HealthDavid Kessler: ‘Capturing’ attention with a new theory of mind About the Author Reprints @kweintraub As commissioner of the Food and Drug Administration in the 1990s, Dr. David Kessler was known for regulating cigarettes, cutting time for drug approvals, and enforcing food labels. But ever since leaving Washington, Kessler has worried less about the rule of law and more about why people do things against their own self-interest.A pediatrician and lawyer by training, Kessler talked with STAT about his new book “Capture,” which was published last week.What do you mean that things like smoking and junk food can “capture” us?The theory of capture is composed of three elements: Something seizes our attention; it changes how we feel; [and] there’s a perception of a loss of control.advertisement By Karen Weintraub April 22, 2016 Reprints Can we escape our traps by thinking or willing our way out?Certainly if you look at the traditions of Buddhism — they try to decrease your emotional reactivity. What antidepressants do is reduce emotional reactivity. I’m convinced that the best way to get release from capture is to find something more positive that can be more meaningful that captures you.Such as?In the book, for one character it was music, for another it was running, for [Winston] Churchill it was painting. You don’t necessarily control what you’re captured by, but you can put yourself in a position to be captured by certain things.Is the idea of capture relevant to the current Presidential campaign?What are some of the candidates playing with? They’re playing with highly salient stimuli. Whether it’s the decline of America or scapegoats or being cheated by others. Leadership can either capture people with a negative image of the world or a positive image. Both will work, but [the negative] is scary, with a direct line to violence.Do companies use capture to manipulate us?Making things salient, isn’t that the goal of advertising?Did you try to use this thinking to break yourself of any habits?I have suits in every size. I realized I had to change my own perception of food.Anything that’s captured you outside of work?My first grandchild.Dr. David Kessler is a professor of pediatrics at the University of California, San Francisco. This interview has been edited and condensed. Karen Weintraub is an independenthealth/sciencejournalist, journalism teacher, and bookauthor. Karen Weintraub Former FDA chief Dr. David Kessler is advancing a new theory of mental suffering. Molly Ferguson for STAT What drew you into studying this? I became convinced there was a common mechanism underlying many of our emotional struggles and mental illnesses. If you look at someone who’s depressed, there’s a constant attentional shift toward negative: I’m a fraud, I’m a failure, I’m no good.And you think this idea of capture can help break the cycle?To be able to offer up a new theory of mental suffering in a way that people can understand it, and most importantly not to feel that people who suffer are broken — that to me is the most important aspect of capture.advertisement Tags foodmental healthPresidential campaign
Pharmalot Log In | Learn More Despite having some success in launching and developing new drugs in recent years, the returns on R&D efforts by a dozen of the biggest pharmaceutical companies has declined from 10.1 percent in 2010 to a projected 3.7 percent this year, according to a new report.During that period, the average peak sales for each drug reached $394 million, which represented an 11.4 percent year-over-year drop from 2010, according to the analysis by the Deloitte Centre for Health Solutions. And while costs to discover, develop, and launch a drug have largely stabilized at slightly more than $1.5 billion, the upshot is that blockbuster costs are not producing blockbuster sales. Unlock this article — plus daily coverage and analysis of the pharma industry — by subscribing to STAT+. First 30 days free. GET STARTED STAT+ is STAT’s premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. Memo to pharma R&D chiefs: Returns on investment are declining rapidly David L. Ryan/The Boston Globe GET STARTED By Ed Silverman Dec. 19, 2016 Reprints Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr. What is it? Pharmalot Columnist, Senior Writer Ed covers the pharmaceutical industry. [email protected] Ed Silverman What’s included? @Pharmalot Tags financepharmaceuticalsSTAT+ About the Author Reprints
With ‘shame on you’ chants and harsh tweets, nurses union pushes single-payer bill GET STARTED @pbartolone Members of the California Nurses Association and supporters rally at the Capitol in Sacramento, Calif., in June, calling for passage of a single-payer health plan. Rich Pedroncelli/AP What is it? About the Author Reprints Log In | Learn More Unlock this article — plus daily intelligence on Capitol Hill and the life sciences industry — by subscribing to STAT+. First 30 days free. GET STARTED SACRAMENTO, Calif. — To some, the California Nurses Association’s political tactics in pushing for a single-payer health system seemed a bit, well, New Jersey-ish.Never mind the raucous demonstrations it brought to the state Capitol in recent weeks, the “shame on you” chants in the hallways, the repeated unfurling of banners in the rotunda despite admonitions from law enforcement. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr. Tags insurancenursingpolicystates By Pauline Bartolone — California Healthline July 11, 2017 Reprints Pauline Bartolone — California Healthline What’s included? STAT+ is STAT’s premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. [email protected] Politics
WASHINGTON — The medical expense deduction targeted for repeal by GOP tax writers has helped to offset costs including nursing home care and fertility treatments, laser eye surgery, and travel out-of-state for a second opinion on a rare cancer.Several million people unlucky enough to face big medical bills not covered by their insurance would lose a valuable deduction under the House GOP bill. Groups representing older people and patients are trying to save it. About the Author Reprints What’s included? Unlock this article — plus daily intelligence on Capitol Hill and the life sciences industry — by subscribing to STAT+. First 30 days free. GET STARTED Politics STAT+ is STAT’s premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. Pablo Martinez Monsivais/AP GET STARTED What is it? Log In | Learn More Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr. By Associated Press Nov. 7, 2017 Reprints Repeal of medical deduction prompts tax bill pushback Associated Press Tags policy
About the Author Reprints Despite widespread optimism about the tax cut bill racing through Congress, biopharma insiders across the U.S. say they’re not expecting to add new jobs at their companies in the coming year, a new STAT Plus survey finds.Nearly 6 in 10 respondents said it’s unlikely their companies will be expanding. Nonetheless, they remain bullish on the industry at large, with more than half expressing strong confidence that biotech will have a good year. What is it? [email protected] Opinions+ @cooney_liz General Assignment Reporter Liz focuses on cancer, biomedical engineering, and how patients feel the effects of Covid-19. By Elizabeth Cooney Dec. 15, 2017 Reprints NordWood Themes/Unsplash What’s included? Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr. Elizabeth Cooney Unlock this article by subscribing to STAT+ and enjoy your first 30 days free! GET STARTED GET STARTED STAT+ is STAT’s premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. Industry insiders are upbeat about 2018, but that doesn’t mean more hiring Log In | Learn More Tags biotechfinancepharmaceuticlspolicypoliticsSTAT+
About the Author Reprints In people younger than 55, Apple Watch’s positive predictive value is just 19.6 percent. That means in this group — which constitutes more than 90 percent of users of wearable devices like the Apple Watch — the app incorrectly diagnoses atrial fibrillation 79.4 percent of the time. (You can try the calculation yourself using this Bayesian calculator: enter 0.001 for prevalence, 0.98 for sensitivity, and 0.996 for specificity).The electrocardiogram app becomes more reliable in older individuals: The positive predictive value is 76 percent among users between the ages of 60 and 64, 91 percent among those aged 70 to 74, and 96 percent for those older than 85.The positive predictive value of the Apple Watch’s atrial fibrillation detection byage group<5555-5960-6465-6970-7475-7980-8485+0%20%40%60%80%100%AgePositive predictive valueAgePositive predictive value<550.255-590.6260-640.7665-690.8670-740.9175-790.9480-840.9685+0.96age groupHere’s the bottom line: For the vast majority of individuals under age 55 whose Apple Watches tell them they have atrial fibrillation, the odds are high that the watch is wrong. But it is more accurate for the aging population that is becoming a part of the wearable generation.Does this mean younger folks should ignore a notification about atrial fibrillation?No. Even younger individuals whose Apple Watch signals atrial fibrillation should contact their physicians to discuss any symptoms or medical conditions that heighten the risk for this disease. The Apple Health app lets users download a PDF of the watch’s electrocardiogram tracing to send to a physician. Efforts to integrate data from this app with electronic health records are currently underway.Daniel Yazdi, M.D., is a second-year internal medicine resident at Brigham and Women’s Hospital in Boston. A version of this article was published by Medtech Boston. Related: The Apple Watch 4 can now do something that was once available mainly in your doctor’s office or a hospital: take an electrocardiogram. This recording of your heart’s rhythm can detect rapid or skipped heartbeats. The watch can also check your heart’s rhythm in the background and notify you if an irregular rhythm appears to be atrial fibrillation.That’s a useful task. A heart in atrial fibrillation beats faster than normal, and the upper and lower chambers don’t work together. Atrial fibrillation can go unnoticed. It can also cause fatigue, dizziness, heart palpitations, or chest pain. Noticed or not, it can increase the risk of having a stroke.As a physician, I’m excited about this new frontier in digital health. But I’m also cautious about its implications. Diagnostic tests like this one are rarely perfect. They usually generate false positives: incorrectly diagnosing a condition in people who do not have it.advertisement According to data that Apple submitted in its petition asking the Food and Drug Administration to give clearance to the heart monitoring app, the app accurately detects atrial fibrillation 99 percent of the time it gets a good reading. [email protected] The next Apple Watch wants to monitor your heart. Should you let it? Here’s the data behind the new Apple Watch EKG app @DanielYazdi Tags cardiologymedical technology ADOBE I first needed to know the baseline risk of having atrial fibrillation. According to the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study, which included nearly 1.9 million Americans, the percentage increases with age: 0.1 percent of those younger than age 55 have atrial fibrillation, rising to 9.1 percent among those over age 85.Next I needed to know the sensitivity (the probability of having atrial fibrillation if the watch detects it) and specificity (the probability of not having atrial fibrillation if the watch does not detect it) of the Apple Watch app. Apple helpfully supplies those numbers — 98 percent sensitivity and 99.6 specificity — in its user’s guide.I applied Bayesian statistics to this information. This branch of statistics uses prior information, such as disease prevalence, to interpret the likelihood of an outcome, in this case having atrial fibrillation. The result of the calculation is the positive predictive value: the probability of having atrial fibrillation when it is detected by the watch. That sounds amazing. But it leaves out an important little something: the likelihood of having atrial fibrillation is low among younger individuals and increases with age. I did some calculations to answer the question, “If my watch tells me I have atrial fibrillation, what are the odds it is correct?” The answer depends on the watch wearer’s age.advertisement First OpinionThe Apple Watch 4 is an iffy atrial fibrillation detector in those under age 55 By Daniel Yazdi Jan. 8, 2019 Reprints Related: Daniel Yazdi
A passenger stands outside on the balcony of the cruise ship Diamond Princess anchored at the Yokohama Port near Tokyo. The 3,700 people on board faced a two-week quarantine in their cabins due to coronavirus. Eugene Hoshiko/AP About the Author Reprints Asking people to protect themselves is necessary to help prevent the spread of infectious diseases like Covid-19, for which there yet is no vaccine or cure. But it isn’t sufficient, because not everyone can comply with recommendations like social distancing, such as not going to school or work and avoiding places where others congregate.Following such recommendations is almost impossible for day laborers who don’t get paid if they don’t go to work; for people with low-wage jobs; for people who don’t have paid sick leave; and others. For many Americans, a few days of lost wages can mean not being able to pay the rent, buy food, or afford medications. They may feel compelled to go to work even if they aren’t feeling well, because they need the money.We need to make it possible for such individuals — who make up a large chunk of Americans — to stay home. That means providing some source of replacement income or job security, either through the private sector or the government.Would that be expensive? Yes. But it is equally expensive — and may be even more costly — to put people in institutional quarantine settings because you still have to provide staff, food, water, medicine, and access to communication with friends and family. That’s not cheap. Just look at our prison system.If we can give people the resources they need to stay home during a disease outbreak and avoid workplaces, schools, theaters, and other places where people gather, there would be fewer opportunities for people to fear that they could contract the virus. It would reduce the strain on our hospitals and health care systems. And most importantly, it would recognize and reward the sacrifice that people voluntarily make to protect the community.People don’t want to make other people sick. They will comply with credible recommendations and voluntarily stay home, if it is possible for them to do so. This means preventive measures must include providing the resources that make it possible.During the SARS outbreak, which first emerged in November 2002, the government in Singapore provided economic assistance to individuals and businesses affected by the quarantine; in Hong Kong, individuals received daily material and financial assistance. The CDC’s 2017 regulations don’t mention these legitimate concerns; they only allow the CDC director to authorize payment for treating people who are involuntarily confined in a quarantine facility. Fear of being quarantined itself can create resistance. If you’re afraid you’re going to get locked up somewhere, you may not want to admit you have an illness. You may not want to go to the doctor for fear of being reported. If you are told you can’t leave your city, you might flee. That’s what happened in China during the SARS outbreak. A rumor that the government was planning a large-scale involuntary quarantine caused nearly 250,000 people to leave Beijing.And quarantines aren’t without their costs. The Wuhan quarantine has had numerous unintended effects, some of them fatal. People were unable to reach sick, elderly parents in the city, let alone take them elsewhere for treatment of chronic conditions like heart disease and cancer. The United Nations AIDS agency recently announced that one-third of people in China who are living with HIV were at risk of running out of their HIV medications because of lockdowns and travel restrictions. The quarantine has also severely slowed China’s economy.As the CDC and other public health agencies know, quarantine by itself may delay the spread of an infectious disease, but it cannot prevent or end any disease outbreak. It has not succeeded in the past and is ill-suited to the realities of the contemporary world.A better way to fight infectious disease outbreaks is by creating a resilient population that is more likely to withstand potential epidemics. As my colleague Michael Ulrich and I wrote in the SMU Law Review in 2018, “Populations with good nutrition, high literacy rates, adequate income, and access to appropriate medical care, social services, and sources of reliable information are better prepared to understand the meaning of an outbreak and what to do in response.” They are also less likely to suffer severe illness if the infection spreads to them.Even in a reasonably resilient population like the United States, limiting the spread of a novel pathogen depends on public trust in government recommendations. But trust goes both ways. Government must also trust people to follow reasonable recommendations. And it can do that if its recommendations are reasonable and credible and people have the means to voluntarily comply with them.Wendy K. Mariner, J.D., is professor of health law at the Boston University School of Public Health and the Center for Health Law, Ethics & Human Rights. Related: So far, public health recommendations focus on asking people to protect themselves by washing their hands and covering their coughs. While this is good advice, it puts the onus on the individual. Threats of involuntary quarantine often come next, which looks a lot like blaming the victim: punishing people for getting sick or treating people like criminals, not patients. That makes the target of disease-control efforts a person — instead of a pathogen.But when individuals are viewed as potential threats to public health, they may feel unfairly attacked and stigmatized. And if people doubt what the government says, they may decline to follow even sensible recommendations.Infection is not the only harm to the public during an outbreak. During the 2014-2016 Ebola outbreak, hysteria, politicization, and some states’ rejection of CDC recommendations created more harm than the disease itself. People were threatened by law enforcement and public officials. Children were bullied in schools. Individuals were not allowed to work, or in some circumstances dismissed from their jobs. While the spread of misinformation, largely through the media, carries much of the blame, those who embraced, enforced, or advocated for overly strict quarantine measures certainly fanned the flames.To gain public trust, health officials must be honest and transparent about what is and is not known about a disease outbreak, and provide useful recommendations for avoiding infection. Giving people credible information about what they can do is an important first step in facing an infectious disease outbreak. Before resorting to the draconian measure of involuntary quarantine, I think we should make it unnecessary. Two complementary efforts can make that happen: providing credible information the public can trust; and making it possible for people to comply with disease-avoidance recommendations without excessive personal or financial cost.advertisement By Wendy K. Mariner Feb. 28, 2020 Reprints The CDC has broad authority — some say overbroad — to approve involuntary quarantines under final regulations governing domestic and foreign quarantine that were issued in January 2017. A single coronavirus case exposes a bigger problem: The scope of undetected U.S. spread is unknown CDC expects ‘community spread’ of coronavirus, as top official warns disruptions could be ‘severe’ First OpinionQuarantine for coronavirus? Let’s make that unnecessary Wendy K. Mariner Tags BostonCoronavirus Do you trust the government to protect you and your family from the novel coronavirus causing Covid-19? Centers for Disease Control and Prevention officials say more cases are inevitable in the United States, although they can’t predict how many and when they will appear. President Trump says the risk is low and “We’re very, very ready for this.” But what does it mean to be ready?The emergence of a new infectious disease often prompts governments to consider quarantines. Officials in China recently turned to this drastic option, blocking most travel into and out of the city of Wuhan, the center of the Covid-19 outbreak. As cases appear in other countries, they, too, are thinking about quarantine.The term “quarantine” means restricting the movements of individuals who have been, or might have been, exposed to a contagious disease. Although it is often used interchangeably with “isolation,” the latter means confining individuals known to have a contagious infection, usually as part of medical treatment. Quarantine and isolation can be voluntary or involuntary.advertisement [email protected] Related: Related: A critical question in getting a handle on coronavirus: What role do kids play in spreading it?