the sudden, that small little provider, just because we happen to pass some traffic across their network, could very easily cripple access at that point.

“The main concern is not even just, ‘Hey, our bill comes from AT&T every month.’ It doesn't always just go over AT&T lines, so we have to worry about every ISP that our traffic happens to go across to get from one location to another.”

And although major ISPs might say there will be no changes, Hall said there are examples where that has not been the case. Previously, he said, larger providers blocked video applications from going across their network because they competed with another service the provider already offered.

A Milestone for CAR T Cells

More than 7 years have passed since the regression of advanced lymphoma was first reported in a patient who had undergone the infusion of T cells engineered to express a chimeric antigen receptor (CAR) targeting the CD19 antigen expressed on the surface of both normal and malignant B cells.1Subsequent trials of CD19-targeted CAR T-cell therapy showed a complete response in some patients with relapsed or chemotherapy-refractory hematologic cancers for which there were no effective therapies.2-5

The recent approval of anti-CD19 CAR T-cell therapy for the treatment of relapsed or refractory acute lymphoblastic leukemia and large B-cell lymphomas by the Food and Drug Administration sets a new standard of care for the patients who receive these therapies. However, the approval also comes with substantial economic challenges because of the high cost of care, a challenge that will grow as the indications for these therapies expand in the future. Policies will need to be developed to ensure that eligible patients receive these potentially curative therapies.