Tag: brand safety-nsf health issues

How safe is the abortion pill compared with other common drugs | CNN

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CNN
 — 

A federal judge in Texas ruled on Friday to suspend the Food and Drug Administration’s approval of mifepristone, the first drug in the medication abortion process, nationwide by the end of this week.

The judge sided with the coalition of anti-abortion national medical associations that filed the lawsuit. He argued that the FDA failed to adequately consider risks associated with the drug, including “the intense psychological trauma and post-traumatic stress women often experience from chemical abortion.”

However, data analyzed by CNN shows mifepristone is even safer than some common, low-risk prescription drugs, including penicillin and Viagra. There were five deaths associated with mifepristone use for every 1 million people in the US who have used the drug since its approval in 2000, according to the US Food and Drug Administration as of last summer. That’s a death rate of 0.0005%.

Comparatively, the risk of death by penicillin — a common antibiotic used to treat bacterial infections like pneumonia — is four times greater than it is for mifepristone, according to a study on life-threatening allergic reactions. Risk of death by taking Viagra — used to treat erectile dysfunction — is nearly 10 times greater, according to a study cited in the amicus brief filed by the FDA.

“[Mifepristone] has been used for over 20 years by over five million people with the capacity to become pregnant,” said Ushma Upadhyay, an associate professor in the department of obstetrics, gynecology and reproductive science at the University of California, San Francisco. “Its safety is very well established.”

The Justice Department, the FDA, and Danco — a manufacturer of mifepristone that intervened in the case — have already appealed the ruling.

Within hours of the decision in Texas, a federal judge in Washington state issued a conflicting ruling that the federal government must keep mifepristone available in the 17 Democrat-led states and the District of Columbia that had sued in a separate lawsuit.

If the Texas ruling is allowed to take effect this week, 40 million more women of reproductive age would lose access to medication abortion care around the country, according to data from abortion rights advocacy group NARAL Pro-Choice America. That’s in addition to the 24.5 million women of reproductive age living in states with abortion bans.

“The court’s disregard for well-established scientific facts in favor of speculative allegations and ideological assertions will cause harm to our patients and undermines the health of the nation,” said Dr. Jack Resneck, Jr., president of the American Medical Association, in a statement. “By rejecting medical facts, the court has intruded into the exam room and has intervened in decisions that belong to patients and physicians.”

Medication abortion has become the most common method for abortion, accounting for more than half of all US abortions in 2020, according to the Guttmacher Institute.

The growing popularity of medication abortion is largely because of its accessibility, said Abigail Aiken, associate professor at the University of Texas at Austin who leads a research group on medication abortion.

“It reduces the cost, it reduces barriers where people may not want to go to a clinic,” she said.

It is also a safer option than both procedural abortion or childbirth. The rate of major complications — like hemorrhages or infections — for medication abortions is about one-third of a percent, according to a 2015 study conducted by Upadhyay. That means out of more than 11,000 cases, 35 experienced any major complications.

The likelihood of serious complications via procedural abortion — performed second-trimester or later — is slightly higher than medication abortion at 0.41%, according to the same study. And childbirth by far comes with the highest risk, at 1.3%.

If access to mifepristone is cut off, abortion clinics and telehealth organizations could pivot to misoprostol-only abortions, Aiken told CNN. Although misoprostol-only abortions are used around the world, they are less effective, associated with a higher risk of serious complications and often more painful than the mifepristone and misoprostol combination, she said.

In the latest study of self-managed misoprostol-only medication abortions in the US, Johnson found misoprostol-only abortions to be a safe alternative, though less safe than using both pills. The study, published in February, analyzed data from online telehealth medication abortion provider Aid Access from 2020. Nearly 90% of 568 users reported completed abortions and 2% experienced serious complications using only misoprostol.

Mifepristone and misoprostol together is still considered the gold standard, Aiken told CNN. People who used the two-pill combination were less likely to experience serious complications than those who went with the misoprostol-only regimen.

“It’s clear people can use these medications, mifepristone and misoprostol, at home even without the help of a medical professional very safely,” said Aiken.

Because misoprostol is used to treat multiple ailments including stomach ulcers, it’s readily stocked in pharmacies and unlikely to be taken off the market anytime soon, Johnson told CNN.

However, a lesser-effective method means more people will likely have unsuccessful abortions.

“It’s possible that it might not work for some people, and it will prolong their abortions,” said Upadhyay. “Then by the time they get back to the clinic, they’re seeking abortion later in pregnancy.”

Before the ruling, 19 states already restricted telehealth abortion care, limiting access to medication abortion. Nearly half of US adults were unsure whether medication abortion was currently legal in their state as of late-January, according to a survey conducted by the Kaiser Family Foundation. Experts say that confusion will only be exacerbated.

“People are not going to be sure mifepristone or misoprostol in fact, is available. I think it’s going to be confusing,” said Aiken. “As people look around for options or feel unsure about their options, they may end up delaying [care].”

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Why you keep having the same dream | CNN

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Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.



CNN
 — 

For years, dreams of my teeth cracking, loosening or falling out plagued my sleep. Loved ones of mine have repeatedly dreamed of flying, rolling away in a self-operating car, or running late for school or work. These aren’t typical nightmares, which usually happen once. They’re some of the most common recurring dreams, which tend to lean negative and can take some work to overcome.

“Recurring dreams are likelier to be about very profound life experiences or just very character logic issues that are kind of guaranteed to recur in waking life because they’re part of you rather than a one-time event,” said dream researcher Deirdre Barrett, a lecturer of psychology in the department of psychiatry at Harvard Medical School.

Since our dreams typically don’t repeat themselves, all it takes is dreaming the same dream twice or more for it to be considered recurring, Barrett said. They’re more common in childhood, Barrett said, but can last into adulthood. And recurring dreams don’t always happen in close proximity to each other — they can pop up multiple times per month or years apart, Barrett said.

Recurring dreams might be the same every time, or they might just recycle the same types of scenarios or worries, experts said.

“It is difficult to assess the prevalence of recurrent dreams because it is not something that happens on a regular basis for most people,” said clinical psychologist Dr. Nirit Soffer-Dudek, a senior lecturer in the department of psychology at Ben-Gurion University of the Negev in Israel, via email. “And when people are asked about past dreams in their life, they may be influenced by memory distortions, interest in dreams (or lack thereof), or other factors.”

Regardless, anything that comes up repeatedly is worth investigating, said sleep medicine specialist Dr. Alex Dimitriu, founder of Silicon Psych, a psychiatry and sleep medicine practice in Menlo Park, California.

“People have this kind of touch-and-go approach with things that are uncomfortable or fear-inducing, and I think dreams are, in some way, the same way,” Dimitriu said. “As a psychiatrist, I’m inclined to say that there is some message that might be trying to be conveyed to you. And the answer, then, might be to figure out what that is. And I think when you do, you might be able to put the thing to rest.”

Here’s how to figure out what’s triggering your recurring dreams.

For some recurring dreams, the message is straightforward — if you repeatedly dream about running late for school or work, you’re probably just often nervous about being unprepared for those things. But others, despite their commonness, might not have a universal meaning, requiring you do some soul-searching to learn more.

“In interpretation, we really don’t believe there are universal symbols, but that (it’s) what an individual’s own sort of personal symbol system is and their associations to something are,” Barrett said.

In addition to unpreparedness, other common themes of recurring dreams include social embarrassment, feeling inadequate compared with others, and danger in the form of car crashes or natural disasters, Barrett and Dimitriu said.

Some people have dreams revolving around test anxiety even if they haven’t been in school in years, Barrett said. This can reflect a general fear of failure or a sense of being judged by authority figures. Dreams of tooth loss or damage might have to do with loss of something else in your life, feelings of hopelessness or defenselessness, or health concerns.

When faced with a recurring dream, ask yourself what the message could be, Dimitriu said. What is your relationship to the things or people in the dream? What are your fears and belief systems about those things? What are the top five things in your life that might be triggering it or related to it? What are you really worried about?

“I definitely think it’s fine to do informal dream interpretation, either on your own or with a close, trusted person who may just sort of see things to question in it that you don’t,” Barrett said.

People with post-traumatic stress disorder or anxiety are more likely to have recurring dreams, especially ones with anxious natures, Dimitriu said. A PTSD dream stems from a trauma so severe it keeps returning as a nightmare.

“The brain is trying to resolve something and lay it to rest,” he added. But “in people with PTSD, their dreams are so vivid that they wake them up from sleep. And that becomes the problem because the dream never gets processed. … And that’s why it recurs — it’s unfinished work.”

Sometimes recurring dreams can point to biological sources, too. “People with sleep apnea will report dreams of, like, drowning, suffocating, giant waves, gasping for air, being underwater or being choked,” Dimitriu said, when they’re actually experiencing breathing interruptions because of their condition.

There can be environmental triggers as well, such as a car alarm down the street or a dripping faucet, he added, which can set off dreams with imagery of those things.

Once you have a better sense of what your worries are, writing about them before bed can be helpful for alleviating negative recurring dreams and stress in general.

“For my patients and myself, journaling is such a powerful tool,” Dimitriu said. Meditating could also help.

When you know what fear is behind your dream, Dimitriu recommended processing it via a three-column method used in cognitive behavioral therapy: What is your automatic thought? What’s your automatic feeling? Lastly, what’s the more reality-based alternative thought?

Dream rehearsal therapy, also known as imagery rehearsal therapy, can be effective for both recurring dreams and nightmares. This approach involves writing down in detail the narrative elements of the dream, then rewriting it so it ends positively. Right before falling asleep, you’d set the intention to re-dream by saying aloud, “If or when I have the beginnings of the same bad dream, I will be able to instead have this much better dream with a positive outcome.”

If your recurring dreams are making you stressed or unhappy, causing other symptoms, or starting to impair your ability to function on a regular basis, it’s time to seek professional help, experts said.

Recurring dreams could also stem from poor sleep hygiene, Soffer-Dudek said.

“A lot of awkward things happen in the night when people are sleep deprived, drink caffeine too late, drink alcohol too late, worked too late or slept four hours last night because they stayed up too late,” he said. “The fundamental core and foundation of healthy dream life starts with healthy sleep.”

Dimitriu also recommended limiting distractions that interfere with your time to reflect and process, such as spending unnecessary time on your phone or always filling the silence.

When your mind is always occupied, “what happens is all that processing has to happen somewhere,” he said. “So now there’s more pressure for that to happen in your dream life.”

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Maternity units are closing across America, forcing expectant mothers to hit the road | CNN

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CNN
 — 

In picturesque Bonner County, Idaho, Leandra Wright, 40, is pregnant with her seventh child.

Wright is due in August, but three weeks ago, the hospital where she had planned to deliver, Bonner General Health, announced that it would be suspending its labor and delivery services in May.

Now, she’s facing a potentially precarious drive to another hospital 45 minutes from her home.

“It’s frustrating and worrisome,” Wright said.

Wright has a history of fast labors. Her 15-year-old son, Noah, was born on the way to the hospital.

“My fifth child was born on the side of the highway,” Wright said. “It was wintertime, and my hospital at the time in California was about 40 minutes away, and the roads were icy, so we didn’t make it in time.”

By the time she and Noah got to the hospital, about 15 minutes after he was born, his body temperature was lower than normal.

“It worries me not to have a doctor there and worries me to have to go through that,” Wright said.

Residents of Bonner County aren’t the only ones dealing with unexpected maternity unit closures.

Since 2011, 217 hospitals in the United States have closed their labor and delivery departments, according to a report by the health care consulting firm Chartis.

A CNN tally shows that at least 13 such closures have been announced in the past year alone.

Services provided at maternity units vary from hospital to hospital. Most offer obstetrics care in which an obstetrician will deliver a baby, either vaginally or via cesarean section. These units also provide perinatal care, which is medical and supportive care before and after delivery.

Other services provided may include lactation specialists and private delivery rooms.

After May 19, Bonner General Health will no longer offer obstetrical services, meaning there will be zero obstetricians practicing there. Consequently, the hospital will no longer deliver babies. Additionally, the unit will no longer provide 24-hour anesthesia support or post-resuscitation or pre-transportation stabilization care for critically ill newborns.

Some hospitals that have recently closed their maternity units still offer perinatal care, along with routine gynecological care.

Bonner General is planning to establish a clinic where perinatal care will be offered. Gynecological services – such as surgical services, preventative care, wellness exams and family planning – will still be provided at a nearby women’s health clinic.

The Chartis report says that the states with the highest loss of access to obstetrical care are Minnesota, Texas, Iowa, Kansas and Wisconsin, with each losing more than 10 facilities.

Data released last fall by the infant and maternal health nonprofit March of Dimes also shows that more than 2.2 million women of childbearing age across 1,119 US counties are living in “maternity care deserts,” meaning their counties have no hospitals offering obstetric care, no birth centers and no obstetric providers.

Maternity care deserts have been linked to a lack of adequate prenatal care or treatment for pregnancy complications and even an increased risk of maternal death for a year after giving birth.

Money is one reason why maternity units are being shuttered.

According to the American Hospital Association, 42% of births in the US are paid for by Medicaid, which has low reimbursement rates. Employer-sponsored insurance pays about $15,000 for a delivery, and Medicaid pays about $6,500, according to the Health Care Cost Institute, a nonprofit that analyzes health care cost and utilization data.

“Medicaid funds about half of all births nationally and more than half of births in rural areas,” said Dr. Katy Kozhimannil, a public health researcher at the University of Minnesota who has conducted research on the growing number of maternity care deserts.

Kozhimannil says communities that are most likely to be affected by maternity unit closures tend to be remote towns in rural counties in states with “less generous Medicaid programs.”

Hospitals in larger cities are often able to offset low reimbursement rates from Medicaid births with births covered by employer-sponsored insurance, according to Dr. Sina Haeri, a maternal-fetal medicine specialist and CEO of Ouma Health, a company that provides virtual prenatal and perinatal care to mothers living in maternity care deserts.

Many large hospitals also have neonatal intensive care units.

“If you have a NICU, that’s a substantial revenue generator for a hospital,” Haeri said.

Most rural hospitals do not have a NICU, only a nursery where they care for full-term, healthy babies, he said. Due to that financial burden, it does not make financial sense for many rural hospitals to keep labor and delivery units open.

A low volume of births is another reason for the closures.

In announcing the closure, Bonner General noted that in 2022, it delivered just 265 babies, which the hospital characterized as a significant decrease.

Rural hospital administrators providing obstetric care say it takes at least 200 births annually for a unit to remain safe and financially viable, according to a study led by Kozhimannil for the University of Minnesota’s Rural Health Research Center.

Many administrators surveyed said they are working to keep units open despite low birth rates.

“Of all the folks that we surveyed, about a third of them were still operating, even though they had fewer than 200 births a year,” Kozhimannil said. “We asked why, and they said, ‘because our community needs it.’ ”

Another issue for hospital administrators is staffing and recruitment.

The decision to close Bonner General’s labor and delivery unit was also directly affected by a lack of experienced, qualified doctors and nurses in the state, said Erin Binnall, a Bonner General Health spokesperson.

“After May 19th, Bonner General Health will no longer have reliable, consistent pediatric coverage to manage neonatal resuscitations and perinatal care. Bonner General’s number one priority is patient safety. Not having board-certified providers certified in neonatal resuscitation willing to provide call and be present during deliveries makes it unsafe and unethical for BGH to provide these services,” Binnall told CNN by email.

The American Hospital Association acknowledges the staffing challenges some hospitals face.

“Simply put, if a hospital cannot recruit and retain the providers, nurses, and other appropriately trained caregivers to sustainably support a service then it cannot provide that care,” the association said in a statement. “Such challenges are only magnified in rural America, where workforce strain is compounded by aging demographics that in some communities has dramatically decreased demand for services like Labor and Delivery.”

Wright is considering moving because of the lack of maternity and pediatric care available in Bonner County.

More stringent abortion laws may be playing a role in the closures, too.

Bonner General said in a news release last month that due to Idaho’s “legal and political climate, highly respected, talented physicians are leaving. In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care.”

According to the Guttmacher Institute, Idaho has one of the strictest anti-abortion laws in the country: a complete ban that has only a few exceptions.

Idaho requires an “affirmative defense,” Guttmacher says, meaning a provider “has to prove in court that an abortion met the criteria for a legal exception.”

No matter the reason, Kozhimannil said, closures in rural communities aren’t just a nuisance. They also put families at risk.

“That long drive isn’t just an inconvenience. It actually is associated with health risks,” she said. “The consequence that we saw is an increase in preterm births. Preterm birth is the largest risk factor for infant mortality. It is a huge risk factor for developmental and cognitive delays for kids.”

Haeri says the decline in maternal care also has a clear effect on maternal mortality rates.

The maternal death rate for 2021 – the year for which the most recent data is available – was 32.9 deaths per 100,000 live births in the US, compared with rates of 20.1 in 2019 and 23.8 in 2020, according to a report from the National Center for Health Statistics. In raw numbers, 1,205 women died of maternal causes in the US in 2021.

Conditions such as high blood pressure, obesity, and diabetes may raise a person’s risk of complications, as can being pregnant with multiples, according to the National Institutes of Health. Pregnant women over the age of 35 are at a higher risk of pre-eclampsia.

As labor and delivery units continue to shut their doors, possible solutions to the growing problem are complex, Haeri says.

“I think anyone that comes to you and says the current system is working is lying to you,” he said. “We all know that the current maternity system is not good.”

Kozhimannil’s research has found that many women who live in maternity care deserts are members of minority communities.

“When we conducted that research, we found the communities that were raising the alarm about this … tended to be Black and indigenous, or tribal communities in rural places,” she said. “Black communities in the South and East and tribal communities throughout the country, but especially in the West, Mountain West and Midwest.”

Haeri says one possible solution is at a woman’s fingertips.

“I always say if a woman’s got a cell phone, she should have access,” he said.

A 2021 study found that women who live in remote areas of the US could benefit from telehealth visits, which would decrease the number of “in-person prenatal care visits and increase access to care.”

The American College of Obstetricians and Gynecologists recommends 12 to 14 prenatal care appointments for women with low-risk pregnancies, and the study suggests that expansion of prenatal telehealth appointments could help women living in remote areas better adhere to those guidelines.

Ouma works with mothers who are typically remote and high-risk, Haeri says.

He also believes that promoting midwifery and doula services would help bolster maternity care in the US.

Certified nurse midwives often assist remote mothers who are high-risk or who decide to give birth at home, he says.

Midwives not only deliver babies, they often work with medical equipment and can administer at-home physical exams, prescribe medications, order lab and diagnostic tests, and assess risk management, according to the American College of Nurse Midwives. Doulas – who guide mothers through the birthing process – are often present at home births and even hospital births.

“That midwifery model shines when it comes to maternal care. [And] doula advocacy involvement leads to better outcomes and maternity care, and I think as a system, we haven’t made it easier for those two components to be really an integral part of our maternity care in the US,” Haeri said.

After living in Idaho for 10 years, Wright says, she and her fiancé have considered leaving the state. The lack of maternity and pediatric care at Bonner General Health is a big reason why.

“I feel safe being with [my] doctors. Now, I have to get to know a doctor within a couple of months before my next baby is born,” Wright said.

As she awaits the arrival of her new son, she feels doubtful that there is a solution for mothers like her.

“Everywhere – no matter what – everybody has babies,” she said. “It’s posing a problem for people who have babies who don’t have the income to drive or have high risk pregnancies or first-time mothers who don’t even know what to expect.”

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How to tell when stress is a problem | CNN

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It’s National Stress Awareness Month, which means it’s a good time to sign up for CNN’s Stress, But Less newsletter. Our six-part mindfulness guide will inspire you to reduce stress while learning how to harness it.



CNN
 — 

As we mark Stress Awareness Month in April, I know there’s so much to be stressed out—mass shootings, wars around the world, the pandemic’s long-term effects and the daily stresses of living and working in the 21st century. I’m sure you’ve got your list.

Everyone experiences stress at different points in their life. But when is stress a problem that requires our attention? What symptoms should people be on the lookout for? What are the health impacts of long-term stress? What are healthy and unhealthy coping mechanisms? And what techniques can help in addressing—and preventing—stress?

Fresh from dropping off my kid at school late (sorry, kid, my fault), I was looking forward to this advice from CNN Medical Analyst Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s Health Commissioner and as Chair of Behavioral Health Systems Baltimore.

CNN: Let’s start with the basics. What exactly is stress?

Dr. Leana Wen: There is no single definition of stress. The World Health Organization’s definition refers to a state of worry or tension caused by a difficult situation. Many people experience stress as mental or emotional strain. Others also have physical manifestations of stress.

Stress is a natural reaction. It’s a human response that prompts us to respond to challenges and perceived threats. Some stress can be healthy and can prompt us to fulfill obligations. Perceived stress can spur us to study for a test or complete a project by a certain deadline. Virtually everyone experiences that kind of stress to some extent.

CNN: Why can stress be a problem?

Wen: The same human response that motivates us to work hard and finish a project can also lead to other emotions, like not being able to relax and becoming irritable and anxious. Some people develop physical reactions, like headaches, upset stomach and trouble sleeping. Longer-term stress can lead to anxiety and depression, and it can worsen symptoms for people with pre-existing behavioral health conditions, including substance use.

CNN: What are symptoms of stress that people should be on the lookout for?

Wen: In addition to feeling irritable and anxious, people experiencing stress can also feel nervous, uncertain and angry. They often express other symptoms, including feeling a lack of motivation; having trouble concentrating; and being tired, overwhelmed and burnt out. Many times, people in stressful situations will report being sad or depressed.

It’s important to note that depression and anxiety are separate medical diagnoses. Someone with depression and/or anxiety could have their symptoms exacerbated when they are undergoing times in their life with added stress. Long-term stress can also lead to depression and anxiety.

One way to think about the difference between stress versus anxiety and depression is that stress is generally a response to an external issue. The external cause could be good and motivating, like the need to finish a project. It could also be a negative emotional stress, like an argument with a romantic partner, concerns about financial stability or a challenging situation at work. Stress should go away when the situation is resolved.

Anxiety and depression, on the other hand, are generally persistent. Even after a stressful external event has passed, these internal feelings of apprehension, unworthiness and sadness are still there and interfere with your ability to live and enjoy your life.

CNN: What are the health impacts of long-term stress?

Wen: Chronic stress can have long-term consequences. Studies have shown that it can raise the risk of heart disease and stroke. It’s associated with worse immune response and decreased cognitive function.

Individuals experiencing stress are also more likely to endorse unhealthy behaviors, like smoking, excessive drinking, substance use, lack of sleep and physical inactivity. These lifestyle factors in turn can lead to worse health outcomes.

CNN: What techniques can help in addressing stress?

Wen: First, awareness is important. Know your own body and your reaction to stress. Sometimes, anticipating that a situation may be stressful and being prepared to deal with it can reduce stress and anxiety.

Second, identifying symptoms can help. For example, if you know that your stress reaction includes feeling your heart rate increase and getting agitated, then you can detect the symptoms as they occur and become aware of the stressful situation as it’s occurring.

Third, know what stress relief techniques work for you. Some people are big fans of mindfulness meditation. Those, and deep breathing exercises, are good for everyone to try.

For me, nothing beats stress relief like exercise. For me, what helps is exercising, in particular swimming. Aerobic exercise is associated with stress relief, and mixing it up with high-intensity regimens can help, too.

A lot of people have other specific techniques that help them. Some people clean their house, organize their closets or work in their gardens. Others spend time walking in nature, writing in a journal, knitting, playing with their pets or cycling.

I’d advise that you experiment with what works, take stock of existing techniques that help you and incorporate some of those practices into your regular routine. Then, in times of stress, they are good tools to turn to that you know will help you.

CNN: What unhealthy copings strategies should people avoid?

Wen: Definitely. There are things people turn to in an effort to make themselves feel better in the short-term that can actually make things worse. Excessive alcohol intake, using drugs and smoking aren’t healthy coping strategies. It’s the same with staying up all night, binge-eating and taking out your frustration on loved ones. These have wide-ranging consequences, and you should reconsider them if they have been your go-to coping mechanisms in the past.

CNN: When is it time to seek help?

Wen: If the stress you are feeling is consistently interfering with your work, social or personal life or if you are experiencing signs and symptoms of depression, anxiety and other mental health disorders, it’s time to seek help.

Consider speaking with your primary care physician to get a referral to a therapist. Your workplace may have an Employee Assistance Program that you can turn to, too. And the federal mental health crisis hotline number, 988, is another resource.

This April, for Stress Awareness Month, I hope we can all assess our own stress levels as well as our reaction to stress. We should recognize what helps us to reduce and alleviate stress as we aim to improve our physical and emotional well-being.

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A new approach to a Covid-19 nasal vaccine shows early promise | CNN

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CNN
 — 

Scientists in Germany say they’ve been able to make a nasal vaccine that can shut down a Covid-19 infection in the nose and throat, where the virus gets its first foothold in the body.

In experiments in hamsters, two doses of the vaccine – which is made with a live but weakened form of the coronavirus that causes Covid-19 – blocked the virus from copying itself in the animals’ upper airways, achieving “sterilizing immunity” and preventing illness, a long-sought goal of the pandemic.

Although this vaccine has several more hurdles to clear before it gets to a doctor’s office or drug store, other nasal vaccines are in use or are nearing the finish line in clinical trials.

China and India both rolled out vaccines given through the nasal tissues last fall, though it’s not clear how well they may be working. Studies on the effectiveness of these vaccines have yet to be published, leaving much of the world to wonder whether this approach to protection really works in people.

The US has reached something of a stalemate with Covid-19. Even with the darkest days of the pandemic behind us, hundreds of Americans are still dying daily as the infection continues to simmer in the background of our return to normal life.

As long as the virus continues to spread among people and animals, there’s always the potential for it mutate into a more contagious or more damaging version of itself. And while Covid infections have become manageable for most healthy people, they may still pose a danger to vulnerable groups such as the elderly and immunocompromised.

Researchers hope next-generation Covid-19 vaccines, which aim to shut down the virus before it ever gets a chance to make us sick and ultimately prevent the spread of infection, could make our newest resident respiratory infection less of a threat.

One way scientists are trying to do that is by boosting mucosal immunity, beefing up immune defenses in the tissues that line the upper airways, right where the virus would land and begin to infect our cells.

It’s a bit like stationing firefighters underneath the smoke alarm in your house, says study author Emanuel Wyler, a scientist at the Max Delbruck Center for Molecular Medicine in the Helmholtz Association in Berlin.

The immunity that’s created by shots works throughout the body, but it resides primarily in the blood. That means it may take longer to mount a response.

“If they are already on site, they can immediately eliminate the fire, but if they’re like 2 miles away, they first need to drive there, and by that time, one-third of the house is already in full flames,” Wyler said.

Mucosal vaccines are also better at priming a different kind of first responder than injections do. They do a better job of summoning IgA antibodies, which have four arms to grab onto invaders instead of the two arms that the y-shaped IgG antibodies have. Some scientists think IgA antibodies may be less picky about their targets than IgG antibodies, which makes them better equipped to deal with new variants.

The new nasal vaccine takes a new approach to a very old idea: weakening a virus so it’s no longer a threat and then giving it to people so their immune systems can learn to recognize and fight it off. The first vaccines using this approach date to the 1870s, against anthrax and rabies. Back then, scientists weakened the agents they were using with heat and chemicals.

The researchers manipulated the genetic material in the virus to make it harder for cells to translate. This technique, called codon pair deoptimization, hobbles the virus so it can be shown to the immune system without making the body sick.

“You could imagine reading a text … and every letter is a different font, or every letter is a different size, then the text is much harder to read. And this is basically what we do in codon pair deoptimization,” Wyler said.

In the hamster studies, which were published Monday in the journal Nature Microbiology, two doses of the live but weakened nasal vaccine created a much stronger immune response than either two doses of an mRNA-based vaccine or one that uses an adenovirus to ferry the vaccine instructions into cells.

The researchers think the live weakened vaccine probably worked better because it closely mimics the process of a natural infection.

The nasal vaccine also previews the entire coronavirus for the body, not just its spike proteins like current Covid-19 vaccines do, so the hamsters were able to make immune weapons against a wider range of targets.

As promising as all this sounds, vaccine experts say caution is warranted. This vaccine still has to pass more tests before it’s ready for use, but they say the results look encouraging.

“They did a very nice job. This is obviously a competent and thoughtful team that did this work, and impressive in the scope of what they did. Now it just needs to be repeated,” perhaps in primates and certainly in humans before it can be widely used, said Dr. Greg Poland, who designs vaccines at the Mayo Clinic. He was not involved in the new research.

The study began in 2021, before the Omicron variant was around, so the vaccine tested in these experiments was made with the original strain of the coronavirus. In the experiments, when they infected animals with Omicron, the live but weakened nasal vaccine still performed better than the others, but its ability to neutralize the virus was diminished. Researchers think it will need an update.

It also needs to be tested in humans, and Wyler says they’re working on that. The scientists have partnered with a Swiss company called RocketVax to start phase I clinical trials.

Other vaccines are further along, but the progress has been “slow and halting,” Poland said. Groups working on these vaccines are struggling to raise the steep costs of getting a new vaccine to market, and they’re doing it in a setting where people tend to think the vaccine race has been won and done.

In reality, Poland said, we’re far from that. All it would take is another Omicron-level shift in the evolution of the virus, and we could be back at square one, with no effective tools against the coronavirus.

“That’s foolish. We should be developing a pan-coronavirus vaccine that does induce mucosal immunity and that is long-lived,” he said.

At least four nasal vaccines for Covid-19 have reached late-stage testing in people, according to the World Health Organization’s vaccine tracker.

The nasal vaccines in use in China and India rely on harmless adenoviruses to ferry their instructions into cells, although effectiveness data for these has not been published.

Two other nasal vaccines are finishing human studies.

One, a recombinant vaccine that can be produced cheaply in chicken eggs, the same way many flu vaccines are, is being put through its paces by researchers at Mount Sinai in New York City.

Another, like the German vaccine, uses a live but weakened version of the virus. It’s being developed by a company called Codagenix. Results of those studies, which were carried out in South America and Africa, may come later this year.

The German team says it’s eagerly watching for the Codagenix data.

“They will be very important in order to know where whether this kind of attempt is basically promising or not,” Wyler said.

They have reason to worry. Respiratory infections have proved to be tough targets for inhaled vaccines.

FluMist, a live but weakened form of the flu virus, works reasonably well in children but doesn’t help adults as much. The reason is thought to be that adults already have immune memory for the flu, and when the virus is injected into the nose, the vaccine mostly boosts what’s already there.

Still, some of the most potent vaccines such as the vaccine against measles, mumps and rubella use live attenuated viruses, so it’s a promising approach.

Another consideration is that live vaccines can’t be taken by everyone. People with very compromised immunity are often cautioned against using live vaccines because even these very weakened viruses may be risky for them.

“Although it’s strongly attenuated, it’s still a real virus,” Wyler said, so it would have to be used carefully.

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Chronic stress can affect your health. One activity can help | CNN

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Sign up for CNN’s Fitness, But Better newsletter series. Our seven-part guide will help you ease into a healthy routine, backed by experts.



CNN
 — 

These days, many people find it hard to unplug. Inflation, global warming and gun violence are on the rise. Bullies proliferate on social media. The 24/7 news cycle constantly blares distressing news, and people often face difficult personal or professional situations.

About half of Americans said they experienced stress within the past day, according to a Gallup Poll survey from last October, a finding that was consistent for most of 2022. Personal finances and current and political events were major sources of stress for one-third or more of adults, a survey from CNN in partnership with the Kaiser Family Foundation found in October.

Stress isn’t inherently bad, said Richard Scrivener, a personal trainer and product development manager at London’s Trainfitness, an education technology company. Stressing your muscles through weight training, for example, leads to beneficial changes. In addition, short-term stress in healthy people typically isn’t a hazard. “But if stress is continuous, especially in older or unhealthy individuals, the long-term effects of the response to stress may lead to significant health issues,” Scrivener said.

Stress occurs when you face a new, unpredictable or threatening situation, and you don’t know whether you can manage it successfully, said clinical psychologist Dr. Karmel Choi, an assistant professor in the Center for Precision Psychiatry at Harvard Medical School and Massachusetts General Hospital in Boston.

When you’re physically or emotionally stressed, your body snaps into fight-or-flight mode. Cortisol rushes through your system, signaling your body to release glucose. Glucose, in turn, provides energy to your muscles so you are better prepared to fight off a threat or run away. During this cortisol rush, your heart rate may rise, your breathing may become rapid, and you may feel dizzy or nauseated.

If you truly needed to fight or flee a predator, your cortisol levels would drop back down once the conflict was over. When you’re chronically stressed, however, those levels stay elevated.

Remaining in that heightened state is no good since high levels of cortisol can exacerbate health conditions such as cardiovascular disease, diabetes and chronic gastrointestinal problems, according to the Cleveland Clinic. Stress can also cause or contribute to anxiety, irritability, poor sleep, substance abuse, chronic distrust or worry, and more.

Luckily, there are many ways to combat stress. Keep a daily routine, get plenty of sleep, eat healthy foods, and limit your time following the news or engaging in social media, recommends the World Health Organization. It also helps to stay connected with others and to employ calming practices such as meditation and deep breathing. One of the most successful tools, though, is physical activity.

“Exercise is remarkably effective for managing psychological stress,” Choi said. “Exercise doesn’t remove what’s causing the stress, but it can boost mood, reduce tension and improve sleep — all of which are impacted by stress — and ultimately this can support people to approach their challenges in a more balanced way.”

Numerous studies back up the positive effect of exercise on stress. Physical activity, and especially exercise, significantly reduced the symptoms of anxiety in a study published in Advances in Experimental Medicine and Biology, for example. Similarly, a Frontiers in Psychology study of university students found that regularly engaging in low- to moderate-intensity aerobic exercises for six weeks helped alleviate their depressive symptoms and perceived stress.

The reason exercise is so effective in squashing stress is fairly simple. Exercise causes your body to produce more endorphins, which are neurotransmitters that boost your mood. Movement also combats elevated levels of the stress hormone cortisol while improving blood flow.

Aerobic workouts, such as running, dancing and boxing, produce lots of mood-boosting endorphins that relieve stress. But gentler exercise such as walking works, too.

Jessica Honig, a clinical social worker in Phoenixville, Pennsylvania, said exercise empowers her clients because they realize that, through movement, they hold the key to reset and lessen their stress. “It’s also one of the best ways to pause — to break up or revive energy from a spiraling, unproductive mindset,” she said.

What types of exercise are best? While studies show aerobic exercise, such as swimming, running, dancing and boxing, may be the most efficient at getting mood-boosting endorphins rushing through your body, gentler forms of physical activity work, too. Think yoga, strength training and walking. In addition, sometimes less is more.

“What we’re seeing from the data,” Choi said, “is you actually need to move less than the recommended guidelines to see positive effects on mood.”

Since stress loads may change weekly or even daily, Scrivener said it can be helpful to alter your exercise based on your mood. Feeling a cheery 8 on a scale of 1 to 10? Then go for a run. Barely hitting a 3? Opt for something gentle. “This could be a 15-minute stretch followed by a light cycle for 15 minutes, or a 30-minute swim followed by a sauna session,” he said.

Since social engagement is a powerful protective factor for positive mental health, Choi encourages exercising with others. Studies also have shown being out in nature boosts your mood, so exercising outside with friends may provide even more benefits.

Combine exercise and social activity by scheduling regular workouts with a neighbor or joining a class.

Scientists continue to study the link between stress and physical activity. A small study published recently found that combining mindfulness and physical activity can improve sleep and help regulate emotions more than either alone, Choi said. She also warned that people need to be careful not to go overboard on exercise or rely on it exclusively for coping with challenges. Doing so can backfire and create more stress.

It’s also important to remember that humans are geared to release stress physically, no matter their age, said Honig, the social worker. “We see in children the permission to throw their body into pillows to release intense emotions,” she said. “We do not outgrow a need to physically release stress. We merely lose the outlets and social normalization of it.”

Melanie Radzicki McManus is a freelance writer who specializes in hiking, travel and fitness.

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FDA approves first over-the-counter version of opioid overdose antidote Narcan | CNN

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CNN
 — 

With drug overdose deaths continuing to hover near record levels, the US Food and Drug Administration on Wednesday approved for the first time an over-the-counter version of the opioid overdose antidote Narcan.

“The FDA remains committed to addressing the evolving complexities of the overdose crisis. As part of this work, the agency has used its regulatory authority to facilitate greater access to naloxone by encouraging the development of and approving an over-the-counter naloxone product to address the dire public health need,” FDA Commissioner Dr. Robert Califf said in a statement.

“Today’s approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available and help reduce opioid overdose deaths throughout the country. We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price.”

Dr. Rahul Gupta, director of the White House’s Office of National Drug Control Policy, said accessibility is key to ensuring that the Narcan nasal spray saves lives.

“It’s really important that we continue to do everything possible in our power to make this life-saving drug available to anyone and everyone across the country,” Gupta said.

The White House drug czar said businesses, such as restaraunts and banks, and schools will be encouraged to purchase over-the-counter naloxone.

“We will encourage businesses, restaurants, banks, construction sites, schools, others to think about this – think about it as a smoke alarm or a defibrillator, to make it as easily accessible, because it’s not just you. It could be your neighbor, it could be your family, your friend, a person at work or school who might need it, ” Gupta said.

The nasal spray will come in a package of two 4-milligram doses, in case the person overdosing does not respond to the first dose. However, the drug’s maker, Emergent BioSolutions, says most overdoses can be reversed with a single dose. The product could be given to anyone, even children and babies.

The nasal spray is expected to be available for purchase in stores and online by late summer, Emergent said Wednesday.

More than a million people have died of drug overdoses in the two decades since the US Centers for Disease Control and Prevention began collecting that data. Many of those deaths were due to opioids. Deaths from opioid overdoses rose more than 17% in just one year, from about 69,000 in 2020 to about 81,020 in 2021, the CDC found.

Opioid deaths are the leading cause of accidental death in the US. Most are among adults, but children are also dying, largely after ingesting synthetic opioids such as fentanyl. Between 1999 and 2016, nearly 9,000 children and adolescents died of opioid poisoning, with the highest annual rates among adolescents 15 to 19, the CDC found.

Nearly every state in the US has standing orders that allow pharmacists or other qualified organizations to provide the medication without a personal prescription to people who are at risk of an overdose or are helping someone at risk, but making it available over the counter can make it easier for people to access the opioid antidote.

Research shows that wider availability could save lives as opioid overdoses have skyrocketed in recent years – much of it due to synthetic opioids like illicitly made fentanyl.

Emergent President and CEO Robert Kramer hailed the FDA’s decision as a “historic milestone.”

“We are dedicated to improving public health and assisting those working hard to end the opioid crisis – so now with leaders across government, retail and advocacy groups, we must work together to continue increasing access and availability, as well as educate the public on the risks of opioid overdoses and the value of being prepared with Narcan Nasal Spray to help save a life,” Kramer said in a statement.

Narcan works by blocking the effects of opioids on the brain and restoring breathing. For the most effectiveness, it must be given as soon as signs of overdose appear.

The drug works on someone only if there are opioids in their system. It won’t work on any other type of drug overdose, but it won’t have adverse effects if given to someone who hasn’t taken opioids.

Naloxone reverses an overdose for up to about 90 minutes, but opioids can stay in the system for longer, so it’s still important to call 911 after giving the drug.

People given naloxone should be watched carefully until medical help arrives and monitored for another two hours.

About 1.2 million doses of naloxone were dispensed by retail pharmacies in 2021, according to data published by the American Medical Association – nearly nine times more than were dispensed five years earlier.

Emergent said it does not have information on how much OTC Narcan will cost.

Harm reduction experts say the price of naloxone has inhibited its accessibility to people who need it most. And although the cost will probably drop as it becomes available over the counter, they say it will probably still be out of reach for many.

“We’re not going to be able to ramp up naloxone distribution in a game-changing way until we get a better handle on the price,” said Nabarun Dasgupta, a scientist at the University of North Carolina’s Injury Prevention Research Center who studies drugs and infectious diseases. “There’s the promise on paper versus on the street, and it’s going to come down to the dollars and cents.”

Separate changes to grant funding by both the CDC and the Substance Abuse and Mental Health Services Administration will make it easier for states and local health departments to buy naloxone, he said.

Gupta said the Biden administration is asking the drugmakers to keep the price of the antidote low.

“That’s one of the things that the president has been very clear: that we’ve got to make sure that these life-saving medications, as well as treatment, is accessible across no matter where you live, rural or urban, rich or poor. We want to make sure this is accessible across broad swaths of people,” he said.

However, experts said the most meaningful work in the fight against the devastating outcomes of the drug overdose epidemic will come with ongoing emphasis on treatment for opioid use disorder and other harm-reduction strategies.

“While enabling people to access quality treatment for substance use disorders is critical, we must also acknowledge that people need to survive in order to have that choice,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, said in January.

Caleb Banta-Green, principal research scientist at the University of Washington’s Addictions, Drug & Alcohol Institute, has described naloxone as the “gateway drug” to a conversation about what substance use disorder is.

“It’s a conversation starter. It’s life-saving for the individual. It’s not a game-changer at the population level,” he said. “We need to do more. And we need to use treatment medications – methadone and buprenorphine – which are far higher overdose preventive approaches.”

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What someone with an eating disorder wishes you knew | CNN

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Editor’s Note: This story is part of an occasional series covering disordered eating and diet culture.



CNN
 — 

Getting diagnosed with an eating disorder happened by accident to Emily Boring.

She went to her university’s mental health office to talk about anxiety she was feeling, and through conversations learned that her behaviors with food were classified as an eating disorder, she said.

Now 27 and a graduate student at the Yale Divinity School in New Haven, Connecticut, her journey of recovery and relapse has taught her a lot about how to care for herself and others, she said.

During Eating Disorders Awareness Week in late February, Boring spoke to CNN about the misunderstanding, shame and stigma around eating disorders so they can be better understood.

This conversation has been edited and condensed for clarity.

CNN: What do you want people to know about disordered eating and eating disorders?

Emily Boring: I wish people knew that it is everywhere. The vast majority of people will experience some kind of disordered relationship to food in their bodies, simply because of the culture we live in.

What I would say first and foremost is disordered eating — and this also applies to formal eating disorders — don’t look a certain way. They affect everyone regardless of gender, race, ethnicity, age, socioeconomic status. Disordered eating and eating disorders do not come with a “thin” or underweight body.

CNN: How do you understand eating disorders and treatment?

Boring: Eating disorders are now classified as metabo-psychiatric illnesses — metabolism referring to the way the body processes energy, and then the psychiatric portion related to brain and behavior.

This has confirmed the experience of people with eating disorders. We for decades — and clinicians also — have noticed that eating disorders tend to be activated when someone falls into energy deficit or doesn’t take in enough calories to support their body.

Eating disorders are not shameful. They’re not a choice, and they’re not a failure. There’s still some lingering stigma around the thought that eating disorders are something that you choose. I would add on to that: if someone is on the precipice of realizing they have an eating disorder or receiving that diagnosis from someone else, I would stress the importance of early intervention. And I would say that the first step to recovery is finding a really good eating disorder team (including a) therapist, dietician and a doctor.

CNN: How should loved ones talk to people in recovery from eating disorders?

Boring: I do speak mostly from my own experience, but I’ve also mentored quite a few teenagers during this process. I’ve learned the hard way what isn’t helpful to say to them, and I’ve also been the recipient (of unhelpful comments).

To the extent that you can, avoid comments and actions that we associate with diet culture. Especially in this country, the way that we privilege fitness in popular culture is antithetical to recovery. Diet culture oftentimes hides beneath the banner of healthism — that’s basically the belief that there is a standard of fitness and able-bodiedness that everyone can attain if we just work hard.

There’s a whole body of literature — scientific literature showing that health and weight are not all causally related. So higher weight doesn’t necessarily equal poor health outcome.

CNN: What do you mean when you say not to use “the eating disorder’s own voice” to talk back to it?

Boring: Let’s say I show up in a doctor’s office, and I’m afraid of what’s happening to my body. I’m afraid I’m going to gain weight. And a clinician may say well meaningly, “Don’t worry, your body’s not going to change that much. Your weight doesn’t have to go higher.”

Regardless of the factualness of that statement or not, that’s just playing right into the eating disorder’s belief. It’s so easy to try to reassure (your loved one) using the eating disorder’s own language, and I found that that just really doesn’t work in the long run.

CNN: What are ways to talk to people without using the voice of the eating disorder?

Boring: Some questions that I encourage folks to ask themselves are things like, “Is what I’m about to say implying that some bodies are better than other bodies? Or that some foods have greater or lesser moral worth?” Also try to avoid mentioning anything with numbers, whether that is weight or calories or number of hours exercising per week.

Don’t assume someone’s inner state based on how they do or don’t look on the outside. As much as people can, step back and ask questions, instead of making an assumption.

An example: “I see that you’re improving in these behaviors, like we set the goal of last week. How’s that feeling to you? How was your mind reacting?” So that process of gentle inquiry rather than statements and assumptions is really key.

CNN: What do people need to know about relapse?

Boring: That it is not a failure, and that doesn’t have to lead you back to the worst of illness that you’ve ever experienced. You can catch it early, and you can turn things around.

What I wish that I had known about relapse is that it happens more quickly and more sudden and all consumingly than I thought.

If you’re someone who has the genes for an eating disorder — whether that’s anorexia, bulimia, binge-eating disorder, any (disease) on the spectrum — you’re probably always going to have to be careful and vigilant about maintaining nutrition, eating an abundance and variety of foods, insulating yourself from diet culture. Because it can happen fast — a few days of restriction, a few lost pounds and all of a sudden, you’re back fully in the eating disorder.

And I would also say that relapse is a learning opportunity. It doesn’t always feel like that in the moment, but the times that I’ve relapsed, I look back and I realized in each instance, I’ve discovered something about what recovery means to me.

I guess that’s just a way to say, be gentle with yourself and be open-minded that yes, relapse is a crisis, and you need to do everything you can to get out of it. But also, it’s not a failure and it’s not a sign that you’ll be struggling with this forever.

CNN: What have you learned about recovery?

Boring: When I first started recovering, people — mostly clinicians, but also on some of the books and blogs that I’d read from people who’ve recovered — frame recovery, mostly in terms of absence. When you’re recovered, you won’t have these troubling symptoms anymore, or you won’t spend so much time thinking about food in your body.

In reality, what it’s like to be recovered is completely about presence. It is an ability to be present to relationships around you to the things that you’re interested in. It’s also just a physical presence of awareness of your own body, ability to perceive sensations, ability to eventually listen to your body’s cues of hunger and fullness.

The eating disorder is completely gray, and it feels like I’m kind of dragging myself through the days. … When I’m recovered, the world comes back into color again.

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Colorectal cancer is rising among younger adults and scientists are racing to uncover why | CNN

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CNN
 — 

Nikki Lawson received the shock of her life at age 35.

A couple of years ago, she noticed that her stomach often felt irritable, and she would get sudden urges to use the restroom, sometimes with blood in her stool. She even went to the hospital one day when her symptoms were severe, she said, and she was told it might be a stomach ulcer before being sent home.

“That was around the time when Chadwick Boseman, the actor, passed away. I remember watching him on the news and having the same symptoms,” Lawson said of the “Black Panther” star who died of colon cancer at age 43 in August 2020.

“But at that time, I was not thinking ‘this is something that I’m going through,’ ” she said.

Instead, Lawson thought changing her diet would help. She stopped eating certain red meats and ate more fruits and vegetables. She began losing a lot of weight, which she thought was the result of her new diet.

“But then I went for a physical,” Lawson said.

Her primary care physician recommended that she see a gastroenterologist immediately because she had low iron levels.

“When I went and I saw my gastro, she said, ‘I’m sorry, I have bad news. We see something. We sent it off to get testing. It looks like it is cancer.’ My whole world just kind of blanked out,” Lawson said. “I was 35, healthy, going about my day, raising my daughter, and to get a diagnosis like this, I was just so shocked.”

Lawson, who was diagnosed with stage III rectal cancer, is among a growing group of colon and rectal cancer patients in the United States who are diagnosed at a young age.

The share of colorectal cancer diagnoses among adults younger than 55 in the US has been rising since the 1990s, and no one knows why.

Researchers at Dana-Farber Cancer Institute are calling for more work to be done to understand, prevent and treat colorectal cancer at younger ages.

In a paper published last week in the journal Science, the researchers, Dr. Marios Giannakis and Dr. Kimmie Ng, outlined a way for scientists to accelerate their investigations into the puzzling rise of colorectal cancer among younger ages, calling for more specialized research centers to focus on younger patients with the disease and for diverse populations to be included in studies on early-onset colorectal cancer.

Their hope is that this work will help improve outcomes for young colorectal cancer patients like Lawson.

Among younger adults, ages 20 to 49, colorectal cancer is estimated to become the leading cause of cancer-related deaths in the United States by 2030.

Lawson, now 36 and living in Palm Bay, Florida, with her 5-year-old daughter, is in remission and cancer-free.

The former middle school teacher had several surgeries and received radiation therapy and chemotherapy to treat her cancer. She is now being monitored closely by her doctors.

For other young people with colorectal cancer, “my words of hope would be to just stay strong. Just find that courage within yourself to say, ‘You know what, I’m going to fight this.’ And I just looked within myself,” Lawson said.

“I also have a very supportive family system, so they were definitely there for me. But it was very emotional,” she said of her cancer treatments.

“I remember crying through chemotherapy sessions and the medicine making you so weak, and my daughter was 4, and having to be strong for her,” she said. “My advice to any young person: If you see symptoms or you see something’s not right and you’re losing a lot of weight and not really trying to, go to see a doctor.”

Signs and symptoms of colorectal cancer include changes in bowel habits, rectal bleeding or blood in the stool, cramping or abdominal pain, weakness and fatigue, and weight loss.

A report released this month by the American Cancer Society shows that the proportion of colorectal cancer cases among adults younger than 55 increased from 11% in 1995 to 20% in 2019. Yet the factors driving that rise remain a mystery.

There’s probably more than just one cause, said Lawson’s surgeon, Dr. Steven Lee-Kong, chief of colorectal surgery at Hackensack University Medical Center in New Jersey.

He has noticed an increase in colorectal cancer patients in their 40s and 30s within his own practice. His youngest patient was 21 when she was diagnosed with rectal cancer.

“There is a phenomenon of decreasing overall colorectal cancer rates in the population in general, we think because of the increase in screening for particularly for older adults,” Lee-Kong said. “But that doesn’t really account for the overall increase in the number of patients younger than, say, 50 and 45 that are developing cancer.”

Some of the factors known to raise anyone’s risk of colorectal cancer are having a family history of the disease, having a certain genetic mutation, drinking too much alcohol, smoking cigarettes or being obese.

“They were established as risk factors in older cohorts of patients, but they do seem to be also associated with early-onset disease, and those are things like excess body weight, lack of physical activity, high consumption of processed meat and red meat, very high alcohol consumption,” said Rebecca Siegel, a cancer epidemiologist and senior scientific director of surveillance research at the American Cancer Society, who was lead author of this month’s report.

“But the data don’t support these specific factors as solely driving the trend,” she said. “So if you have excess body weight, you are at a higher risk of colorectal cancer in your 40s than someone who is average weight. That is true. But the excess risk is pretty small. So again, that is probably not what’s driving this increase, and it’s another reason to think that there’s something else going on.”

Many people who are being diagnosed at a younger age were not obese, including some high-profile cases, such as Broadway actor Quentin Oliver Lee, who died last year at 34 after being diagnosed with stage IV colon cancer.

“Anecdotally, in conferences that I’ve attended, that is the word on the street: that most of these patients are very healthy. They’re not obese; they’re very active,” Siegel said, which adds to the mystery.

“We know that excess weight increases your risk, and we know that we’ve had a big increase in body weight in this country,” she said. “And that is contributing to more cancer for a lot of cancers and also for colorectal cancer. But does it explain this trend that we’re seeing, this steep increase? No, it doesn’t.”

Yet scientists remain divided when it comes to just how much of a role those known risk factors – especially obesity – play in the rise of colorectal cancer among adults younger than 55.

Even though the cause of the rise of colorectal cancer in younger adults is “still not very well understood,” Dr. Subhankar Chakraborty argues that dietary and lifestyle factors could be playing larger roles than some would think.

“We know that smoking, alcohol, lack of physical activity, being overweight or obese, increased consumption of red meat – so basically, dietary factors and environmental and lifestyle factors – are likely playing a big role,” said Chakraborty, a gastroenterologist with The Ohio State University Comprehensive Cancer Center.

“There are also some other factors, such as the growing incidence of inflammatory bowel disease, that may also be playing a role, and I think the biggest factors is most likely the diet, the lifestyle and the environmental factors,” he said.

It has been difficult to pinpoint causes of the rise of cases in younger ages because, if someone has a polyp in their colon for example, it can take 10 to 15 years to develop into cancer, he says.

“During that, all the way from a polyp to the cancer stage, the person is exposed to a variety of things in their life. And to really pinpoint what is going on, we would need to follow specific individuals over time to really understand their dietary patterns, medications and weight changes,” Chakraborty said. “So that makes it really hard, because of the time that cancer actually takes to develop.”

Some researchers have been investigating ways in which the rise in colorectal cancer among younger adults may be connected to increases in childhood obesity in the US.

“The rise in young-onset colorectal cancer correlates with a doubling of the prevalence of childhood obesity over the last 30 years, now affecting 20% of those under age 20,” Dr. William Karnes, a gastroenterologist and director of high-risk colorectal cancer services at the UCI Health Digestive Health Institute in California, said in an email.

“However, other factors may exist,” he said, adding that he has noticed “an increasing frequency of being shocked” by discoveries of colorectal cancer in his younger patients.

There could be correlations between obesity in younger adults, the foods they eat and the increase in colorectal cancers for the young adult population, said Dr. Shane Dormady, a medical oncologist from El Camino Health in California who treats colorectal cancer patients.

“I think younger people are on average consuming less healthy food – fast food, processed snacks, processed sugars – and I think that those foods also contain higher concentrations of carcinogens and mutagens, in addition to the fact that they are very fattening,” Dormady said.

“It’s well-publicized that child, adolescent, young adult obesity is rampant, if not epidemic, in our country,” he said. “And whenever a person is at an unhealthy weight, especially at a young age, which is when the cells are most susceptible to DNA damage, it really starts the ball rolling in the wrong direction.”

Yet at the Center for Young Onset Colorectal and Gastrointestinal Cancers at Memorial Sloan Kettering Cancer Center, researchers and physicians are not seeing a definite correlation between the rise in colorectal cancer among their younger adult patients and a rise in obesity, according to Dr. Robin Mendelsohn, gastroenterologist and co-director of the center, where scientists and doctors continue to work around the clock to solve this mystery.

“When we looked at our patients, the majority were more likely to be overweight and obese, but when we compare them to a national cohort without cancer, they’re actually less likely to be overweight and obese,” she said. “And anecdotally, a lot of the patients that we see are young and fit and don’t really fit the obesity profile.”

That leaves many oncologists scratching their heads.

Some scientists are also exploring whether genetic mutations that can raise someone’s risk for colorectal cancer have played a role in the rise of cases among younger adults – but the majority of these patients do not have them.

Karnes, of UCI Health, said “it is unlikely” that there has been an increase in the genetic mutations that raise the risk of colorectal cancer, “although, as expected, the percentage of colorectal cancers caused by such mutations, e.g., Lynch syndrome, is more common in people with young-onset colorectal cancer.”

Lynch syndrome is the most common cause of hereditary colorectal cancer, causing about 4,200 cases in the US per year. People with Lynch syndrome are more likely to get cancers at a younger age, before 50.

“In my practice and in the medical community, the oncologic community, I don’t think there’s any proof that genetic syndromes and gene mutations that patients are born with are becoming more frequent,” El Camino Health’s Dormady said. “I don’t think the inherent frequency of those mutations is going up.”

The tumors of younger colorectal cancer patients are very similar to those of older ones, said Mendelsohn at Memorial Sloan Kettering Cancer Center.

“So then, the question is, if they’re biologically the same, why are we seeing this increasingly in younger people?” she said. “About 20% may have a genetic mutation, so the majority of patients do not have a family history or genetic predisposition.”

Therefore, Mendelsohn added, “it’s likely some kind of exposure, whether it be diet, medication, changing microbiome,” that is driving the rise in colorectal cancers in younger adults.

That rise “has been something that’s been on our radar, and it has been increasing since the 1990s,” Mendelsohn said. “And even though it is increasing, the numbers are still small. So it’s still a small population.”

Dormady, at El Camino Health, said he now sees more colorectal cancer patients in their early to mid-50s than he did 20 years ago, and he wonders whether it might be a result of colorectal cancer screening being easier to access and better at detecting cancers.

“The first thing to consider is that some of our diagnostic modalities are becoming better,” he said, especially because there are now many at-home colorectal cancer testing kits. Also, in 2021, the US Preventive Services Task Force lowered the recommended age to start screening for colon and rectal cancers from 50 to 45.

“I think you have a subset of patients who are being screened earlier with colonoscopies; you have advancing technology where we can potentially detect tumor cell DNA in the stool sample, which is leading to earlier diagnosis. And sometimes that effect will skew statistics and make it look like the incidence is really on the rise, but deeper analysis shows you that part of that is due to earlier detection and more screening,” he said. “So that could be one facet of the equation.”

Overall, pinpointing what could be driving this surge in colorectal cancer diagnoses among younger ages will not only help scientists better understand cancer as a disease, it will help doctors develop personalized risk assessments for their younger patients, Ohio State University’s Chakraborty said.

“Because most of the people who go on to develop colorectal cancer really have no family history – no known family history of colon cancer – so they would really not be aware of their risk until they begin to develop symptoms,” he said.

“Having a personalized risk assessment tool that will take into account their lifestyle, their environmental factors, genetic factors – I think if we have that, then it would allow us hopefully, in the future, to provide some personalized recommendations on when a person should be screened for colorectal cancer and what should be the modality of screening based on their risk,” he said. “Younger adults tend to develop colon cancer mostly in the left side, whereas, as we get older, colon cancer tends to develop more on the right side. So there’s a little difference in how we could screen younger adults versus older adults.”

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Many firefighters who responded to Ohio train derailment didn’t have the needed training, equipment | CNN

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CNN
 — 

Many of the first responders who helped fight the fire that erupted after the train derailment in East Palestine, Ohio, last month were ill-equipped and untrained to fight the massive chemical blaze that some now call “the hell fire.”

In testimony Wednesday before the US Senate’s Commerce, Science and Transportation Committee, lawmakers heard about myriad issues that snarled the response and that put firefighters who rushed to the scene at greater immediate risk – and may raise risks to their health throughout their lives.

About 300 firefighters from 50 departments dashed to the scene of the derailment in East Palestine on the night of February 3. Many of them were volunteers without hazmat training or specialized equipment.

Officials investigating the derailment testified that these first responders weren’t able to access information about the chemicals that were in 11 overturned cars carrying hazardous materials.

Jennifer Homendy, chair of the National Transportation Safety Board, the agency investigating the crash, urged senators to consider meaningful changes to help inform exposed communities and first responders.

“People deserve to know what chemicals are moving through their communities and how to stay safe in an emergency, That includes responders who risk their lives for each of us every single day. They deserve to be prepared,” Homendy said.

Studies have shown that firefighters have a higher rates of cancer compared with members of the general population because of toxic chemicals they’re exposed to on the job. These cancers include digestive, oral, lung and bladder cancers. A rare type of cancer called malignant mesothelioma is about twice as common in firefighters than in the general population, probably due to exposure to asbestos in burning buildings, for example.

Cancer is now the leading cause of death for working firefighters, according to the International Association of Fire Fighters.

Ohio Gov. Mike DeWine said Wednesday that he is very concerned about the long-term health of the firefighters who responded to the derailment.

“They all need to be assessed,” he said. “There needs to be established a baseline, and they need to be assured that in five years or 10 years, there’s still a place where they could go.”

“We look to the railroad to establish that fund,” DeWine said in testimony before the committee.

The derailment occurred about 9 p.m. February 3, and the night air quickly filled with smoke. Visibility was poor, and some of the placards on overturned railcars had burned away, leaving responders clueless about what chemicals were spilling and catching fire around them.

There’s an app, AskRail, meant to give users more information about the what’s on trains involved in accidents, but none of the first responders to the derailment in East Palestine had access to it, Homendy said.

Even if they had been able to use it, the app lists what is in cars by their order on the train, and its information may have been of limited help to firefighters on the scene who were looking at cars that were “bunched up” and not in their normal order, said David Comstock, chief of the Ohio Western Reserve Fire District.

There are better ways of getting urgent information to first responders, he told the senators.

After auto accidents, for example, some telematic systems in cars transmit information about the crash to emergency dispatchers who can then send it to crews responding to the scene.

“So en route to a motor vehicle accident, I know the car has flipped three times, airbags gone out, and it has information about that car – whether it’s an electric car, things I have to worry about,” Comstock said.

No information like that was available to crews responding to the derailed train.

“They didn’t have the information for quite a long time on what was on the train,” Homendy said.

Facing criticism over its role in the response, the company that owns and operates the train, Norfolk Southern, has announced that it will create a new regional training center for first responders. CEO Alan Shaw repeated that pledge in his testimony Wednesday before the committee.

The company also intends to expand its Operation Awareness & Response program, which travels its 22-state network to teach first responders how to stay safe after train accidents.

Comstock testified that more training is important, but so is more gear. He said most fire stations in the area are lucky if they can supply each member of their crew with a single set of turnout gear: the protective coat, pants, boots, gloves and helmets firefighters wear.

“When I have to wash that, I’m out of service,” he said. “In response to the derailment, I had three firefighters who were exposed. Their gear is contaminated. I can’t use it.”

It takes six months to order replacement gear, he said.

“That means I have three firefighters who are out of service for six months who can’t respond to auto accidents or structure fires,” he said.

Even then, that basic gear isn’t designed to stand up to hazardous materials like the chemicals on the Norfolk Southern train.

For that kind of incident, firefighters need hazmat suits, which can cost $15,000 each, Comstock testified, along with specialized monitoring equipment.

“It’s unrealistic for the federal government to provide that to every department, but we do need to look at a regional approach so we can call in those teams that can supplement what we’re trying to do,” he said.

Comstock said he hopes the committee will consider the needs of firefighters as it drafts legislation to right the wrongs of the East Palestine incident.

“This incident has emphasized the need to better train and equip firefighters to respond to hazardous material incidents, specifically to derailments in rural areas, which are mostly served by volunteer fire departments that often lack sufficient resources, tax base and manpower,” he said.

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