It’s difficult to imagine a world without antibiotics. They cure diseases that killed our forebears in droves, and enable any number of medical procedures and treatments that we now take for granted. Yet in 1945, while accepting a Nobel Prize for discovering penicillin, Alexander Fleming warned of a future in which antibiotics had been used with abandon and bacteria had grown resistant to them. Today, this future is imminent. Speaking to reporters last fall, Tom Frieden, the director of the Centers for Disease Control and Prevention, sounded a similar alarm: “If we’re not careful, we will soon be in a post-antibiotic era. In fact, for some patients and some microbes, we are already there.”
CVS/Caremark announced this morning that it will stop selling tobacco products starting October 1.
The pharmacy chain said selling cancer-causing products was incompatible with its overall mission of improving health, both through its pharmacies and its MinuteClinic walk-in primary care centers. The company will forgo $2 billion in annual tobacco sales by no longer carrying the number-one cause of preventable death.
“We have about 26,000 pharmacists and nurse practitioners helping patients manage chronic problems like high cholesterol, high blood pressure, and heart disease, all of which are linked to smoking,” Larry J. Merlo, chief executive of CVS, told the New York Times. “We came to the decision that cigarettes and providing healthcare just don’t go together in the same setting.”
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We got the human genome a decade ago. Where are the drugs?
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IBADAN, Nigeria — Marcus Chukwu was having a hard time coming to terms with the idea that he should refrain from evangelizing to a patient on his deathbed. “Religion is always effective, when the patient gets to the end of the road,” said Chukwu, who works as a nurse at an Anglican hospital in the southwestern Nigerian city of Ibadan. “When you are seeking medical help, and you know there is nothing left to do, then the next step is God; even a Muslim, in that situation, 70 percent of them will go to church.”
Chukwu and a handful of colleagues were gathered around a horseshoe of folding tables at the Center for Palliative Care in Ibadan, a cream-colored stucco bungalow that houses Nigeria’s oldest hospice program, established in 2007. The occasion was a three-day “Training for Carers”, which for the first time included a session on the role of spirituality and religion in end-of-life care. As an oversized fan hummed in one corner, Chukwu and other caregivers working for local religious organizations went over the basics and boundaries of palliative care.
Life-threatening illness can bring anyone face to face with the supernatural. In Nigeria, though, the supernatural peers out from posters and billboards everywhere. It invites you to attend “Miracle Arenas” and “Anointing Revivals,” and reminds you in block letters on hospital walls, “We care, God cures.” Nigeria is roughly 50 percent Christian, and an increasing number of the faithful are “Renewalists,” a subset of Protestant Christianity including Pentecostal and so-called Charismatic churches, whose adherents believe in God’s ongoing intervention in daily life. This is thought to occur through the physical presence of the Holy Spirit, which possesses believers and wards off illness and all manner of misfortune.
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"We believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough."
So reads an authoritative editorial today in one of the widest-read U.S. medical journals, Annals of Internal Medicine. The authors are five physicians from Johns Hopkins School of Public Health and Warwick Medical School in the U.K., including one of the journal’s senior editors. Each has at least five letters worth of postgraduate degrees after their name.
"Beta-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful,” they specify. “Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases.”
The year in review, from the editors of The Atlantic’s Health channel
Some people with potentially lethal gut infections find that the only effective treatment is an orally-administered fecal transplant. The treatment is gaining acceptance among physicians.
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Abraham Lincoln often spoke and dreamed about being assassinated, convinced that he would not outlast the rebellion when his work would have been done. Prior to his inauguration, he received letters warning him that he would be killed before reaching Washington. After he died an envelope with eighty such letters was found among his eﬀects, and although twice while president he had his hat shot from his head by unknown assailants, he deprecated all attempts to guard his life.
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On April 28, 2009, a box containing a newly isolated virus showed up at Doris Bucher’s lab. She and her colleagues at New York Medical College opened it up right away. Thousands, or perhaps millions, of lives might depend on what they did next.
The virus was a new kind of influenza, known as 2009 H1N1. It had abruptly started spreading across North America in the previous month, and was beginning to appear in countries around the world. Once scientists at the Centers for Disease Control and Prevention analyzed it, they realized that the vaccine already in production for the next flu season probably wouldn’t be effective against it. And because it was so new, people’s immune systems might also be unable to stop the virus, which meant that it could become a global outbreak—a pandemic.
No one knew how bad 2009 H1N1 might prove to be, but the experts did know that the virus had the capacity to be very bad. Flu pandemics had occurred three times in the previous century, and the worst of them, the so-called Spanish Flu of 1918–19, had killed an estimated 50 million people. It, too, was an H1N1 virus. Once researchers at the CDC got hold of the 2009 H1N1 virus, they had one urgent mission: make a new vaccine.
The first step was to send batches of the virus to a handful of vaccine experts like Bucher. As soon as she received her supply of 2009 H1N1, she got to work on creating a “seed stock” of modified viruses that could be used to produce hundreds of millions of vaccine doses. Manufacturers for the most part still make flu vaccines the way they did in World War II: in chicken eggs. Bucher had to transform the viruses, which grow very well in human airways, so that they would grow very well in eggs.
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Medical treatment for elderly, chronically ill patients is costly and often ineffective. Why better care may be found outside the hospital system.
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