Complementary and Alternative Medicine: Get the Facts on CAM

What is complementary medicine?

Complementary medicine is a group of diagnostic and therapeutic disciplines that are used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort following surgery.

Complementary medicine is usually not taught or used in Western medical schools or hospitals. Complementary medicine includes a large number of practices and systems of health care that, for a variety of cultural, social, economic, or scientific reasons, have not been adopted by mainstream Western medicine.

Complementary medicine is different from alternative medicine. Whereas complementary medicine is used together with conventional medicine, alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a physician.

Complementary and alternative medicine (CAM) can include the following:

Complementary and alternative cancer treatments are often lumped together. But to a cancer specialist, there is a big difference. Complementary therapy is used in addition to mainstream medical treatment. Alternative therapy is used instead of proven treatment. Another term you may hear is integrative medicine. This means combining CAM and standard care to try to treat cancer in a way that involves your body, mind and spirit. Complementary and alternative medicine (CAM) includes:

What is alternative medicine?

Alternative medicine includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, and spiritual healing.

What are complementary and alternative medicine therapies?

Complementary and alternative medicine therapies fall into five major categories, or domains:

Alternative medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda.

Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques that were considered CAM in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy). Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

Biologically based therapies in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements,3 herbal products, and the use of other so-called natural but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer).

Manipulative and body-based methods in CAM are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation, and massage.

Energy therapies involve the use of energy fields. They are of two types:

Questions to ask your doctor when considering complimentary or alternative medicine therapies

Cancer patients using or considering complementary or alternative therapy should discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it. 1

Choosing a CAM practitioner 1

For additional information, please read"Consumer Financial Issues in CAM."

SOURCES: 1 National Center for Complementary and Alternative Medicine, National Institutes of Health

Latest Prevention & Wellness News

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Complementary and Alternative Medicine: Get the Facts on CAM

Types of Complementary and Alternative Medicine | Johns …

Many different areas make up the practice of complementary and alternative medicine (CAM). In addition, many parts of one field may overlap with the parts of another field. For example, acupuncture is also used in conventional medicine. In the U.S., CAM is used by about 38% of adults and 12% of children. Examples of CAM include:

Traditional alternative medicine. This field includes the more mainstream and accepted forms of therapy, such as acupuncture, homeopathy, and Oriental practices. These therapies have been practiced for centuries worldwide. Traditional alternative medicine may include:

Body. Touch has been used in medicine since the early days of medical care. Healing by touch is based on the idea that illness or injury in one area of the body can affect all parts of the body. If, with manual manipulation, the other parts can be brought back to optimum health, the body can fully focus on healing at the site of injury or illness. Body techniques are often combined with those of the mind. Examples of body therapies include:

Diet and herbs. Over the centuries, man has gone from a simple diet consisting of meats, fruits, vegetables, and grains, to a diet that often consists of foods rich in fats, oils, and complex carbohydrates. Nutritional excess and deficiency have become problems in today's society, both leading to certain chronic diseases. Many dietary and herbal approaches attempt to balance the body's nutritional well-being. Dietary and herbal approaches may include:

External energy. Some people believe external energies from objects or other sources directly affect a person's health. An example of external energy therapy is:

Mind. Even standard or conventional medicine recognizes the power of the connection between mind and body. Studies have found that people heal better if they have good emotional and mental health. Therapies using the mind may include:

Senses. Some people believe the senses, touch, sight, hearing, smell, and taste, can affect overall health. Examples of therapies incorporating the senses include:

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Types of Complementary and Alternative Medicine | Johns ...

What is Alternative Medicine? – Learn.org

'Alternative medicine' is a general term that covers medical practices that aren't considered mainstream, but are believed to have some beneficial purposes. Common types of alternative medicine include chiropractic, acupuncture, herbal medicine, and some types of massage. Read on to learn more about this field.Schools offeringComplementary & Alternative Health degreescan also be found in these popularchoices.

Alternative medicine is made up of a variety of medical practices that have not yet become part of conventional medicine. Professionals who have earned a Doctor of Medicine (M.D.) or a Doctor of Osteopathy (D.O.) degree practice conventional medicine. Most forms of alternative medicine stem from a combination of traditional medical practices, spiritual beliefs, and folk medicine.

While much of this medicine has been practiced and refined over centuries, it's only recently that alternative medicine has obtained widespread interest on the part of both patients and medical practitioners. Many medical practitioners refer to alternative medicine as complementary medicine, since it's often used to complement more accepted and modern medical practices. When alternative medicine is combined with conventional medical techniques, it's called integrative or integrated medicine.

Source: *U.S. Bureau of Labor Statistics

The National Center for Complementary and Alternative Medicine (NCCAM) is a government agency that performs research in the field. NCCAM groups alternative medicine practices into the following categories:

There are completed scientific studies involving various alternative medicine practices, and some studies are still ongoing. A good place to start looking for the results of these studies is the NCCAM website. The site features research and advice about various therapies, as well as information on alternative medicine practitioners and sources for training in the field. One may also call the NCCAM Clearinghouse (1-888-644-6226) to ask specific questions or to locate publications.

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What is Alternative Medicine? - Learn.org

The Complete Guide to Complementary and Alternative Therapy – Happiful Magazine

Over the years the wellness industry has evolved and grown. And while there are some trends well be steering clear of (sorry Gwyneth - we wont be buying a candle that smells like your vagina), theres a smorgasbord of therapies housed under the complementary and alternative therapy umbrella were happy to explore.

Because heres the thing were all different. Whats helpful for one person, wont be helpful for another. We all have our own preferences, beliefs and approaches that resonate. So, it can be helpful to know that if one approach doesnt work, we have other options.

Anything that doesnt fit under conventional or standard medical care can be called a complementary or alternative therapy (or complementary and alternative medicine, CAM). These practices, products and therapies include approaches that have been used throughout history such as aromatherapy, yoga and ayurveda. Some have roots in ancient Eastern philosophies of health such as Traditional Chinese Medicine, like acupuncture and herbalism.

The aim of these approaches is to be holistic and treat the whole person, not just the symptoms. This means they can help with both mental and physical health, and your overall wellbeing will be taken into account.

Complementary therapies are intended to be used alongside conventional approaches. For example, if youre receiving treatment for cancer you may benefit from exploring complementary therapy to help cope with the side-effects.

Alternative therapies are generally used in place of a conventional approach. Often this is the case when someone has tried a number of conventional approaches but they havent found them helpful. For example, if you find conventional approaches to anxiety dont help, you may decide to try aromatherapy or yoga.

Of course, many therapies here overlap and can be used as either a complementary therapy or an alternative. Whichever way you choose to use a therapy, you are advised to speak to a medical doctor before trying a new therapy, especially if youre receiving treatment for a condition.

Most therapies that fall under the CAM umbrella are not currently regulated in the UK (with the exception of physiotherapists, chiropractors, osteopaths and chiropodists). This means there are no laws that say what level of training someone needs in order to practice.

There are, however, several professional bodies which self-regulate certain therapies. Therapists can choose to join a professional body and then the body will ensure they meet their training requirements. Professional bodies have a complaints procedure, so if youre unhappy with your treatment, you will be able to make a complaint.

When you come to search for a complementary or alternative therapist, we recommend you ask about their qualifications, ensure they have insurance and see if they have a membership with a professional body. They dont need to be a member of a professional body in order to practice, but if youre worried, this may help put your mind at ease.

While there are some complementary and alternative therapies options through the NHS, sadly, theyre not widely available. Speak to your doctor to find out the availability in your area; if you cant get what you need on the NHS, you may need to look for a private therapist.

The National Institute for Health and Care Excellence (NICE) offers guidance to the NHS on which treatments are effective. Currently they recommend the use of CAMs in certain circumstances, including:

The great thing about these therapies is that there are lots to choose from. So, take your time if youre new to the world of CAM and see what resonates with you. Here we explore five common therapies and how they could support you.

Using very fine needles, acupuncture aims to bring balance to the bodys energy flow (known as qi pronounced chee). Traditional Chinese Medicine works on the premise that we have energy within our bodies, carried by meridian channels. You can imagine this like a network of rivers.

Its believed that when these energy channels become blocked or stagnant, our physical and mental health are affected. Stimulating the meridian channels with needles is thought to remove blockages to restore flow.

Despite what it sounds like, this therapy is not supposed to hurt and many report feeling very calm throughout. Acupuncture is particularly helpful for pain-related conditions including migraines, tension headaches and back pain. Many practitioners say this treatment can support overall wellbeing, mental health and work as a preventative to future ill health.

In reflexology its believed that certain areas on the feet, hands and ears (called reflexes) relate to other areas of the body through the nervous system. The aim is to apply pressure and massage certain reflexes to encourage energy flow and natural healing.

This approach is wonderful at reducing stress as the experience itself is very calming. As well as helping with stress, reflexology is thought to help ease pain, help with insomnia, improve circulation and support overall wellbeing.

Digital Marketing Executive at Happiful Katie has reflexology to help cope with the after-effects of glandular fever.

During the treatment, Im so relaxed. I have actually fallen asleep many times and I almost feel Im floating or in a trance-like state, completely at ease with myself and my surroundings. It allows me to accept the symptoms I struggle with, acknowledge why they are there but also trust that my body will eventually heal itself.

Reiki is considered an energy healing therapy, and again the aim here is to maintain balance within this energy. Reiki practitioners attune themselves to Reiki energy and then use their hands to help balance energy. This doesnt often involve touching, and may be used with hands above the body.

You will be lying or sitting, fully clothed in a calm and relaxing room. Encouraging relaxation, Reiki is ideal for those feeling overwhelmed, disconnected or isolated. The process can help you feel more centred and able to cope with lifes ups and downs.

Because this approach is non-invasive, its suitable for all ages. However, as with all of these approaches, if you have a medical condition or injury, be sure to tell your practitioner so they can take the necessary precautions.

Using essential oils from plants and flowers, aromatherapy can be used in a number of ways. The most common are through inhaling the scents (usually by burning essential oils) or by applying the oils (usually by massage). Aromatherapy massages are a popular way of enjoying essential oils, combining the healing power of essential oils with the physical benefits of massage.

Aromatherapy can be used for several conditions but is thought to be particularly helpful for people struggling with stress, anxiety and insomnia. Its also been suggested by NICE that aromatherapy can help ease feelings of agitation in those with dementia.

Targeting certain parts of the body with gentle rolling movements, the Bowen Technique is a physical therapy that looks to help the body balance, repair and reset itself. The approach was developed in the 1950s by Tom Bowen and it is holistic by nature, looking at the whole person, not just the condition presented.

Believed to be helpful for a wide range of conditions, Bowen therapy can be especially helpful for back, neck and shoulder pain.

This really is just the tip of the iceberg when it comes to complementary and alternative therapies. If its an area youre interested in, we recommend doing your research and having fun exploring different approaches. Some will require you to work with a professional, others you might be able to try at home yourself.

Try some different therapies out, see what helps and remember to keep your doctor in the loop at all times.

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The Complete Guide to Complementary and Alternative Therapy - Happiful Magazine

Medical Marijuana in the Ohio Valley – WTRF

JEFFERSON COUNTY, Ohio (WTRF)- Today marks the one year anniversary of medical marijuana sale in Ohio. 4 dispensaries opened on the first day of the program just one year ago, and only one of them was small and locally owned, and it is right here in the Ohio Valley!

Ohio Valley Natural Relief (OVNR) in Wintersville provides alternative medicine to countless patients. A lot of preparation went into its opening, and despite many obstacles at first, business is good for this pioneering industry. The owner tells me education is key to making a decision- whether for or against- and that the stigma of medical marijuana is fading away.

In 2016, Mike Petrellas father was diagnosed with Stage 4 cancer, passing away 2 months after diagnosis. Petrella was overcome by the suffering his father had to endure and wanted a better way to alleviate pain. This is when his journey began.

Petrella, the Owner and CEO of Ohio Valley Natural Relief, LLC, told 7News I started to dig a little deeper, went to Colorado, spent 5 days out there, learned the industry from cultivation, processing, dispensaries, visited dozens of dispensaries to try to learn the business from the ground up.

OVNR has helped thousands of patients, averaging 20-30 per day.

Petrella said on day one we had people from all over the state of Ohio again there was only 4 of us open we had people hours away and even to this day some of those relationships that we built with those patients they feel the most comfortable coming here with our staff so they still drive at least 3 hours away to come and see us.

Yes, patients are often skeptical and afraid at first. But, an exemplary staff covers all of the bases, making their patients completely comfortable with their products.

Petrella added for 2020 we see our sales probably doubling and as a state we see the patient count where its at 80,000 patients registered we see that number as a statewide hopefully jumping to 200,000 patients by the end of 2020 so it will only benefit owners and obviously patients because it will drive the price down as well.

At 28 years old, Mike Petrella is one of the youngest owners and one of the only single-sole proprietors of a dispensary in the entire nation. Featured in Marijuana Venture Magazines 40 under 40, Petrella was humbled by the honor, but more importantly, the community is highlighted on a national stage. Petrella said anytime you can shine a positive light on your local community on a national level, on state level, on a local level, its been great for everyone involved especially for the community of Wintersville.

Everything is based on qualifying health conditions. Safety and compliance come first. And nobody walks into the actual dispensary without their official medical cards. Even our 7News reporter had to give a drivers license to enter the lobby.

Lastly, Petrella added, we just really look forward to keep helping as many people as we can, educating people trying to get them to understand what were doing, why were doing it, how much its going to actually help. And at least come talk to us before you make a judgement on medical marijuana.

Heres how Ohio is doing compared to other states:

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Medical Marijuana in the Ohio Valley - WTRF

Complementary and Alternative Medicine Market by Product Type, by Application, by Geography Forecast to 2028 – Fusion Science Academy

Steel Wire Rope Market Trends, In-Depth Research on Market Size, Emerging Growth Factors, Global 2020 Trends and Forecasts 2025

The Steel Wire RopeMarket report is one of the most comprehensive and important dataabout business strategies, qualitative and quantitative analysis of Global Market.It offers detailed research and analysis of key aspects of the Steel Wire Ropemarket. The market analysts authoring this report have provided in-depth information on leading growth drivers, restraints, challenges, trends, and opportunities to offer a complete analysis of the Steel Wire Ropemarket.

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Leading players covered in the Steel Wire Rope market report: WireCo World Group, Tokyo Rope, Kiswire, Jiangsu Langshan, Guizhou Wire Rope, Fasten Group, Usha Martin, Bekaert, Xinri Hengli, Bridon, Juli Sling, Jiangsu Shenwang, Shinko, Xianyang Bamco, DSR, Jiangsu Safety, Gustav Wolf, Ansteel Wire Rope, YoungHeung, PFEIFER, Teufelberger, Hubei Fuxing, Redaelli, Haggie, DIEPA, Brugg and More

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Complementary and Alternative Medicine Market by Product Type, by Application, by Geography Forecast to 2028 - Fusion Science Academy

Complementary and Alternative Medicine Market Highlighting Regional Revenue Share Dominance During 2019-2029 – Fusion Science Academy

Global Digital Talent Acquisition Marketwas valued US$ 41.2 Bn in 2018 and is expected to reach US$ 79.6 Bn by 2026, at CAGR of 8.58% during forecast period.

The digital talent acquisition market is projected to be driven by increasing innovations and technological advancements. As the Big Data analytics industry quickly grows to include mainstream customers, technologies like Hadoop and cloud solutions are in demand and they have growth potential. So, it is expected to boost the digital talent acquisition market in the near future. An enormous amount of structured and unstructured data is available in firms owing to increased Internet adoption and they need digitally skilled people to manage the same.

Limited awareness regarding benefits of digital skills is hindering the development of digital talent. Some end-users are still not aware of the importance of digital skills. Despite the evolution of technology, the adoption of tools associated with digital skills still remains challenging. So, it is restraining the growth of the digital talent acquisition market globally.

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Based on skill segment, AI developers are fastest growing sub-segment in the digital talent acquisition market owing to numerous platforms have been created to upscale digital talent skills over the years, like the emergence of AI in talent management. In recent years, organizations are using AI for pre-hiring assessments and to give employees with projects that need their specific skills. Companies are shifting toward AI and machine learning and upscaling their skills to gain a competitive benefit in the digital talent industry.

Region-wise, North America is expected to leading the market for a digital talent acquisition during the forecast period. Growth in data volumes drives analytical skills as well as needs software specialists. Thus, exponential growth in data volumes is expected to drive the digital talent acquisition Industry in the region.

Accenture, IBM, SAP SE, Oracle Corporation are some of the prominent players in the global market for digital talent acquisition. IBM Corporation is an international company that manufactures and markets products like computer hardware, middleware, and software along with hosting and IT consulting services. The company proposals AI-powered talent management solutions with the help of IBM Watson.

A recent development in Global Digital Talent Acquisition Market: In 2017, Accenture PLC acquired data analytics company Search Technologies. Accenture is expected to the association the analytical technologies of Search Technologies with its AI and data analytics capabilities.

The objective of the report is to present a comprehensive assessment of the market and contains thoughtful insights, facts, historical data, industry-validated market data and projections with a suitable set of assumptions and methodology. The report also helps in understanding Global Digital Talent Acquisition Market dynamics, structure by identifying and analyzing the market segments and project the global market size. Further, the report also focuses on the competitive analysis of key players by product, price, financial position, product portfolio, growth strategies, and regional presence. The report also provides PEST analysis, PORTERs analysis, and SWOT analysis to address the question of shareholders to prioritizing the efforts and investment in the near future to the emerging segment in Global Digital Talent Acquisition Market.

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Scope of the Global Digital Talent Acquisition Market

Global Digital Talent Acquisition Market, by Skill

Data Managemento Data Analyticso Big Datao Master Data Management Web Presentationo User Interface Designo App Developmento Web Development AI Developers Cloud Computing & SecurityGlobal Digital Talent Acquisition Market, by Training Type

Internal ExternalGlobal Digital Talent Acquisition Market, by Enterprise Size

Small Enterprises Medium Enterprises Large EnterprisesGlobal Digital Talent Acquisition Market, by End-user

Bankingo Retail Bankingo Wholesale/Corporate Bankingo Investment Bankingo Private Banking Insuranceo Life & Pensiono Property & Casualtyo Healtho Reinsurance Retail IT & Telecom Serviceso Mediao Professional Serviceso Real Estate/Facility Managemento Tourism Government & Defense Manufacturingo Automotive & Discrete Manufacturingo Process Manufacturing LogisticsGlobal Digital Talent Acquisition Market, By Region

North America Europe Asia Pacific Middle East and Africa South AmericaKey players operating in the Global Digital Talent Acquisition Market

Skillsoft Limited Engaging Ideas Pvt. Ltd., The Training Associates Corporation, Hortonworks Inc., Data Science Council of America, BrainStation Inc., Accenture, IBM Corporation, SAP SE Oracle Corporation. Microsoft (Linkendin) Upwork iCIMS Ultimate Software CornerStone Workday ADP


Chapter One: Digital Talent Acquisition Market Overview

Chapter Two: Manufacturers Profiles

Chapter Three: Global Digital Talent Acquisition Market Competition, by Players

Chapter Four: Global Digital Talent Acquisition Market Size by Regions

Chapter Five: North America Digital Talent Acquisition Revenue by Countries

Chapter Six: Europe Digital Talent Acquisition Revenue by Countries

Chapter Seven: Asia-Pacific Digital Talent Acquisition Revenue by Countries

Chapter Eight: South America Digital Talent Acquisition Revenue by Countries

Chapter Nine: Middle East and Africa Revenue Digital Talent Acquisition by Countries

Chapter Ten: Global Digital Talent Acquisition Market Segment by Type

Chapter Eleven: Global Digital Talent Acquisition Market Segment by Application

Chapter Twelve: Global Digital Talent Acquisition Market Size Forecast (2019-2026)

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Complementary and Alternative Medicine Market Highlighting Regional Revenue Share Dominance During 2019-2029 - Fusion Science Academy

NutriDrip, ahead of funding round, sets up aging and hangover treatments at Wynn Hotels, Equinox – CNBC

At Clean Market in Midtown, New Yorkers have a wide menu of healthy offerings to choose from, such as "superfood smoothies" and bowls with a side of a "moon dust of choice."

But if clean food isn't enough, customers can also get a boost from vitamins delivered intravenously at the NutriDrip bar. The service is growing in popularity and attracting customers from fitness and lifestyle companies like Equinox to some major hotel chains.

NutriDrip sells 15 vitamin infusions administered by medical professionals via an IV drip that takes about 30 minutes. The Nutribody drip aims to support fat loss with a combination of l-carnitine, taurine, vitamin C, B complex, among others. There are also the popular hangover remedies Basic Recover, Super Recovery and Mega Recovery which range in price from $119 to $199 depending on how much you're hurting from the night before. The Nutriyouth drip claims the ability to "help stop cellular aging in its tracks" with a mixture of anti-aging enzymes, molecules and vitamins for $599.

Founded five years ago, NutriDrip is looking to expand in 2020 with a Series A funding round in the first half of this year. Executives declined to say how much money they're looking to raise.

"Over the last three years, IV nutrient therapy, specifically NutriDrip, has grown, at like a 60 to 80% year-over-year growth rate, even while opening new stores," said co-founder Asa Kitfield. "So we're really excited to see what sort of saturation the market can see on like a local and national basis."

One of its new corporate clients is Wynn Hotel will be offering NutriDrip IV drips to its guests in Las Vegas in early 2020.

A woman receives a vitamin infusion via intravenous drip.

Carlos Allegri | Reuters

"As many of our guests now expect a more holistic set of wellness options, we have evolved to include broader wellness themes related to functional wellness, physical fitness, and healthy cuisine," said a Wynn spokeswoman, adding "providing IV therapy is one more way to help our guests maintain personal wellness routines while they are traveling."

The Equinox Hotel in Hudson Yards also has been offering the service to guests when it opened last summer. Kitfield also told CNBC, NutriDrip is slowly rolling out the service to other Equinox gym locations in early 2020 as well.

Equinox executives Jeffrey Weinhaus and Harvey Spevak were early investors in NutriDrip parent company Clean Market, along with real estate investor Jack Terzi, Seritage Growth Properties CEO Ben Schall, fashion designer Andrew Rosen and venture capital firm Able Partners.

Celebrities, including Madonna, Rihanna and Simon Cowell, are reportedly fans of IV vitamin treatments, but it's drawn some controversy.

"Anytime you poke a hole in somebody's vein, there is some risk that they'll bleed excessively. There's also some risk that they will clot excessively," said Dr. David Katz, founding director of Yale University's Prevention Research Center. "So the risks are not great. And the risks are not very common, but there are risks, and the only way to justify any risk in medicine is by a greater likely benefit."

He said there is "minimal evidence that there is any meaningful benefit for most people."

Kitfield said NutriDrip doesn't make grand promises about its treatments but said the company and customers clearly believe in its benefits.

"When you look at our business where 50 to 60% of our revenue comes from regulars, and that's why we continue to grow, the proof is kind of in the pudding, Kitfield said.

According to the Global Wellness Institute, a nonprofit that tracks the industry, the global wellness market is a $4.5 trillion industry. While IV therapy and alternative medicine is a small portion of the overall spending, GWI says it's among the fastest-growing sectors.

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NutriDrip, ahead of funding round, sets up aging and hangover treatments at Wynn Hotels, Equinox - CNBC

Robby Andrews Lyme Disease Recovery | Running With Lyme Disease – Runner’s World

In early June of 2018 elite middle-distance runner Robby Andrews was on fire. Was, unquestionably, at the top of his running game. The then-27-year-old had just run one of his fastest races ever: 3:36 in the 1500 meters at the Oslo Diamond League Meet in Norway, beating out 18-year-old phenom Jakob Ingebrigtsen. Which is why, for Andrewswinner of the 800-meter national outdoor title in high school, holder of a national indoor record in the 800 meters as well as the 1000 meterswhat happened two weeks later was such a shock.

June 21. The USATF Championships in Des Moines, Iowa. Andrews felt confident going into the 1500 meters, but mid-race he completely ran out of steam. He placed a disappointing fifth in his heat, not even qualifying for the finals. I dont know what happened, a confused Andrews told reporters after the race.

Kevin Morris

A few days later he came down with flu-like symptoms. For the next month he battled nasty upper respiratory and sinus infections and 102-degree fevers. Training just sucked, says the Olympian. My paces were nearly 40 seconds slower than theyd been just a few weeks before. Andrews went to his doctor, who ran tests for everything from Lupus to Lyme, but they all came back negative. I was told, There is literally nothing wrong with you, recalls Andrews. But there had to be, he knew. This could not possibly be all in his head.

Still, he had a contract with Adidas to fulfill, so Andrews traveled to Europe, where he clocked disappointing times: 3:44 in the 1500 meters at the Lignano Meeting International in Italy; 1:52 in the 800 meters in Flanders Cup Kortrijk in Belgium. For the remainder of the summer, Andrews felt constantly wiped out. Normally he would be up at 7:30 to train; now, he couldnt pry himself out of bed until 10. The few days a week he forced himself to run, hed get so dizzy and breathless hed have to quit after 20 minutes. Every afternoon, he napped for up to four hours.

He kept thinking how closely his symptoms resembled those of people he knew whod had Lyme, including his older sister Kristin (also a runner who is a 2020 Olympic hopeful) and his former roommate, Donn Cabral (a 2012 and 2016 Olympian in the 3,000-meter steeplechase), so Andrews asked to have his Lyme test re-run in September. It came back positive. The doctor wanted to prescribe antibioticsthe standard treatment for Lymeimmediately, but Andrews was worried about the side effects. Instead, he decided to take the advice of a holistic doctor who had helped his sister during her bout with Lyme in 2016.

Once a week Andrews swallowed eight drops, an hour aparta concentration of herbs such as ashwagandha, rhodiola, turmeric, licorice root, and cordycep mushroomsthat the holistic doctor said would help strengthen his immune system. He soaked his feet in a proprietary blend of herbs that he was told would draw toxins out of his body. He spent more than $1,000 on treatment. He didnt care if anyone thought he was nuts. He just wanted to feel better.

And he did, for a few months. My energy went way up. I could run three miles without having to stop, says Andrews. Then, in February, it all fell apartan almost overnight, dramatic decline in his physical and emotional health. Fatigue weighed down his body. Headaches crackled through his brain. He was sweating so much at night that he had to change the sheets. And perhaps the worst? Really depressive thoughts. It was a dark couple of months, Andrews says. If it wasnt for my girlfriend and family, I would have gone days without talking to anyone or leaving the house. He raced at the U.S. Championships at the end of February on Staten Island, in the 1000 meters. I felt bad from the first step. Something was wrong. He clocked in at 2:26dead last.

Drew Reynolds

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Disillusioned with the holistic protocol, Andrews finally accepted a prescription for antibiotics in March. His doctor told him to take them until his symptoms were relieved for a full month. Andrewss concerns about side effects were valid; the antibiotic gave him severe fatigue and headaches, brain fog and GI issues.

Desperate to make the 2019 world championship team, he ran the 800 meters at the Adrian Martinez Classic in April, only to come in last, again. In June he set his sights on the Princeton Qualifier. I missed my college roommates wedding for it, that is how important this race was for me, he says. Midway through the 1500-meter race, he dropped out, wheezing and depleted.

Andrews felt like he was out of options. And although he didnt know it at the time, he had entered the Lyme Wars, a fiercely contested fight about why some Lyme patients develop chronic, relapsing symptoms even after treatmentand what to do about them.

A stealth pathogen. Thats what some researchers call the corkscrew-shaped bacteriaBorrelia burgdorferithat causes Lyme disease, now one of the fastest growing infectious diseases in America. More than 300,000 new cases are diagnosed every year, according to estimates from the Centers for Disease Control and Prevention (CDC).

Black-legged ticks pick up Borrelia from the birds and small mammals they feed on, then they pass the bacteria into our blood when they feed on us, usually from May to Septemberprime months for logging miles on wooded trails and grassy park paths.

Removing a tick quickly lowers your risk for infectionit takes an estimated 36 to 48 hours for the arthropod to transmit Borrelia. But once the bacteria enters your body, it is a master of evasion. The Borrelia can spread from the skin to other tissues, which can make it more challenging to treat. Your immune system takes days to a few weeks to recognize any infection, including Lyme. Thats why the standard Lyme testwhich checks for antibodies (not the bacteria itself)can more easily give a false negative test early on, like Andrewss did.

When your body finally detects Borrelias presence, it launches an immune response to fight it, which is what can bring on flu-like symptoms such as sluggishness, fatigue, muscle aches, and joint pain. Runnersespecially those who spend hours outside during the summer training for fall marathonscan attribute symptoms to overtraining.

The majority of Lyme cases are easy to treat and cure with a 10- to 28-day course of antibiotics, says Paul Auwaerter, M.D., the president of the Infectious Diseases Society of America (IDSA). Ying Zhang, MD, Ph.D., a leading expert on the Lyme bacteria and a professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health, disagrees. Lyme can be a really terrible disease and a very complex one. Different patients have different responses, and the disease can manifest in different ways, says Zhang, who believes Lyme can indeed develop into a chronic form that resists the current antibiotic treatment.

Indeed, for around 20 percent of Lyme patients, a dose of antibiotics isnt the end of the story. Not by a long shot. They continue to suffer from a variety of symptoms that can last for months, even years: fatigue, headaches, muscle and joint pain, difficulty concentrating, and sleep disruptions. The frequently used medical term for these persistent problems is Post-Treatment Lyme Disease Syndrome (PTLDS). PTLDS means that we know that a patient has had Lyme, has gotten a course of antibiotics, and doesnt feel like theyve bounced back, says Auwaerter.

PTLDS is often referred to as chronic Lyme, a term Auwaerter disparages as a catchphrase for otherwise unexplained fatigue, pain, and neurologic symptoms in people who dont meet the diagnostic criteria for Lymeusually obtained by medical history, a positive blood test, and physical exam. But diagnosing Lyme can be tricky. In the first three weeks after infection, the test detects Lyme only 29 to 40 percent of the time and some 30 percent of all Lyme patients, like Andrews, dont get the telltale bullseye rash.

Drew Reynolds

Drew Reynolds

What really keeps the controversy alive is this: There isnt yet a sensitive and reliable test that can determine if ongoing symptoms after Lyme treatment are due to an ongoing active infection, says Brian Fallon, MD, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University. Without one, some medical organizations, like the International Lyme and Associated Diseases Society (ILADS), believe chronic symptoms may be due to the persistence of the Lyme bacteria. They suggest that for some patients, the potential risks of treating with antibiotics for longer periods of time outweighs the consequences of an untreated persistent infection. Giving credence to this argument are several recent studies that found Lyme bacteria remained in animals even after they were treated with antibiotics. And in March, Zhang and his colleagues found that a slow-growing form of persister Lyme bacteria not only resisted standard single antibiotic treatment, but also caused more severe arthritis-like symptoms in mice. They found that a cocktail of three antibioticsdaptomycin, doxycycline, and ceftriaxonecompletely killed the bacteria, and they are now planning clinical trials to see if the result is the same in humans.

On the other hand, groups including the IDSA maintain that symptoms that linger after antibiotic therapy are not due to an ongoing active infection of the Lyme bacteria and therefore should not be treated with additional rounds of antibiotics because theyre unlikely to help. Six clinical trials have shown that long-term antibioticsbeyond the recommended 28 dayare not effective, says Auwaerter. Plus, long-term use of antibiotics can lead to serious side effects, such as blood clots and, even, in rare cases, death.

If chronic symptoms are not caused by an active infection, then what? It could be due to an autoimmune reaction, where a prior infection has triggered an immune reaction that is now acting independently, or it could be that the prior infection changed the brain activation patterns, Fallon says. Theres some evidence to support both of these processes.

While researchers debate, patients are left sick, with lots of questions, and no good answers. Its devastating for peoples lives and some are willing to try anything to get better, Fallon says. After his dismal race in Princeton, Andrews was one of them.

This June, after battling symptoms for nearly a year, Andrews visited Mark Sivieri, M.D., a board-certified family practice doctor in Maryland who is also board certified in integrative medicine (which pairs traditional medicine with complementary therapies). Andrewss cousin had been seeing him for her own ongoing Lyme symptoms. There was an instant connection: Sivieri had also been a professional runner; he and Andrews even shared a coach at one point. During the three-and-a-half-hour appointment, Sivieri studied Andrewss previous blood tests. He noticed that, in addition to Lyme, Andrews had tested positive for two other tick-borne infections (Andrews says the doctor who had ordered the test never mentioned them).

Ticks carry and transmit loads of other bacteria, parasites, and viruses beyond Borrelia burgdorferi. A single tick can make a person sick with several diseases at the same time, including Anaplasmosis (a bacterial infection that causes fever, aches, chills, and muscle aches), Babesiosis (a parasitic infection that attacks red blood cells), and Powassan virus (which can cause an infection in the brain and can even be deadly). And not all doctors check for these when they are focused on Lyme; those who do test for them may believe the antibiotics prescribed for Lyme will be enough to wipe out the co-infections. The estimates for co-infection rates with Lyme disease can widely range anywhere from about two to 40 percent. And not only are some, such as Powassan, more dangerous than Lyme, but simultaneous infection, some research suggests, may make Lyme harder to treat or recognize, and might affect how the immune system responds to Burgdorferi.

Sivieri put Andrews on a 60-day course of the two antibiotics hed previously been taking to kill the bacteria for Lyme; he also prescribed a medication to wipe out the co-infections. He said the night sweats and the shortness of breath, thats what the Babesia parasite does, it eats your red blood cells and prevents the oxygen from moving around your body. Thats obviously a big concern for runners. I couldnt breathe well when running, right from the start, says Andrews. And Im a trained athlete.

Sivieris tests showed that Andrews was also sensitive to gluten and dairy; he recommended avoiding them to help take pressure off his immune system. My stereotypical Italian grandma was aghast when I told her no more pasta and chicken parmesan, Andrews says. That was a big transition for me. But if thats whats was going to get me better, I didnt care at all.

Drew Reynolds

Sivieri then turned to natural remedies to help strengthen Andrewss immune system, putting him on adaptogenic herbssaid to help with all types of stresssuch as curcumin which can reduce the inflammatory response caused by Lyme.

Using alternative medicine to nuke hard-to-kill bugs might sound like folklore, but science is starting to back the theory: Zhang recently found that, in laboratory dish tests, 10 oilsincluding from garlic cloves, myrrh trees, thyme leaves, allspice berries, and cumin seedsshowed strong killing activity against the non-growing and slow-growing persister forms of the Lyme bacteria, even better than standard antibiotics. We need to do proper clinical trials, to see how to use them more effectively without being toxic but [in the future, I believe that] the more effective treatment is going to come from a combined approach of antibiotics with essential oils or natural products.

The combination of traditional and alternative medicine helped Andrews. The past year has been brutal, but he finally feels like his old self again. I wake up in the morning and I have energy all day, he says. Im not sweating at night, [there are] no headaches. The depressive thoughts are gone. Im training at full capacity. He plans to run the indoor season in 2020, still in hopes of achieving the Olympic qualifying time.

He stopped taking antibiotics in mid-August, now its complementary treatmentsincluding vitamin C for his adrenals and immune system and curcumin for inflammation. He still avoids gluten and dairy and is content to continue the regimen for the near future. The supplements could be pointless, but hes not going to chance it. It seriously feels like I have my life back, he says. This is me. Im back to me.

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Robby Andrews Lyme Disease Recovery | Running With Lyme Disease - Runner's World

Alternative therapies to cope with workplace stress – The Sunday Guardian

Therapies like yoga, meditation, mindfulness and sound healing programmes can help us manage work-realted stress, which often translates to ill health and low productivity levels.

Increasing job uncertainty, grueling work hours and an abject lack of work-life balance often translates to heavy stress in our professional lives. Rapidly changing nature of jobs, 24/7 connectivity and the resultant pressure of constant deadlines have turned Indian workplaces into pressure cookers where thousands of young professionals struggle to maintain mental balance. Rates of burnout or exhaustion syndrome are high among bright professionals who fail to reach their full potential because stress gets the better of them on their way to success. A survey by insurance company Cigna TTK found that a whopping 89% of people were suffering from stress, with work and finances being the primary causes of stress.

Interestingly, a number of corporate organisations have realised the negative impact stress is having on their employee productivity, and holistic wellness programmes have gained much traction. However, it is important to educate people at individual levels as well to learn to cope with stress on a daily basis. While we cannot change the stressors, we encounter every day, we can most certainly change the way our mind deals with them.

A number of alternative therapies can help individuals achieve better mental health and wellness. These therapies can be adopted as a way of lives as coping mechanisms for the mind. A study published in the BMC Complementary and Alternative Medicine journal concluded that yoga, mindfulness-based cognitive therapy and cognitive behavioural therapy were very effective in promoting overall mental health and preventing burnout due to work-related stress among participants.

Lets take a look at some alternative therapies that can help you cope with professional stress:


Mindfulnessis a psychological process through which one tries to maintain complete awareness of the present moment. It trains the mind to prevent distractions of the future or past musings. Achieving a moment-by-moment awareness of our thoughts, feelings, acts, sensations as well as the environment plays a very impactful role in reducing stress. When you are bathing, you are focusing completely on the act of water interacting with your body; when you are eating, you are doing it so mindfully that all your thoughts are focused on your movement from the plate to the palate and beyond. A study published in theJAMA Internal Medicinereview found that a mindfulness-based programme helped reduce anxiety symptoms in people with generalised anxiety disorder. Another study published in the journalBiological Psychiatry found significant changes to the brain on scans after just three days of mindfulness meditation on 35 unemployed people experiencing major stress of a job search.

Mindfulness works by inducing a sense of calmness and improving focus. Mindfulness is even associated with lower levels of inflammation markers.


Yoga and meditation are widely known to induce benefits for mental health including stress management. Yoga combines the physical and mental disciplines to help achieve a peaceful alignment between the body and mind. When combined with meditation, yoga relaxes and soothes the nerves, aligns the mind towards a calm centre and helps an individual become more mindful of the present. Approach has significant benefits for stress and anxiety. Yoga doesnt just help in stress management, it also helps curtail the negative impact of stress on the body and reduces risk factors for chronic diseases, such as heart disease and high blood pressure. Yoga modulates the stress response systems by training the mind to perceive stress and anxiety differently.

Sound Healing:

Sound healing or music therapy is another highly under-utilised therapy that has significant benefits on stress and anxiety healing. It can effectively be termed as vibrational medicine with the use of music, singing, and sound tools that release vibrations to better the mental, emotional and physical state of a person. Sound healing creates a shift in our brainwave state by using entrainment; a bio-musicological sense that refers to the synchronisation (e.g. foot tapping) of humans to an external perceived rhythm such as music and dance. Entrainment creates a stable frequency in the brain. This allows for the mind to go from the normal beta state (normal waking consciousness) to the alpha state (relaxed consciousness). Quite similar to meditation which regulates the breath, sound healing influences the shift in the brain through its frequency.

Sound healing particularly helps in reducing anxiety, stress, and sleep disorders. A study published in the Journal of Evidence-based Integrative Medicine examined the impact of sound meditation, specifically Tibetan singing bowl meditation, on mood, anxiety, pain, and spiritual well-being. It found participants experienced a significant reduction in tension and feeling of spiritual well-being also significantly increased through sound healing.

The author is the director, Poddar Wellness Ltd and managing trustee, Poddar Foundation

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Alternative therapies to cope with workplace stress - The Sunday Guardian

Gwyneth Paltrow’s new Goop Lab is an infomercial for her pseudoscience business – The Conversation CA

Last week, Netflix dropped the trailer for Gwyneth Paltrows new show The Goop Lab. It is a six-episode docuseries launching on Jan. 24 that, according to the trailers, focuses on approaches to wellness that are out there, unregulated and dangerous. (Read: science-free.)

The backlash by health-care professionals and science advocates was immediate and widespread. And for good reason. As noted by my friend, obstetrician and gynecologist Dr. Jen Gunter in Bustle magazine, the trailer is classic Goop: Some fine information presented alongside unscientific, unproven, potentially harmful therapies.

We know the spread of this kind of health misinformation can have a significant and detrimental impact on a range of health behaviours and beliefs. This is the age of misinformation and this show seems likely to add to the noise and public confusion about how to live a healthy lifestyle.

But what has been largely overlooked in the initial wave of critiques is the conflict-of-interest issue. The producers of this show that is, Gwyneth Paltrow and her company Goop benefit directly from not only the show being popular but also from the legitimization of pseudoscience. This show is, basically, an infomercial for the Goop brand, which is built around science-free products and ideas.

To be fair, I have yet to see a full episode. But given the content of the trailer and Goops history of pushing harmful nonsense, there is little reason to be optimistic about the role of science in the series. Regardless, the mere existence of the series will allow Paltrow and Goop to build the brand, which is currently estimated to be worth US$250 million.

The show serves as an opportunity to market the kind of magical thinking and pseudoscience that will help to sell Goops products. It would be like Netflix streaming a show called The Coca-Cola Beverage Lab or the The Starbucks Coffee Adventure.

One of the things that attracts people to the alternative health practices pushed by entities like Goop is frustration with the impact of private industry and the profit motive particularly in the context of the pharmaceutical industry on the conventional health-care system.

This concern about the impact of industry is understandable. There is a vast literature highlighting industry misbehaviour and the adverse consequences of Big Pharmas influence on research, clinical practice and clinical guidelines. Awareness of these issues has contributed to a decrease in trust in the medical profession and even to harmful trends like vaccination hesitancy.

For the advocates of alternative approaches to wellness, conventional medicine is often positioned as irrevocably compromised and corrupt. And many have come to believe even extreme versions of this narrative.

A 2014 survey found 37 per cent of Americans believe (and another 31 per cent think it could be true) that the Food and Drug Administration is deliberately preventing the public from getting natural cures for cancer and other diseases because of pressure from drug companies. Goop has also enabled these kinds of extreme perspectives.

The implication, of course, is that alternative approaches are somehow untainted or, at least, less tainted by vested interests and are, therefore, the better choice. But this clean hands framing is patently false.

First, we need to recognize that alternative medicine is also a huge industry. The worldwide wellness market, which is largely composed of unproven and alternative modalities, has been estimated to be worth over US$4 trillion.

The sale of herbal medicine and supplements are also multi-billion dollar industries. Given the size of these markets, it would be naive to believe that alternative medicine is somehow missing the twisting profit-motive incentives that have created problems for conventional health care.

Second, the alternative health community is also rife with conflicts and biases. To cite just a few examples, naturopaths profit from the in-office sale of products and have partnered with the vitamin industry to expand the reach of their practice.

In addition, alternative medicine research has been influenced by various systemic biases. And we shouldnt forget that many of the most commonly used alternative products, most notably supplements and herbal remedies, are often made by the very pharmaceutical industry that alternative wellness devotees are seeking to avoid.

Third, motivated reasoning plays a big role here. When an individual or a company has built a profession or a business model around a particular worldview, this commitment will have an impact on how the relevant evidence is interpreted, used and presented to the public.

If you are a practising homeopath, for instance, it would be tremendously difficult to accept what the evidence says about the remedies you offer. Indeed, accepting the science would mean you would lose your livelihood and professional identity.

More needs to be done to combat the adverse impact that conflicts of interest issues can have on bio-medical research and clinical practice. But we also need to recognize that profound conflicts of interest exist in the alternative health and wellness domain. We should not give those involved with this industry including Paltrow and Goop a pass.

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Gwyneth Paltrow's new Goop Lab is an infomercial for her pseudoscience business - The Conversation CA

‘How to live and die well’: what I learned from working in an NHS hospice – The Guardian

Shes called Gemma. Shes three years old. She fell into a canal, said a senior nurse. By the time her parents managed to get her out, apparently shed already stopped breathing. Paramedics three minutes away, called another nurse, holding the scarlet phone on which emergencies were called through. With a grace and efficiency akin to choreography, a team of professionals who moments beforehand had been as disparate as atoms, dispersed across the hospital, were poised around an empty resuscitation bed, waiting as one to swing into action.

The consultant quietly confirmed each team members role. The anaesthetist, responsible for airway. The scribe, who would note down, in meticulous detail, the timings, the drugs, the doses, every iota of care which, if we were lucky, might snatch life back from lifelessness. Doctor one, doctor two the roles and responsibilities went on. Then, a moment of silence before the paramedics brute force pushed a trolley through the swing doors and there, tiny, limp and pale, lay a toddler, unmoving beneath the harsh fluorescent lights.

It was impossible to hear the paramedics handover above the screams of Gemmas mother. Save her! she pleaded, over and over. Please, please, save her! Gently, a nurse discussed with her whether she wished to stay or leave the bay for a moment. The crash team worked on, its focus absolute. In moments, the child had been intubated. Tubes and electrodes sprouted everywhere. Tiny, toddler-sized chest compressions continued, interrupted every two minutes to check for the resumption of a heartbeat.

Too inexperienced to help, I hovered on the periphery, trying not to wear my shock visibly. I had never before seen a child this unwell. Unless the crash team managed to restart the heart, I was watching, in effect, a dead little girl. I thought of my own toddler, safe at nursery, and of the magnitude of the horror with which Gemmas mother, sequestered in a relatives room, must now be seized.

On and on the crash team worked. Compressions, adrenalin, electric shocks, compressions. A miniature mannequin, manhandled with conviction. The collective will in the bay for this child to live, to survive, was so strong as to be almost palpable. A forcefield of longing around the bed. Its silent incantation: come on, come on, come on, come on.

Fifteen, 20 minutes must have passed. The resuscitation attempt was going nowhere. In an adult, the risk of brain damage is high, but Gemmas youth gave her body resilience. I bit my lip to keep tears at bay. And then, impossibly, before our disbelieving eyes, the chaotic scrawl of the ECG trace was jolted by the latest shock into something that coalesced into a normal rhythm. Gemmas stunned, battered, fibrillating heart had somehow started to beat again. This bodys submersion in brackish water, these lungs fully flooded with rank green canal despite it all, this little heart had maintained its capacity for life. A resurrection had occurred. Right there, on crumpled NHS cotton, a girl had been brought back from the dead. I wanted to cheer from the rooftops.

Not for one second did the teams concentration dip. The luxury of jubilation was forbidden while her life, her brain, still hung in the balance. ROSC return of spontaneous circulation is only the first step from an arrest back to health, and Gemma was whisked straight to the paediatric intensive care unit.

The smiles after she departed could not have been any broader. Consultant hugged staff nurse hugged student, in a rare moment of shared elation. But what stayed with me, as I walked out of A&E that night, was not this eruption of joy but the preceding ruthless dispassion. That total focus while I, on the sidelines, had fought not to quiver and cry. The crash team, simultaneously human and robotic, crunching through the protocols that maximised a childs chances of life. I wanted to eradicate my human weakness and become, like these doctors, part machine.

The man widely regarded as the father of modern medicine, the Canadian professor William Osler (18491919), famously recognised the unique importance of stories in medicine. Osler insisted that medical students should learn from seeing and, crucially, from talking to their patients. Memorably, he said: Just listen to your patient, he is telling you the diagnosis.

Those words are as true today as they were back then. Storytelling is the bedrock of good medical practice.

The author Philip Pullman goes one step further, stating that: After nourishment, shelter and companionship, stories are the thing we need most in the world. In boldly insisting on stories as imperative for human survival he imbues them with a transformative force in medicine. It is undeniable that the meanings we construct around our afflictions and diseases, the stories we tell ourselves about what is wrong, and where we are heading, can overturn our experience of illness.

You might imagine that storytelling is the last thing on a doctors mind. We are all far too busy doing our jobs, often with time running out. But Pullmans words are nowhere more apt than in a hospital, where what heals is not confined to a doctors drugs or scalpel blades. It is the quieter, smaller things too being held, heard and shown you matter that make patients feel cherished, and hospitals humane.

The NHS hospice where I work today is strikingly beautiful. Natural light streams in from skylights and floor-to-ceiling French windows, allowing patients to look out on gardens, trees and the birds just outside. There are whirlpool baths, massage, art and music therapy, ice-cream and homemade smoothies on tap. We hold weddings here, set up date nights, sneak in pets, break the rules. There is even a drinks trolley, wheeled from room to room twice a day, amply stocked with fine wines and cans. Because what better way, for those who fancy a drink, of remembering normal life back home?

Bird food and beer might not seem revolutionary, but when I arrived here, seven years after starting life as a doctor, they signalled something thrillingly radical. For all the care contained within hospital walls, it would be hard to design a more dehumanising space than your typical busy teaching hospital.

Even after resolving to specialise in palliative medicine, the decision was less a conviction than a leap of faith. Indeed, during my early days in the hospice I felt like a brand-new doctor all over again, learning an alternative medical paradigm, one with people, not diseases, at its heart.

Simon was a man in extremis. He had a cancer of his thyroid that was threatening to suffocate him. Already requiring oxygen, this morning his breathing had taken a turn for the worse and now, we had been told, he was fighting for air.

A former policeman in his 60s, Simon had retired a few months earlier. He was looking forward to having time to while away in the fresh air, walking and jogging. Shortly afterwards, he had noticed a lump in his neck, painless, innocuous and perhaps, he had assumed, related to a recent head cold. But the lump, unlike the cold, persisted and, more unnervingly, continued to grow. Still more curious than concerned, he visited his GP.

The speed of his referral to hospital impressed him, innocent of the fact that he was on a two-week cancer pathway, its celerity commensurate with his doctors worst fears. There was to be no well-earned peace in the countryside for Simon. The scan became a biopsy, and the biopsy a consultant, murmuring cryptically about inoperability, as Simon sat stricken, pinned to his seat, hearing nothing of substance after cancer.

I heard him before I set eyes on him. Specifically, I heard the sound of air being sucked into his lungs through an airway severely compressed by tumour. Stridor the harsh rasp of air with each intake of breath, audible only when the trachea is critically narrowed. Once heard, never forgotten.

When I entered his room, Simon was sitting bolt upright, eyes darting frantically, his shirt ripped off and both hands gripping the bed like his life depended on it. From deep inside his body, from the depths of his spinal cord, he trembled with fear. Beside him stood a woman in her 30s, distraught and dishevelled, saying: Its OK, Dad. Look. Look, the doctors here. Everythings going to be OK now.

Simon stared up at me, beads of sweat on his brow, gulping for air. There was no way he could sustain this work of breathing. At the same time, I observed, the oxygen required was sufficiently low to be delivered not through a mask, but through small tubes in the nose. Although petrified, and with good reason, he was not yet in respiratory failure.

In an A&E department, Simon would have been gowned, cannulated and hooked up to lines and monitoring. I chose instead, you might argue, to gamble. If Simon was about to die, I reasoned, none of this paraphernalia was going to prevent that. But if, as I suspected, panic had exacerbated his airway obstruction, then I knew how to help.

I ascertained from Sophie, Simons daughter, that he had completed radiotherapy to his thyroid a few days earlier. His oncologists hope had been to shrink the tumour, eking out a little more time, perhaps even enabling him to reach his grandsons sixth birthday.

Simon, I am confident we can help you feel better, I began, but Id like to sort out some treatment straight away. Then we can talk. Is that OK? He nodded, mute.

I worked fast. The nurses brought the large dose of steroids that would, I hoped, begin to shrink the swelling in Simons neck. Next, a tiny dose of a fast-acting sedative, just enough to take the edge off his panic.

Would you like me to explain what I think is happening? I asked him, keen to allow the sedative more time to calm his fears. Yes, he said clearly the first word he had been capable of speaking out loud. I spoke evenly, unhurriedly, hoping to instil trust and confidence. I think there are two problems, Simon. First, there is your tumour, pressing on your windpipe, but there is also the radiotherapy, which has damaged the tissues in your throat and caused them to swell. We see this very commonly. The breathing often becomes worse for a few days after radiotherapy, maybe a week or so, before it gets better. Steroids can really help bring down the swelling.

There are moments in medicine when what you say next feels as pregnant with risk as the surgeons first incision

As I talked, Simons eyes never left me. His gasps, I noticed, were beginning to decelerate. How does it feel now? Is the injection we just gave you helping at all? Well, I dont feel quite as bad, he said doubtfully. Out of the corner of my eye I saw that Sophie was crying.

Simon began to describe living alone with his cancer, having been widowed a few years previously. Its all been so quick. Too much to take in. Sophie, if Im honest, is my rock, but she has Timmy, her boy, to look after as well.

Dont be ridiculous, Dad, Sophie interjected, almost angrily. You know looking after you is no problem. We all love being with you, especially Timmy.

Simon could not meet his daughters eye. His chest, damp with sweat, still undulated with muscle, a torso sculpted from lifelong activity, not yet effaced by cancer. I wondered how much it cost him to appear this vulnerable in his daughters eyes, and whether shame was inflaming his distress.

Gently, I kept tweaking the oxygen downwards. Simon, you know this is really encouraging? Youre managing to talk in full sentences. I dropped the oxygen down as low as it will go a good 10 minutes ago. May I try taking it off you?

Youre a sly one, he exclaimed, with the faintest trace of a smile.

The hint of a relationship forged, I broached the topic of the future. He cut me off instantly. Look, Im not stupid, he exclaimed. I dont have one, do I? This is it. I know whats going on. Dad, pleaded Sophie, tears flowing. Shes trying to help. Dont shout at her.

There are moments in medicine when what you say next feels as pregnant with risk as a surgeons first incision. The right words, used wisely, can bridge the airiest expanse between you and your patient but, if misjudged, may blow trust to pieces. In scarcely a month, cancer had snatched from this man of action and authority his health, his future, his strength and his fearlessness. And today, perhaps worse than all of that, his daughter had witnessed him writhing in fear.

Few sensations are more terrifying than that of fighting to breathe. In that moment, every mental sinew you have ever possessed lifelong habits of logic, love, faith and reason are wiped out by a frenzied craving for air. Simon had been fighting for his life, the most powerful and desperate of all human instincts. I needed to give him control, if only over our conversation.

Simon, are you the kind of person who likes to discuss everything frankly, I began, or do you prefer to take things one day at a time, without speculating about the future? I already know Im dying, he responded. What else could you possibly tell me?

Well, people often assume that once you arrive here, you will never leave. But around half of our patients dont die here. They go home again once weve managed to sort out their symptoms. Its not always a one-way ticket.

He blinked. No one said anything for a while, as we listened uncomfortably to the scrape of his stridor. Finally, it was his daughter who spoke: I didnt realise that, Dad. Did you?

Silence. My intuition was that Simon not only feared never leaving the hospice, but was also convinced he was imminently dying. Perhaps the only way to reach him was to confront this head-on. One of the things Ive noticed working here, Simon, is how often patients feel unable to ask about the thing theyre most preoccupied with, which is what its actually going to be like when they die and I wonder whether this is something youd like to talk about?

I saw a flash of horror distort Sophies face; but her father, if anything, looked relieved. Go on, he said cautiously, giving nothing away.

OK. But please stop me at any point if you dont want me to continue. I glanced at Sophie. Simon confirmed that he wanted her to stay. So ... we tend to see the same patterns over and over in people with cancer, or another terminal illness, who are approaching the end of life. One of the first things many patients notice is losing their strength, their energy. Things they used to take in their stride become a real physical and mental effort. Im guessing youre already aware of that?

A dying man had faced his end and found the strength to look towards what mattered more than anything: those he loved

A rueful roll of the eyes. No kidding. I used to run marathons. Cant even get up the stairs now.

That loss of energy gradually worsens. You might find you need a nap most days, more than one, probably. Then, one day, you realise youre sleeping more than youre awake. Its not painful or horrible, its just immensely frustrating. Patients can find it helps to try and plan in advance a bit, saving up their energy for the things that really matter.

Like Timmy, Simon interrupted. I like to know when hes visiting so I can have a sleep beforehand. I didnt realise that, Dad, said Sophie. Well, I want to give him my best, dont I? And I dont want to lose a second with him.

Sophie now turned to me. Timmys dads not around any more, you see. Left when he was two. Dads more like his real father.

I see, I said slowly, computing the layers of loss, more intricate and heftier than I ever imagined.

By now, I noted, Simon had been breathing calmly for half an hour without requiring any additional oxygen. Encouraged, I went on. Often, at the end, there arent any dramatic changes. That sleepiness continues. A patient finds they are sleeping nearly all of the time. You stop feeling hungry and you dont want to eat. You may stop feeling thirsty, too. Then, one day, rather than sleeping, you slip into unconsciousness. Its not a distinction you are even aware of. Your brain is just more deeply unresponsive. Sometimes, I wonder if this is the bodys way of protecting the mind you stop being afraid, youre oblivious to it all.

I paused, trying to gauge Simons reaction. Shall I go on? I asked. The most perfunctory of nods, so I continued. You might be thinking that what youve experienced today is nothing like what Ive just described. Youve felt as though youre suffocating to death and I cant imagine how awful that must be. But what I can promise you is that, if you feel like that again, we will still be able to help you. We can take away that feeling of panic with drugs that work almost instantly. You dont need to feel like that again. We will be right here for you, whatever happens.

Both Simon and Sophie were quietly crying. The sky was darkening outside. We were sitting, I realised, in a small pool of light from the adjustable lamp just above Simons bed. A father, a daughter and a doctor, surrounded by shadow, staring together at the death to come. Weighing it, considering its shape and form, perhaps for the very first time. The hostility with which Simon had been bristling was gone.

How long do you think I have left? he asked me directly.

I have no reason to think you are going to die today, Simon. Im not even certain the blockage in your airway is what will kill you. I do think your time is short weeks, not months, perhaps only very short weeks but I would love to believe we can get you home for a bit, if thats what you would like.

For a while, Simon said nothing. The silence, though thick with emotion, was not strained. Finally, he raised his eyes to mine and smiled. OK. Maybe Ill get to my boys birthday too. Thank you, Rachel I mean it.

So often, soreliably, Iwitness peoplerising totheir best onfacing theworst

My heart, for a beat, threatened to knock me off balance but only later, that night, did I allow myself to feel. A dying man had looked his end in the eye all of it, the worst of it, potential suffocation and yet, in that moment of profound mortal reckoning, with every single thing he loved slipping from his grasp, had found within himself the strength to look outwards, towards what mattered more than anything: the human beings he loved. How, I wondered, could someone be so aghast at their weakness while behaving with such unseen strength?

I cried that night. But not for what we lose. It is who we are that moves me, time and again, in the hospice. When people ask me if my job is depressing, I reply that nothing could be further from the truth. All that is good in human nature courage, compassion, our capacity to love is here in its most distilled form. So often, so reliably, I witness people rising to their best, on facing the worst. I am surrounded by human beings at their finest.

In 2017, my dearest Dad was himself a dying man. He had spent half a year on the chemotherapy carousel. Infusions, blood tests, nausea, fatigue, infusions, damaged nerves, infusions, bleeding skin. Hope, more than anything, kept him coming back for more. Even when the scans showed terminal spread, still he yearned, burned, for more life. He took these monthly batterings of the cytotoxic drugs because they allowed him to imagine a future.

Even as new symptoms revealed themselves, Dad managed to maintain his poise. He was a doctor and, I suppose, his training was useful. None of it came as a surprise to him. Theres something you need to know, he told me later. Over the weeks he had sat down in private and, through the fog of cancer fatigue, written letters to his wife, children and grandchildren. Theyre in a sports bag in my wardrobe, Rachel. Youll find them under my shirts. This was love, painstakingly scrawled and sealed inside envelopes, a legacy of words for his family.

After the funeral, I returned to work a different doctor. I have known the taste and weight of grief. Now, when I enter a patients room, I recognise the sunken eyes and tired frowns of those who cling to the one who would be lost to them. I understand that from the inside out, grief, like love, is non-negotiable, and that the only way to avoid the pain is to opt out of ever loving.

Above all, I have learned from my conversations with my father that being given a terminal diagnosis changes both everything and nothing. Prior to this news, a man of 74, he knew he would die one day, just not when exactly. And after this news, he knew he would die one day, just not when exactly. Everything he had always loved about life was still there to be loved, only more attentively now, more fiercely. All that had changed was the new sense of urgency, the need to savour each day and its sweetness.

Dear Life: A Doctors Story of Love and Loss, by Rachel Clarke, is published by Little, Brown on 30 January. To order a copy go to guardianbookshop.com. Free UK p&p on all online orders over 15.

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'How to live and die well': what I learned from working in an NHS hospice - The Guardian

‘Comfort’ or con? Despite money, education, well-off Filipinos turning to questionable treatments – Coconuts

In 2008, retired finance professional Pablito Bermundo found himself staring up at the surgical lighting hanging over the operating table, feeling both annoyed and amused that he was once again going under the knife.

After his gallbladder was removed in 2006, a massive cyst grew in his liver, one that would need to be surgically drained every six months. After two years of being wheeled in and out of the operating room, he decided that hed had enough.

I have to look for other options, he thought.

In 2009, Bermundo met a man who convinced him to give hilot a shot. Hilot is an ancient Filipino healing method in which ailments are purportedly treated with massages administered by healers known as manghihilot, who supposedly derive their power from God. Though many doctors are skeptical that hilot can cure serious illnesses, Bermundo credits it with saving his life.

With standards of living and education levels on the rise across much of Southeast Asia, including the Philippines, it would stand to reason that traditional healing methods often scientifically dubious, and occasionally accused of making matters worse would have begun to wane outside of remote areas where traditional ways still hold sway. However, Bermundo is one of many middle- and upper-class Filipinos who, despite their means and access to modern treatments, have continued to put their faith in alternative healing methods over Western medicine.

Meanwhile, as access to science-based Western medicine increases, so too does exposure to Western quackery, and questionable new-age healing practices many of which have quasi-Orientalist roots, and have been debunked by science are also beginning to make inroads among well-off Filipinos.

A gift from the gods

Though finding figures on alternative medicine use is next to impossible, medical anthropologist and physician Dr. Gideon Lasco says that the embrace of alternative treatments transcends class.

People just go to different places. For example, our fellow Filipinos in far-flung areas might go to an albularyo [a traditional healer], whereas a millionaire might fly into some Indian [retreat], or see some Korean practitioner.

He said people have different reasons for being wary of modern treatments.

Some people might have previous experience in hospitals or [with] doctors that they didnt enjoy.

In Bermundos case, what pushed him to go for hilot was his unhappiness with the options Western medicine and health professionals were presenting him.

I sought a second, third opinion. One doctor said he could cut off the cysts [because he said the liver] would still regenerate, he said, adding that to him, the treatment sounded too invasive.

But that all changed when he met the late Boy Fajardo, a manghihilot who learned the treatment through apprenticeships with rural healers he met in his travels around the Philippines.

Bermundo felt he had nothing to lose by trusting the healer, and Fajardo put him through regular weekly hilot sessions, and made him drink an herbal concoction containing water spinach and banaba leaves after every meal. After one month under Fajardos care, Bermundo went for an ultrasound and was pleasantly surprised to see that his cyst had shrunk dramatically.

Bermundo recalls his doctor telling him, There are no scientific studies that prove that hilot works, but just continue what youre doing.

Fajardo passed away in 2018, but Bermundo, now 76, still goes for hilot sessions, and remembers the healer as a charming man who was easy to trust.

He was naturally friendly; he wasnt in a hurry. He would answer all of your questions; you can call him anytime.

Fajardos protg Louanne Calipayan told Coconuts Manila that kindness was an especially important requirement for a manghihilot, and not just because it improves their bedside manner.

They have to be good people because what they offer is a service. A healer needs to have this characteristic because [we believe] he channels the energy from a Supreme Being, she said. A healer has to change whats in his heart because thats the energy that he will channel out of himself.

Calipayan said that despite the advancements modern medicine has made, she and her associates are seeing a resurgence in interest in hilot.

We have people flying in from Visayas and Mindanao and all other parts of Luzon. These are not the stereotypical people who go for hilot, who are uneducated or dont have money to pay a doctor, she said. In many cases, these are people who have been to many doctors or have had different treatment options, but they found the relief they were looking for in hilot.

Its not just Filipino patients who are becoming increasingly interested in hilot. As with other Eastern medicinal practices of unproven efficacy like Indias Ayurvedic healing, for instance hilot is attracting attention among Westerners. Calipayan said that not only has their group trained students from all over the country on how to practice hilot, she has also had some from as far away as Canada.

Medical anthropologist Lasco said he was skeptical of the actual medical benefits of hilot, but allowed there was still a lot of things doctors could stand to learn from traditional healers like Fajardo and Calipayan.

Patients dont just go to a doctor to get a diagnosis or treatment. They also go to the doctor to get comfort, to get reassurance, to understand whats happening to their bodies, to be given a chance to discuss choices, he said.

These traditional medicine practitioners offer us a clue of what patients are looking for. These hilot, albularyo what they offer is a personal connection.

He died of sadness

But for every apparent alternative healing success story like Bermundos, theres another like J.B. Bolaos.

A publicist by trade, Bolaos had grown skeptical of Western medicine after he witnessed what it did to his late mother, Lina.

In a recent phone interview, J.B. told Coconuts Manila how he lost both of his parents, starting with Lina, who died of lung cancer in March of 2018 after a grueling course of chemotherapy that ravaged her body. When his father, Melecio, was diagnosed with pancreatic cancer, he looked for another option.

I saw what chemo did to my mom. Every three weeks we would fly to China for cryosurgery, and chemo. She would feel so weak after two days, he recalled. [Thats why I thought] I would not go for conventional therapy for my father.

J.B. explained that based on his research, pancreatic cancer has a very poor prognosis, which further pushed him to try alternative means for his father. Chemo, he believed, would have just made Melecio weaker.

Melecio went through an alternative treatment called Gerson therapy, a dietary regimen devised by the German-American physician Max Gerson, who began touting it as an effective alternative cancer treatment in the 1920s. In Gerson therapy, patients adhere to a strict diet, purportedly to flush out toxins, and are also given coffee enemas, supposedly to spur the production of glutathione, a detoxifying antioxidant.

However, by 1989, the American Cancer Society had already evaluated the treatment and labeled Gerson therapy a sham, finding no evidence that it could effectively treat cancer. Prior to that, the National Cancer Institute in the United States studied 60 patients who used the Gerson therapy between 1947 and 1959, and concluded that the regimen did not benefit those patients.

More recently, an Australian wellness blogger documented her own rejection of more aggressive cancer treatment in favor of Gerson therapy. Despite consuming 10 juices and undergoing five coffee enemas a day as part of the regimen, she died at age 30 in 2015.

Despite the questionable nature of the treatment, J.B. and his father decided to try the method, which proved equally as expensive and taxing as chemotherapy.

Its all about juicing, the right diet, where everything has to be organic, J.B. explained. He had to take around nine juices a day, but theyre organic. All are fresh. You cannot prepare the juice like two hours before [you drink them]; you have to prepare them on the spot.

Because J.B. was busy managing his own company while juggling a teaching career, he had to hire two nurses who worked in shifts to take care of his father. Aside from the organic juices, his father was also infused with high doses of Vitamin C, Vitamin B17, and Chinese herbal medicines, and underwent ozone therapy, an alternative treatment that supposedly increases the amount of oxygen in the body.

Melecio ultimately passed away, but his son still believes that the treatment he received gave him the best quality of life.

Conventional [chemo] therapy would have given him no assurance that he would win the battle against cancer, J.B. said. There were no assurances; in fact, he might have died sooner.

My dad died of heart failure. Normally, if you die of cancer, its multiple organ failure. What he died from was totally unrelated. His heart just stopped. And I know that when someone has pancreatic cancer when you hold that persons hand, they would feel pain. My dad never had that experience, he added.

He died of sadness [from my mothers passing]. I would like to believe that he did not die of cancer.

Lasco, the medical anthropologist, said a belief in alternative treatments is common among those who have been diagnosed with cancer because of the high rate of mortality. Ditching chemotherapy as JB did for his father is understandable given the extreme side effects.

Its natural for us to want to live as long as we can, but for other people, their priority is their quality of life. They would rather have a normal and non-chemotherapy kind of life and think, OK, Ill risk this treatment. If it doesnt work out, thats OK with me, he said.

Still, as a physician, Lasco would not recommend alternative treatments to his own family.

People have their own reasons [for using such treatments]I dont want to debate [against them] because its easy to find someone who died due to chemotherapy, he said.

Whether we like it or not, we are mortals and one way or another, we will all die. So the best thing we can do [as doctors] is to show patients that this kind of treatment, based on a global study, has a recovery rate of this percentage.

Profiting on pain

Lasco, however, remains worried about fraudulent healers who take advantage of patients desperate to find a cure for their terminal illnesses, specifically cancer.

The country is no stranger to such charlatans. In the 1970s, for example, the Philippines became known for its psychic healers and those who claimed to be able to perform surgery with their bare hands. The most famous of them, Ramon Jun Labo, even treated the late comedian Andy Kaufman and then-President Ferdinand Marcos. Labo was later sued for swindling in Moscow by thousands of his former clients.

Another high-profile alternative healer was Antonia Park, who admitted to Rappler in 2014 that she was not a registered physician in the Philippines, despite working as a stem cell doctor for former President Gloria Macapagal Arroyo and the late Quezon City Vice Mayor Charito Planas.

Park was sued by businessman Bernard Tan in 2013 after Park treated his late daughter, Kate Tan, whose cancer recurred in 2012.

According to Bernard, Park said his daughter was just suffering from a hormonal imbalance and promised to treat her within three months through stem cell therapy, Rappler reported. Park also put Kate on a restrictive diet featuring fruit and vegetable juices. But as the months passed, Bernard noticed that his daughter was not getting any better.

Kate ultimately went back to chemotherapy and died in July 2013, with Bernard blaming Park for her death. Park was charged with fraud and reckless imprudence resulting in homicide, and her clinic was shut down by the authorities.

Lasco said that despite peoples understandable motivations for seeing alternative treatments, there is a need to protect patients and their families from healers of questionable backgrounds, without dismissing the legitimate fears and concerns of patients.

We should be vigilant about how peoples desperation [is] being used by these alternative providers. Our regulatory agencies should go after these treatments, Lasco said.

People dont want to give up that easily, and they will avail of treatments, especially these treatments offered by people who offer them hope. Ive seen it happen that theyre taken advantage of, he noted. Theres no way to prove if these treatments work or not because people dont complain because theyre dead.

Read more Coconuts Manila feature stories here.

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'Comfort' or con? Despite money, education, well-off Filipinos turning to questionable treatments - Coconuts

Phage therapy: The antibiotics alternative – Sydney Morning Herald

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Just after 10pm on a still Sunday night in March 2016, Jeremy Barr, having cleaned up the dinner dishes in his San Diego apartment, was thinking about bed when his mobile phone buzzed into life with a FaceTime call. Barr instantly recognised the mane of striking salt-and-pepper hair and trimmed beard on the screen. It was his laboratory supervisor at San Diego State University, Professor Forest Rohwer, one of the worlds leading microbial ecologists, and his tone was urgent.

Rohwer, a 47-year-old with a thoughtful demeanour, began quizzing the young scientist from Brisbane about his research into bacteriophage therapy phage therapy, for short which turns viruses into chemical weapons against antibiotic-resistant bacterial infections. Rohwer was curious about how Barr removed toxins from phages, so they were safe to use in humans.

Whats this about Forest? interrupted Barr, whod been working at Forests San Diego lab for four years on a postdoctoral fellowship. Rohwer explained that a local man had contracted a superbug while on holiday in Egypt and the most powerful antibiotics had failed to work. Now on the brink of multi-organ failure, the man would almost certainly die within days unless the infection could be stopped in its tracks. Could bacteria-eating phages be put to work to kill the deadly disease?

Phages, unlike antibiotics, are not drugs. Rather, they are hunt-and-kill viruses.

Both men were aware of the perilous risks of such a procedure. Phages, unlike antibiotics, are not drugs. Rather, they are hunt-and-kill viruses that inject their DNA into bacteria cells, causing the bacteria to burst and die.

The downside is that when the bacteria burst, they also release poisonous impurities and endotoxins, which can kill a person quickly with septic shock. Thats why its vital the phages be scrubbed clean of these endotoxins, without damaging or deactivating the bacteria-zapping viruses.

Could Barr perform this critical task of purifying the phages, sourced from laboratories across the US, within a couple of days, Rohwer enquired. Barr did a quick mental calculation. Yes, he said. I reckon its doable.

But Barr, a tall, slim, fair-haired 30-year-old, was terrified the moment he hung up. Hed never prepared anything for human trial before; his was still an experimental treatment. And this would be the first case in the US of a person receiving intravenous phage therapy for a systemic superbug infection that antibiotics couldnt treat.

About 20 minutes drive away, at Thornton Hospital at UC San Diego Health, the patient in question, a 69-year-old man, a lifelong surfer whod always been super fit, was hooked up to a maze of tubes, including a respirator, in an induced coma.

A. baumannii now shares top billing with two other superbugs listed by the WHO as being the most dangerous to human health.

Tom Pattersons swollen stomach contained a pseudocyst (a pocket of fluid) the size of a football and his body was swimming with a deadly, multi-drug-resistant superbug, the bacterium Acinetobacter baumannii, sometimes dubbed Iraqibacter for its signal talent for striking wounded soldiers during the last Iraq War. (A. baumannii now shares top billing with two other superbugs listed by the World Health Organisation (WHO) as being the most dangerous to human health.)

Patterson had been in a coma for weeks and had lost 45 kilograms from his formerly athletic, strapping 6 feet 5, 100-kilogram-plus frame. Only months earlier, in late November 2015, Patterson and his wife, Steffanie Strathdee, had been holidaying in Egypt.

Just hours after enjoying a romantic moonlit dinner on the top deck of a cruise boat on the Nile, Patterson developed nausea and vomiting, which hed initially dismissed as food poisoning (the intrepid couple had had their share of stomach bugs during their many trips, and routinely packed the antibiotic Cipro). But when he developed severe diarrhoea and a fever, Patterson was rushed by ambulance to a local medical clinic. Within hours the pain was so excruciating the hairs on his head burned.

Pattersons condition worsened over the next few days, to the extent he could no longer even get up to go to the bathroom. Overcome with a growing sense of panic, Strathdee pressured the doctors, who diagnosed pancreatitis.

After two weeks of not responding to treatment, looking deathly pale and losing weight, Patterson was medivaced to Frankfurt Hospital in Germany. Here, doctors discovered a pancreatic cyst teeming with A. baumannii. The only antibiotics that had any braking effect on the microbes lethal spread were the powerful meropenem and tigecycline, and the big gun colistin, a drug of last resort because it can lead to kidney damage.

By the time Patterson was airlifted home to San Diego to the intensive care unit at Thornton Hospital he was delirious, imagining (among other things) that there were hieroglyphics on the walls. He had become resistant to the big three antibiotics administered to him intravenously. Even worse, A. baumannii had migrated through his whole body. He was placed in a medically induced coma.

So much for the dark part of the story; now for the moment of serendipity. Pattersons wife Steffanie Strathdee was an infectious disease epidemiologist at UC San Diego (UCSD), where Patterson was a professor of psychiatry. Refusing to give up on her husband, Strathdee had been researching A. baumannii and treatments to fight it via PubMed, the search engine of the National Library of Medicine, for some weeks.

One night in February, 2016, she researched phage therapy in more detail, compiling a list of US phage researchers. Her mind drifted back to studying phages in virology classes as an undergraduate. Derived from the Greek term phagein, meaning to devour, phages were once medicines great hope, after these bacteria-eating viruses were discovered in England and France during World War I, and later employed with mixed success.

An artists illustration of a phage virus attacking bacteria.Credit:Getty Images

But after the mass production of the more reliable, easier-to-use antibiotic, penicillin, in the mid-1940s, phage research was left behind and eventually forgotten in the West, although it remained popular in the Soviet Union (Stalin was a fan of phage therapy). Its still possible to buy generic phages over the counter in Russia, Poland and Georgia, but they are only effective if they match the specific bacterium causing the infection, so can be unreliable.

The difference between the phage therapy of the past and today is DNA technology, which allows phages to be matched for their specific bacteria-killing properties. Now, with time running out, Strathdee appealed to Dr Robert Chip Schooley, professor of medicine in the division of infectious diseases at UCSD, who, although sceptical at first, helped her locate a selection of phages specifically designed to fight the malevolent invader killing her husband, which sequencing showed was an Egyptian strain of A. baumannii.

Researchers from three US laboratories forwarded the phages and they were granted emergency approval for use from the US Food and Drug Administration.

The tiny bacteriophages, housed in sealed plastic tubes, arrived at Barrs lab in the late afternoon after Rohwers phone call the night before. Dressed in his regulation white lab coat, plastic goggles and rubber gloves, Barr set about stripping the phages of their toxins, a long and painstaking process involving successive washes, cooling and spinning treatments in a centrifuge. What he had to avoid at all costs was damaging or destroying the phages: these were the only batches available.

A phage resembles an alien spacecraft with spindly legs that lock on to the surface of the much bigger bacterial cell.

In the early hours of the following morning, a weary Barr placed the cleaned phages in a speed vacuum to boil away the residual alcohol, a process that would take five hours. Then he went home to grab some sleep.

And wait.

Since his days studying microbiology at the University of Queensland in his 20s, Barr had been fascinated with phages. Under an electron microscope, a phage resembles an alien spacecraft with spindly legs that lock on to the surface of the much bigger bacterial cell. Here it penetrates the bacteriums protective shell and takes over its cellular machinery to produce more phages.

Overwhelmed by the invader, the bacterium dies, releasing a flood of new bacteria-gobbling phages.

When Barr returned to the lab the next morning, everything appeared to have gone smoothly. But the phage testing kit, which compared the results before and after endotoxin removal, repeatedly failed and his heart sank. Another had to be despatched from Germany, which set him back another day.

After 24 hours of intense frustration, Barr faced the moment of truth with the new testing kits colourimetric read-out: bright yellow marked a high and dangerous endotoxin level, clear indicated a low safe level. When it came up clear, Barr almost jumped for joy and immediately buzzed Forest Rohwer, who got in his car and drove the phages, packed in a freezer box with ice packs on the passenger seat, straight over to the hospital.

Dr Schooley pumped the first of five phages directly into Pattersons pseudocyst via catheters, and followed this up with an intravenous injection of the remaining phages.

On the evening of March 19, 2016, Patterson awoke from his coma for the first time in more than two months, turned to his eldest daughter and kissed her on the hand. Even though the bacteria developed resistance to the initial phages, and Patterson slipped into septic shock the following week, Schooleys team fought back the infection with more phages, while Barr kept adjusting the cleaning protocol to keep them safe. After three months and another setback, Pattersons infection was completely under control and, in August, he was discharged.

Illustration of Bacteriophage anatomy.Credit:Getty Images

The case grabbed international headlines when it was announced to the press in early 2017, and since then there have been a number of remarkable victories with phage therapy, including the recovery of a 16-year-old girl with cystic fibrosis in Kent, England, whose life was threatened by a strain of mycobacterium,and a 17-year-old Sydney boy critically ill with a golden staph infection, who suffered a stroke and went into a coma.

Trials in the US, Belgium, the UK and Australia suggest that phage therapy could become an important part of the arsenal against the growing crisis of antibiotic resistance across the globe.

Its a common myth that only those who use antibiotics regularly, or the sick, elderly and infirm, are at risk of developing antibiotic resistance. The unhappy fact is that anyone can get an infection thats resistant to the drugs, no matter how healthy and fit they are.

I should know. When it comes to antibiotic resistance, Im an interested party.

Ding Dong. Its 8pm on a steamy night in mid-January 2019, and Luna, our highly excitable Staffordshire cross, skids across the polished floorboards trying to beat my partner to the front door when the doorbell rings. Im in the kitchen drinking my umpteenth glass of water. I dont feel well.

I ask whether I might eat a bite of dinner first. He hands me the results of the tests and a referral for hospital staff. No, he says.

Its my doctor, a compact man in his 30s with a kind, round face, floppy, jet-black hair, and a taste in bright chinos. Ive been trying to ring you, he says, standing in our living room, to which I splutter something about my phone sitting upstairs being recharged. Youve got to go straight to hospital. Youre very seriously ill. You have highly elevated inflammatory markers.

I ask whether I might eat a bite of dinner first. He hands me the results of the tests and a referral for hospital staff. No, he says gently. You should go now.

I take a deep breath. Since returning from a short work trip to South Africa some weeks earlier, Id been feeling strangely under par, with an overpowering lethargy and body aches classic flu symptoms but with no sore throat or cough. The leeching of my energy levels was disconcertingly out of character, my partners standard simile for me being that Im like a human Eveready battery.

Before departing, Id had a complete physical (passing with flying colours), and all the requisite jabs, including for hepatitis A, malaria and tetanus. On the day before I flew back to Australia, I, along with a small posse of other journalists, was given a tour of a crowded medical clinic in a remote, northern part of the country. Within a day or so of my return, I fell ill. I asked my doc: could I have picked up some unpleasant microbial hitchhiker while I was away, or was this just an unlucky coincidence?

I dont believe in coincidences, he replied, writing me a script for oral antibiotics. Lets see if this knocks it out.

After a few days on them, I felt better, but within a week or two of finishing the script the symptoms returned, only with far, far greater force. These peaked one night in a fitful, feverish sleep in which my eyes were jolted open every couple of hours by unusually vivid dreams. Of my teeth falling out. Of cutting my way through a steamy jungle as thorns and sharp branches ripped the hell out my skin. Each time I awoke I was saturated in a sweat so thick my hands were drenched wiping it off despite a standing fan blasting air on me less than a metre away.

Fevers always seem worse at night, of course, with sensitivities heightened and distractions lowered. The next morning, I went straight back to my doctor, who after taking my temperature (raised) and blood pressure (significantly up) immediately ordered a full battery of blood and urine tests.

Ill mark them urgent, he said, scrolling back through my medical records. The results should be back by late this afternoon. Ill call you.

When I check my medical report I notice more than half the antibiotics administered to me resisted the killing powers of the bug.

So after my doctors visit to my house, here I am sitting in the waiting area of Accident and Emergency at my local hospital, mind in neutral, mystified as to why Ive become enveloped by this mysterious illness, but concerned about the man next to me, who is bent over, wracked in far greater pain than I.

After a couple of hours of waiting, and another series of tests, including blood cultures, Im taken into triage, where the doctor and nurse trade glances and talk about IV antibiotics. He also needs IV fluids, the doc adds.

What you reckon this is? I ask tentatively. Im sure you havent got cancer, the doctor says reassuringly. But you do have a serious infection.

Within a couple of hours of receiving IV antibiotics, my heart rate and blood pressure have settled down, Im feeling a hell of a lot better, and Im discharged the following morning. But when I later check my medical report I notice more than half the antibiotics administered to me resisted the killing powers of the particular bug, from the enterobacteriaceae family, Id been infected with.

Fortunately, the bug was sensitive to three of the drugs so I was soon on the mend. The earlier round of oral antibiotics just hadnt been strong enough to vanquish the bacterium, my doctor later tells me.

Peter Collignon, professor of microbiology at the Australian National University, has been warning about the overuse of antibiotics for more than 30 years.

Weve known about the increasing threat of drug-defying strains of bacteria for decades. In 2014, the World Health Organisation called antibiotic resistance a major global threat and early last year warned that a slew of serious and common complaints, from sexually transmitted diseases such as gonorrhoea and syphilis to respiratory and urinary tract infections, are becoming untreatable, posing a major public-health menace, especially among the very young, the elderly and the seriously ill.

We have reached the point where we should be very worried. An increasing number of infections are becoming harder or almost impossible to treat. Thats Peter Collignon, professor of microbiology at the Australian National University, and director of the infectious diseases unit at Canberra Hospital, whos been warning about the overuse of antibiotics for more than 30 years.

Although Australia has much lower antibiotic-resistance levels than most countries, were facing a tsunami of resistance among our neighbours to our north, in Indonesia, India and China, where levels are two or three times those of 30 years ago, says Collignon. Fifty per cent of common infections in India are untreatable now, he warns. Were virtually back to the 1920s.

We have reached the point where we should be very worried. An increasing number of infections are becoming harder or almost impossible to treat.

Since that day in September 1928 when Alexander Fleming realised the spores growing in his lab were what hed call penicillin, to antibiotics coming into general use in the late 1940s, countless millions of lives have been saved.

But humanity swiftly began to overuse the drugs, especially after it was found in the early 1950s that they helped accelerate growth and weight in chickens, pigs and cattle. By volume, 80 per cent of antibiotics in the world are given as food to animals, although its much lower in Australia, around 50 per cent, says Collignon. Whatever you do with animals comes back to people.

The overuse of antibiotics in livestock produces dangerous drug resistant bacteria that can spread throughout the environment. This prompted the WHO in 2017 to call for a global ban on the use of antibiotics to promote growth in healthy livestock.

China, which produces and consumes the most antibiotics in the world, uses more than 160,000 tonnes of the drugs a year, according to a 2013 study by the Chinese Academy of Sciences. Antibiotic-resistant genes are turning up in river systems, soil and even the air around farming areas in China and the US, say a wave of reports coming out of those countries.

In an eye-opening study early last year, a team of scientists at Perths Murdoch University found that one in five Australian silver gulls were carrying superbugs such as E. coli, resistant to antibiotics. Worryingly, the latest research also shows mutated strains of common bugs are becoming more potent in infecting hosts.

Antibiotic resistance not only makes it more challenging to treat infections, but it may make bacteria more robust, more able to cause infection, notes Collignon. Which means not just more antibiotic-resistant deaths but many more people with urinary tract, sinus and respiratory infections that will become chronic because theyll never be completely cleared up.

Theres no doubt the number of people dying from antibiotic resistance is climbing each year, from about 700,000 currently to an estimated (and conservative) 10 million deaths annually by 2050, according to the WHO. Although no global system for tracking antibiotic use exists, a survey of 76 countries published in the journal Proceedings of the National Academy of Sciences in 2018 found the use of antibiotics in humans increased nearly 40 per cent between 2000 and 2015.

One distinct advantage of phages over antibiotics is that theyre a natural part of the environment, found in air, soil and water in countless trillions upon trillions. Thats because wherever a bacterium set up home, theres a bacteriophage ready to break in.

Even a drop of raw sewage, taken from deep within the bowels of a hospital, could contain the chemical elixir that might fight an antibiotic-resistant infection in a patient languishing in a bed four floors above, as I find to my astonishment when I visit a research facility in western Sydney.

Sydney phage researcher Dr Aleksandra Petrovic Fabijan has worn a hazmat suit to collect samples of raw sewage at the citys Westmead Hospital.Credit:Dominic Lorrimer

Its mid-morning at Sydneys Centre for Infectious Diseases and Microbiology at Westmead Institute for Medical Research, the largest phage research facility in Australia, and Dr Aleksandra Petrovic Fabijan is telling me how she always keeps an eye out for a good spot to take a sample of bacteriophages, whether at placid, bucolic landscapes such as lakes and parks, while out for a picnic with her family, or at less pleasant, germ-filled places such as water treatment facilities.

Petrovic Fabijan and other members of her team have even donned impermeable yellow hazmat suits to venture into the deepest bowels of Westmead Hospital to extract samples of raw sewage to drop into specimen jars (for less hazardous sites of phage collecting, they dont have to swaddle themselves in a hazmat suit). The amount of protection depends on where youre sourcing the phages, she explains.

Dr Carola Venturini, a postdoctoral scientist at the institute, tells me shes even collected stool samples from her 12-year-old cattle dog, Cathy. You have to go where the bacteria are, which is also where youre likely to find a phage against it. From humans, weve taken sputum, faeces and skin scrapings and baby poo.

Dr Carola Venturini, phage researcher at Sydneys Centre for Infectious Diseases and Microbiology. "You have to go where the bacteria are, which is also where youre likely to find a phage against it," she says.Credit:Dominic Lorrimer

For phage therapy to advance, phage biobanks will have to be built into research facilities, explains Venturini, and the institute was recently awarded a research grant for this very purpose. You need to have a wide variety of high-quality phage samples already on hand to deal with any number of antibiotic resistant infections that arise.

The team at Westmead has treated 14 patients with phage therapy since 2017, including people seriously immunocompromised from kidney transplants and infected heart valves. If success is judged by the elimination of superbugs (so-called 28-day mortality, or survival one month after the infection has cleared), then its been a success, with eight patients beating the infection.

Long-term survival is very challenging because of these serious pre-existing and underlying diseases, explains Associate Professor Ruby Lin, project manager of the bacteriophage therapy team. Treatment typically takes about 14 days, with the phages intravenously injected twice a day, in parallel to prescribed antibiotics for the patient.

So far, research at Westmead has shown that phage therapy is safe and tolerable in patients, and only kills bacteria, with no harm to human cells. However, we need more evidence, particularly from randomised controlled trials, before we can offer it in a regular health case setting, says Lin, who as a teenager was driven to study genetics to find a treatment or cure for her older blind brother, who would go on to become the respected New Zealand wine consultant, C.P. Lin.

Phage researcher at Sydneys Centre for Infectious Diseases and Microbiology, Associate Professor Ruby Lin.Credit:Dominic Lorrimer

Lin, Venturini and Petrovic Fabijan are part of the Critical Infection/BARRD Group, a team of microbiologists led by Professor Jon Iredell at the front line of phage therapy in Australia.

Iredell, a youthful-looking 59-year-old who has been working in infectious diseases for more than 30 years, sums up the advantage of phages over antibiotics in three bullet points. First, because phages can be found everywhere on Earth, there are untold trillions available, unlike antibiotics. Second, phages only target bacteria, not the so-called good bugs in the host. Third, once biobanks are established, phages can be administered fairly quickly within 24 hours of a superbug diagnosis, in some cases.

But Iredell concedes phages cant beat the convenience of antibiotics. With antibiotics we know what their structure is and we can administer them to multiple people. With phage therapy, we have to develop phage cocktails for each patient tailored to the infecting bacterium.

Were now able to link the DNA signatures of viruses to the signatures of the bacteria, which accelerates the matching process.

But what Iredell calls the ultimate personalised medicine is also perfectly placed to take advantage of the leaps in todays medical technology, such as DNA testing, mapping the human genome, robotics and artificial intelligence.

These technologies, which werent possible 15 years or so ago, are advancing phage therapy, he says. Were now able to link the DNA signatures of viruses to the signatures of the bacteria, which accelerates the matching process.

Money for phage research worldwide has been slow to pour in, notes Iredell. How do you develop intellectual property around a product that naturally occurs in the environment? he asks. No one knows how to make a dollar out of it. Its not like you need to take a pill every day for the rest of your life, which is how pharmaceutical companies make money. (A similar lack of financial incentive is the reason why research into new antibiotics, also a class of drugs you only take occasionally, has been progressing at a snails pace for decades: most new drugs in the pipeline are only enhancements of existing drugs.)

Phage researcher at Sydneys Centre for Infectious Diseases and Microbiology, Professor JonIredell: "How do you develop intellectual property around a product that naturally occurs in the environment?"Credit:Dominic Lorrimer

Dr Karen Weynberg, of the school of chemistry and molecular biosciences at the University of Queensland, is researching synthetic phages, which in theory would be free of the toxins and risks associated with the natural ones. My goal is to engineer superphages to fight superbugs, she tells me.

Because phage therapy to date has been largely administered on compassionate grounds to elderly people gravely ill with other long-term illnesses that may sooner or later kill them, its success in eliminating a life-threatening infection isnt easy to herald to the media, or even the medical community. Its the miracle recovery stories of the young that grab the headlines.

But sometimes a couple of extra weeks or months of survival can mean the world of difference, not just to sufferers but loved ones, too. Penelope Jackson, a semi-retired resident of the Blue Mountains outside Sydney, had a serious heart condition dating back to a bout of rheumatic fever she suffered as a child growing up in Britain in the 1960s.

Until about 12 years ago, nothing seemed to stop Penny, recalls her husband Russell Jackson, who migrated to Australia with her in 1999, when the couple were in their 40s. Even after Penny had her second heart valve replaced in 2007, she was working hard and keeping busy around the house. Almost until the final months of her life, she was running her dog grooming business from home, he adds, in a thick Mancunian accent.

Russell Jackson is grateful for how phage therapy helped his wife.Credit:Wolter Peeters

One Saturday night in June last year, after suffering breathlessness and chest pain, Penny was taken to the hospitals in Katoomba and later in Nepean, where her condition rapidly deteriorated.

She arrested three times, was intubated, and went into a coma, says Russell, 62. After Penny was transferred to Westmead Hospital, doctors told him that a superbug infection (methicillin-resistant staphylococcus or MRSA) had colonised the tissue around her mechanical heart valves, and antibiotics had failed to quell the infection.

Here it was decided that Penny would be a good candidate for phage therapy, and after two weeks of treatment, the infection cleared up. The antibiotics on their own werent working, but a combination of the phages and the antibiotics saw her recover, says Russell. Another major operation to replace her faulty valves appeared to have been a success.

Even the most fervent advocates for phage therapy concede its unlikely to supplant antibiotics.

Penny returned home and the couple had a blissful two weeks together. So much better did Penny feel that on a Sunday afternoon the pair trudged through car sales yards to check out options for a new car for her. She was due to see her cardiologist on Monday morning.

When Russell went to wake her at about 7am, she had passed from a heart attack. It was of course a terrible shockbut Im so grateful she died at home peacefully, he says.

If phage therapy is a new script for an old plot the one titled humanitys millennia-old battle against infectious disease the obvious question is, will it ever replace antibiotics? Does it represent a stand-alone cure-all?

No, and no. Even the most fervent advocates for phage therapy concede its unlikely to supplant antibiotics because of the latters long-standing success and ease of use. At most, it will be a powerful ally in the battle against infectious disease. For this to happen, phage therapy needs to be shown to be safe, effective and practical on a large scale.

Since her husbands ordeal made medical history, Steffanie Strathdie has written a book about her story, The Perfect Predator, published last year, and set up IPath, a non-profit phage facility at UCSD aimed at ensuring patients suffering from life-threatening superbug infections have a place to turn.

The rest is here:

Phage therapy: The antibiotics alternative - Sydney Morning Herald

Measures to regulate wellness tourism sector in the pipeline – Sunday Observer

The Sri Lanka Export Development Board (EDB), is working to generate more revenue, particularly foreign exchange through ayurvedic services by catering to niche markets which are growing fast. An emphasis on this sector has been placed in the National Export Strategy (NES) where wellness tourism is a major component.

Wellness tourism includes Ayurveda, the Western medical sector, yoga, meditation, spa and relaxation activities. This is a sector where tourists spend four-five folds more and measures are needed to regulate the sector to attract tourists which is a high-end product, Director General, EDB, Jeevani Siriwardena said.

There has been a holistic approach towards the wellness tourism sector by several institutions, including Ayurveda Department, Ministry of Health, EDB, and Foreign Ministry. The country will be geared to meet the growing demand for this kind of services and to this end, required standards and regulatory measures will be taken by the government, she said.

The EDB has identified the export value of the Sri Lankan Ayurveda services in 2013 and facilitated the International Trade Centre (ITC) to carry out a study on the Sri Lankan Health Tourism industry. The study identified the niche capabilities of the Sri Lankan Ayurveda and Wellness sector and the significance of synergy between the main two segments in terms of promotion.

There is an increasing trend in non-communicable diseases (NCDs) in the country and an ayurveda related approach has been the choice of many. This has created a huge demand for the services locally and internationally and it is necessary to improve the service to ensure high standards are maintained, Deputy Director, Technical-Medical, Ministry of Health, Nutrition and Indigenous Medicine, Dr. T. Weerarathna said.

It is necessary to focus on the quality of practitioners, education, products, safety, quality and efficiency. It is encouraging to note that the government has taken steps to provide and pay emphasis on ayurveda education. A university degree up to Masters level has been offered to selected students. This has ensured the high standards of the ayurvedic services. There has been a project to preserve ayurveda knowledge. To this end, a research centre to collect data and identify ayurveda practitioners is in place, he said.

Dr. Weerarathna said that health tourism has two components of medical and wellness tourism. It is necessary to set up regulated healthcare facilities in the country to promote health tourism in a sustainable manner. The concept includes spa, meditation and yoga to ensure well-being and prevent illness. There is a four fold promotion to achieve desired results, he said.

The Department of Ayurveda has drafted regulations to ensure quality, standards and safety. There will be accreditation and guidelines for ayurvedic practitioners. With a view to ensure credibility of service, an Act will be introduced with specific rules and regulations shortly. The EDB is working in collaboration with the Department of Ayurveda to develop National Standards/Regulations for Ayurveda Private Healthcare Institutions to regulate the industry. According to this process, the Department of Ayurveda has now developed the Draft Rules and Regulations on Traditional Medicine (Medical Tourism) Institutions (under Section 10 of the Ayurveda Act, No. 31 of 1961).

A pilot project to set up wellness centres is currently underway to promote the sector in a regulated environment, he said.

Practitioners in the wellness tourism industry have endorsed the formation of the Sri Lanka Wellness Tourism Association (SLWTA).

The EDB has identified the health sector as a prominent export sector, and in 2017, the sector selected as the key focus sector in National Export Strategy (NES). The Wellness Tourism Strategy was developed as part of the NES of Sri Lanka with three main objectives with development and promotional activities in collaboration with the Ayurveda, Western medical and Tourism sector stakeholders.

The first objective concentrates on sector coordination and cohesion. The traditional wellness and the western medicine segments need clusters to organise and improve cooperation among stakeholders.

The second objective focuses on regulation and quality assurance through standardisation, licensing of activities and recognition of traditional healing in target markets and streamlining of institutional procedures. The third objective focuses on gathering more information on the sector through more effective collection of statistics and sharing sector information, to the local population and to foreigners in target markets.

The concept of Wellness Tourism is with a broader spectrum of niche health and medical services inherited by Sri Lanka. However, the ayurveda/indigenous sector remains as the major contributor to this wellness tourism service followed by western medical service and other alternative medicines.

The sector achieved this position within the short time spam considering the contribution to the export growth of the country. Following the National Export Strategy (NES), the EDB formed the Wellness Tourism Advisory Committee comprising leading private sector stakeholders and relevant government officials to drive the sector specific activities.

The EDB identified the wellness tourism mainly Ayurveda and health services as a key sector and initiated this international promotions to increase earnings from the service export sector. The EDB has created a platform for the different service segments to work together towards the economic development of the sector.

By developing these standards, all private sector businesses, including the private healthcare hospitals, clinics and the Wellness centres which are carried out based on Ayurvedic principles will be regulated by the Department of Ayurveda to ensure safe and quality service for the medical travellers.

The rest is here:

Measures to regulate wellness tourism sector in the pipeline - Sunday Observer

Heart attack: New protein therapy may improve recovery – Medical News Today

New preclinical research in animal models finds that infusing a specific protein into scar tissue after a heart attack improves and speeds up the recovery of the heart.

According to the American Heart Association (AHA), around 605,000 people in the United States have a new heart attack each year, and approximately 200,000 experience a recurrent attack.

Reperfusion, which is a technique that frees up the flow of oxygen to the heart's tissue, is a common form of treatment after a heart attack. However, up to one-quarter of people who undergo reperfusion develop heart failure within a year.

So, researchers led by James Chong an associate professor at the University of Sydney in Australia have explored an alternative treatment that targets the scar tissue that forms after a heart attack.

Chong and colleagues evaluated the therapeutic potential of a protein therapy called recombinant human platelet-derived growth factor-AB (rhPDGF-AB).

As its name suggests, rhPDGF-AB is a recombinant growth factor-AB derived from human platelets. Platelets are small blood cells that rush to an injury site when they are needed to help the blood clot and start the healing process.

The researchers tested the new treatment in a porcine model of heart attack, and their promising results suggest that the therapy may soon help humans recover from heart attack.

The findings appear in the journal Science Translational Medicine.

The study was a randomized trial. Chong and team assigned 36 pigs to one of three groups:

Nine of the pigs who experienced a heart attack died before having the chance to receive any treatment.

A month after the intervention, the researchers used cardiac MRI and other methods to show that their treatment caused more new blood vessels to form, decreased abnormal heart rhythm, and boosted overall heart function.

Specifically, 28 days after the heart attack, the new procedure improved survival by 40% compared with placebo and improved the heart's ejection fraction in the left ventricle where the heart attack had taken place by 11.5%.

"By improving cardiac function and scar formation following a heart attack, treatment with rhPDGF-AB led to an overall increase in survival rate in our study," explains Chong.

"While the treatment did not affect overall scar size, importantly, we found that rhPDGF-AB led to increased scar collagen fiber alignment and strength. This improved heart function after a heart attack."

"This is an entirely new approach with no current treatments able to change scar in this way."

James Chong

Chong explains how these findings build on the team's previous work, saying, "Our collaborator Prof. Richard Harvey, from the Victor Chang Cardiac Research Institute [in Darlinghurst, Australia], had previously shown that the protein can improve heart function in mouse models following heart attack."

"This project has been developed over more than 10 years, and we now have compelling data in two species for the effectiveness of this treatment."

Chong places the findings in the larger context of the rise of heart disease as a leading cause of death:

"While we have treatment protocols in place, it's clear that there is an urgent, unmet need for additional treatments to improve patient outcomes, particularly after large heart attacks."

"Some further animal studies are required to clarify safety and dosing. Then we can start looking toward clinical trials in humans very soon," says Chong.

"RhPDGF-AB is clearly a promising therapeutic option and could potentially be used alongside existing treatments to improve heart attack patient outcomes and survival rates."

In the future, says Chong, "We [...] hope to further investigate the treatment, including whether it could be used in other organ systems impacted by scar tissue, such as the kidneys."


Heart attack: New protein therapy may improve recovery - Medical News Today

Are you among the growing number of Americans using alternative therapy? You’ll surely find something on this list, from A-Z. – Chattanooga Times Free…

The use of alternative medicine is growing.

According to the National Center for Complementary and Integrative Health, more than 30% of Americans now say they use a form of non-conventional healing such as herbs or yoga.

One reason for this growth is access to information, says Blake Storey, co-owner of Chattanooga Holistic Medicine, which specializes in Chinese medicine, among other natural therapies. When he first opened the practice in 2016, Storey had one patient. In 2019, he had more than a thousand.

"Dr. Google has a big influence on people's knowledge," Storey says.

Prior to the internet age, ailments and illnesses were diagnosed and treated through a "doctor-patient pipeline," says Storey. But now, a person can type symptoms into a search bar, add the word "natural," and connect to a myriad of alternative forms of medicine from acupuncture to zang fu organ theory.

Many of these therapies are now available in Chattanooga, and more are sure to follow. To help prepare you for a new year of wellness and this ever-growing list of treatments, here are the ABCs of alternative healing.


Acupuncture is traditional Chinese medicine dating back to 100 BCE, in which thin needles are inserted into the body. Ancient China believed that disease was caused by energy flow disruptions in the body, and that the needles helped stimulate and release those flows.

Western science now has other theories. One of the leading hypothesis is that the needles stimulate nerves which send signals to the brain to release certain hormones. Studies have shown acupuncture to be an effective treatment for headaches, asthma, fibromyalgia and more.

Connect locally: There are more than a dozen local places that practice acupuncture, from holistic centers to hospitals. Chattanooga Holistic Animal Institute even offers acupuncture for pets.


Bodywork is an umbrella term for techniques involving therapeutic touch. Its most familiar form is massage. Others include reiki, reflexology and rolfing, which involves manipulating the connective tissues throughout the entire body. Bodywork is most commonly used to reduce stress, soreness or pain.

Connect locally: Like acupuncture, Chattanooga offers no shortage of places that practice bodywork. We suggest asking someone you know for a recommendation.


Cryotherapy, also known as cold therapy, is a form of healing that exposes the whole body to extremely low temperatures, typically between minus-166 and minus-202 degrees Fahrenheit. The idea is built upon the more common practice of using ice packs or ice baths to treat some injuries though proponents of the therapy say it also helps burn calories, increase energy, improve sleep and more.

Cold therapy was first introduced in Japan in the 1970s and was popularized in the U.S. in the 2010s. Comprehensive research on its risks and benefits are still inconclusive.

Connect locally: Norspring Center for Rejuvenation, 140 W. 14th St., or Glace Cryotherapy, 13 Kent St.


Dance therapy is based on the idea that motion and emotion are connected. Sessions can range from ballroom dancing to simple stretching. Also known as movement therapy, it is used to treat a number of emotional, cognitive, physical or social issues, from body image issues to chronic pain.


Electromagnetic therapy, also called pulsed electromagnetic field therapy or PEMF, works by directing mild electrical magnetic currents to targeted parts of the body. The idea is that these currents help restore weakened cells and can help treat pain, cancer or depression.

Nikola Tesla, most famous for his electric-powered automobiles, was an early pioneer of the therapy and invented the magnetic loop coil, which is now used in all PEMF devices.

Connect locally: Pulse Centers, 5811 Lee Hwy.


Float therapy, also called restricted environmental stimulation therapy (REST), employs the use of an isolation tank to restrict all environmental stimuli, including gravity. The light-proof, sound-proof tank contains about a foot of water filled with Epsom salt for buoyancy. Both the water and the air are heated to the same temperature as one's skin.

Studies suggest that sensory deprivation helps induce deep relaxation, leading to a number of positive health benefits including helping with stress, depression, anxiety and muscle tension pains.

Connect locally: Lucidity Float and Wellness Center, 1405 Cowart St.


Gut biome therapy, or microbiome therapy, is a still-evolving study that focuses on healthy gut bacteria, known as microbiota. Scientists believe that this bacteria can have a significant impact on health, affecting conditions that range from inflammatory bowel disease to cancer.

However, the gut's microbiome made up of trillions of bacteria is complex, and research is still needed to better understand how the microbiome links to certain conditions and how to use it restore one to health.


Herbalism is the use of plants for medical treatments. The practice is prehistoric. In fact, many modern drugs are derived from plants, such as aspirin from willow bark and morphine from poppy.

Connect locally: Chattanooga boasts a number of places where one can find herbal supplements, but only a few places where one can consult with an on-site herbalist: Chattanooga Holistic Medicine, 1000 E. Third St., Suite 103; Hill City Acupuncture and Herbs, 50 Frazier Ave.; and The Wellness Tree, 2805 Dayton Blvd.


Intravenous vitamin therapy is a wellness trend that administers vitamins and minerals directly into the bloodstream via an IV drip. The treatment is commonly used to help hydrate, boost immunity or relieve symptoms of morning sickness or hangover; however, health claims are anecdotal as they have not yet been tested in clinical studies.

Connect locally: RevIVe Chattanooga, 518 Georgia Ave.


Journaling, or more specifically proprioceptive writing, is a tool used to help improve mental and emotional clarity. Unlike other forms of journaling, proprioceptive writing involves the use of "auditory imagination," in which a person shifts to overhearing thoughts as if they were spoken rather than experiencing those thoughts as words in their own head.

In order to accomplish that shift, the practice instructs one to to find a space free of distractions, light a candle, play Baroque music, which has a rhythmic quality reflective of the human pulse, and write down his or her thoughts on unlined paper for 25 minutes.

Connect locally: Proprioceptive Writing Center, Southeast, 1401 Williams St.


Kampo is traditional Chinese medicine adapted to Japanese culture. Many of those adaptations are found in Kampo's herbal formulas, which utilize a different basic collection of healing herbs and plants. Though the uniquely Japanese practice fell out of favor in the late 1800s, it has since been revived and is now taught in Japanese medical schools.


Laughter yoga is a form of yoga that combines simulated laughter with breathing techniques. Science has long shown that laughter can reduce blood pressure and stress hormone levels, as well as increase one's general sense of well-being. And, more recent studies have shown that self-induced laughter provides the same benefits.

Connect locally: Toes Yoga Studio of Chattanooga, 3228 Brained Road.


Music therapy is a holistic form of healing that uses sound, vibration or harmonics to treat the mind, body and soul. It may employ the use of gongs, singing bowls, tuning forks, flutes, drums, chimes, rattles, didgeridoos and acoustic vibrations to aid with deep relaxation, pain management, terminal illness, post-surgery healing and more. Music therapy, however, can take on many different expressions. One study found that listening to pop music helped reduce post-surgery pain in children.

Connect locally: Purple Sky Healing Arts, 625 E. Main St.


Nature therapy refers to the use of the outdoors to improve a person's mental or physical health. One example is forest bathing, which is simply the practice of taking a walk through the forest while focusing on one's senses as triggered by the setting. Research shows this form of nature immersion can lower blood pressure, heart rates and stress hormones.

Connect locally: While there are countless places around town to get lost in the woods, local herbalist and psychotherapist Holli Richey has led coordinated forest bathing walks with Crabtree Farms and Reflection Riding.


Orthopathy is more of a philosophy than a therapy. It stems from the Nature Cure movement, which promotes natural cures as healing methods. Followers of orthopathy believe that fasting, dieting and other holistic practices are all that is necessary to prevent disease.


Prana healing is a form of energy medicine that involves treating a person's invisible energy field. Examples may include tapping, massaging, pinching or twisting specific energy points on the skin. Pranic therapy has been used to treat everything from asthma and ulcers to mental illness and multiple sclerosis. It is sometimes described as acupuncture without needles. Though the therapy is not clinically proven, a number of top U.S. medical research centers now offer some form of energy healing.

Connect locally: Purple Sky Healing Arts, 625 E. Main St.


Qigong, pronounced chee-gong, is an ancient Chinese healing practice that integrates meditation, breathing and movement exercises. While somewhat similar to both tai chi and yoga, qigong is different in that it places more emphasis on the meditation than the movements. Studies have shown meditation to help reduce stress hormones, thus helping treat some stress-related conditions such as inflammation, fibromyalgia or irritable bowel syndrome.

Connect locally: Yin Yang House Acupuncture and Wellness Center, 7053 Lee Hwy.; Tai Chi @ St. Peters, 848 Ashland Terrace; SunBodywork, 6237 Vance Road.


Red light therapy uses low-level red light transmitted through lasers or LED lights to address a myriad of issues, including collagen production, scar treatment, muscle repair, poor circulation and much more. Having been explored only since the mid-1990s, the therapy lacks extensive research, so it is largely considered experimental.

Connect locally: Chattanooga Wellness Natural Health Center, 6016 E. Brainerd Road.


Saunas use dry heat to promote sweating, which has long been used as therapy. The latest trend is the use of infrared saunas. Unlike traditional saunas, which use fire or electricity to heat a small room to temperatures typically between 158 degrees and 212 degrees Fahrenheit, infrared saunas use light waves to heat a person's body rather than the entire room. Studies have shown saunas help release toxins, lower stress levels and improve cardiovascular health.

Connect locally: Sisu Sauna Studio, 26 E. Main St.


Thalassotherapy is the use of seawater, sea products or shore climate to help rejuvenate and restore the skin and body. It has three main forms: hydrotherapy, involving saltwater; algotherapy, involving seaweed, algae or mud; and physiotherapy, involving water exercises.


Unani medicine is a traditional South Asian system of healing. The practice is based on the belief that good health depends on the balance of elements in the body, and that those elements are present in four fluids: phlegm, blood, yellow bile and black bile. Therapies to treat elemental imbalances may include a number of other alternative forms of healing, including cupping, bloodletting, aromatherapy or massage.


Vibroacoustic therapy uses musical vibrations and low-frequency sounds to "massage" deep parts of the body. The vibrations are emitted from a specially designed piece of furniture such as a recliner or table. Research indicates this type of "musical massage" may help reduce stress, decrease pain, lower blood pressure and even treat symptoms of Parkinson's disease.

Connect locally: Purple Sky Healing Arts, 625 E. Main St.


Water therapy, in this case, does not refer to water aerobics. Rather, this wellness trend, also called morning water therapy, refers to the practice of drinking 1.5 liters of water, the equivalent of 5-6 glasses, upon waking. The idea is that drinking water on an empty stomach helps increase the body's ability to repair and regulate itself. Benefits include boosted immunity and metabolism, in addition to improved skin and hair health.

Though studies have not proven these claims, the benefits of hydration are well known. According to the U.S. Centers for Disease Control and Prevention, 43% of American adults drink less than 1.5 liters of water in a day.


Yoga is an ancient practice focused on breath control, simple meditation and a series of postures. It offers many different styles, ranging from beginner-friendly restorative yoga to the more intense power yoga, hot yoga or Bikram yoga. One interesting trend seen in 2019 was the emergence of goat yoga, which just as it sounds is the practice of yoga in the presence of live goats.

Connect locally: There are dozens of local studios and gyms that offer yoga classes. Finding one close to your home or work will be no sweat.


Zang fu theory is the foundation on which traditional Chinese medicine is built. The theory describes the study of the organs, which are divided into two categories: zang organs (heart, lung, spleen, liver and kidney) and fu organs (gall bladder, stomach, large intestine, small intestine, urinary bladder and the sanjiao, comprising three areas of the body cavity). Zang organs are considered yin; fu organs are considered yang. The theory states that harmony between the two is required for good health. The diagnosis and treatment of illness, therefore, is based on interrelationships between the zang-fu organ systems.

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Are you among the growing number of Americans using alternative therapy? You'll surely find something on this list, from A-Z. - Chattanooga Times Free...

The 2010s were a decade of medical breakthroughs – Los Angeles Times

For all the flak the pharmaceutical industry has taken for its exorbitant pricing practices, theres no getting around the fact that its been a pretty stunning decade for medical progress.

Multiple new categories of medicines have moved from dreams and lab benches into the market and peoples lives, and investors who came along for the ride often reaped extraordinary profits. The Nasdaq Biotech Index is up 360% over the last 10 years to the S&P 500s 190%. And thats without mentioning the hundreds of billions of dollars in takeovers that rewarded shareholders with windfalls.

As 2020 approaches, its worth highlighting how far weve come in the last decade in developing new therapies and approaches to treating disease, even as politicians grapple with how to rein in healthcare costs without breaking an ecosystem that incentivizes the search for new discoveries. Here are some of the decades biggest medical breakthroughs:

First approved in the U.S. two years ago, these treatments still sound like science fiction. Drugmakers harvest immune cells from patients, engineer them to hunt tumors, grow them by the millions into a living drug, and reinfuse them. Yescarta from Gilead Sciences Inc. and Novartiss Kymriah the two treatments approved so far can put patients with deadly blood cancers into remission in some cases. At the beginning of the decade, academics were just beginning early patient tests.

Its still in the early days for the technology, and some issues are holding these drugs back. There are significant side effects, and the bespoke manufacturing process is expensive and time-consuming. That has contributed to a bruising price tag: Both of the approved medicines cost over $350,000 for a single treatment. And for now, cell therapy is mostly limited to very sick patients who have exhausted all other alternatives.

Luckily, more options are on their way. Some drugmakers are focused on different types of blood cancers. Others hope to mitigate side effects or create treatments that can be grown from donor cells to reduce expenses and speed up treatment. In the longer run, companies are targeting trickier solid tumors. Scientists wouldnt be looking so far into the future without this decades extraordinary progress.

Researchers have spent years trying to figure out how to replace faulty DNA to cure genetic diseases, potentially with as little as one treatment. Scientific slip-ups and safety issues derailed a wave of initial excitement about these therapies starting in the 1990s; the first two such treatments to be approved in Europe turned out to be commercial flops.

This decade, the technology has come of age. Luxturna, a treatment developed by Spark Therapeutics Inc. for a rare eye disease, became the first gene therapy to get U.S. approval in late 2017. Then in May came the approval of Novartiss Zolgensma for a deadly muscle-wasting disease. The drugs have the potential to stave off blindness and death or significant disability with a single dose, and, unsurprisingly, Big Pharma has given them a substantial financial endorsement. Roche Holding paid $4.7 billion to acquire Spark this year, while Novartis spent $8.7 billion in 2018 to buy Zolgensma developer Avexis Inc.

Dozens of additional therapies are in development for a variety of other conditions and should hit the market in the next few years. They offer the tantalizing potential not just to cure diseases, but to replace years of wildly expensive alternative treatment. If drugmakers can resist the temptation to squeeze out every ounce of value by doing things like charging $2.1 million for Zolgensma, theres potential for these treatments to save both lives and money.

The above treatments modify DNA; this group uses the bodys messaging system to turn a patients cells into a drug factory or interrupt a harmful process. Two scientists won a Nobel Prize in 2006 for discoveries related to RNA interference, or RNAi, one approach to making this type of drug, showing its potential to treat difficult diseases. That prompted an enormous amount of hype and investment, but a series of clinical failures and safety issues led large drugmakers to give up on the approach. Sticking with it into this decade paid off.

Alnylam Inc. has been working since 2002 to figure out the thorny problems plaguing this class of treatments. It brought two RNAi drugs for rare diseases to the market in the last two years and has more on the way. The technology is also moving from small markets to larger ones: Novartis just paid $9.7 billion to acquire Medicines Co. for its Alnylam-developed drug that can substantially lower cholesterol with two annual treatments.

Ionis Pharmaceuticals Inc. and Biogen Inc. collaborated on Spinraza, a so-called antisense drug that became the first effective treatment for a deadly rare disease. It was approved in late 2016 and had one of the most impressive drug launches of the decade. And Moderna Therapeutics rode a wave of promising messenger RNA-based medicines to the most lucrative biotechnology initial public offering of all time in 2018. From pharma abandonment to multiple approvals and blockbuster sales potential in under 10 years. Not bad!

Scientists had been working on ways to unleash the human immune system on cancers well before the 2010s without much luck. Checkpoint inhibitors drugs that release the brakes on the bodys defense mechanisms have since produced outstanding results in a variety of cancers and are the decades most lucrative turnaround story.

Merck got Keytruda via its 2009 acquisition of Schering-Plough, but it was far from the focus of that deal. Once Bristol-Myers Squibb & Co. produced promising results for its similar drug, Opdivo, Merck started a smart development plan that has turned Keytruda into the worlds most valuable cancer medicine. Its now available to treat more than 10 types of the disease, and has five direct competitors in the U.S. alone. Analysts expect the category to exceed $25 billion in sales next year.

If anything, the drugs may have been too successful. Copycat efforts are pulling money that could fund more innovative research. There are thousands of trials underway attempting to extend the reach of these medicines by combining them with other drugs. Some are based more on wishful thinking than firm scientific footing. Still, the ability to shrink some previously intractable tumors is a considerable advance. If drugmakers finally figure out the right combinations and competition creates pricing pressure that boosts access, these medicines will do even more in the years to come.

From a combined economic and public-health standpoint, a new group of highly effective hepatitis C medicines may outstrip just about anything else on this list so far. Cure rates for earlier treatments werent especially high; they took some time to work and had nasty side effects. The approval of Gileads Sovaldi in 2013, followed in time by successor drugs such as AbbVie Inc.s Mavyret, have made hepatitis C pretty easily curable in a matter of weeks. For Gilead, getting to market rapidly with its drug proved enormously profitable; it raked in over $40 billion in revenue in just three years.

Hepatitis C causes liver damage over time that can lead to transplants or cancer. The existence of a rapid cure is a significant long-term boon even if the initial pricing on the drugs made them, in some cases, prohibitively expensive. Sovaldi notoriously cost $1,000 per pill at launch and over $80,000 for a course of treatment. The good news is that treatments have become a lot more affordable, which should allow this class of drugs to have a broad and lasting positive health effect.

Hepatitis C is one of the relatively few markets where the drug-pricing system has worked well. As competing medicines hit the market, the effective cost of these treatments plummeted. That, in turn, made the drugs more accessible to state Medicaid programs and prison systems, which operate on tight budgets and care for populations with higher rates of hepatitis C infection. Louisiana has pioneered the use of a Netflix model, under which the state paid an upfront fee for unlimited access to the drug. Its an arrangement that will help cure thousands of patients, and other states are expected to follow its lead.

Many of the medicines highlighted in this column have list prices in the six figures, a trend thats helped drive up Americas drug spending by more than $100 billion since 2009. Building on this decades medical advances is going to lead to even more effective medicines that will probably come with steeper prices.

Id like to hope that policymakers will come up with a solution that better balances the need to reward innovation with the need to keep medicines accessible.

That would really be a breakthrough.

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The 2010s were a decade of medical breakthroughs - Los Angeles Times

Direct-to-Consumer Fertility Testing: A Viable Alternative or Confusing and Misleading? – Technology Networks

A study investigating direct-to-consumer (DTC) fertility testing has revealed that consumers view it as a viable alternative to traditional medical testing. However, it was also found to be confusing and misleading, highlighting the need for education surrounding the purpose and accuracy of DTC tests. The paper is published in Social Science & Medicine.

Fertility testing outside of the clinic

Although their accuracy and reliability are the subject of much debate, DTC medical tests are on the rise; low costs, widespread availability and a population increasingly concerned about their health have seen people turning to DTC testing for information they may not so easily be able to receive from a healthcare professional.

This has extended to fertility testing for women; several companies now provide tests for anti-Mllerian hormone (AMH).

AMH levels in the blood are often used to provide an estimate of the ovarian reserve i.e. the remaining egg supply. This is primarily used as a diagnostic tool before ovarian stimulation, as part of the in vitro fertilization or egg freezing process. However, it can also potentially be used as an indicator of fertility.

Peoples desire to find out more about their fertility is understandable around 6.1 million women in the US have difficulty becoming or staying pregnant, according to the CDC. With other factors like a lack of insurance coverage potentially playing a role, DTC fertility testing could provide an accessible, alternative means of understanding individual fertility.

But do these tests provide genuine benefits to people looking into their fertility? Or are they misleading, taking advantage of health-concerned consumers?

Theyre attractive, but they dont deliver on their promise

To discover more about peoples experiences with DTC fertility testing, author Moira Kyweluk, Ph.D., followed 21 individuals who were interested in pursuing DTC ovarian reserve testing.

In an effort to ensure diversity, Kyweluk used ethnographic methods; participants stemmed from a range of groups, including those of different ethnicities, socioeconomic status and sexual orientation.

The study found that there were some positive views surrounding DTC testing. Particularly for LGBTQ+ individuals and single women, DTC ovarian reserve testing was viewed as an alternative method for family planning. Participants also stated that receiving testing outside of a traditional medical context felt empowering.

However, it was not all positive; some participants were uncertain about the accuracy of the test results. Others were unsure of what the next steps were supposed to be in order to confirm fertility status, or how to preserve it.

Consumers continue to desire these tests, and theyre attractive, but they dont deliver on their promise. said Kyweluk in a recent press release. Though there may be some benefits to consumers using DTC fertility testing, across the board participants were left with incorrect assumptions about the power of hormone testing to predict fertility.

Education, education, education

I view DTC testing as an entry point into what I term the new (in)fertility pipeline for women today, said Kyweluk. Because it is low cost and widely available, its reaching a larger demographic, people of diverse identities and backgrounds, and raising awareness of more advanced procedures and technologies like egg freezing.

However, Kyweluk emphasizes the need to improve consumers education around this kind of test, to make it clear what they are getting for their money, reduce confusion around result interpretation, and to increase understanding of fertility treatments in general.

No test or medical procedure guarantees future fertilityincluding egg freezingand these startups directly target women who are concerned about their reproductive futures, concluded Kyweluk.


Kyweluk. (2020) Quantifying fertility? Direct-to-consumer ovarian reserve testing and the new (in)fertility pipeline. Social Science & Medicine. DOI: https://doi.org/10.1016/j.socscimed.2019.112697

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Direct-to-Consumer Fertility Testing: A Viable Alternative or Confusing and Misleading? - Technology Networks

Top vascular medicine news of 2019: Colchicine benefit, valsartan recall and more – Healio

In this list, Healio and Cardiology Today present the most-popular vascular medicine articles published in 2019.

In no particular order, Healio readers this year were most interested in results of the COLCOT trial, new BP measurement standards from the American Heart Association, updates on the valsartan recall, type 2 MI and more.

COLCOT: Low-dose colchicine reduces CV risk after MI

Adults with a recent MI were less likely to experience an ischemic CV event over 2 years when assigned the anti-inflammatory gout medication colchicine compared with assignment to placebo, according to new results of the COLCOT trial presented at the American Heart Association Scientific Sessions. Read more

AHA updates BP measurement standards

Advances in techniques to measure BP accurately are essential outside and in the office setting, according to a scientific statement published by the American Heart Association in Hypertension. Read more

Long-term sitting affects vascular health

Long bouts of uninterrupted sitting in relatively healthy patients negatively impacted markers of peripheral and central vascular health, according to a study published in The American Journal of Cardiology. Read more

Many Americans unaware of MI signs, symptoms

Nearly half of all U.S. citizens do not know the five signs and symptoms of MI and, depending on the sociodemographic subgroup, may not know any at all, according to research published in JAMA Network Open. Read more

ED visits spike, prescribing patterns change in wake of valsartan recall

When multiple generic valsartan products were recalled worldwide in July 2018 due to the presence of a carcinogenic contaminant, valsartan dispensing immediately decreased. However, there was an immediate spike in ED visits for hypertension and incomplete replacement with alternative products in some patients, according to new data presented at the American Heart Association Scientific Sessions. Read more

More focus on BP control, diet may prevent 94.3 million premature deaths

BP control, sodium intake reduction and trans fatty acid elimination may prevent nearly 100 million global deaths within a 25-year period, according to a study published in Circulation. Read more

LEGEND-HTN: Thiazide, thiazide-like diuretics superior to ACE inhibitors

Drug classes used as monotherapy for hypertension were shown to be comparable, although thiazide or thiazide-like diuretics were superior to ACE inhibitors, according to results from the LEGEND-HTN study published in The Lancet. Read more

Noninvasive testing after ED visit for chest pain may reduce event rates

Patients who underwent noninvasive diagnostic testing after evaluation for chest pain in the ED had a lower observed rate of CV death or MI, according to a retrospective cohort study published in the Journal of the American Heart Association. Read more

Salt substitute reduced hypertension incidence by 55% in Peru

A pragmatic population-wide salt substitute strategy implemented in Peru, which consisted of 75% sodium chloride and 25% potassium chloride, contributed to reductions in both systolic and diastolic BP, especially in participants who were high risk, according to results from a study presented at the European Society of Cardiology Congress. Read more

Type 2 MI confers elevated risk for death within 1-year follow-up

Patients with type 2 MI are at greater risk for recurrent CV events and death within the first year of follow-up compared with patients experiencing type 1 MI. Read more

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Top vascular medicine news of 2019: Colchicine benefit, valsartan recall and more - Healio