What patients want the FDA to consider about the role of AI in medicine

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Novel Dementia Risk Charts Underline the Role of Lifestyle

Ten-year dementia risk charts that combine cardiovascular and genetic risk factors have been developed by Danish researchers and graphically underline the impact of modifiable lifestyle factors, even in the face of increased genetic risk.

The research was presented at the European Atherosclerosis Society (EAS) 2020 Virtual Congress, held online this year due to the COVID-19 pandemic, and simultaneously published October 7 in the European Heart Journal.

Ida Juul Rasmussen, MD, PhD, Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, combined data from more than 60,000 patients — more than 2000 with dementia — with a median follow-up of 10 years.

By combining genetic risk factors with gender and age, as well as lifestyle factors — such as diabetes, smoking, and educational level — they were able to develop a series of risk charts similar to those for cardiovascular risk from the Framingham study.

This showed that a women at least 80 years of age with the highest genetic risk factors who had diabetes, smoked, and had a low educational level would have a 66% risk for dementia over 10 years; this would drop to 45% if she did not smoke or have diabetes and had a higher educational level.

With this pattern repeated across age groups and in both men and women, Rasmussen said that “the overall message from this study is that a healthy cardiovascular risk lifestyle attenuates genetic susceptibility for dementia.”

She added that “by combining genetic risk factors and modifiable risk factors, we are indeed able to identify the individuals at the highest risk of a future dementia disease that would benefit the most” from an intensive lifestyle intervention.

Ralph L. Sacco, MD, professor and chair of neurology and executive director at the Evelyn F. McKnight Brain Institute, Leonard Miller School of Medicine, University of Miami, told theheart.org | Medscape Cardiology that an “important message” of the study is that lifestyle factors still have an appreciable impact on the risk for dementia, even in those at high genetic risk.

“I think the novelty here is the combination of cardiovascular lifestyle factors and the genetics,” Sacco said.

“In the past, there are numerous scores that have been developed on the lifestyle side, some developed on the genetic side, but this group combined both, and I think that makes it an important and well-done comprehensive risk model.”

However, Sacco noted that there were some limitations to the study, saying that the way in which some of the risk factors were defined “is pretty, I would say, crude,” citing, for example, the threshold for hypertension of 140/90 mm Hg blood pressure or medications, or 4 hours a week for high physical activity.

He also believes that the concept of the tables may not fit with the way in which, “nowadays, everybody works with an app and a portable device,” allowing them to enter continuous measures rather than rely on “categorical definitions.”

Sacco added that the very idea of using risk stratification to assign individuals to lifestyle interventions to lower

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As Purdue Pharma Agrees to Settle with the DOJ, Revisit Its Role in the Opioid Crisis | Opioids, Inc. | FRONTLINE | PBS

In the latest chapter of a complex legal battle over who is responsible for the nation’s opioid crisis, Purdue Pharma, the manufacturer of the notorious painkiller OxyContin, has arrived at an $8.3 billion settlement with the federal government, pending court approval.

Announced in an Oct. 21 Department of Justice press conference, the settlement, if approved, resolves the federal government’s civil and criminal probes into Purdue Pharma, which is currently in bankruptcy; an additional settlement resolves a federal civil case against Purdue Pharma’s owners, the Sackler family.

“It’s also important to note that this resolution does not prohibit future criminal or civil penalties against Purdue Pharma’s executives or employees,” Jeffrey A. Rosen, the U.S. deputy attorney general, said at the press conference.

Under the settlement, Purdue Pharma admits guilt on three felony charges involving conspiring to defraud the U.S. and break anti-kickback regulations in how it marketed opioids. The settlement involves a $3.5 billion criminal fine and a $2 billion criminal forfeiture, as well as a civil payment of $2.8 billion, though actual monetary payments could be substantially less, once the company’s value is factored in. Separately, the Sacklers themselves will make a $225 million payment to the U.S.

The settlement “will require that the company be dissolved and no longer exist in its present form,” Rosen said, with the Sacklers barred from any controlling or owning role moving forward. Instead, if the settlement is approved by bankruptcy court, the company’s assets would become “owned by a trust for the benefit of the American public,” Rosen said. The new company would still be able to manufacture opioid drugs but would also be required to produce large quantities of medicines to treat and respond to addiction and overdoses, and would need to offer the latter as donations or “at cost.”

“Purdue deeply regrets and accepts responsibility for the misconduct detailed by the Department of Justice in the agreed statement of facts,” Steve Miller, chairman of Purdue Pharma’s board, said in a statement.

In a separate statement, Sackler family members who served on the Purdue Pharma board said they had “acted ethically and lawfully” and that they “reached today’s agreement in order to facilitate a global resolution that directs substantial funding to communities in need, rather than to years of legal proceedings.”

The statement also said, “Regarding the plea agreement between the government and Purdue, no member of the Sackler family was involved in that conduct or served in a management role at Purdue during that time period.”

A number of states’ attorneys general spoke out against the terms of the proposed settlement as inadequate and vowed to continue to pursue cases against the company and the Sacklers, which the federal settlements do not resolve.

Purdue Pharma has long been accused of being a driver of America’s opioid crisis. FRONTLINE’s 2016 documentary Chasing Heroin investigated how that crisis came to be, examining allegations about Purdue Pharma’s role in the early years of what has been called the worst drug epidemic in U.S. history.

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Role of Alternative Medicine in Modern Society

Typically, alternative medicine differs from traditional medicine in that alternative medicine is older and what we might call unconventional or non-Western medicine. Alternative medicine does not follow the traditional science and research that current medicines undergo. Alternative medicine could also be termed complementary or traditional medicine or the therapies that can be integrated into current medicine. The staff of the National Library of Medicine of the United States classified alternative medicine under the category of complementary therapies in their Medical Subjects Heading Section. This was done in the year 2002. The definition provided was that alternative medicine therapeutic practices were not considered as an integral part of the traditional allopathic medicine. Therapies like acupuncture, dieting, physical therapy like exercises or yoga, etc. are termed as alternative medicine. These therapies are called complementary when they are used along with conventional treatments. If they are done in place of conventional treatments, they are known as alternative treatments.

In April 1995, the panel of National Institutes of Health, Bethesda, Maryland, worked on Definition & Description, CAM Research Methodology Conference, Office of Alternative Medicine. The panel defined alternative medicine and complementary medicine as those healing resources that encompass all health systems and practices that are different from the dominant health system of a particular society or culture. Usually, therapies like ayurveda, herbal medicine, folk medicine, homeopathy, acupuncture, naturopathy, diet practices, chiropractic, music therapy, massage, pranic healing, etc. are classified as alternative or complementary medicine. People who do not find a cure, remedy or success in allopathic medicine generally try alternative medicine. Such people generally suffer from cancer, arthritis, acquired immuno deficiency syndrome (AIDS), chronic back pain, etc. Therapies included under alternative medicine would cease to be included in that category once their efficacy is proven and they are considered safe and effective. They are then considered as part of traditional medicine. An example would be chiropractors. Twenty years ago insurance would not pay for them as they were considered "alternative and ineffective." Today thousands of people have been helped by chiropractors and they are now recognized in the medical community. A similar movement is underway in the nutritional supplement and nutraceutical industry.

Over the years, more and more people have been using alternative medicine because traditional medicine is not working for them. The 2004 survey by the National Center for Complementary & Alternative Medicine of the United States revealed that approximately 36% of Americans used alternative medicine in 2002. If alternative medicine is used in conjunction with traditional allopathic medicine, an integrative doctor is a person's best option. Some traditional doctors are adamantly against or simply do not believe in complementary medicine, even though research continues to show the benefits of many compounds. Your doctor should be informed about other approaches you may be using and if they are not comfortable with that then always feel free to choose another doctor. This would enable the doctor to foresee any possible complications or a better time in which to use a complementary therapy. The concern …

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The Role Of An Emergency Dentist

Emergency dentists play an important role in your dental care plan. It is imperative that you have a number for a reputable emergency dentist in case you chip a tooth, loose a tooth, or you have a severe toothache in the evening or on the weekend or a holiday. Your emergency dentist can be your regular dentist, but many dentists still do not provide emergency services. In a severe emergency where you can not find an a suitable dentist on call, an emergency room might be able to get you the care you need until a dentist can be reached.

Emergency Dentists provide emergency dental care to patients in the evening or weekends. Sometimes an on call dentist will make you an appointment for early the next morning before regular business hours, and although not ideal, it does beat waiting till the office opens to see when you can be seen.

The most common problem requiring emergency dental services is a severe toothache caused by impaction or an abscess (infection). Your dentist may be able to help you by pulling your tooth or doing a root canal, but sometimes you’ll have to take an antibiotic first.

Some other forms of emergencies requiring urgent care are a chipped tooth, broken tooth, loose tooth, a tooth being knocked out, a broken filling or cap, or any other dental problem causing severe pain. There is no specific guideline as to what constitutes an emergency, and services and procedures vary from dentist to dentist.

An emergency dentist is not a substitute for regular dental care, but can be an important part of your overall dental care plan. By keeping a dentist’s contact information on hand you can save yourself pain, and lessen the chance of permanent damage to your smile.

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