Yesterday, I got an email that Al Franken is hosting the Daily Show this week. If you are a regular viewer, you probably already know that. If not, you will have missed a show by now, but they probably can be streamed through The Daily Show’s YouTube channel – if not in full, at the very least highlights (and the guest was only Lindsay Graham anyway). You’re welcome. I also got confirmation to visit Virgil Sunday.
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Short Takes –
Steve Schmidt – Donald Trump: innocent until proven guilty
Quote – I am saying these things because I am about to make an important point — and I want to remind people of my bonafides to make it on the eve of Donald Trump’s long-overdue arrest. Donald Trump is innocent. Let me say it again. Donald Trump is innocent until proven guilty. This moment requires restraint from Donald Trump’s fiercest and most committed antagonists, of which I am certainly one. This moment requires Trump’s most ferocious opponents to be better than his most committed fanatics. This moment requires those of us who despise Trump the most to be the loudest voices for his constitutional rights to due process. Click through for full article. It is extremely easy to forget this point of law, particularly when the defendant in question is someone you despise, and even more so if you feel that you already have evidence. This reminder is coming from someone who is in both those categories, and is therefore, I believe particularly compelling.
Pro Publica – This Georgia County Spent $1 Million to Avoid Paying for One Employee’s Gender-Affirming Care
Quote – When a sheriff’s deputy in Georgia’s Houston County sought surgery as part of her gender transition, local officials refused to change the department’s health insurance plan to cover it, citing cost as the primary reason. In the years that followed, the central Georgia county paid a private law firm nearly $1.2 million to fight Sgt. Anna Lange in federal court — far more than it would have cost the county to offer such coverage to all of its 1,500 health plan members, according to expert analyses…. In 2016, the county’s insurance administrator recommended changing the policy to align with a new federal nondiscrimination rule. But Houston County leaders said no. Click through for sad story. It’s nearly always cheaper to do the right thing. Seriously, if an insurance administrator suggests spending money, you can take it to the bank that that spending is going to save you money in the long run.
Food For Thought
Funny thing about choice and freedom: You have freedom to choose not to try to take away freedom from someone else over something they did not choose. pic.twitter.com/2Wvj0leJMw
The fact that someone found this content offensive is quite a self-own by that person. For a transcript, highlight the following with your mouse : Being LGBTQ is not a choice. Being black is not a choice. Being the child of animmigrant is not a choice. Being a Christian IS a choice. Being a busybody IS a choice. Being a Christian busybody IS a really annoying choice. Mind your own business. Learn to leave others in peace.
Yesterday, I was thinking about TomCat and his amputation, because there is now another reader of PP who is going to have an amputation of one leg below the knee. He doesn’t comment, but he does get and read the Sunday emails. I’ll call him James, because that’s his first name. In hiis case, the amputation is necessitated because, after a bunch of years, the titanium rod and steel screws which were put in after an injury are still not working, and he has never been pain free since they were put in. He was denied SSDI so doesn’t have Medicare, and has had other personal issues, so has never been in a position to demand better care, as TomCat was when providers messed up. I asked for and received his permission to request prayers (and/or of course however you communicate with the universe), so I’m requesting.
Cartoon –
Short Takes –
Crooks and Liars – Phoenix VA Predator Doc Faces 2nd Accusation—How Many More?
Quote – [T]he VA does not appear to have responded to everything MRFF asked for—specifically the “immediate and aggressive investigation” of Cheron. We know that because another veteran abused by Dr. Cheron, Stephen Brittle, has stepped forward after reading our earlier story. He had already lodged a similar complaint against Cheron before Rinsem’s case reached a crisis point. He, too, raised the prospect of Dr. Cheron “brow-beating other patients, given how he acted,” in a letter to the VA dated July 23. Click through for more. This is the same doctor named in a short take from August 24. Yes, MRFF is on it but how many more are there? And more to the point, how many veterans have died because of his fanaticism?
Axios – Study: Greenland ice melt will raise sea levels by nearly a foot
Quote – The study indicates that human-caused global warming driven by greenhouse gas emissions has effectively locked in a certain amount of sea level rise from the melting of the Greenland ice sheet…. The researchers estimated that the ice sheet will lose about 3.3% of its total volume within this century, which corresponds to 110 trillion metric tons of ice and an average global sea level rise of at least 270 millimeters, or 10.6 inches. Click through for more information. This is based on the assumption that human action causing warming were to stop immediately – and as we know, that isn’t happening. So it’s actually worse. And there’s 96.7% more of it to melt.
Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, though no one really knows how many there were supposed to be, the three names we have are Alecto, Megaera, and Tisiphone. These roughly translate as “unceasing,” “grudging,” and “vengeful destruction.”
If by any chance you were looking for a good example of the law of unintended consequences, here is one. Although “good” is probably not the appropriate word – it isn’t good at all. It is strong and convincing, however. What to do about it, I really don’t know. I wsh I did – although that might even be more frustrating if no one would listen.
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After the FDA issued warnings about antidepressants, youth suicides rose and mental health care dropped
The link between antidepressant use and increases in suicidal thoughts or behaviors among treated youth is unproven. FatCamera/E+ via Getty Images
Depression in young people is vastly undertreated. About two-thirds of depressed youth don’t receive any mental health care at all. Of those who do, a significant proportion rely on antidepressant medications.
Since 2003, however, the U.S. Food and Drug Administration has warned that young people might experience suicidal thinking and behavior during the first months of treatment with antidepressants.
The FDA issued this warning to urge clinicians to monitor suicidal thoughts at the start of treatment. These warnings appear everywhere: on TV and the internet, in print ads and news stories. The most strongly worded warnings appear in black boxes on medication containers themselves.
We have found that FDA drug warnings can sometimes prevent life-threatening adverse effects, but that unintended consequences of these warnings are also common. In 2013, working for the FDA itself, we published a systematic review of the effects of previous FDA warnings on a variety of medications. We found that about a third backfired, resulting in underuse of needed care and other adverse effects.
In our more recent study from 2020, we found that the FDA antidepressant warnings have led to reduced mental health care and increased suicides among youth – even though researchers have yet to find a clear link between antidepressants and increased suicidality in young people.
Further, despite the warnings, monitoring by clinicians of suicidal thoughts at the start of treatment has not increased from its tiny rate of less than 5%.
Youth suicides rose following FDA warnings
For our 2020 study, we obtained 28 years of data, between 1990 and 2017, on actual suicide deaths in the U.S. among adolescents and young adults. We used data from the WONDER Database, maintained by the U.S. Centers for Disease Control and Prevention, which contains mortality counts based on death certificates for U.S. residents and population counts for all U.S. counties.
We found that during the pre-warning period, there was a 13-year stable downward trend in youth suicides, following availability of new and safer antidepressants.
That trend reversed, we found, soon after the FDA began antidepressant warnings in late 2003. Youth suicide deaths increased significantly.
Then we applied our findings to the whole U.S. population of adolescents and young adults. The results of that analysis suggest that there were almost 6,000 additional suicide deaths in just the first six years after the FDA issued the boxed warnings, from 2005 through 2010. The rates also continued to rise thereafter.
Over this same time period, older adults – whose depression is not targeted by the warnings – experienced much lower increases in suicide.
Fewer depressed youths got treatment
Our findings align with a growing body of research that confirms these warnings have had serious unintended effects: scaring many patients, as well as their parents and doctors, away from both antidepressant medications and psychotherapy that can reduce major symptoms of depression.
These studies include a rigorous 2017 study that analyzed mental health care trends among 11 million youths who rely on Medicaid for insurance coverage. This research documented that immediately after the FDA warnings began in 2003, there was a sudden and sustained 30%-40% drop in youth visits to doctors for all depression care, including antidepressant prescriptions.
Seven years after the first FDA warning, doctor visits for depression by young people had dropped by around 50%, compared with the pre-warning trend, thus severely reducing treatment and suicide prevention.
Almost simultaneously, youth poisonings via prescription drugs, such as sleeping pills, went up. Research has shown that prescribed medications are a widespread method by which young people attempt suicide. This finding adds to the evidence that the antidepressant warnings increased suicidal behavior.
In 2018, researchers reported on two patients in their 20s whose experiences illustrate the potential real-life impacts of the black-box warnings. Both young adults had been prescribed antidepressants for major depression and severe panic attacks, but they refused to take them because of the FDA’s message.
Their conditions worsened, and eventually both attempted suicide. Fortunately, family members were able to intervene in time, and each young adult was then hospitalized.
After they accepted the reassurances of hospital psychiatrists that the benefits of the medications would likely exceed any risks, both patients began to take their prescribed antidepressants. These medications, combined with talk therapy, alleviated their symptoms without intensifying suicidal thoughts.
As scientists, we are trained to always seek potential alternative explanations – some additional factor not included in the research – that could explain the reduction in care or increase in suicides that we and others have recorded in our studies.
However, the sudden, simultaneous and large effects – all of which directly reduced treatment and increased suicidal behavior – strongly suggest this is not a coincidence. It is unlikely that any outside factor can account for the multiple parallel effects on depression care, suicidal behavior and suicide deaths.
A large and growing body of evidence shows that the FDA’s black-box warnings on antidepressants need to be reevaluated.
More generally, there’s a need for independent researchers to monitor the effects of FDA warnings on public health – both intended and unintended.
Stephen Soumerai, Professor of Population Medicine, Harvard Medical School, Harvard University and Ross Koppel, Professor of Medical Informatics and Adjunct Professor of Sociology, University of Pennsylvania; Professor of Biomedical Informatics, University at Buffalo
============================================================== Alecto, Megaera, and Tisiphone, This is another situation in which I have been very fortunate and thrived while too many others have suffered. When I decided to seek prescriptive help for my condition, I had done dome research and had a particular drug in mind. The Doctor and I were not in total agreement on what the condition actually was – but the drug I had researched was used for both, and he was amenable to prescribing it for me. It worked very well, and I ave been stable on it for – well, actually decades. But not everyone can find (or trip over) the right places to research, not everyone can find a doctor who listens, and matbe even more to the point, not everyone can safely make it into their 40’s without self-harn.
Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, though no one really knows how many there were supposed to be, the three names we have are Alecto, Megaera, and Tisiphone. These roughly translate as “unceasing,” “grudging,” and “vengeful destruction.”
This sounds like something out of a fantastic hidden-object-puzzle-adventure (“HOPA”) computer game – such as “The Andersen Accounts.” But apparently, even though supernatural powers are not in the offing, there is some promise of getting tattoos to be more than just art.
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Dynamic tattoos promise to warn wearers of health threats
In the sci-fi novel “The Diamond Age” by Neal Stephenson, body art has evolved into “constantly shifting mediatronic tattoos” – in-skin displays powered by nanotech robopigments. In the 25 years since the novel was published, nanotechnology has had time to catch up, and the sci-fi vision of dynamic tattoos is starting to become a reality.
The first examples of color-changing nanotech tattoos have been developed over the past few years, and they’re not just for body art. They have a biomedical purpose. Imagine a tattoo that alerts you to a health problem signaled by a change in your biochemistry, or to radiation exposure that could be dangerous to your health.
You can’t walk into a doctor’s office and get a dynamic tattoo yet, but they are on the way. Early proof-of-concept studies provide convincing evidence that tattoos can be engineered, not only to change color, but to sense and convey biomedical information, including the onset of cancer.
Signaling biochemical changes
In 2017, researchers tattooed pigskin, which had been removed from the pig, with molecular biosensors that use color to indicate sodium, glucose or pH levels in the skin’s fluids.
In 2018, a team of biologists developed a tattoo made of engineered skin cells that darken when they sense an imbalance of calcium caused by certain cancers. They demonstrated the cancer-detecting tattoo in living mice.
UV radiation sensors
My lab is looking at tech tattoos from a different angle. We are interested in sensing external harms, such as ultraviolet radiation. UV exposure in sunlight and tanning beds is the main risk factor for all types of skin cancer. Nonmelanoma skin cancers are the most common malignancies in the U.S., Australia and Europe.
UV-activated tattoo ink is invisible until exposed to UV light. Jesse Butterfield/The Laboratory for Emergent Nanomaterials, University of Colorado Boulder, CC BY-NC-ND
To help address this problem, we developed an invisible tattoo ink that turns blue only in UV light, alerting you when your skin needs protection. The tattoo ink contains a UV-activated dye inside of a plastic nanocapsule less than a micron in diameter – or thousandth of a millimeter – about the same size as an ordinary tattoo pigment.
The nanocapsule is needed to make the color-changing tattoo particles large enough. If tattoo pigments are too small, the immune system rapidly clears them from the skin and the tattoo disappears. They are implanted using tattoo machines in the same way as regular tattoos, but they last for only several months before they start to degrade from UV exposure and other natural processes and fade, requiring a “booster” tattoo.
I served as the first human test subject for these tattoos. I created “solar freckles” on my forearm – invisible spots that turned blue under UV exposure and reminded me when to wear sunscreen. My lab is also working on invisible UV-protective tattoos that would absorb UV light penetrating through the skin, like a long-lasting sunscreen just below the surface. We’re also working on “thermometer” tattoos using temperature-sensitive inks. Ultimately, we believe tattoo inks could be used to prevent and diagnose disease.
In this TEDx talk, the author demonstrates the UV-detecting tattoo.
Temporary high-tech tattoos
Temporary transfer tattoos are also undergoing a high-tech revolution. Wearable electronic tattoos that can sense electrophysiological signals like heart rate and brain activity or monitor hydration and glucose levels from sweat are under development. They can even be used for controlling mobile devices, for example shuffling a music playlist at the touch of a tattoo, or for luminescent body art that lights up the skin.
The advantage of these wearable tattoos is that they can use battery-powered electronics. The disadvantage is that they are much less permanent and comfortable than traditional tattoos. Likewise, electronic devices that go underneath the skin are being developed by scientists, designers and biohackers alike, but they require invasive surgical procedures for implantation.
Tattoos injected into the skin offer the best of both worlds: minimally invasive, yet permanent and comfortable. New needle-free tattooing methods that fire microscopic ink droplets into the skin are now in development. Once perfected they will make tattooing quicker and less painful.
Ready for everyday use?
The color-changing tattoos in development are also going to open the door to a new kind of dynamic body art. Now that tattoo colors can be changed by an electromagnetic signal, you’ll soon be able to “program” your tattoo’s design, or switch it on and off. You can proudly display your neck tattoo at the motorcycle rally and still have clear skin in the courtroom.
As researchers develop dynamic tattoos, they’ll need to study the safety of the high-tech inks. As it is, little is known about the safety of the more than 100 different pigments used in normal tattoo inks. The U.S. Food and Drug Administration has not exercised regulatory authority over tattoo pigments, citing other competing public health priorities and a lack of evidence of safety problems with the pigments. So U.S. manufacturers can put whatever they want in tattoo inks and sell them without FDA approval.
A wave of high-tech tattoos is slowly upwelling, and it will probably keep rising for the foreseeable future. When it arrives, you can decide to surf or watch from the beach. If you do climb on board, you’ll be able to check your body temperature or UV exposure by simply glancing at one of your tattoos.
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AMT, in 75 years, it never once crossed my mind that a tattoo might be something I might one day consider. But here it is. If a tattoo could actually give me a health warning – and I can think of situations where that could go way past handy, all the way to life-saving – I’m on board.
