Investigative journalist takes a trip through America’s opioid epidemic

The U.S. opioid epidemic left roughly 30,000 people dead in 2014 — with overdose deaths outnumbering fatalities from car accidents in 16 states.

In his book, “Dreamland: The True Tale of America’s Opiate Epidemic,” Sam Quinones, a former reporter for the Los Angeles Times, traces the history of this epidemic, and the forces that fueled the crisis to grow, unnoticed and unabated for years.

❝ The story begins in the “ranchos” of one small Mexican community, continues at paid speaker training seminars in Boca Raton, Fla., and slowly unravels in places like Portsmouth, Ohio; Huntington, W.Va.; and Denver.

Quinones met with addicts and others who’ve witnessed the crisis up close. He spoke with scientists, physicians, marketing representatives, and former drug dealers. He spoke with MedPage Today (MPT) about his quest to answer the question — how did this epidemic happen?…

MPT: What surprised you the most when you spoke with healthcare professionals about the opioid epidemic?

Quinones: I guess how many of them actually bought the idea that you could prescribe [opioids] without any consequences. That was weird…but when you have forces of economics and law and culture and peer pressure all in play, things like this can happen…

MPT: What about the environment physicians were working in as the opioid epidemic began to grow?

Quinones: Being a doctor in certain areas is a withering, wearying job, because you are constantly confronted with people whose health is part of a much larger issue — lack of work , maybe a culture of poverty, poor diet, there’s a long list of things. People tend to look at these doctors like keys to life strategies; a linchpin to a survival strategy: ‘Get me workers comp.’ How do I get [supplemental security income]?’ The only way you can get that is with a doctor…

MPT: What responsibility do healthcare providers have for the opioid crisis, and how can they help to resolve it?

Quinones: I feel for doctors. They were in a very difficult place. If they didn’t give people these pills, then people might be in horrible pain, and if they did, they might risk addiction.

RTFA. There’s a lot more – covering a broader analysis. Maybe you should read Quinone’s book.

My central criticism of the epidemic reflects the use of doctors to perform means testing to satisfy conservative creeps in Congress. The concept of healthcare as a privilege, not a right, permeates our politics. It’s lousy economics. It’s lousy politics. Neither of which means much to the beancounters Americans keep electing and re-electing.

Sydney, Australia, high schoolers cooked up $2 malaria pills

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Click link below to the article – and this video

❝ The “pharma bro” who increased the price of a life-saving medicine, Daraprim, by 5,000% has been rattled by a group of Australian school students who managed to make the same drug for $2 per pill.

❝ Former hedge fund manager Martin Shkreli last year bought Turing Pharmaceuticals and almost immediately increased the price of the drug – which has been off-patent since the 1970s – from US$13.50 to US$750 a tablet.

The drug is used to treat certain types of malaria as well as toxoplasmosis, a rare and life-threatening infection caused by the Toxoplasma parasite which particularly affects people with weakened immune systems, such as those with HIV.

❝ To show how exorbitant Shkreli’s pricing of the drug was, a group of year 11 students aged 16 and 17 from Sydney Grammar aimed to recreate the drug molecule in their school laboratory under the guidance of Dr Alice Williamson and Associate Professor Matthew Todd from the Open Source Malaria consortium.

They succeeded, making the drug for a mere $2 a pill

❝ On Twitter Shkreli dismissed what the students achieved, saying “how is that showing anyone up? Almost any drug can be made at small scale for a low price”.

❝ Williamson told Guardian Australia showing how cheap and easy the drug was to produce was part of the point of the project, as it highlighted how unfair Shkreli’s pricing of the drug was…“I like to let the work speak for itself.”

The kids are all right. Shkrell is still a creep!

Thanks, Honeyman and many others

America, you can eat gluten again!

❝ In fact, most of you always could. That isn’t stopping the food industry from making a mint on gluten-free products.

❝ Only 1 percent of the U.S. population has been diagnosed with celiac disease, yet gluten-free products are still filling up—and flying off—grocery store shelves. U.S. sales reached $1.57 billion last year, up 11 percent over 2014, according to data from Packaged Facts.

Sure, that growth has slowed — it was at 81 percent in 2013. But it still runs laps around the grocery sector’s overall growth of 3 percent. In the cereal aisle, for example, where sales have been declining for the past decade, claims such as “gluten-free,” as well as “GMO-free” and “no high-fructose corn syrup” have made for one of the few bright spots, according to a recent Nielsen report…

❝ Avoiding gluten while dining out is also getting easier. Although some restaurants are now celebrating grain, others are touting their gluten-free options. “Gluten-free” was on 23.6 percent of menus this year, beating out “organic” (21 percent), “locally” (14.2 percent), and “all natural” (8.9 percent), according to DataSsential Menu Trends. That’s a big jump from 2014, when it was on only 15 percent of menus, and organic was still the health term to beat, appearing on about 19 percent of U.S. menus…

❝ For those diagnosed with celiac disease or a gluten sensitivity, the sudden boom in tasty, sort-of-affordable gluten-free foods is a “blessing”…But only 15 percent of consumers make these purchases because a member of the household has a gluten sensitivity, and only 9 percent make them for a member with celiac disease…

❝ The top reason for purchase? Thirty percent responded that “some products that I buy for other reasons are marked gluten-free.” Nearly as many — 29 percent—said they buy them because “gluten-free products are generally healthier,” and 20 percent said they make the purchase to manage their weight. Other surveys confirm these findings. NPD Group found that about one in four consumers thinks “gluten-free is good for everyone.”

Healthcare professionals say this is a misconception — people without a related diagnosis don’t need to avoid gluten.

I didn’t have to sit around waiting for Bloomberg to publish this little article. As is my habit, when I see food purveyors ramping up production of something that reads like a fad diet, I start looking for articles from recognized sources of medical and nutritional information based on science – not profit or popularity.

I’d already learned the size of the legitimate market. I was able to compare that to what I saw in the markets where I shop. Fortunately, folks working in local stores belonging to national chains specializing in natural and organic foodstuffs have an obvious sense of humor. Signs appeared in both stores for gluten-free water, gluten-free carrots, and on and on.

Yes, they carried a chunk of the newly-expanded catalogue of wheat-free, gluten-free products. Some folks need them. Provide useful access for those who benefit and you may as well sit back and get your share of the fad from the rest.

RTFA for more details. Think you have a problem with nutrition? Consult a good doctor. Hopefully, you already have one. There are plenty around, at least, it feels like it in my neck of the prairie.

Here’s a mosquito bite you don’t want to look forward to!


James Gathany

Most people hate mosquitoes, and who could blame them? At best, we associate mosquitoes with itchy red bites. They also happen to be our most deadly animal adversary: 400,000 people died of malaria alone in 2015, which was a huge improvement from death tolls in recent years. The recent spike in Zika cases — and the spread of the disease into new regions like North America, thanks to global warming — has researchers working even harder to understand how the insects got so good at transmitting pathogens and how we might stop them.

❝ But if you think Zika sounds bad, just imagine contracting that virus and another exotic ailment from the same irritating little mosquito. According to new research from Colorado State University, that’s totally possible: The scientists were able to infect mosquitoes with both Zika and chikungunya, a virus that causes fever and joint pain in humans. And when they tested the amount of mosquito spit that would usually go into a single bite, they found enough copies of those viruses to simultaneously infect a human host. The team also confirmed previous reports that chikungunya and dengue virus could shack up in the same mosquito. It remains to be seen whether a nasty trifecta is possible, but all three of these viruses have been spotted in North America in recent years…

❝ The findings, Greg Ebel readily admits, are still preliminary—and the results don’t suggest that these concurrent outbreaks are common. In fact, he and his team aren’t even sure what would happen if a human was simultaneously infected with Zika and chikungunya at the same time…

But while it’s tempting to freak out over the possibility of a double or triple viral infection, Ebel and his colleagues are more concerned with how the viruses might interact inside mosquitoes than they are with theoretical human symptoms. The human scenario is a little too far-fetched to prompt immediate concern, but if the viruses behave strangely when they end up in the same mosquito, that could have implications for the transmission rate of any of those illnesses in humans.

Frequently, I note the unforeseen successes that roll out of basic research. Scary stuff happens as readily, perhaps more often. All the more reason to continue searches simply to extend human knowledge.

A tiny USB drive will soon tell you if you have HIV — and how much

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❝ Rapid, at-home HIV tests aren’t new: OraQuick, which was released with much fanfare in 2012, provides reasonably accurate results using an oral swab in just 20 minutes. That product allows those who might not otherwise get tested for HIV — because of stigma or lack of access to treatment — to have a better chance of detecting the disease early and getting to a doctor.

But a new at-home device promises to do one better: Using a drop of blood, the USB stick test can actually detect the amount of virus present in a patient’s bloodstream in just half an hour. While OraQuick helps individuals figure out their HIV status so that they can seek medical treatment, the new device described this week in Scientific Reports could show a patient how well their ongoing medical treatment is working — and how transmissible their HIV might be…

❝ Why is that important? The more HIV virus present in a patient’s blood, the more taxed their immune response. A patient with a higher viral load will have fewer of the white blood cells that protect them from other infections. If HIV is allowed to run rampant in the bloodstream, patients can develop AIDS. But if anti-retroviral medication is used to lower the viral count — these days, often to zero — a patient can live normally, in good health and with a typical lifespan…

❝ More research is needed to confirm the accuracy of the device, and making it widely available across HIV-ravaged regions would be no small task. But the idea that monitoring HIV status could soon be as simple as checking blood sugar levels is certainly appealing, and provides hope that researchers may one day be able to all but eradicate the virus.

Bravo! Hopefully, to be manufactured and distributed by a firm with as much heart as profit motive.

A new way to die in the West — thanks to Colorado

❝ Apart from the presidency, Tuesday’s election offered some interesting results for the way Americans meet their ends. In Nebraska, Oklahoma and California, voters supported restoring or accelerating the death penalty.

Meanwhile in Colorado, voters approved a measure that will allow terminally ill people to end their own lives. This makes it the sixth state to offer such an option.

❝ Assisted suicide allows a terminally ill person to buy — with a doctor’s permission and evaluation — a barbiturate, usually pentobarbital or secobarbital. These drugs depress central nervous system function, and can be used as anti-convulsants or anesthetics. At high doses, they cause death.

Colorado’s ballot initiative passed overwhelmingly, with two-thirds of voters in support and just one-third opposed…

❝ Colorado’s new law was modeled after Oregon’s “Death with Dignity” law, which passed 22 years ago. The much-publicized assisted death of 29-year-old Brittany Maynard in that state was a central aspect of the campaign in Colorado; her husband, Dan Diaz, has been working to change the law in other states…

California, Vermont and Washington have similar laws that allow some form of medical aid in dying. In Montana, people can be given the option through case-by-case court approval. Canada, Belgium, the Netherlands, Luxembourg, and Switzerland also allow medically assisted death…

Nicest thing about the Colorado law? C’mon, you already know the answer to this one. In Colorado you can get stoned on the way out – making the experience a bit easier on the decision-maker.

Why was the last Ebola epidemic so much worse than previous?

❝ In late 2013, the Ebola virus began spreading through a small village in the West African nation of Guinea following human contact with an animal, likely a fruit bat. This was the start of what turned out to be the most widespread of all recorded Ebola outbreaks, resulting in 28,646 confirmed and suspected cases of illness, and 11,323 recorded deaths.

The unprecedented outbreak left a devastating toll on the social and economic infrastructure in West Africa, but it also forever changed the perspective from which virologists and epidemiologists study and track infectious diseases.

❝ Kristian Andersen…set out to determine why the recent epidemic was different from previous Ebola outbreaks. Specifically, his team wanted to figure out exactly how the virus spread so rapidly—and why it had such devastating effects on the people infected.

❝ Ebola is in a category of viruses that are especially prone to mutations because they lack the ability to correct mistakes during replication. This means that a virus such as Ebola can rapidly change as it spreads, for example, by evolving into a more deadly virus. That is the scenario that appears to have played out during the epidemic in West Africa.

But how? As described in a paper in the recent issue of Cell, a peer-reviewed scientific journal focused on the life sciences, Andersen and his group found what could be the smoking gun: a mutation—dubbed the GP-A82V mutant—on a particular type of protein, the viral receptor glycoprotein, in samples of the virus from the epidemic. This mutation increased the ability of the virus to infect human dendritic cells, the type of immune cells that the Ebola virus uses to make copies of itself.

A few more links in the article are useful for further perusal. I think we’re all fortunate that Andersen’s study landed on target in a reasonable stretch of time. No one knows when and exactly where the next outbreak of Ebola will strike. Perhaps by then his research will have better equipped other medical professionals to fight back and save more lives.

Trump won — So did marijuana, gun control and minimum wage


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❝ …Not all is doom and gloom. While Democrats lost big, liberals won some of the big initiatives that were on statewide ballots. It wasn’t a total sweep — several states, for example, affirmed the death penalty — but there were gains on some issues, including marijuana legalization, minimum wage, and gun control.

The full results paint a much more mixed picture than the top-ballot results suggest: The Democratic Party got clobbered, but some of the major policies Democrats support also won big.

1) Democrats mostly — but not entirely — lost in the state races

Four houses in 3 states – including here in New Mexico went the other way. And liberal control of our state Senate expanded. Not an accident. Hard work since the racist danger of tea party Confederates became obvious – has paid off.

2) Three — and maybe four — states legalized marijuana

❝ Voters in California, Massachusetts, and Nevada opted to fully legalize marijuana for recreational purposes. They join Alaska, Colorado, Oregon, Washington state, and the District of Columbia in legalizing pot.

Legalization was also on the ballot in Maine, but the race is too close to call…

Voters in Arkansas, Florida, and North Dakota also opted to legalize medical marijuana. And voters in Montana voted to ease their state’s rules on medical marijuana. No state voted against allowing pot for medicinal purposes.

3) Four states approved a higher minimum wage

❝ Arizona, Colorado, Maine, and Washington state all considered raising their minimum wages to $12 an hour. And the proposal won in all four of these states.

4) Three states passed new gun control measures

❝ California, Nevada, and Washington state all approved new restrictions on guns, while Maine narrowly rejected more gun control measures.

Progressive and Liberal policy ideas had a better night than the Democrat establishment. Many local ballot initiatives succeeded in moving the quality of life forward in states and cities around the country.

Guess what? The kind of activism that produced those victories need to continue and multiply if we’re going to maintain any semblance of sanity. Get ready for the mid-term election in 2018. Prepare yourself for the redistricting fight beginning in 2020. Time to sort out one of the major avenues of backwards political thought in Western Democracies.

No surprise; but – teens vaping links to higher smoking later

Los Angeles area teens who reported regular e-cigarette use were more likely to be smoking cigarettes 6 months later, researchers found, with more frequent vaping associated both with a higher likelihood of smoking and with heavier smoking at follow-up.

Adjusting for baseline smoking, each increment higher on a four-level baseline frequency continuum was associated with a roughly two-fold greater odds of smoking and heavier smoking…

The growing evidence that vaping increases the risk for smoking uptake among teens suggests that this transition “may warrant particular attention in tobacco control policy,” the researchers noted…

“Showing teen vaping to be associated with progression to more dangerous patterns of smoking raises red flags and has public health implications.”…”When teens who vaped on a weekly basis were compared to those who had never smoked an e-cigarette in their lives, the vapers had a 10-times greater odds of progressing to smoking,” Adam Leventhal said…

This research was funded by grants from the National Institutes of Health.

Seems pretty sensible to me. How would you expect anything different about behavior with an addictive substance like nicotine?