Archive for Ease and Disease

A dog-paddle of sorts

He can’t help it, he was born this way:

A remark from Vetbook, a sort of wiki for veterinarians:

In most cases, euthanasia is not recommended as restoration of normal movement eventually occurs as the pup grows, provided the walking surfaces are firm such as carpet, grass, soil, etc.

There’s a lot to be said for not recommending euthanasia.

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We said your time was up

And $DEITYdamnit, we meant it:

Alfie Evans, a British toddler with a degenerative brain condition whose parents lost a legal battle to keep him on life support at a Vatican hospital, was mourned with balloons set free in the sky and prayers from the pope after he died Saturday weeks shy of his second birthday.

Much of the criticism of the National Health Service came from the United States; while Twitter would not permit the topic to be listed as “trending” because of course they wouldn’t, American tweeters were keen to point out that It Can’t Happen Here.

One might not want to be too sure about that:

Orwell would be proud: QALY (quality of life years) criteria are how the death panels the NICE (National Institute for Health and Care Excellence) decides if you should live or die.

and with the growing “elderly” population (and fewer kids/immigrants to support them by their taxes) you can see how this cost control idea could rapidly expand to active killing of the old, senile, and those denied treatment.

But before you point fingers at the UK, maybe you should read about the “futile care” law in Texas that has gotten little publicity. From Wikipedia:

“The Texas Advance Directives Act (1999), also known as the Texas Futile Care Law, describes certain provisions that are now Chapter 166 of the Texas Health & Safety Code. Controversy over these provisions mainly centers on Section 166.046, Subsection (e), which allows a health care facility to discontinue life-sustaining treatment ten days after giving written notice if the continuation of life-sustaining treatment is considered futile care by the treating medical team.”

Unlike the UK, if the family wants to, they can move the patient and pay their bills.

Or they can ask the hospital “ethics committee” to decide. The problem being that most “bioethics” types already believe in the “QALY” mindset, so good luck to you fellah.

I assure you, my interest in this topic is not entirely academic; I am, after all, sixty-four years old.

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Please don’t clap

So it’s finally come to this:

A man in the UK has caught the world’s “worst-ever” case of super-gonorrhea.

He had a regular partner in the UK, but picked up the superbug after a sexual encounter with a woman in south-east Asia. Public Health England says it is the first time the infection cannot be cured with first choice antibiotics.

Health officials are now tracing any other sexual partners of the man, who has not been identified, in an attempt to contain the infection’s spread.

The main antibiotic treatment — a combination of azithromycin and ceftriaxone — has failed to treat the disease.

This is also the course of treatment recommended by the CDC in the US, although:

Treatment of patients with gonorrhea with the most effective therapy will limit the transmission of gonorrhea, prevent complications, and likely will slow emergence of resistance. However, resistance to cephalosporins, including ceftriaxone, is expected to emerge. Reinvestment in gonorrhea prevention and control is warranted. New treatment options for gonorrhea are urgently needed.

That was 2012. Didn’t take long for the bug to evolve resistance, did it?

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Busted cycle

During recent spates of insomnia, I assumed that my circadian rhythms were totally out of whack. I am currently not quite so sleep-deprived, but this old body persists in traveling to the beat of a different drum.

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Oh, by the way

A really dreadful gurney-side manner, this is:

Laura Cameron, then three months pregnant, tripped and fell in a parking lot and landed in the emergency room last May — her blood pressure was low and she was scared and in pain. She was flat on her back and plugged into a saline drip when a hospital employee approached her gurney to discuss how she would pay her hospital bill.

Though both Cameron, 28, and her husband, Keith, have insurance, the bill would likely come to about $830, the representative said. If that sounded unmanageable, she offered, they could take out a loan through a bank that had a partnership with the hospital.

I got hauled to the ER twice in 2016. The first time, an underling who came off like Truman Capote’s taller brother let me know that I was facing a hundred-dollar copay, and would I like to take care of that now? I was sufficiently conscious to nod assent, and dug out my debit card.

An hour later, part two of the Truman show: “They’re telling us you haven’t met your deductible yet this year.” I shrugged, handed over the plastic, and signed for a thousand. Shortly thereafter, I was wheeled to an actual room.

[P]romoting bank loans at hospitals and, particularly, emergency rooms raises concerns, experts say. For one thing, the cost estimates provided — likely based on a hospital’s list price — may be far higher than the negotiated rate ultimately paid by most insurers. Sick patients, like Cameron, may feel they have no choice but to sign up for a loan since they need treatment. And the quick loan process, usually with no credit check, means they may well be signing on for expenses they can ill afford to pay.

I suppose I was fortunate in that I actually had $1100 in the bank. Not everyone is in such a position.

Here’s an option I heartily endorse when possible:

If you should find yourself in hospital unexpectedly, and confronted with this sort of aggressive approach, I suggest you tell them to talk to your significant other, or ask them to wait until you’re in a proper mental and physical and emotional state to make such decisions. If they persist, tell them what they can do with the paperwork. After all, they’re in a place where it can be extracted once they’ve done that!

Damn straight.

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Those bloodsuckers must be around here somewhere

The story begins here:

In July of 2017, 13-year-old Olivia Goodreau was on vacation in Missouri with her family. While outside Olivia noticed a tick on her dog, Mo (short for Missouri). Olivia & her mom watched the tick start to burrow into Mo’s leg. They quickly found needle nose tweezers to properly remove the tick from Mo. As Olivia was removing the tick she asked her mom, “”s there an app that can show what ticks are around us?” That night Olivia looked online and found that currently there was no app to help track, report, and educate people about ticks. This gave Olivia the idea to create the TickTracker app to help keep everyone safe.

TickTracker development teamI understood. Forty-five (!) years before that, I was stationed at Fort Leonard Wood in Missouri, where, according to the popular jape of the times, the state flower is the rock and the state bird is the tick. God knows I saw plenty of both over the two seasons I spent there.

The LivLyme Foundation was set up to develop the app and aggregate user data. TickTracker is offered at no charge. And if you ask me, they ought to be selling some of these spiffy black caps worn by the development team.

(Dear Brad Paisley: would you be interested in lending your name to a Good Cause?)

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To go without the flow

First there was meth, and it was bad, and the powers that be were forced to admit that they couldn’t possibly make it any more illegal than it already was; desperate to appear to be doing something, they eventually hit on the idea of making pseudoephedrine (Sudafed and its friends) hard to come by, apparently reasoning that the way to foil thousands of methheads was to inconvenience millions whose heads were merely stuffed up.

Now comes phase two:

As part of the fight against the nation’s opioid epidemic, the US Food and Drug Administration said Tuesday, one common antidiarrheal drug should be given new packaging.

The agency is working with manufacturers to change the packaging of the drug loperamide to include blister packs and single-dose packaging, which could reduce the likelihood of overdose, according to FDA Commissioner Dr. Scott Gottlieb.

Loperamide, sold under brand names such as Imodium, is an over-the-counter opioid medication used to treat diarrhea. However, it is sometimes taken in large doses by those seeking to suppress symptoms of withdrawal from such other opioids as heroin. In such high doses, loperamide can lead to cardiac problems and even death, Gottlieb said in a statement Tuesday.

Because nobody, but nobody, would ever bother to punch a dozen pills out of a blister pack when the monkey’s on his back and laughing out loud.

(Sent me by Holly H.)

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You deserve to hurt

Sam Quinones, a former Los Angeles Times scribe who wrote the book Dreamland: The True Tale of America’s Opiate Epidemic, was in town this week to talk about our Dreadful Addiction, and this is some of what he said:

Quinones traced the origins of the epidemic to indiscriminate prescribing in the 1990s as doctors came to believe they were undertreating pain — an argument that had some merit. The problem began when pharmaceutical companies and some doctors underplayed the addictive potential of opioids, he said.

Well, yeah, dependence does come with the package. But then:

“We began to believe that we were entitled to a life free of pain,” he said.

The more I repeat that, the worse it sounds. What say you?

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From the Something Must Be Done files

And this definitely qualifies as something:

Walmart is helping customers get rid of leftover opioids by giving them packets that turn the addictive painkillers into a useless gel.

The retail giant announced Wednesday that it will provide the packets free with opioid prescriptions filled at its 4,700 U.S. pharmacies.

The small packets, made by DisposeRX, contain a powder that is poured into prescription bottles. When mixed with warm water, the powder turns the pills into a biodegradable gel that can be thrown in the trash.

Research has shown that surgery patients often end up with leftover opioid painkillers and store the drugs improperly at home.

I dunno. I sort of sympathize with the Fark submitter, who asks: “But who has leftover opioids?”

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Just like it says

Still, it’s startling to see it in print on an actual product label:

Coprophagia remedy for dogs

And I suppose you really don’t want the dog in the picture to be grinning.

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When your brain hurts

Apparently there is now surgery to reduce migraines:

Surgical decompression of the peripheral sensory nerves around the skull can have a beneficial effect on the frequency, severity and duration of the migraine headaches. Surgery is performed as an outpatient procedure under local or (usually) general anesthesia and usually takes one to two hours. Some patients have multiple migraine triggers and surgery may take longer if the trigger sites are on different areas of the head. Surgery is not on the brain and we do not remove or go through the skull bones.

How well does this actually work?

Most studies have shown success rates above 70 percent, with roughly one-third of the patients experiencing total relief of their migraines. When successful, patients report an improvement in migraine frequency, duration, intensity and in health-related quality-of-life.

One thing’s for sure: I don’t know anyone with migraines who wouldn’t rather be someone without migraines.

(Via Finestkind Clinic and fish market.)

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One shot, so to speak

Two shots, if you’re doing both sides:

A transformative genetic treatment for a rare, inherited form of blindness will come with a price tag of of $425,000 per eye, or $850,000 for both, said Spark Therapeutics Inc., the tiny biotechnology company that is bringing the therapy to market.

Since Spark’s Luxturna was approved by the U.S. Food and Drug Administration last month, speculation over the price has grown as it became clear the therapy would be one of the first in a wave of medicines that yield remarkable results after a single treatment — and would carry a commensurate cost.

No quantity discounts, apparently.

Luxturna (Voretigene neparvovec) is one of those few pharmaceuticals for which the trade name and the generic name have roughly equal plausibility as a name for a minor Star Trek character.

There are admittedly not many patients for whom this stuff is indicated:

Leber’s congenital amaurosis, or biallelic RPE65-mediated inherited retinal disease, is an inherited disorder causing progressive blindness. Voretigene is the first treatment available for this condition. The gene therapy is not a cure for the condition, but substantially improves vision in those treated. It is given as a subretinal injection.

Now: is it worth $850,000 to not be blind anymore?

In an agreement with the Boston-area insurer Harvard Pilgrim Health Care, Spark will get the full price of treatment up front. If patients don’t get an immediate benefit — measured at 30 days, or a long term one — measured at 30 months, Spark will have to give some of the money back in a rebate.

There’s a new wrinkle.

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The reward for doing without

For certain values of “reward,” I suspect:

Prostate cancer is the most common cancer among men, hitting about one in eight at some point — with 43,000 UK cases each year.

Oxford University researchers studied 220,000 men aged 40 to 69 over six years.

They found those who had never had intercourse had a 47 per cent lower rate of the disease, dropping the risk to about one in 16.

Explaining why, lead researcher Prof Tim Key said: “Infections passed during sex, raising prostate cancer risk, could be a possibility.”

Out of any given sample of 220,000 men, 40 and above, how many are going to admit to having never had sex? Admittedly, university researchers are not likely to tell any of your friends at the pub, but this is a difficult thing to admit, unless you’re one of the Involuntary Celibates who have nothing else to distinguish themselves.

Dig a bit farther down, and there’s the answer:

Prof Key admitted: “It is a huge study but there were only about 20 cases of men who had never had sex.”

I might have known.

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It was one of those nights

I’ve had more of these than I perhaps ought to admit:

I wake up cold — but sweating. I’d had nightmares again. My heart felt heavy in my chest, my limbs felt entirely useless. Every time I stood up I thought I was going to fall, and my brain was blank and numb. I hate this, I hate feeling like I’m getting somewhere with my health, and then one morning it completely takes me by surprise and pulls me back in.

The only advantage I’ve had in such matters is that I can sometimes see them coming. If I crash into bed at eleven and I’m still running full-tilt thought patters at twelve-thirty, I can pretty well assume that “Well, this night is ruined.”

There’s no telling what mood I’ll wake up in, and there’s no guarantee that mood will stick around all day.

After many years, I have become conditioned to expect, if not The Worst, something Worst-Adjacent.

Morning ablutions are supposed to take me half an hour. To get the time down that far, I have to make sure that I don’t fall down in the shower, because I have this morbid idea that this is how I die, despite having survived one already, and I have to do without socks, which take me longer to put on than anything else. (This latter may be troublesome come Tuesday, when it’s supposed to be somewhere around 5°F during the morning commute.) The fact that these conditions exist at all tells me that I’m a long, long way from being out of the woods.

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Our shareholders want Lamborghinis, goddamnit

Where have we heard this before?

Since 2013, the price of a 40-year-old, off-patent cancer drug in the U.S. has risen 1,400%, putting the life-extending medicine out of reach for some patients.

Introduced in 1976 to treat brain tumors and Hodgkin lymphoma, lomustine has no generic competition, giving seller NextSource Biotechnology LLC significant pricing power.

The U.S. Food and Drug Administration is seeking to encourage more competition for drugs like lomustine, one of at least 319 drugs for which U.S. patents have expired but which have no generic copies, according to a list the agency published earlier this month.

What makes this drug so suddenly expensive?

For many years, lomustine was marketed under the brand name CeeNU by Bristol-Myers Squibb Co., which charged about $50 a capsule for the highest dose, before selling the product in 2013.

Now, the same capsule costs about $768, after nine price increases by a little-known Miami startup, NextSource, which supplies lomustine in a deal with the drug’s new owner, manufacturer CordenPharma.

Not a lot of lomustine is sold, so it’s hard to blame BMS for selling the rights to the drug. What hasn’t happened, of course, is an increase in production costs:

Robert DiCrisci, chief executive of NextSource, said in a statement the company bases its pricing on product-development costs, regulatory-agency fees, and the benefit the treatment delivers to patients. The company provides discounts to uninsured patients and those with financial limitations, he said.

“Product-development costs?” Is he kidding? The most they’ve spent on this stuff is whatever it cost to change the name on the box and the cost of PR announcing the price increases.

I am persuaded that the major cause of price-gouging like this is the desire to make a killing before the Feds come down and sweep the last vestiges of the marketplace under the rug.

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Why, he’s no fun, he fell right over

I spent enough time in the hospital in 2016 to know I didn’t want to do it again in 2017. However, I am growing older and probably more fragile, so I’m not sure I’ll manage to do the same as 2018 looms. If I must, though, I hope I have this much brain activity going for me:

It’s a blank to me — my last memory ahead of time was laying on the table in the OR and having a nurse ask after my name and birth date, to which I replied,

“I was born on Roberta X and my name is twenty-eight May, nineteen hundred and…”

She laughed and looked at her clipboard. “Do you know why you’re here today?”

“If it doesn’t say ‘sinus surgery to open up the sphenoid, erthymoid and left maxillary sinuses, with a side of turbinate reduction as needed’ on your form, I think we should lock the doors, order pizza, and hang out for a couple of hours.”

The anesthesiologist thought that would be a good idea, if his snicker was any indication, but alas, the fancy anatomical Latin was what it said on the form the nurse was holding, so it was too late to change plans, and besides, the ENT surgeon was on her way and we’d never have got the doors locked in time. And you know surgeons — she probably would have wanted anchovies or blue cheese or something. Might as well get operated on instead.

“No anchovies? You’ve got the wrong man. I spell my name DANGER.”

Wut?

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On the Richter scale

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Emptiness ensues

In late October, Sarah Sloan Macleod put up a video called “The Realest I’ve Ever Been About My Depression.” It was frightening in spots, and some of those spots were entirely too familiar to me:

A week later, things got realer:

Both of these contain occasional rough words, so watch where you play them.

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How it’s done down under

An American expat meets up with Australian health care:

Off to the ER I went. After a wait of 4 hours, I was brought into a procedure room, where I was examined other doctors brought in, and was told immediately that I’d be scheduled for surgery. They had me in a ward within 20 minutes, and began pumping me full of anti-biotics. The next morning, they had me prepped and the anesthesiologist asked me if I would prefer to be sedated with a mixture of ketamine and other fine drugs, or epidural. I’ve had an epidural before. That did not go well. IV cocktail it is.

There followed the actual surgery, and then:

I was made to stay another night for more antibiotics being pumped in while they looked after me. The next day, the nurses did a repack and bandaging. From there, it was a matter of getting me scripts and arranging for a care nurse that will come to my home everyday for the next month and deal with dressings until it’s no longer needed.

His one out-of-pocket expense was for those scripts:

Individual pharmacy bill from an Australian hospital

Ten antibiotic, ten painkillers, 100 acetaminophen. Twenty bucks American. About what you’d fork over for a single antibiotic in the States, if you’re lucky.

(Via Fark.)

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In case you couldn’t find the tablet

Just follow the otherwise-empty arrow:

A box of two? Wow.

Wikipedia semi-helpfully points out that “[i]n the United States, it is available only by medical prescription (and is frequently limited, without prior authorization, to a quantity of nine in a 30-day period).” A quantity of nine, per Drugs.com, runs $92.52. To someone with a migraine, a condition for which this drug is indicated, ten bucks and change for a single tab is probably worth it. Maybe the two-tab version is intended to get you through a particularly bad weekend.

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Technically not a black-and-white

Dothan Alabama police car wrapped in pink

Oh, yeah, it’s the same old Panther-bodied Ford Crown Victoria Police Interceptor you’ve known and feared for years, but this one is for a cause:

The idea behind the pink car came from Chris Lee who is the owner of Shift Designs in Dothan.

After serving the Dothan community for eight years, he wanted a way to give back to the community that has been so great to him and his team.

So, he volunteered to wrap a patrol car in honor of Breast Cancer Awareness month.

With the help of Avery Dennison Graphic Solutions, a premiere vinyl and wrap company, they were able to have the supplies donated for the cause.

Pretty spiffy, though the standard Ford dog-dish hubcaps look even tinier than usual.

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That damn night fever

In the event of something happening to me,
There is someone I should probably go to see:

Please tell me this is not the result of someone starting a joke.

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In sickness and in, um, more sickness

I ran this little poll on Twitter, and I am not heartened, if not surprised, by the results:

CFI Care (not its real initials) isn’t dropping the group, necessarily; but the group policy we had is being discontinued, to be replaced by God Knows What. And God, presumably wisely, is keeping His mouth shut.

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Up to the minute

She set her computer on her lap and crossed her legs. For a moment I wondered how she was going to type like that.

“So how do you feel right this minute?” she asked.

Something like this, I thought.

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Quote of the week

The American health-care system in a nutshell, per Chuck Pergiel:

This whole medical insurance debate is complete and utter horseshit. (Heh, my new catch phrase.) What we need is real information, but we’re not getting it. It might be out there, but digging it out would be a lot of work, and why bother? Nobody in power is listening, they are all listening to each other trying to score political points by telling bullshit stories.

Our healthcare system is built on a fantasy, a fantasy that is carefully nurtured by everyone with a financial interest, like doctors, lawyers, insurance executives and media moguls. This fantasy has doctors curing all diseases, patients recovering fully and leading happy, productive lives. Oh, that happens occasionally, and for common afflictions that are well understood, it might even be the norm. But the more people you have, the more variation you have and the more obscure, inscrutable diseases show up. Life is a terminal disease. People spend their lives trying to be happy. They should spend their time getting ready to die.

Health care is a trillion dollar business in this country. All those people who are engaged in the debate over insurance are just trying to influence the trajectory of that money so that more of the random spray that emanates from such a powerful stream will land on them and make them rich. Because even a single droplet from that trillion dollar stream is worth a million bucks.

I take issue with that “getting ready to die” business; I mean, with the death rate seemingly frozen at 100 percent, everyone’s going to go through that routine at least once, if only for a few seconds, and there are enough differences among us to insure that a Standard Preparation Routine would fall under the general heading of “one size fits none.”

That said, there apparently exists no sum of money so small that someone won’t try to get a piece of it: ask the guy who buys 10,000 shares of Consolidated Veeblefetzer at $37.19 and sells them in three minutes for $37.20.

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Reelin in the years

This Rube Goldberg-esque glycoprotein is called reelin:

Crystalline structure of reelin

It’s named for the reeler mouse, a mutant with really terrible motor skills.

Reelin is a complicated chemical found floating around in your body. Near as I can tell, it has some influence over the central nervous system. I got onto this from a Reddit link to a Wikipedia passage about schizophrenia, one of my least favorite diseases.

It’s a busy little substance:

Reelin has been suggested to be implicated in pathogenesis of several brain diseases. The expression of the protein has been found to be significantly lower in schizophrenia and psychotic bipolar disorder, but the cause of this observation remains uncertain as studies show that psychotropic medication itself affects reelin expression. Moreover, epigenetic hypotheses aimed at explaining the changed levels of reelin expression are controversial. Total lack of reelin causes a form of lissencephaly. Reelin may also play a role in Alzheimer’s disease, temporal lobe epilepsy and autism.

A mere 3,461 amino acids go into this stuff, which sort of reminds me of why I never became a chemist:

I’m not very good at chemistry. Oh, I understand the basics well enough, water is made of two hydrogen atoms and one oxygen atom, but once you get past the basics there is an endless profusion of chemical compounds and I quickly become lost. It’s almost like the English language, you can stick words, or atoms, together in a limitless number of ways. If you use it every day, those combinations will become familiar to you, like the books you have read. But if you don’t immerse yourself in this sea of arcane knowledge it will always be gibberish.

And even then, I suspect, you’re always going to be at least somewhat behind the times.

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BFFs again

Integris Health, the biggest hospital in town, and Blue Cross/Blue Shield, the only insurer left in the federal insurance exchange for this state, were on the outs. Shortly before the pertinent contracts ran out, they kissed and made up.

Yesterday, I got a letter from Integris, signed by CEO Bruce Lawrence, to this effect:

I sincerely apologize for any frustration, inconvenience or concern you experienced during these contract negotiations. Our intent was to negotiate an agreement that would allow Integris to continue to offer the critical services not offered elsewhere in Oklahoma … service you or a family member may need some day. Although we tried to be as reassuring as possible during this process, we recognize the uncertainty the negotiations may have caused you.

Well, yeah, considering the war of words was fought largely in local media, with FUD as ammunition. To bolster that impression, here’s Mr Lawrence again:

I truly appreciate those of you who made phone calls to Blue Cross on our behalf; your efforts made a significant impact.

Of course, this has been the guiding principle of high-zoot health care since the invention of the phrase “Ask your doctor if [hyperexpensive new drug] is right for you.”

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Truly distinguished

All about the Distinguished Gentleman’s Ride:

Our focus is on gentlemen who have been dealt a tough hand in life. In particular, we raise funds for research into prostate cancer and mental health programs as part of our mission to support men’s health globally. These funds are invested by our partners the Movember Foundation, the world’s largest men’s health organisation.

Based in Australia, Movember, whose signature event involves the growing of mustaches, has raised over half a billion dollars in 21 countries.

Jack Baruth will be riding:

I’ve signed up for the Distinguished Gentleman’s Ride next month. It’s a great charity masquerading as a bunch of dickheads wearing suits on dorky motorcycles. I’m planning on wearing a Hickey Freeman pinstripe and riding my Honda CB1100. If you want to throw five bucks towards the cause, you can do it here.

I have done so.

Those of you who hate my guts can be reassured by the fact that it’s almost certain to rain this time of the year and that I’ll basically be spending two hours wrapped in three layers of soaking-wet wool. There’s also a reasonable chance that one of these hipsters who can barely ride a motorcycle by themselves, let alone in a group, will run into me and cut off my leg.

Hmmm. Maybe five bucks isn’t enough.

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Downright cheap, maybe

Try not to look at the digits:

The Food and Drug Administration on Wednesday approved a futuristic new approach to treating cancer, clearing a Novartis therapy that has produced unprecedented results in patients with a rare and deadly cancer. The price tag: $475,000 for a course of treatment.

That sounds staggering to many patients — but it’s far less than analysts expected.

The therapy, called a CAR-T, is made by harvesting patients’ white blood cells and rewiring them to home in on tumors. Novartis’s product is the first CAR-T therapy to come before the FDA, leading a pack of novel treatments that promise to change the standard of care for certain aggressive blood cancers.

Novartis’s therapy is approved to treat children and young adults with relapsed acute lymphoblastic leukemia. It will be marketed as Kymriah.

The generic name of this stuff is “Tisagenlecleucel.” Now, about that price tag:

Novartis picked the $475,000 price tag in an effort to balance patient access to Kymriah while giving the company a return on its investment, said Bruno Strigini, Novartis’s head of oncology, in a conference call Wednesday. The cost is below Wall Street analyst expectations, which reached as high as $750,000 for a dose. And it’s considerably cheaper than the roughly $700,000 price tag that U.K. regulators said would be fair considering Kymriah’s potential benefits.

For one dose?

In a clinical trial, a single dose of Kymriah left 83 percent of participants cancer-free after three months, results oncologists have hailed as a major advance for patients with few other options. The most frequent side effect was an inflammatory storm called cytokine release syndrome, a reaction to CAR-T that can prove fatal in some patients but is commonly controlled with immunosuppressant drugs.

About that CRS:

Deaths due to cytokine release syndrome with OKT3 (muromonab-CD3) have been reported, and it can cause life-threatening pulmonary edema if the patient is fluid overloaded. However, if treated appropriately it is usually not dangerous, just extremely unpleasant for the patient.

I bet it is. And it’s probably unpleasant for one’s insurance carrier as well.

(Via Joanna Blackhart.)

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Monday morning feels so bad

The very first line of the Easybeats’ classic hit “Friday On My Mind” pretty much says it all: Monday morning has little to recommend it. And as Zoe Thomson explains, if you’re fighting a mental illness, “little” dwindles to imperceptibility:

The alarm goes off and I’m tossing and turning, feeling weighted by the duvet but also uncomfortable, not feeling well rested in the slightest. “5 more minutes” I think to myself, a pit of dread sitting nervously in my stomach, but why? It’s another day. I don’t snooze my alarm — I stop it. I hope that I sleep in far too late and I have no choice but to jump out of bed and get out the door. I haven’t got it in me today, just like every other day. The dread fills my stomach until I can no longer only acknowledge it — it’s the only thing I can think about. I feel sick. I feel ill. Maybe I could use that? No, I can’t. I feel so groggy and not very well put together and I wonder how I’m going to do this for another 5 days.

My own issues are more or less out in the open, so you probably won’t be too surprised to hear that my own Monday-morning dread begins about 9 pm Sunday. Bedtime is still two hours away, and I wonder how much, if any, sleep I’m going to get during the seven and a half hours allotted. I’m certainly wide awake that Sunday evening. (The weekly roundup of strange search-engine queries? I did that early Sunday afternoon. Maybe even late Saturday night.) Somehow, I’ve managed to sleep through the alarm only two or three times in the past year. I remember that my work week has shrunk by about five hours since then; and then I recall that what I really want is to have it shrink by about five days. But that’s not happening any time soon.

In fact, the weirdest aspect of all this is that the pertinent song by The Cure is decidedly happier in tone, at least at the beginning:

And here we are, somehow, at Friday, looking forward to the weekend.

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