Wednesday, 30 May 2018

Roseanne and Ambien: Racism won't Be a Side Effect

Roseanne

Roseanne and Ambien: Racism won't Be a Side Effect, But There Are Many, Many Others

The Roseanne saga took an unexpected turn in the week because the actress returned to Twitter to elucidate that the tweet that led to the cancellation of her show was sent out while she was on Ambien.

Sanofi, the drug company that creates the drug, fired back a tweet of their own.

“People of all races, religions, and nationalities work on Sanofi a day to enhance the lives of individuals around the world,” the corporate said.

“While all pharmaceutical treatments have side effects, racism isn't a known side effect of any Sanofi medication.” By mid-day, #Ambien was one of the highest trends on Twitter.

It maybe true that racism isn’t a side effect, but that doesn’t mean there aren’t many, many other side effects to the drug.

In fairness, it might have required quite an epic Twitter thread for the corporate to list all of them.

In my book The Sleep Revolution, I spent the higher a part of a chapter writing about so-called sleep aids (just because you’re not awake doesn’t mean you’re asleep) and therefore the very real dangers they pose, which can outlive the present twitter feud.

So whether or not you've got a while suddenly freed up by the cancellation of the Roseanne reboot, here’s an abridged version of that chapter.

SLEEPLESSNESS AND SLEEPING PILLS: A MATCH MADE IN BURNOUT HEAVEN?


An entire industry has arisen to facilitate our attempts to urge more sleep.

In us, quite 55 million prescriptions for sleeping pills were written just in 2014, with sales topping $1 billion.

A 2013 Centers for Disease Control report stated that 9 million Americans—4 percent of all adults—use prescription sleeping pills.

It also found that ladies are bigger users of sleeping pills than men; that sleeping-pill consumption increases with age and education, which white adults consume quite the other racial group.

I asked several sleep experts what they thought of the 4 percent number from the CDC, and therefore the general conclusion was that the survey number involved significant underreporting.

A National Sleep Foundation poll found startlingly high rates of sleep aid usage among women, with 29 percent reporting that they use a sleep aid of some kinda minimum of a couple of nights hebdomadally.

The survey by Parade magazine of quite fifteen thousand people found that 23 percent of respondents took sleeping pills once every week and 14 percent took them nightly.

the matter is global: in 2014, people around the world spent a staggering $58 billion on sleep-aid products, a figure projected to rise to $76.7 billion by 2019.

Not surprisingly, the utilization of sleeping pills is highest among those that regularly get but five hours of sleep an evening.

For the drug industry that stands to take advantage of today’s sleep crisis, business is sweet and therefore the future looks bright.

But the strength of this market is simply a mirrored image of the depth of the matter.

And although marketers use the soothing term “sleep aids,” burnout is that a necessary condition that feeds the sleep-aid market.

“In twenty years, people will reminisce on the sleeping- pill era as we now reminisce on the acceptance of cigarette smoking,” Jerome Siegel, director of UCLA’s Center for Sleep Research told me.

“Movies and television glamorized smoking. Advertisements, often with doctors or actors posing as doctors, were wont to sell cigarettes.

”Only after a few years and lots of studies linking cigarettes to carcinoma and other diseases did the govt step in to manage tobacco advertising.

So we may have moved beyond the age of Joe Camel and advertisements proclaiming “More doctors smoke Camels than the other cigarette!” and “Give your throat a vacation . . . Smoke a fresh cigarette,” but as Siegel put it, “history appears to be repeating itself.

The chronic use of sleeping pills is an ongoing public health disaster.”

Sleep difficulties can become serious medical problems, as I discuss within the Sleep Disorders chapter.

For the overwhelming majority folks, however, sleep difficulties are a life-style
problem. Yet we tend to treat all our sleep-related woes an equivalent way: with a pill. this is often hubris on the size of Greek mythology.

We expect as if by magic, to wrestle sleep into submission.

This isn’t accidental. Combine the marketing power of the fashionable pharmaceutical the industry with a client market that has, potentially, every fatigued and burned out worker—which is to mention nearly every worker—and you’ve got the makings of the juggernaut that's the fashionable sleep-aid industry.

 As Matthew Wolf- Meyer put it within the Slumbering Masses, by “empowering medical practitioners, pharmaceuticals, and caffeine as mediators in individuals’ relationships with sleep,” we've created a world where “rather than a mild sovereign, sleep has become demonized and rendered an object of medical and scientific control.”

As numerous folks blow out in our efforts to stay up in today’s high-pressure, always-on world, we’ve made it easier and easier for the pharmaceutical industry to tighten its grip on us and expand its reach.

Instead of questioning how we live our lives, we fall prey to stylish marketing that promises us health, happiness, sleep, and energy.

And who wants to be the naysayer, the Luddite who rejects such progress? an excellent deal of ingenious and insidious brainpower, alongside billions of dollars, goes into selling us an answer that doesn’t actually solve our problems but only disguises and prolongs them.

The most common pharmaceutical weapon we use to knock ourselves out is that the drug zolpidem, which you almost certainly know as Ambien.

It accounts for quite two-thirds of the sleeping pills sold within us.

It is also sold under the soothing names Intermezzo, Sublinox, Zolfresh, and Hypnogen.

That the last one is a component peculiarly apt since zolpidem is part of a category of medicine referred to as hypnotics, which work to induce and lengthen the duration of sleep.

Of the 55 million prescriptions written for sleeping pills within us in 2014, 38 million were for zolpidem, accounting for sales of quite $320 million.

Lunesta, another hypnotic, marketed with a seductive green butterfly logo, had quite $350 million in sales within us in 2014, which figure doesn't include the generic version, eszopiclone, which generated another $43 million.

When you hear the stories of individuals who became hooked into sleeping pills, you realize that they really shouldn’t be called sleeping pills in the least.

Because we now know that simply not being awake doesn’t necessarily mean you’re actually asleep.

It’s not the clean, binary, game the drug manufacturers would have us believe.

This is why sleeping pills aren’t the answer to our sleep-deprivation crisis—they’re another crisis masquerading as an answer, offering a false promise that takes us beyond the advantages of real, restorative sleep.

Harvard school of medicine professor Patrick Fuller explained to me the difference between natural sleep and drug-induced sleep.

Sleeping pills typically target just one of the various different chemical systems employed by the brain as a part of the sleep process, which “necessarily produces an imbalance within the chemical signaling by which the brain achieves normal sleep and should limit restorative slow-wave sleep.

The newer drugs like Ambien produce more naturalistic sleep but can have side effects, albeit rarely, like sleep eating and sleepwalking, which by definition aren't a neighborhood of normal sleep behavior.”

This limbo state, once we aren't really awake but not really asleep, may result in behaviors starting from the harmless and humorous to the disturbing and dangerous.

And a part of the danger is that you simply will quite likely haven't any memory of whatever you are doing.

The Today show’s Julia Sommerfeld was a daily user of Ambien until what she describes as her “wake-up call.

” Her Mastercard company called to report suspicious activity on her account—nearly $3,000 charged to the shop Anthropologie at 2 a.m. Her initial reaction—a fraud! was quickly disproven, within the sort of an e-receipt at the highest of her inbox: she had been the perpetrator of an Ambien-induced online shopping spree.

On other occasions, while on Ambien, she had also consumed large quantities of sugar right out of the bag devoured two of her sons’ decorated Easter eggs, and written an embarrassing email to her boss.

What finally got her to kick the hypnotic habit was her husband invoking their toddler son.

“How are you able to make certain you’d never hurt Jude?” he asked.

“What if you made the decision to place him within the car?” actually, during a University of Washington study, people that took generics of Ambien, Desyrel, or Restoril was nearly twice more in danger of being involved during a driving accident.

In response to growing concerns, the FDA in 2013 cut the recommended dose of zolpidem in half—in half!—for women and commenced requiring stronger warning labels highlighting the risks of driving an automobile after taking extended-release versions of the drug.

it had been a big step forward—as well as a dramatic, unequivocal acknowledgment of how the drug manufacturers are allowed to take advantage of a sleep-deprived public for therefore long.

Ambien has also been used as a defense in criminal trials—a pharmaceutical version of the “Twinkie defense.”

On The Fix, a site about recovery and addiction, Allison McCabe told the story of Lindsey Schweigert, a thirty-one-year-old working for a contractor.

Returning from a business trip exhausted, she took one dose of generic Ambien.

Several hours later, when she emerged from her zombie state, she was in police custody.

She’d gotten out of bed, filled the bath and left the water running, taken her dog out, climbed into her car, and, while driving, collided with another car.

She failed a sobriety test after falling 3 times when asked to steer a line.

The police charged her with driving under the influence.

Prosecutors sought a sentence of six months, but Schweigert’s lawyer pointed to the warning the label on the Ambien she took and argued that she belonged within the hospital, not jail.

The label read: After taking Ambien, you'll rise up out of bed while not being fully awake and do an activity that you simply don't know you're doing.

the subsequent morning, you'll not remember that you simply did anything during the night. . . . Reported activities include: driving a car (“sleep-driving”), making and eating food, talking on the phone, having sex, sleepwalking.

Put aside for a flash the absurdity of this label and therefore the incontrovertible fact that it exists.

Or file it under Warning Labels Apparently Written by The Onion.

The charges were dropped, though Schweigert was left with a suspended license and nearly $10,000 in lawyers’ fees.

The more of those stories I hear, the more shocked I'm at the number of individuals who walk off from such incidents with similar consequences—a suspended license, a financial burden, but ultimately nothing more.

Because of the FDA warning, the results of Ambien use are treated as a side effect, not as a criminal offense.

I asked Ted Olson, a former US lawman, to elucidate why something that might be a criminal offense in one context isn't in another.

“Criminal laws aren't well-suited for prosecutions in these sorts of cases,” he explained, “because of the problem in articulating standards for impairment from various sorts of medication and, for that matter, for driving while tired, sleep-deprived, emotionally distracted, et cetera.

Tuesday, 29 May 2018

They’re Out of Prison. Can They Stay Out of the Hospital?

Out of Prison

SAN FRANCISCO — The night Ronald Sanders turned his life around, he had been smoking crack for 2 days during a tiny, airless room. His infant son, Isaiah, was inhaling the fumes.

“His the chest was beating really hard,” Mr. Sanders recalled.

“So I pray: ‘If my son makes it through the night, that’s it.’

”Mr. Sanders quit using drugs and stopped cycling in and out of prison quite 20 years ago.

he's now a community doctor who helps people getting out of prison to affect a number of medical, psychiatric, and drug abuse disorders.

As the country tries to shrink its aging prison population, the inmates being released after years locked away often have mental illnesses and addictions which will land them back in prison if untreated.

Mr. Sanders and other former prisoners are central players in an approach to helping these men and ladies that are expanding in California and North Carolina, among other states.

By year’s end, l. a. County plans to possess hired 220 such workers to assist released inmates navigate life outside.

“We’ve always known incarceration is bad for health,” said Leah G. Pope, director of the substance use and psychological state program at the Vera Institute of Justice, a search and advocacy group.

“But in an age of accelerating attention to justice reform and health care reform, the 2 are increasingly connected.”

Mr. Sanders works for the Transitions Clinic Network, which has doubled in size over the past five years and now works out of 25 health centers in eleven states and Puerto Rico.

It has treated some 5,000 patients since it got its start here in 2006 at a city-run clinic for low-income residents in Bayview-Hunters Point, an area heavily suffering from incarceration.

At the time, the majority of inmates left prison without insurance.

prison

The expansion of Medicaid in 32 states under the Affordable Care Act has been what many within the field consider a criminal justice milestone, making low-income men and ladies who are single and childless potentially eligible for free of charge health looks after the primary time.

Mr. Sanders, 54, who was incarcerated during his twenties for drug dealing and parole violations now counsel formerly incarcerated patients whose experiences echo his own.

He urges them to manage chronic diseases and quells their occasional scare. Offenders incarcerated as teens emerge in a time of life as if from a machine, unacquainted transit swipe cards, smartphones, even email.

Among his regulars are Darryl, 58, who did time in prison for drug dealing, vehicle theft, and possession of a firearm.

Darryl, who asked that his surname not be wont to protect his privacy, has hypertension, near-crippling depression, and amnesia from a traumatic brain injury.

Mr. Sanders said Darryl was suicidal once they first met: He connected Darryl with a therapist, helped him get into treatment for white plague, and eventually found him housing during a single-room-occupancy hotel within the Tenderloin, an equivalent neighborhood where Mr. Sanders once lived on the streets.

When Darryl is out of touch, Mr. Sanders goes to his door.

“I don’t want to ascertain you dead because you haven’t checked your damn blood pressure!” Mr. Sanders chides him.

The community workers function mentors.

“You’re building that rapport with someone who has walked an equivalent walk and been successful,” said Nicole Sullivan, the re-entry director for the North Carolina Department of Public Safety.

It is spending $600,000 to expand the Transitions model, which started as a grant-funded pilot in Chapel Hill, across the state.

Prisons and jails are constitutionally mandated to supply health care, but that responsibility ends upon release.

For those getting out, the primary fortnight is particularly perilous.

A study in Washington State published within the New England Journal of drugs in 2007 found that former inmates are 12 times likelier to die than other state residents within the fortnight following their release, especially of lethal overdoses, a risk factor confirmed by later studies.

Access to health care is often a roll of the dice: Medical discharge plans vary from nonexistent to prisons with dedicated planners who coordinate insurance and medical appointments before release.

Most of the 32 Medicaid expansion states suspend, instead of terminate, coverage for inmates who previously had it and send them out with an insurance card once they leave.

Ohio and Indiana, among others, have programs to enroll inmates in Medicaid before release.

Preventive care is usually lacking within the disadvantaged neighborhoods that are habitat for several inmates, the overwhelming majority of whom are black and Hispanic.

“There’s mistrust combined with a scarcity of data about navigating the health system,” said Joseph Calderon, a Transitions worker.

“In our communities, people are taught the way to look out of their cars but not the way to look out of their health.”

Many ex-offenders ignore chronic conditions and finish up in costly emergency rooms or hospitalized for preventable conditions.

There is no definitive evidence yet that the Transitions program helps ex-inmates stay out of prison.

Preliminary data from a study in New Haven, Conn., suggests that folks who received care through the Transitions Network spent less time incarcerated than those during a control group within the year following their release.

There is some evidence that the program helps people stay out of emergency rooms and hospitals: A study within the American Journal of Public Health of 200 chronically ill former inmates in San Francisco, half assigned to a Transitions clinic and half to a medical care program found that the Transitions patients’ use of emergency rooms was 50 percent lower.

“People coming home have many health needs,” said Dr. Shira Shavit, the network’s executive and a clinical professor of family and community medicine at the University of California, San Francisco.

“They need food, an area to remain and employment, and lots of face discrimination in housing and employment.

They'll have lost connections with family. So it's important to deal with the large picture.”

At the clinic, she saw a replacement patient who had just been released after 16 years and eight months in prison. “Any tattoos?” she asked him.

”Drug use? Sexual acts in prison?”

Knowing a patient’s history can yield important clues “about past drug abuse, trauma, poverty, violence, lack of access to wash needles for tattooing or drug use or PTSD from solitary, all of which are clinically relevant,” she said.

Friday, 25 May 2018

Five Blood Transfusions, One Bone Marrow Transplant — All Before Birth

Five Blood Transfusions

SAN FRANCISCO — within the three months before she was even born, Elianna Constantino received five blood transfusions and a bone-marrow transplant.

All got with a needle skilled her mother’s abdomen and uterus, into the vein in her duct.

Elianna, born Feb. 1 with a strong cry and a cap of gleaming black hair features a genetic disorder that sometimes kills a fetus before birth.

The condition, alpha Cooley's anemia, leaves red blood cells unable to hold oxygen round the body, causing severe anemia, coronary failure, and brain damage.

The transfusions within the womb kept her alive, but only treated her illness.

The bone marrow transplant has the potential to cure it. Whether it'll succeed remains timely to inform.

Elianna and her mother, Nichelle Obar, were the primary patients in an experiment that pushes the bounds of fetal therapy, a field is already known for its daring.

If the treatment works, it could open the door to using bone-marrow transplants before birth to cure not just Elianna’s blood disorder but also red blood cell anemia, hemophilia, and other hereditary disorders, some so severe that a diagnostic procedure may lead parents to finish the pregnancy.

Bone marrow is taken into account a possible cure because it teems with stem cells, which may create replacements for cells that are missing or defective as a result of genetic flaws.

“This line of labor moves the sector of fetal surgery, which currently consists of massive operations for anatomic disorders, during a new direction of molecular and cellular therapies are given non-invasively,” said Dr. Tippi MacKenzie, a pediatric and fetal surgeon who is leading the study at the U.C.S.F. Benioff Children’s Hospital-San Francisco, a part of the University of California, San Francisco.

Ms. Obar, 40, and her husband, Chris Constantino, 37, are healthy but learned during her first pregnancy that they're thalassemia carriers. There are several sorts of the disease, and worldwide about 100,000 children a year are born with severe cases.

Millions of people are carriers, most ordinarily those from Asia, the Mediterranean, Africa, or the center East.

Carriers are generally healthy, but when two have children together, the youngsters are in danger of the disease. Ms. Obar’s ancestry is Filipino and Puerto Rican; her husband is Filipino. They sleep in Kilauea, on the Hawaiian island of Kauai.

Their first child, Gabriel, now 3, is healthy. But each child they conceive features a 1 in 4 chance of being affected, and through Ms. Obar’s second pregnancy, her doctors were on the lookout for the disease.

They found it. An ultrasound at 18 weeks showed that Elianna’s heart was twice the dimensions it should are, and fluid was accumulating around her lungs and other organs.

Blood flow through her brain was abnormally rapid, a symbol of severe anemia.

Everything pointed toward alpha Cooley's anemia — the worst sort of the disease.

Ms. Obar’s doctor and genetic counselor warned her and her husband that their daughter won't survive.

“Her the heart was working so hard,” Ms. Obar said, with tears in her eyes.

By now in pregnancy, the trimester, an affected fetus has little or not working hemoglobin, the molecule that carries oxygen to cells everywhere the body.

Tissues are suffocating, and therefore the heart struggles to compensate.

Some medical references describe the illness as “incompatible with life,” and most fetuses die within the womb from coronary failure.

The pregnancy may end in miscarriage, and fogeys might not know why. Many don't know they're carriers.

Baby


Sometimes, because the fetus weakens, a phenomenon called mirror syndrome occurs: The mother also becomes ill, with a severe high vital sign and other problems that will kill her unless the pregnancy is ended.

Infants with untreated alpha Cooley's anemia who somehow survive until birth nearly always have severe brain damage from lack of oxygen.

Transfusions the duct during pregnancy can save the fetus and should prevent brain damage.

the kid will then require transfusions every three or four weeks for life; the procedures cost about $50,000 a year and pose their own risks, especially a dangerous buildup of iron.

A bone-marrow transplant after birth can cure the disease, but as long as an identical donor is found.

The the transplant also has dangers and costs about $150,000.

Many obstetricians don't even tell patients about transfusions, Dr. MacKenzie said.

“Everyone now's told to abort,” said Dr. Elliott Vichinsky, one among her research partners and therefore the founding father of Northern California Comprehensive Thalassemia Center at the U.C.S.F. Benioff Children’s Hospital Oakland.

“We understand families should make that call if that’s right for them. We’re just saying they ought to tend the knowledge that there are other options.”

Some doctors are wary of transfusions because they think that albeit the kid survives, there's still too high a risk of serious brain damage.

A a report last year on a world registry of survivors found that 20 percent (11 of 55) had serious delays in their neurological development.

Another article found delays in 29 percent (4 of 14).

Dr. MacKenzie and Dr. Vichinsky said they didn't attempt to discourage parents who preferred abortion. But some parents would rather avoid it.

“These aren't unwanted pregnancies,” Dr. MacKenzie said. “We’re as pro-choice as you get.

These are wanted pregnancies for whom therapy might be offered.

And you'll have an option to terminate otherwise you can have an option to have therapy, but rock bottom line is you've got to tend those choices.

and that we recognize that’s a really personal choice, but we as doctors got to be providing you with those choices.”

Ms. Obar’s genetic counselor mentioned termination — but also transfusions.

She and her husband chose transfusions.

The the counselor also described Dr. MacKenzie’s study.

the prospect that the transplant might help their daughter appealed to them, though they understood it had been an experiment and there have been no guarantees.

At this early stage within the research, the first aim of the study was to seek out out whether the treatment was safe.

The the general goal of fetal therapy is to act early enough to attenuate or maybe prevent lasting harm from severe problems that start within the womb.

With a bone-marrow transplant, the added advantage of giving it before birth is that the fetal system isn't yet fully developed, so it's unlikely to reject the transplant.