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Stock SectorOctober 19, 201818min6


As its fellow midsize, modestly endowed private colleges look nervously to the future, Marist College in New York’s Hudson Valley is making a bold, nearly $180 million bet: last month, it announced that it will partner with a regional health-care provider to build a new medical school.

Marist Health Quest School of Medicine is expected to open its doors in 2022, reaching capacity in 2032 with about 500 students.

Adding a medical school to a private college is “honestly a big leap up in scope and complexity,” said President David Yellen. But it makes sense, he said. “If you have the resources, there’s room for another good medical school. And we think it will boost our status and reputation.”

The move is unusual — if not unprecedented — for a regional institution. In 2013, Marian University in Indianapolis did much the same, opening its College of Osteopathic Medicine, only the second medical school in Indiana.

In both cases, relatively nonwealthy — if economically secure — private institutions surveyed the educational landscape and decided that training doctors made sense. Opening a medical school represents not just a worthy pursuit, they concluded, but a possible key to long-term financial security, despite a byzantine and ever-shifting health-care industry.

Marian president Daniel Elsener said the endeavor turned out to be so enormous that it’s best understood not as a typical campus expansion but as an “intergenerational” undertaking.

But he said it is a smart investment, since most medical students eventually become physicians — who become donors.

“The likelihood that they can support their institution as an alum increases,” he said.

Geoffrey Young, senior director for student affairs and programs at the Association of American Medical Colleges, said the demand for new doctors will continue to grow. “We have a generation of physicians — the baby boomers — who are at or are rapidly approaching retirement age,” he said.

And as the median age of Americans inches up, “We know that we’re going to continue to need physicians to care for our population,” said Young, a former admissions dean at the Medical College of Georgia. He said the field has seen steady growth in the total number of applicants. “Over all, medical school remains a very attractive option for those who are qualified,” he said.

According to recent AAMC data, the U.S. faces a severe physician shortage over the next 12 years. Its 2017 analysis found that the number of new primary care physicians and other medical specialists is not keeping pace with the demands of a “growing and aging population.” By 2030, it predicted, the U.S. will need between 40,800 and 104,900 more physicians than it is expected to produce.

The analysis found that primary care shortages won’t be as bad — at most, AAMC found, we will come up short by as many as 43,100 primary care physicians. But surgical specialties and others are expected to see a shortfall of as many as 61,800 practitioners by 2030. Other specialties, such as emergency medicine, anesthesiology, radiology, neurology and psychiatry could see shortages that are about half as large.

AAMC statistics suggest that the nation’s 152 accredited medical schools were slightly more competitive last year than they were nine years earlier: in 2017, the schools accepted 41.2 percent of applicants. In 2008, they accepted 42.7 percent.

Over all, the acceptance rate dropped even as the total number of med school slots grew, from 18,036 in 2008 to 21,338 in 2017, or by 18.3 percent.

Mostly that’s because in the same period, the number of applicants grew at an even faster rate: 22.3 percent. In 2017, nearly 9,500 more students applied to medical school than in 2008, but institutions could accommodate only 3,302 more applicants, according to AAMC statistics.

Though the costs to underwrite a brand-new medical school are considerable, analysts have actually said Marist’s move is not as risky as it seems. For one thing, Health Quest has committed to funding construction of the facility that will house it.

Moody’s Investor Services last month said Marist’s plan would have no immediate impact on its $104 million in outstanding rated debt, or on $40 million in proposed bonds to be issued through the Dutchess County, N.Y., Development Corporation. The costs associated with launching and supporting the medical school are “manageable,” Moody’s said, noting that they’ll be split evenly between Marist and Health Quest, which already runs four hospitals in the Hudson Valley and northwestern Connecticut.

Marist will spend about $25 million over the next five years, a small portion of its “sizeable” $290 million in spendable cash and investments, Moody’s said.

Yellen, the Marist president, said building the new school “is only possible because we’re doing very well financially, in an environment that’s pretty challenging for private colleges.”

He estimated that the college and Health Quest will spend nearly $180 million to get the new school to capacity in 2032. It will likely never turn a profit, Yellen said, but if all goes as planned, it will help raise Marist’s reputation and drive enrollment to other programs such as the sciences. “This isn’t something we’re doing to generate revenue for the college at all, in any direction — just the opposite,” he said. “We think it’s going to cost us money for a long, long time.”

Yellen also said the school isn’t designed “to spin off money to be used for other purposes.” While he anticipates that alumni could someday give back generously, it’ll likely be to the medical school and not to Marist’s general fund. “We’re not expecting that medical school alumni will give money to help Marist College build a new undergraduate dorm,” he said. “But it’s kind of a rising tide raising all boats.”

He said the move makes sense for the region: the nearest medical schools in the region sit either in Westchester and Rockland Counties, 50 miles south, or in Albany to the north, 80 miles away.

“In between, there’s a million people,” he said.

Though the success of the new school won’t necessarily be judged by the percentage of graduates who stay to practice medicine in Dutchess County, he believes the area’s natural beauty, low cost of living and proximity to New York City will make it an attractive place for future physicians to put down roots. The new school, he said, will be located just a half mile from Poughkeepsie’s Metro North commuter train station — the trip to Grand Central Station takes about an hour and a half. “This is a beautiful, dynamic part of the country that has a mix of natural beauty and a proximity to New York,” he said.

The recent AAMC data on medical school matriculation show that there’s “a dramatic oversupply of really qualified” medical school applicants, Yellen said. “We’re not worried about enrolling a full class of really good people.”

Part of the new school’s appeal will be its focus on medicine assisted by artificial intelligence and cognitive computing, which will be built into the curriculum. “We want our medical students to begin to be educated in that, and to begin to be acclimated to that.” As data-driven decision making becomes a bigger part of medical practice, “they’ll be ready,” he said.

Despite its isolated location, he predicted that Marist “will do just fine in that competition for the best students, over time.”

Robert Friedberg, Health Quest’s president and CEO, said bringing a medical school to Dutchess County would familiarize students with the region. “We’re hoping that many of them will find it a desirable area” and apply for residencies, he said.

He said he and Yellen “just shared the vision about how this would look and how it will work.”

Marist’s modest size, he said, wasn’t a consideration. “They have strong premedical programs and they have some postgraduate programs as well in the medical arts — they were just positioned really well.”

Alumni Shift Could Pay Off

Marian’s Elsener said Indianapolis is “a great environment to attract talent.” The university boasts that it offers a “faith-based, liberal arts environment,” and has committed an estimated $80 million to $90 million to the new school over the past decade. “If you don’t bring a lot of resources to the game, you should stay off the field,” he said, noting that start-up costs are “very, very significant. If you aren’t prepared to take care of that, it can pull down the whole institution rather than raising it up.”

He said the move could pay off as institutions like Marian shift away from graduating mostly teachers, nurses and social workers — through the 1980s and 1990s, about 80 percent of Marian alumni ended up in these professions — and add more disciplines like medicine and engineering. The shift, he said, could help the university’s bottom line, since these new alumni are more likely to be able to give back generously in future decades. Teachers, nurses and social workers, he said, are “wonderful people,” but they don’t always earn sizable wages.

Patrick McCabe, a Moody’s analyst, said a new medical school “carries both long-term potential benefits as well as more immediate potential risks. Once successfully up and running, a medical school can enhance a college’s reputation and profile, driving additional revenue growth and often resulting in enhanced fund-raising.”

But during the start-up phase, he said, “there can be both operational and financial risks including accreditation, capital needs and unexpected uses of liquidity.”

The Marian project experienced a huge and unpleasant surprise in 2016, when donor Michael Evans, the medical school’s namesake and a key early supporter, backed out after donating just $10 million of a planned $48 million gift. Evans, CEO of AIT Laboratories, a local toxicology testing firm, had fallen on hard times amid a decline in Medicare reimbursement rates and a lawsuit filed by the U.S. Department of Labor, which said he’d sold the company to employees in 2009 for more than it was worth. Evans settled the lawsuit for $3 million, but Marian had to look elsewhere for funding.

In the two years since, Marian has raised more than the $38 million Evans promised, a spokesman said. The larger facility remains the Michael A. Evans Center for Health Sciences.

Many health-care experts praise osteopathic medicine for meeting patients’ needs and for emphasizing primary care more closely than many traditional M.D.s. But it has also come under criticism in a few cases. Elsener said critics are “uninformed” about its methods, its standards and its efficacy. “There’s no doubt that an osteopathic doctor is high-quality,” he said. The field also “sits well in a Catholic university,” which emphasizes focusing on the “whole person.”

Elsener said having potential physicians, surgeons and anesthesiologists as students can’t be overstated: medical students are more willing than other graduate students to take on debt to finance their education. “A medical student can calculate their lifetime earnings,” Elsener said. Carrying debt, for these students, is almost always a smart investment.

Charging more of the student population for full tuition also helps Marian with its discount rate, he said. “Most institutions today are in discount misery.”

Over all, he said, attracting as many of these students as possible is smart for an institution. “Unless you’re heavily endowed, you’d better pay attention to all aspects of the financial model.”

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Stock SectorOctober 18, 20186min9


KANSAS CITY, Mo. — Is it time for medical marijuana in Missouri? As residents prepare to vote on the issue in less than a month, supporters are making a big push to get the measure passed — but others are still skeptical.

Supporters of medical marijuana are holding a rally and concert this weekend in Kansas City. U.S. Rep. Earl Blumenauer of Oregon, who travels across the country advocating for medical marijuana, will be the guest speaker at the rally. 

"This is an unusual movement because it has been driven by the public, not by politicians necessarily," Blumenauer said in an interview Thursday with 41 Action News. "It has been voters who have decided that they want to end this failed prohibition, and it's starting to come to a crest."

Blumenauer​​​​​​​​​​​​​​ said he believes it's only a matter of time before all states make the switch and that Missouri could become the 31st state to legalize medical marijuana. 

"If Missouri is willing to resoundingly support medical marijuana, I think the tide changes nationally, and I think we're in the home stretch," he said.

There are three medical marijuana measures on the ballot in Missouri, which makes it a little confusing, even for some experts. 

"It is confusing. I mean I'm sort of scratching my head trying to figure out how all this works, and I don't even live here," Blumenauer​​​​​​​​​​​​​​ said.

Missouri voters will see three medical marijuana proposals on the Nov. 6 ballot: Amendment 2, Amendment 3 and Proposition C.  

Amendment 2 would:
– legalize marijuana for medical purposes;
– tax marijuana sales at 4 percent; and
– spend tax revenue on healthcare services for veterans.
 
Amendment 3 would:
– legalize medical marijuana; 
– tax marijuana sales at 15 percent; and
– spend the tax revenue on biomedical research and drug development institutes.

According to Ballotpedia, if both amendments pass, then the amendment with the most votes would become law. 

Additionally, Missourians will also vote on Proposition C, which would
– legalize medical marijuana;
– tax marijuana sales at 2 percent; and
– spend tax revenue on veterans' services, drug treatment, education and law enforcement.

If both Proposition C and one or both of the amendments pass, a court would likely have to determine which measure prevails. 

Blumenauer​​​​​​​​​​​​​​, for his part, thinks one of the measures on the Missouri ballot stands out.

"This (Amendment) 2 looks to me to be broadly supported, well-crafted. I've looked at a number of these measures around the country and I think this is the strongest," he said.

Critics of medical marijuana, on the other hand, don't like any of the three options, and they point to problems in other states where medical marijuana is legal. 

Eric Zahnd, a Platte County prosecutor, said he doesn't think Missouri is ready for any form of legalized marijuana.

"In Colorado, which was one of the first states to legalize for medicinal and recreational use, they've actually seen their crime rates increase," Zahnd said. "They've seen their rates of impaired driving crashes increase, so there are a lot of subsidiary problems that come along with the legalization of marijuana that I’m not certain Missouri is prepared to deal with."

Voters go to the polls on Nov. 6. 

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Stock SectorOctober 18, 20183min10


Construction of a new medical office building meant for cancer treatment is underway in Puyallup.

Located at 2916 S. Meridian, the 28,389-square-foot building will house Rainier Hematology Oncology (RHO) and South Cancer Care (SCC). It’s expected to be completed in fall 2019.

The office will give patients a “whole cancer care” experience,” Northwest Medical Specialties spokeswoman Jeni Spokely said.

“The new building will offer seamlessly coordinated patient care along with support services including social work, nutrition, naturopathic medicine, financial counseling and other services that will be provided in a physical property that accommodates for all,” Spokely said. “All the technological services available to patients of Seattle will be available to patients closer to the comfort of their home.”

SCC specializes in radiation and various diagnostic imaging. It will be located on part of the first floor of the medical building and have radiation vaults, scanning equipment and support spaces.

RHO outgrew its current space next door at 2920 S. Meridian. The company will co-locate with SCC and occupy the remainder of the new medical building. The company offers chemotherapy treatments and other types of infusions and laboratory services, according to its website. It will have an infusion suite and on-site lab.

“The space, including a bistro/café and activity rooms, is intended to create a relaxing and less stressful environment for patients during their care, while also providing all of the resources they need to learn about their diagnosis,” according to a press release by architecture company Helix Design Group.

Helix Design Group company partnered with developer Rush Development Companies for the project.

Allison Needles: 253-597-8507, @herald_allison

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Stock SectorOctober 18, 201810min10


Faye Gishen and Amali Lokugamage

As patient populations grow increasingly diverse and complex, doctors and medical students should be equipped with the skills and knowledge to treat patients from minority groups equitably and non-judgmentally. Educating medical students on diversity-related topics increases confidence in communication and has the potential to improve patient care. The implementation of such a “diversity curriculum” has largely been left to individual medical schools. [1] However, existing cultural competence training programmes have been criticised for being simplistic and flattening cultural differences down to lists with diversity training in higher education accused of being tokenistic. [2,3]

The Windrush scandal of 2018, has highlighted systemic inequalities within British organisational systems and points to the persistence of colonial influences within society. Medicine and medical education could, on some levels could be accused of “colonising” students, patients, and doctors. This analogy is drawn by Stern who describes “biomedicine and its training as ‘colonising’ both doctor and patient.” [4] By colonising Stern means that the cultural identities of students are shaped (often by organisational “hidden curriculum” messages) by medical schools and the “club” of medicine. Medical schools themselves tend to have higher BME student populations than many institutions; a recent GMC report found that almost a third of UK graduate doctors in training identify as BME. Of those who entered medical school in 2016, 42% on standard entry medical programmes identified as non-white.

As clinical academics at a London medical school, we have recently run two university grant funded public engagement events on “liberating” (diversifying) and “decolonising” the undergraduate medical curriculum. Contrary to what several of our clinical colleagues presumed, the decolonising project was not about bowel sanitation and gut microbes, nor were they about bowels’ proverbial contents. “Decolonising” describes an academic movement across universities and other institutions to highlight inequalities resulting from historical colonial influences and to transform and modernise materials. The aim is to make teachers and students aware of any unconscious biases and remove colonial references, thereby creating fairer curricula. The equality and diversity agenda tend to be a top down endeavour from institutions but the decolonising agenda is more about ground up activism from those affected by the legacy of colonial injustice.

Our goal is to enable students (and faculty) from minority groups, including from Black and Minority Ethnic (BME) backgrounds to feel less marginalised by traditionally white, male euro-centric content. It forms part of a broader equality, diversity and widening participation agenda and resonates with the more global movement to challenge and flatten power hierarchies. It fits with the notion of the patient, students, and the public as powerful “agents of change” in co-producing curricula. This mirrors patient and public involvement in healthcare and research, which we recognise as clinicians.

Following feedback from faculty, students, and the public at our first event last year, we have made several curricular changes. For example, it was highlighted that students are not taught practically to detect clinical signs such as anaemia and cyanosis in BME patients, which we now consider when teaching. In addition, since melanomas may be harder to detect on darker skins, we procured melanoma “stickers” to use on darker skins as a teaching aid to illustrate this diagnostic point. The fact that certain laboratory tests, such as renal function have different normal reference ranges in certain ethnic groups, has been highlighted in teaching materials as a result of these discussions. Case studies using patients from varying cultural groups are now used more frequently to introduce more heterogeneity. This agenda also acted as a catalyst to address other widening participation platforms such as LGBT+ case inclusion; for example, counselling a transgender male about breast cancer or a transgender female about prostate cancer, and familiarising medical students with taking histories comfortably from the LGBT+ community.

The philosophy of patient centred care within medical education and the NHS naturally embraces equality, diversity, and decolonising movements in order to serve our patients best. Better communication and clinical skills means better care for all patients. Educators and clinicians need to ensure that learning materials and guidelines are grounded in human rights as suggested by the World Health Organisation’s Sustainable Development Goals.

Any pedagogical development in this field of social justice should not be tokenistic and it should also be underpinned by sound educational principles. These are understandably emotive, sensitive, and political issues for many, and as medical educators, we need to find a path that evolves curricula in a fair and measured way to produce student-centred pedagogy, reflective of the populations we teach and serve clinically.

We feel that in this academic quest of diversifying and decolonising the medical curriculum, we are paving new paths and may make mistakes along the way. We are forging through areas of sensitivity and historic injustice, where triggering unconscious biases and wounds are equally possible. Diplomacy and an understanding of people’s emotional triggers are required. We recommend that those leading diversity projects at higher educational institutions should consider being reflective about their own triggers and privileges.

Faye Gishen, consultant physician and academic lead for clinical and professional practice, University College London Medical School

Amali Lokugamage is a consultant in Obstetrics and Gynaecology at Whittington Health NHS Trust, London, UK and a Deputy Lead for Clinical and Professional Practice at UCL Medical School.

Declaration of interests: FG and AL have received two grants from UCL to the Department of Clinical and Professional Practice for ‘Practically Creating an Inclusive Curriculum’ and Decolonising the Medical Curriculum (2017,2018).

AL is on the Board of Directors of the International MotherBaby Childbirth organisation and a Trustee for the Birthlight Charitable Trust. She is a company director of a small publishing company called Docamali Ltd.

References:

  1. Nazar, M., Kendall, K., Day, L., & Nazar, H. (2015). Decolonising medical curricula through diversity education: lessons from students. Medical Teacher, 37(4), 385–393.
  2. George, R. E., & Thornicroft, G. (2015). Exploration of cultural competency training in UK healthcare settings: A critical interpretive review of the literature. Diversity from http://diversityhealthcare.imedpub.com/exploration-of-cultural-competencytraining-in-ukhealthcare-settings-a-critical-interpretive-reviewof-the literature.
  3. Niemann Y (2016). The Social Ecology of Tokenism in Higher Education.  22 Nov 2016 p451-458 Peace Review: Journal of Social Justice. Volume 28, 2016 – Issue 4: Breaking Down the Shades of Color
  4. Stern H (2009). Foreword to ‘The Inner World of Medical Students; listening to their voices in poetry’ by Johanna Shapiro. CRC Press. Taylor and Francis

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Stock SectorOctober 18, 201817min9


April Doyle, a single mom from Visalia, Cal., only lets herself look three months into her future. Since she was first diagnosed with breast cancer in 2014, she’s tried a new treatment every three months to keep the cancer from spreading from her breast tissue to other parts of her body. But it returned: this time in her bone. She is almost out of options for her hard-to-treat cancer, but she finds comfort in online support groups where other women with metastatic breast cancer share their experiences. “Eventually we know we will exhaust all of our options until they keep coming up with more treatments,” she says. “It’s a scary thing.”

Now, people with cancer can do more than just wait. A new non-profit project from several leading health organizations that launched Thursday, called Count Me In, lets cancer patients send their medical information directly to researchers who are searching for cures.

Count Me In allows cancer patients to send their medical information — including blood, saliva and tumor samples — to a public database that any researcher can access. The tumor samples and blood samples are genetically sequenced, and that data, along with the patient’s medical history (including which treatments patients received and how well they worked), is then translated into an anonymous database. This information is invaluable to scientists who can use it to see patterns that might eventually lead to new understanding of how cancer works — and more importantly, to new drugs for treating it.

So far, 5,500 people — including Doyle, who learned about the project on social media — have submitted their information, and the group hopes to include 100,000 in the next few years.

The project is a collaboration among the Emerson Collective, an organization focused on innovative solutions for social change that was founded by Laurene Powell Jobs, who is Apple founder Steve Jobs’ widow, the Broad Institute of MIT and Harvard, the Biden Cancer Initiative and the Dana Farber Cancer Institute. The Broad, a leading genetics institute, performs the sequencing and for now will store the samples patients send in. People in the U.S. and Canada can send their medical records and samples by signing an online consent form on Count Me In’s website. After signing up, they receive a kit by mail for providing a saliva sample; Count Me In contacts their hospitals to collect medical records and blood and tumor samples. Since it’s not a commercial business, Count Me In’s patient database will not be sold to other entities like pharmaceutical companies, and the project will be funded mainly through philanthropy.

“We wanted to meet patients where they are,” says Reed Jobs, director of Emerson Collective’s Health team and co-chair of Count Me In, as well as Steve and Laurene’s son. “We didn’t want to have a high burden for patients to get engaged, so people can virtually do everything from their couch.”

Jobs, whose father died of pancreatic cancer in 2011, has been discussing the patient-based project with Eric Lander, president of the Broad Institute, for several years and says it appealed to him because of his own experience with his father’s illness. There are few effective treatments for pancreatic cancer, since most patients are diagnosed at late stages. “I don’t want other families to have to go through what we did,” he says. “It was tragic.”

That’s why Count Me In is focusing on rare cancers and those with few reliable treatments — like Doyle’s — to start. “I think aggregating the most information we possibly can about the rarest cancers is really the logical first step for us being able to figure out which patients should go on which treatments, and what new ideas are out there,” says Jobs.

The project is currently building four major databases — for metastatic breast cancer, metastatic prostate cancer, angiosarcoma and gastroesophageal cancer — and people like Doyle have been signing up after learning of the project through social media or advocates in the cancer community. Count Me In plans to add other cancer databases in the future.

Lander says Count Me In is an attempt to take advantage of an underappreciated resource: the data that every cancer patient provides in the form of their tumor’s DNA, their treatment decisions and their outcomes. Currently, patients’ tumor and blood samples are only used to help their doctors make decisions about their individual treatment. But combining that information from the hundreds of thousands of cancer patients who are treated by cancer doctors across the country — not just the ones who happen to live near academic centers — could teach doctors valuable lessons and provide new insights about novel ways to treat the disease. “There has never been a way for the 90-plus percent of patients in the U.S. who aren’t being treated at academic medical centers to be part of research,” Lander says. “All of that information is going to waste about which patients are responding to which medicines and what mutations are contributing to which tumors. This is a sea change in the idea of patients not just as subjects, but as partners.”

Count Me In is not intended to be a resource for changing the medical treatments of the patients who provide their samples, but rather as a repository of data for researchers to access to answer fundamental questions about cancer. Why, for example, does some breast cancer spread beyond the breast tissue, and other breast cancer does not? Are there markers that researches can find to identify women who are most likely to develop metastatic disease? Which treatments work best for which cancers, and why?

“This data may exist at a few cancer centers, but we are trying to break down the silos there and share,” says Dr. Nikhil Wagle, director of Count Me In, who treats cancer patients at Dana Farber and conducts research at the Broad. “But we don’t have a single database that contains clinical, genomic, molecular and patient-reported data.”

Wagle and the project’s associate director, Corrie Painter, a cancer researcher at Broad, have been reaching out to patient advocates to spread the word about the opportunity for cancer patients to contribute their medical records to cutting-edge research. The ability to contribute to finding such answers is what attracted Doyle to sign up. “We are the ones screaming from the rooftops for help,” she says. “Of course we want to be a part of it if we can.”

When she was first diagnosed with breast cancer, Doyle had genetic testing of her cancer. But her doctors told her she was part of 11% of people for whom they can’t explain why they developed the disease; she had no known genetic mutations to explain her cancer. “This project makes you feel like maybe they can find the why,” she says.

Barbara Bigelow, who was also diagnosed with metastatic breast cancer, is motivated by the same desire for answers. The Massachusetts resident was diagnosed with stage 2 breast cancer in 2001 and had a lumpectomy, chemotherapy and radiation. In 2015, she learned her cancer had spread. Her two sisters were also diagnosed with the disease, so they all received genetic testing. But none of them carry any of the genes known to contribute to breast cancer. “We may have a gene that has not yet been discovered,” Bigelow says.

Bigelow has two daughters who, because of their family history of breast cancer, have a high chance of developing the disease themselves. But if researchers could find any genetic hint that they will get the disease, that could steer them toward early and more effective treatments — one of the goals of Count Me In. “My hope is that by participating now, researchers will find some key to making metastatic breast cancer a chronic disease and not a terminal one,” Bigelow says. “And that my daughters could be saved because of my participation.”

Her medical experience is also valuable to future metastatic breast cancer patients for another reason. Because she lives near the Dana Farber Cancer Institute in Boston, in 2016 she joined a clinical trial that was testing the combination of a recently approved immune-based drug and chemotherapy. The therapy took a toll — her immune system reacted so violently that she was hospitalized for two months and put into a medically induced coma as her kidneys started to shut down. After she recovered, however, her cancer had started to shrink, and two years later, she has no active signs of cancer.

Doctors are eager to study her genetics and her tumors to better understand why her cancer responded to the immunotherapy combination, and how more people like her with metastatic disease can benefit.

Patients with other types of cancer also stand to benefit from Count Me In’s democratic collection of patient information. Already, by scanning records provided from the few hundred people with angiosarcoma, a rare cancer, scientists have found a tantalizing hint for an effective new treatment. Two of the people who have sent in their samples were treated by doctors with immunotherapy in a practice known as off-label use, in which physicians can use medications approved for one disease to treat another. After the team at Broad sequenced the tumors from these patients, they found that angiosarcomas have a high number of mutations — something that doctors treating the disease hadn’t known for sure, since so few people are affected and so few have their tumor DNA sequenced. For immunotherapy, having lots of mutations is a good thing: it makes the cancer cells more vulnerable to some of the immunotherapy drugs that expose cancer cells to attack by the immune system.

In less than a year, that finding has led to new studies that are enrolling people with angiosarcoma; these patients will test the immunotherapy to determine the best dose and timing of the treatment. “That shows patients that, yes, if you do donate, it will benefit patients,” says Jobs. “It’s been a real eye-opener.”

Tracey Noce, a designer at Disney in Los Angeles, also donated her medical records to help others with angiosarcoma. “Cancer can be very isolating, especially if you have a rare cancer,” she says. “Count Me In is really empowering, because as a patient you can say, ‘If my tumor can help somebody please, please, please take it.’ Nobody should have to feel like there are not any answers and that they are going to die.”

When Noce was told there weren’t many treatment options for her, she did her own research on which experimental therapies might be promising. She found a French study showing some encouraging results with the chemotherapy drug Taxol, which is generally used to treat breast cancer. After discussing it with her doctor, she began getting Taxol and has had no evidence of disease since 2009. Her records could help researchers better understand if Taxol is a feasible new treatment for her cancer, and if not, she’s hoping other people’s records in Count Me In will inspire new studies of potential new treatments she could try, since angiosarcoma has a 50-50 chance of returning even after remission.

Noce, Doyle, Bigelow and other people with cancer who are joining Count Me In are aware that they are donating their information not to find a treatment for themselves, but for future generations. An app that Jobs and his team at Emerson developed will alert them when researchers are accessing the metastatic breast cancer or angiosarcoma database to which they contributed, but they may never know if their information led to a new treatment or insight that saves lives. And that’s okay with them. “My information that I’ve given them is going to be there long after me,” says Doyle. “I don’t know what the next three, six or nine months will bring. But I know that they have my information, and hopefully it will help researchers to come to some kind of resolution at some point. It’s not about me; it’s about the big picture. It’s about all of us.”

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Stock SectorOctober 18, 20183min9



18 October, 3:33pm

Benetton Rugby communicates the following medical bulletin regarding Nasi Manu.

On 30th August, following a medical check-up completed by the team’s medical staff at the athlete’s uro-genital apparatus, it had emerged the presence of a neoformation at this level that, the following day, had forced the immediate surgical intervention by the team of the urology department Ca’ Foncello hospital of Treviso.

The surgery was perfectly successful, the player was so resigned last September 4 observing a period of post-surgical convalescence.

Yesterday, the last blood tests were carried out that highlighted for Nasi Manu the need to start a cycle of chemotherapy in the next few days.

Manu stated: “I just want to say a big thank you to Dr. Luigi Maccatrozzo, Dr. Alberto De Gobbi, Dr Giandavide Cova and the rest of the team in the urology department of Treviso hospital.

“Thank you to my club, management and teammates, I appreciate all your support. Thank you to my wife, family and friends. I’ve still got a little bit of treatment before the fight is over but I know I’ll get through and be back soon”

Watch the Pro14 streaming live on rugbypass.com, home of the world’s best global rugby coverage including news, highlights, previews & reviews, live stats, and more!

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Stock SectorOctober 18, 20184min10


The Food and Drug Administration and Department of Homeland Security signed a memorandum of agreement to improve coordination around medical device security, including a framework.

IMPACT

While the two federal agencies have worked together in the past to improve medical cybersecurity and vulnerability disclosures, the new agreement formalizes the process and the FDA and DHS relationship. The goal is to bolster coordination around potential or confirmed threats and/or flaws.

“As innovation in medical devices advances and more devices are connected to hospital networks or to other devices, ensuring that devices are adequately protected against cyber intrusions is paramount to protecting patients,” wrote FDA Commissioner Scott Gottlieb.

“The FDA has been proactive in developing a robust program to address medical device cybersecurity concerns. But we also know that securing medical devices from cybersecurity threats cannot be achieved by one government agency alone,” he added.

The strengthened partnership will make it easier for the groups to share data and better collaborate, while reaffirming their commitment to combating cyber threats, Gottlieb explained. The hope is that it will lead to more timely, better responses to potential threats.

For one, DHS and FDA will perform collaborative assessments to determine the extent a potential flaw could pose to patient safety, while coordinating device testing when needed. DHS will remain the central medical device vulnerability coordination center and consult with the FDA for device expertise.

TREND

For years, researchers have warned that hackers could easily gain access to a network through these flaws. But worst case scenario, these vulnerabilities could put patient lives at risk and providers aren’t being trained to detect or react to a hacked device.

Both the FDA and DHS have ramped up device vulnerability disclosures in recent years. In fact, since the FDA released its cybersecurity guidelines for devices in 2016, manufacturers reported 400 percent more flaws per quarter. It’s a sign vendors are beginning to take action to improve device security.

ON THE RECORD

“Ensuring our ability to identify, address and mitigate vulnerabilities in medical devices is a top priority,” Christopher Krebs, undersecretary for the DHS National Protection and Programs Directorate, said in a statement. “DHS has some of the top experts on control systems technology, and we look forward to continuing to leverage this expertise for the sake of improving the lives and safety of people across the country.”

Twitter: @JF_Davis_
Email the writer: jessica.davis@himssmedia.com

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Stock SectorOctober 17, 20183min7


The FDA and Department of Homeland Security are stepping up efforts to protect patients from cybersecurity attacks on medical devices, according to a press release.

The two agencies announced a memorandum of agreement that formalizes a “long-standing relationship” between the FDA and DHS that encourages the agencies to share information about possible or actual medical device cybersecurity vulnerabilities and threats. This can lead to faster and better responses to threats to patient safety, the agencies stated.

“The FDA has been proactive in developing a robust program to address medical device cybersecurity concerns,” FDA Commissioner Scott Gottlieb, MD, said in the release. “But we also know that securing medical devices from cybersecurity threats cannot be achieved by one government agency alone. Every stakeholder has a unique role to play in addressing these modern challenges.”

Christopher Krebs, DHS’s undersecretary for the national protection and programs directorat, explained why his agency needs to coordinate with the FDA.

“Ensuring our ability to identify, address and mitigate vulnerabilities in medical devices is a top priority …. This agreement is another important step in our collaboration,” he said in the release. “DHS has some of the top experts on control systems technology, and we look forward to continuing to leverage this expertise for the sake of improving the lives and safety of people across the country.”

According to the press release, the agreement allows for the FDA to continue participating in regular, ad hoc and emergency coordination calls with DHS and advise DHS regarding the risk to patient health and the potential for harm posed by identified cybersecurity threats and vulnerabilities. DHS will continue coordinating medical device vulnerabilities and interfacing with appropriate stakeholders. The agency will consult the FDA for clinical and technical expertise regarding medical devices.

Disclosures: Gottlieb and Krebs report no relevant financial disclosures.

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Stock SectorOctober 17, 20188min15


Iowa’s only licensed medical marijuana manufacturer, MedPharm Iowa, says its product is ready and it’s looking for more customers.

At least 1,000 Iowans have gotten doctors’ approval to use medical marijuana, Lucas Nelson, MedPharm’s general manager, told the Des Moines Register, but others may need more or different products to find relief from their ailments.

On Wednesday, Nelson and Stephen Wilson, MedPharm’s dispensary operations manager, publicly presented the products that will be available when the state’s five licensed dispensaries open in the coming months. So far, the medical cannabis company is producing tinctures — medicine made by dissolving a drug in alcohol — capsules and creams.

The state approved medical marijuana for limited use in 2017 and strictly limited the types of medicine that could be produced and sold. Since then, backers — and some lawmakers — have advocated expanding the law so that it would be available in different forms and to more people. But Gov. Kim Reynolds, Iowa House Speaker Linda Upmeyer and others have said the program should have time to develop before they undertake changes.

For now, MedPharm will offer three products with ranging levels of cannabidiol, commonly referred to as CBD, and tetrahydrocannabinol, commonly referred to as THC. CBD is a type of non-intoxicating cannabinoid that can help people with seizures or Crohn’s and Parkinson’s diseases; THC is the psychoactive cannabinoid that can help people with cancers, Lou Gehrig’s disease, Multiple sclerosis and terminal illnesses manage their pain.

More: National marijuana firm to build multimillion-dollar production facility in Cedar Rapids

Along with a slideshow that showed growing marijuana plants, Wilson shared mock-ups of the products and labels, which list the CBD to THC ratios, as well as one of MedPharm’s planned dispensaries, located in Windsor Heights.

“It’s set up like a Verizon store, so patients feel comfortable,” Wilson said. “We want people to feel comfortable going in, to trust us and trust what you’re putting in your body.”

It is not clear whether Iowa has a big enough market for medical marijuana to sustain MedPharm and other dispensary companies looking to enter the state. Only 438 people have been issued registration cards, which allow them to purchase medical marijuana, according to the Iowa Department of Public Health.

But there are several hundred Iowans “waiting in the pipeline,” Nelson said, as MedPharm has encouraged patients to hold off on getting their card until dispensaries open, because the cards are only valid for one year.

“We expect those numbers will shoot up as they go pick up their cards,” Nelson said.

Even though Nelson was optimistic about increasing the patient pool, Wilson said he had talked to some patients who have had trouble convincing their doctors to allow them to sign up for medical marijuana, especially in rural areas.

“We want to be clear: Doctors are never prescribing this; they’re just certifying these patients can use it,” Wilson said.

But to make medical marijuana more effective (and less costly), MedPharm leaders are still pushing for legislators to lift Iowa’s current 3 percent cap on THC. The chemical is what makes recreational marijuana users high, but medical marijuana proponents say it is also an essential part of what makes their products useful for the treatment of pain and some other conditions.

Limiting THC quantities based on total milligrams instead of by percent for each product would let people take fewer pills every day to treat their pain and cost less overall, Nelson argued.

“Rather than focusing on that individual capsule and saying, ‘Well, as long as that’s under 3 percent,’ you can basically buy as much as you want,” he said. “Let’s limit people on how much they can totally get but give them the option within that range to take a capsule that’s 50 milligrams or five depending on, again, what their condition is.”

MedPharm has also asked legislators to expand the list of conditions for which Iowans may purchase medical marijuana. The current list consists of just nine conditions, including seizures, cancers, Parkinson’s disease and untreatable pain, but Nelson said adding issues like post-traumatic stress disorder and additional definitions of pain to the list would put Iowa on par with other states with legal medical marijuana programs.

5 dispensaries are slotted to open their doors by Dec. 1:

  • MedPharm Iowa — 5700 Sunnybrook Drive, Sioux City, IA 51106
  • Have A Heart Compassionate Care — 3615 9th Ave., Council Bluffs, IA 51501
  • MedPharm Iowa — 7229 Apple Valley Drive, Windsor Heights, IA 50324
  • Iowa Cannabis Company — 1955 La Porte Road, Waterloo, IA 50702
  • Have A Heart Compassionate Care — 2222 E. 53rd St., Davenport, IA 52807

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