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Unjustified medication shortened 456 lives in a UK hospital, report says

GOSPORT, England (Reuters) – More than 450 patients died prematurely in a British hospital after they were given powerful painkillers with no medical justification, in what a damning report on Wednesday found was a “disregard for human life”.

The exterior of Gosport War Memorial Hospital can be seen here in Gosport, Britain, June 20, 2018. REUTERS/Henry Nicholls

Britain’s prosecution service said it would examine whether criminal charges could be brought following the deaths at Gosport War Memorial Hospital in southern England.

An independent panel found that between 1989 and 2000, there was an institutionalized regime of prescribing and administering dangerous doses of opioids at the hospital which were not clinically necessary.

“There was a disregard for human life and a culture of shortening the lives of a large number of patients,” the report said, adding that warnings from nurses had been ignored and there had been a failure by police and medical regulators to protect patients.

The exterior of Gosport War Memorial Hospital can be seen here in Gosport, Britain, June 20, 2018. REUTERS/Henry Nicholls

“The families, and indeed the nation as a whole, are entitled to ask how these events could have happened,” it added.

The 387-page report concluded that 456 patients were given opioids without justification and “probably at least another 200 patients similarly affected but whose clinical notes were not found”.

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“The events at Gosport Memorial Hospital were tragic, they are deeply troubling, and they brought unimaginable heartache to the families concerned,” Prime Minister Theresa May said in parliament. “The findings are obviously distressing.”

Health Secretary Jeremy Hunt apologized in parliament to the families, and said police would work with the prosecutors on possible charges.

“Had the establishment listened when ordinary families raised concerns… many of those deaths would not have happened,” he said.

The report noted the Gosport deaths and the concerns raised about them occurred at the same time as it was revealed that British family physician Harold Shipman, dubbed “Dr Death” had been responsible for killing patients in his care with lethal heroin injections.

Shipman, convicted in 2000 for murdering 15 patients, killed as many as 250 people in his care according to a later inquiry. But the panel examining the Gosport scandal said the circumstances were different.

“We draw a distinction because Harold Shipman acted alone, apparently, whereas what we are describing … in this report is an institutionalized practice, and that is a significant difference,” Reverend James Jones, the chairman of the independent panel, told reporters.

Writing by Michael Holden and Alistair Smout; editing by Stephen Addison

GSK takes billion-dollar drug fight with Gilead to top AIDS meeting

LONDON (Reuters) – GlaxoSmithKline is taking its fight with Gilead Sciences for dominance of the HIV market to the world’s leading AIDS conference next month by showcasing detailed results from its new two-drug treatment.

FILE PHOTO: Dolutegravir pills used in the treatment of HIV are seen at the Kenyan ministry of health offices in Nairobi, Kenya, June 27, 2017. Picture taken June 27, 2017. REUTERS/Baz Ratner

The drugmakers are touting rival strategies for fighting the AIDS virus, with GSK betting that a shift to using two drugs rather than the standard three will boost its market share, while Gilead sticks with the tried and tested triple approach.

Deborah Waterhouse, head of GSK’s majority-owned HIV business ViiV Healthcare, aims to overtake Gilead as market leader in the $ 26 billion-a-year HIV market by the mid-2020s, assuming the gamble on two-drug combinations pans out.

She has her work cut out. Gilead currently has a market share of 52 percent against GSK’s 22 percent – a breakdown that has changed little this year, despite the successful launch of Gilead’s new three-drug medicine Biktarvy.

Last week GSK reported successful headline results with its experimental combination of dolutegravir and lamivudine, paving the way for potential approval next year of a therapy some analysts see selling $ 1.5 billion annually.

Details of its so-called GEMINI trials, however, will only be disclosed at the biennial International AIDS Conference in Amsterdam on July 24 – a day before GSK reports second-quarter results.

GSK was informed late last Friday that its presentation had been accepted at the meeting, officials said.

Doctors will analyze the trial results closely to assess whether GSK can indeed rewrite treatment standards by delivering a cheaper two-drug regimen with fewer side effects.

The worry is it might risk drug resistance because the virus will only have to evade two drugs rather than three. While no resistance was seen in the latest 48-week trials, there was a case in an earlier study, although GSK believes this was likely down to failure to take the drugs properly.

As a result, analysts think many physicians may stick with using three-drug combinations for now, suggesting a slow sales ramp-up for GSK.

That is certainly the expectation at Gilead, which anticipates imminent approval of Biktarvy in Europe and will also have some additional data to present in Amsterdam.

“Physicians are interested in anything new that comes along in HIV, as they should be, but are a bit cautious about anything that steps back from established standards,” Mike Elliott, Gilead’s European head of medical affairs, told Reuters.

GSK is more upbeat but acknowledges the HIV community may be divided.

“Some clinicians will take the 48-week data and be absolutely convinced,” ViiV head of R&D Kimberly Smith told reporters on Wednesday.

“There will be others who, because this is a change in the treatment paradigm, will want to see longer-term data. We will be providing that as the GEMINI studies are designed to go for three years.”

GSK has made HIV a central pillar of the British company’s pharmaceuticals division and its strategy is all about coping with increasingly elderly patients who have to take HIV medicine for decades.

Nearly half of all HIV patients in the profitable markets of North America and Europe are now over 50 and are vulnerable to side effects from the drugs that keep them alive, making tolerability more important than in the past.

“Quality of life is where the unmet medical need is,” said ViiV CEO Waterhouse.

Editing by Alexandra Hudson

Latecomer Sanofi looks to catch next wave of cancer therapies

PARIS (Reuters) – Sanofi missed the boat on immune system-boosting cancer drugs. Now it’s trying to catch up.

FILE PHOTO: The logo of Sanofi is pictured during the Viva Tech start-up and technology summit in Paris, France, May 25, 2018. REUTERS/Charles Platiau

The French drugmaker has hired John Reed, the former top scientist at oncology market leader Roche to head its group research operations. And it is now focusing on a pipeline of 10 medicines that it hopes will help it get a piece of the $ 100 billion-a-year cancer drug market.

Dmitri Wiederschain, head of Sanofi’s immuno-oncology research, acknowledged the company had failed to capitalize on the takeoff of immunotherapy – drugs that activate the body’s immune system to attack tumor cells – in the early 2010s.

But he said the group could now gain an edge in the next waves of immunotherapy treatments, which include combining different drugs to better target cancer.

“It is of course a very competitive space but we now have ‘foundation assets’ to form a better rationale for combinations,” he told Reuters in an interview, citing immunotherapy approaches known as PD-1, TGFBeta and the antibody CD38.

“If you look across the biopharmaceutical landscape, Sanofi is the only company which has all three assets in its own pipeline or partnered with Regeneron,” Wiederschain said. Sanofi teamed with U.S firm Regeneron in 2007 to increase its presence in biotech medicine.

Immunotherapy is the fastest-growing part of the cancer drug segment, with sales expected to top $ 25 billion-a-year by 2021, according to analyst forecasts compiled by Thomson Reuters.

Frederic Ponchon, a manager at Sycomore Asset Management which holds 6.7 million Sanofi shares, said the French company was unlikely to rival cancer leaders like Switzerland’s Roche and U.S. firm Merck & Co soon.

“They could enjoy occasional breakthroughs but it won’t carry a lot of weight in their overall sales,” he said.

“We can see that Sanofi takes cancer seriously but you must remember R&D cycles are very long. So I would say Sanofi won’t be a great player in oncology but it may have some successes from time to time.”

Sanofi’s main business areas include drugs for diabetes, heart diseases and vaccines, with cancer treatments making up only about 4 percent of sales. Its cancer drug sales totaled $ 1.7 billion last year, compared with Roche’s $ 25.9 billion.

CROWDED MARKET

Sanofi has not always been behind the curve in oncology; in the 1990s, it produced top-selling cancer drugs such as Taxotere and Eloxatin.

However it has been seven years since the company launched its last one, Zaltrap, which targets metastatic colorectal cancer and had sales of 75 million euros ($ 87 million) last year.

In the meantime, companies such as Bristol-Myers Squibb and Merck & Co have developed their immunotherapy blockbusters. New treatments, if successful, can fetch more than $ 100,000 a year.

In Sanofi’s current cancer pipeline, only one has made it to regulatory review in the United States and the European Union: immunotherapy agent cemiplimab to treat cutaneous squamous cell carcinoma. Regeneron is its partner on the project.

The company expects to submit for U.S. regulatory review another of its cancer candidates, isatuximab, to treat multiple myeloma later this year or in early 2019.

With over 2,000 drugs in the cancer immunotherapy space, the competitive landscape has never been more crowded as each firm seeks its own proprietary version of often similar drugs.

“There is clearly huge market potential but also a very large number of players, it is the toughest issue here,” Nicolas Baudouin, a director at ratings agency Standard & Poor’s said of immunotherapy.

Many of the immunotherapy drugs work in only a minority of patients, which companies hope to improve by combining drugs that target tumors in different ways.

This area, where Sanofi says it can be successful, has proven a challenge for drugmakers so far. Earlier this year, a study showed an experimental drug developed by U.S Incyte had failed to bolster the effectiveness of Merck’s blockbuster Keytruda to treat skin cancer patients.

Roche also failed a key combination trial last month in colorectal cancer.

ACQUISITIONS

Wiederschain said molecular oncology, which targets a tumor based on its genetic makeup, would also be a future differentiator.

“It is about understanding better what drives the growth of cancer tissues, how the cells works and proliferation in the body.”

This has led Sanofi to launch early-stage trials in breast cancer using molecular oncology technology.

Newly appointed research chief Reed will start the job on July 1, when industry veteran Elias Zerhouni retires.

Under Zerhouni’s leadership, Sanofi has tried to improve research and development productivity but still struggled to find enough new products to offset the impact of weak diabetes drug sales.

It has also been looking to acquisitions to fill its pipeline.

It struck two big deals in January, agreeing to buy U.S haemophilia specialist Bioverativ for $ 11.6 billion and Belgium’s Ablynx, which is developing an experimental drug for a rare blood disorder, for 3.9 billion euros.

Editing by Elyse Tanouye and Pravin Char

Severe obesity rates surging in rural America

(Reuters Health) – Severe obesity rates have been on the rise nationwide since the turn of the century, disproportionately affecting children and adults in rural communities, two U.S. studies suggest.

Researchers examined data on height and weight collected from 2001 to 2016 for adults 20 and older and for youth ages 2 to 19. Severe obesity rates were higher in rural areas for youth as well as for men and women, while overall rates of obesity were higher only for rural women, researchers report in JAMA.

In rural communities, severe obesity rates more than tripled for men and more than doubled for women during the study period, while climbing 29 percent among young people. Obesity rates in rural areas, meanwhile, rose about 9 percent among children and teens and about 36 percent for adults.

“A major finding that surprised us was this difference between obesity and severe obesity,” said Cynthia Ogden of the U.S. Centers for Disease Control and Prevention in Hyattsville, Maryland.

“Severe obesity affects quality of life and has serious health risks,” including an increased risk of premature death and several cancers, Ogden, lead author of the youth study and senior author of the adult study, said by email.

About 10 percent of rural men had severe obesity in rural communities by the end of the study period, compared with 4 percent of urban men, the adult study found. Almost 14 percent of rural women had severe obesity, compared with 8 percent of urban women.

Differences in education levels, smoking status, age, and racial demographics in rural versus urban communities didn’t appear to explain the different rates of obesity and severe obesity among adults.

More than 9 percent of rural youth had severe obesity by the end of the study period, compared with about 5 percent of urban children and teens.

Obesity and severe obesity were more common among black and Hispanic youth than white children and teens, and also more likely to develop in older youth and children from households headed by an adult with limited education.

Children and teens are considered obese when their weight is higher than 95 percent of other youth their same age and sex. They’re considered severely obese when their weight is 20 percent higher than the cutoff for obesity.

For adults a body mass index (BMI) of at least 30 is considered obese, and a BMI of at least 40 is classified as severely obese. (An online BMI calculator for adults is available from the U.S. Centers for Disease Control and Prevention, here: bit.ly/2ylWKJC.)

One drawback of using BMI is that it doesn’t distinguish between muscle and fat. Therefore, obesity rates might not have been as high as they appeared, particularly among the adults.

The studies also weren’t controlled experiments designed to prove whether or how certain aspects of rural life might obesity more likely to develop.

“When looking at the global epidemic of obesity, we ironically often blame urbanization as a factor due to urban centers having more fast food locations, a pace of life where there is less emphasis on family meals, and work environments that are not physically taxing,” said Dr. Rekha Kumar of Weill Cornell Medicine’s Comprehensive Weight Control Center and NewYork-Presbyterian in New York City.

“We have passed that stage in the U.S. and measures are being taken in some but not all urban areas to prevent obesity,” Kumar, who wasn’t involved in the studies, said by email. “All (of) these factors such as energy sparing technology, fast food, and desk jobs have now reached rural areas as well in the U.S. so we are seeing an escalation of the obesity epidemic.”

No matter where people live, the key to preventing and reducing obesity comes down to healthy eating and regular exercise, said Ashlesha Datar, a researcher at the University of Southern California in Los Angeles who wasn’t involved in the studies.

“The only difference is that folks in rural areas are at a higher risk and we need to figure out whether that is due to lack of opportunities for pursuing healthy behaviors or other constraints,” Datar said by email. “What might work for people in the cities might not necessarily work for those in rural areas.”

SOURCE: bit.ly/2th8uY4 and bit.ly/2ypKY0R JAMA, online June 19, 2018.

Fathers' antidepressant use doesn't worsen babies' health risks

(Reuters Health) – Fathers’ use of antidepressant medications around the time mothers become pregnant does not increase babies’ risk of preterm birth, birth defects, autism or intellectual disability, according to a study in the BMJ.

Study leader Sven Sandin of the Icahn School of Medicine at Mount Sinai in New York City told Reuters Health by email that while it has generally been assumed that paternal use of antidepressants holds no risk for a developing baby, this previously had not been well-studied.

The results were not “a big surprise,” he said, but are nevertheless important, since there has been extensive research into the risks of mothers taking antidepressants, but less attention paid to fathers.

“Depression and anxiety disorders are very common and many potential fathers take antidepressant medication to treat these illnesses,” he wrote. “The findings from this study are reassuring for men using antidepressant medication, showing that this does not increase risk of autism, intellectual disability or birth defects for their infants.”

Sandin and colleagues studied 170,508 Swedish children who were conceived between 2005 and 2007. The team tracked the children’s outcomes through December 31, 2014 using the Swedish Medical Birth Register and the Swedish National Patient Register. They also used the Swedish Prescribed Drug Register to identify fathers who filled prescriptions of antidepressant drugs around the time of conception and after a child was conceived, as well as fathers who did not take any antidepressants.

After controlling for factors such as paternal and maternal age and history of psychiatric disease, the researchers found that fathers’ use of antidepressant medications at conception did not increase the risk to their offspring. They did find an increased risk of intellectual disability in offspring of fathers who initiated treatment after conception, but Sandin said this may be a chance finding.

“Use after conception cannot affect the infant,” he said.

Dr. Anna Sara Oberg of the department of Medical Epidemiology & Biostatistics at the Karolinska Institutet in Sweden said she and fellow researchers published a similar analysis of the same data focused on maternal antidepressant usage in the Journal of the American Medical Association last year. She said the new findings support previous research indicating that underlying conditions and patient characteristics – rather than antidepressant medication itself – may influence the risk of neurodevelopmental disorders in children. Ideally, she said, the new study would have tracked the outcomes of children past the age of 8 or 9, since some children may not receive a diagnosis by that age.

“As a result, these findings may target the more manifest and/or severe cases,” she wrote in an email to Reuters.

Dr. Sonia Hernandez-Díaz, a professor of epidemiology at the Harvard T.H. Chan School of Public Health, said that there had been “no real concern in the scientific community about paternal exposure.” She said that, for years, studies had implied a possible connection between maternal use of antidepressants and the development of neurodevelopmental or mood disorders in children. An increasing body of evidence shows that it is likely not these medications, but, rather, the mental disorders that led the mothers to take the medications – or associated environmental or genetic factors – that increases babies’ risks for these problems.

“It is a sensitive issue and the possibility of an effect of taking medications and hurting your child has created suffering and guilt in women,” she wrote in an email to Reuters.

“We have learnt from what we have done to moms, that we need to be extra careful and thoughtful before screaming ‘wolf,’” she added. “In this sense, a negative study is important to publish and communicate because had it been ‘positive’ (i.e., found an increased risk) it would had been on the cover of the magazines.”

SOURCE: bit.ly/2lnO109 BMJ, online June 8, 2018.

Canada Senate approves recreational use of marijuana

TORONTO (Reuters) – Canada’s upper house of parliament on Tuesday approved a revised bill to legalize recreational marijuana, setting the stage for the country to become the first Group of Seven nation to legalize cannabis.

A Canadian flag with a marijuana leaf on it is seen during the annual 4/20 marijuana rally on Parliament Hill in Ottawa, Ontario, Canada, April 20, 2017. REUTERS/Chris Wattie

The Senate voted 52-29 in favor of the revised bill from the elected House of Commons, paving the way for a fully legal cannabis market within eight to 12 weeks.

Prime Minister Justin Trudeau’s Liberals had made legalizing recreational use of marijuana part of their successful 2015 election campaign, arguing the new law would keep pot out of the hands of underage users and reduce related crime.

“It’s been too easy for our kids to get marijuana – and for criminals to reap the profits. Today, we change that. Our plan to legalize & regulate marijuana just passed the Senate,” Trudeau said in a tweet.

As the first major economy to fully legalize cannabis, Canada’s regulatory rollout will be closely watched by other nations considering the same path – and by global investors, who have already poured billions into Canadian marijuana firms.

Smoke rises during the annual 4/20 marijuana rally on Parliament Hill in Ottawa, Ontario, Canada, April 20, 2018. REUTERS/Chris Wattie

Canadian marijuana companies like Canopy Growth Corp, Aphria Inc, Horizons Marijuana Life Sciences ETF and Aurora Cannabis Inc have been at the center of investor frenzy surrounding attempts to legalize marijuana for recreational use nationwide.

Legalization has already been delayed from the government’s initially planned July launch.

While production of cannabis is regulated by the federal government, provinces and cities have more powers over retail sales either through private or government-owned stores.

“I’m feeling just great,” CBC News quoted Tony Dean, who sponsored the bill in the Senate, as saying. “The end of 90 years of prohibition. Transformative social policy, I think. A brave move on the part of the government.”

Reporting by Denny Thomas; Editing by Lisa Shumaker

Stress disorders tied to increased risk of autoimmune diseases

(Reuters Health) – People who suffer from posttraumatic stress disorder (PTSD) and other stress-related psychiatric issues may be more likely to develop autoimmune diseases than individuals who don’t, a Swedish study suggests.

Researchers studied 106,464 people diagnosed with stress disorders. 126,652 of their siblings without stress disorders, and more than 1 million other individuals in the Swedish population who didn’t have stress disorders.

They were able to track half these people for at least 10 years. During the study, individuals with PTSD were 46 percent more likely to develop an autoimmune disorder, and more than twice as likely to develop at least three autoimmune disorders, compared to adults without stress disorders.

“Severe or prolonged emotional stress causes alterations in multiple bodily functions through dysregulation in the release of stress hormones,” said lead study author Dr. Huan Song of the University of Iceland in Reykjavík and the Karolinska Institute in Stockholm, Sweden.

When PTSD patients took commonly prescribed anti-depressants known as selective serotonin reuptake inhibitors (SSRIs) during their first year after diagnosis, however, their risk of developing autoimmune disorders appeared to decline.

PTSD patients who took SSRIs for at least 320 days that first year after diagnosis were 82 percent more likely to develop autoimmune disorders than individuals without stress disorders, the study found. When PTSD patients took SSRIs for 179 days or less, however, they had more than triple the risk of autoimmune disorders.

“The main message to patients suffering from severe emotional reactions after trauma or other life stressors is to seek treatment,” Song said by email. “There are now several treatments, both medications and cognitive behavioral approaches, with documented effectiveness.”

Most people experience significant trauma or stress at some point in their lives, including the loss of loved ones and exposure to various disasters or violence, researchers note in JAMA. While many people gradually recover, some people can develop severe and lasting psychiatric illnesses.

Previous research has linked stress disorders to an increased risk of autoimmune disorders, but much of this work has focused on men who developed PTSD related to military service.

Immune problems can often run in families, and studies to date also haven’t offered a clear picture of how much shared parentage or life circumstances might explain the connection between stress and autoimmune disorders.

When people have an autoimmune disorder, the body’s immune system attacks healthy cells. Common autoimmune disorders include rheumatoid arthritis, lupus, ulcerative colitis and Crohn’s disease, celiac disease, multiple sclerosis, and type 1 diabetes.

Roughly 9 in every 1,000 people diagnosed with stress disorders in the study developed autoimmune disorders each year, researchers calculated. That compares to about 6 in 1,000 people in the population without stress disorders, and 6.5 in 1,000 siblings.

“It’s a bit surprising that there is not a big difference between siblings and general population,” said Dr. Johnny Ludvigsson, a researcher at Linkoping University in Sweden who wasn’t involved in the study.

“One would have expected more importance of genetic background,” Ludvigsson said by email.

The connection between stress and autoimmune disorders was stronger for endocrine problems like diabetes and weaker for skin and blood conditions.

Still, the results offer fresh evidence of the complex ways the brain can influence the immune system, and visa versa, said Dr. Michael Eriksen Benros, head of research at the Mental Health Centre Copenhagen in Denmark.

“There clearly is bidirectional interplay between the immune system and the brain,” Benros, who wasn’t involved in the study, said by email.

“Long-term psychological stress can influence multiple bodily systems including stress hormone levels and the autonomic nervous system resulting in impairment of immune functioning,” Benros added. “This can lead to increased autoimmune disease activity and trigger exacerbations of autoimmune diseases or make individuals more prone to acquiring infections that together with genetic factors are believed to be the main etiological factors for autoimmune diseases.”

SOURCE: bit.ly/2lll5pW JAMA, online June 19, 2018.

Good social media experiences don't outweigh bad ones for young adults

(Reuters Health) – For young adults, the adverse effect of negative social media experiences on mental health outweigh any potential benefits of positive experiences, a study of university students suggests.

Each 10 percent increase in a student’s negative experiences on social media was associated with a 20 percent increase in the odds of depressive symptoms, researchers found.

But positive experiences on social media were only weakly linked to lower depressive symptoms. Each 10 percent increase in positive social media interaction was associated with only a four percent drop in depressive symptoms – a difference so small that it might have been due to chance.

“This is not inconsistent with the way we see things in the offline world . . . The negative things we encounter in the world count more than positive ones,” said study leader Brian A. Primack, director of the Center for Research on Media, Technology and Health at the University of Pittsburgh in Pennsylvania.

“If you have four different classes in college, the fourth class that you did poorly in probably took up all your mental energy,” he told Reuters Health by phone.

Primack said he believes social media lends itself to negativity bias because it is saturated with positive experiences that leave people jaded.

As reported in the journal Depression and Anxiety, Primack and colleagues surveyed 1,179 undergraduate and graduate students, ages 18 to 30, at the University of West Virginia in August 2016. They asked students to estimate what percentage of their social media interactions were positive or negative. They also assessed students’ depressive symptoms using a four- item standardized questionnaire called the Patient -Reported Outcomes Measurement Information System (PROMIS) scale. Participants were asked how frequently in the past seven days they had felt hopeless, worthless, helpless or depressed.

Sixty-two percent of participants were female. The majority were white. About half were single, and about half were at least 20 years old.

This is not the first time researchers have tried to gauge the effects of social media. According to a study published online last month by the Pew Research Center, teens have mixed views on the impact of social media on people their age. Thirty-one percent of teens said social media’s impact is mostly positive impact, 24 percent described it as mostly negative, and 45 percent felt social media have neither positive nor negative effects. (pewrsr.ch/2liERlN)

Aaron Smith, associate director of research on internet and technology issues at Pew Research Center in Washington, DC and a coauthor of that study, told Reuters Health that teens who reported a negative impact of social media were troubled by bullying and rumors, among other things.

Among the limitations of the study by Primack’s team is that the subjects aren’t representative of a broad swath of the public, so the results cannot be generalized to a more diverse population. Also, the authors acknowledge, participants may have under-reported their depression. Furthermore, the researchers did not have enough information to disentangle cause and effect.

Michael Schoenbaum, senior advisor for mental health services, epidemiology and economics at the National Institute of Mental Health, told Reuters Health in a phone interview that he found the new study “deeply frustrating.”

“There are lots of important questions about the role of social media in our psychological lives and, in particular, how the effect that social media might have on people with psychological distress or on people who are vulnerable to psychological distress . . . and I don’t think this study answer all of these questions,” he said.

Schoenbaum added, “One cognitive error in social media is to imagine if you turn it off your social life is over . . . As a researcher, but also as a parent, I definitely think turning it off needs to be an option.”

SOURCE: bit.ly/2yo2xhQ Depression and Anxiety, online June 6, 2018.

California deals with dementia among aging inmates

STOCKTON, Calif. (Reuters) – California prison inmate Richard Arriola does not remember the digestion problems that drove him to the doctor on a recent morning, or details of the conviction for child molestation that sent him to prison at age 88.

Arriola is one of about 18,400 inmates over the age of 55 in California prisons, according to the California Department of Corrections and Rehabilitation.

It is a swelling population that has led authorities to take the first steps toward creating a dementia unit at the state’s main prison medical facility in the San Joaquin Valley city of Stockton, Reuters has learned.

“We have identified a specific need for a specialized unit for our dementia population and are in the very early phases of concept development,” said Elizabeth Gransee, spokeswoman for California Correctional Health Care Services.

The wing would mark a shift from California’s earlier efforts to treat prisoners with cognitive decline, relying on inmate volunteers and a modest staff to help them rather than a more expensive medical unit.

Reuters visited two California prisons recently to look at the challenges states face, as improved medical care, long sentences from tougher crime laws, and a steady increase of older adults entering prison has contributed to an extraordinary rise of elderly inmates.

In California, seven percent of the state’s 130,000 prisoners were over the age of 60 in 2016, the most recent year for which data is available, compared to just 1 percent 20 years earlier, according to a report by the California Department of Corrections and Rehabilitation.

“We and all of the jails and prisons around the country need to be able to do a better job with individuals who have cognitive impairment,” said Dr. Joseph Bick, chief medical executive at the California Medical Facility in Vacaville.

Throughout the United States, states are grappling with similar challenges as prisoners age. Inmate medical costs amount to about $ 3 billion per year nationwide, according to a recent report by the state of Georgia, where medical care for inmates over the age of 65 costs $ 8,500 per year, compared to $ 950 for those who are younger, the report showed.

Nationwide, 44 percent of inmates over the age of 50 have disabilities, compared to 27 percent of prisoners overall, a 2015 report by the Department of Justice shows. About 20 percent have cognitive disabilities, the report showed.

ROUND-THE-CLOCK CARE

Prisoners with cognitive decline can require round-the-clock care and help with dressing themselves, brushing teeth and going to the restroom. Because prison life – and for many, life on the streets before prison – is so difficult, inmates are considered geriatric after the age of 55 in California and many other states.

Arriola, who is housed with about 2,600 prisoners with chronic conditions at the California Health Care Facility in Stockton, came on a Thursday morning in May for a follow-up visit with a gastroenterologist. But he talked distractedly to the doctor, and said he did not recall having stomach problems.

It is not an uncommon situation at the Stockton facility, where physicians and nurses are trained to work with an increasing number of patients experiencing cognitive decline, said Dr. Anise Adams, the chief medical officer.

About 500 prisoners are being treated for dementia or Parkinson’s Disease in California prisons, including 200 at Stockton, officials said.

An inmate sits in the yard of a cellblock which mainly houses prisoners with cognitive decline, Alzheimer’s, and dementia, at the California Health Care Facility in Stockton, California, U.S., May 24, 2018. REUTERS/Lucy Nicholson

“It’s hard for them to explain to the nurses what they want or how they feel,” said inmate Scottie Glenn, 47, who participates in a program in which able-bodied inmates help those who are ill.

On a recent May morning, Glenn, who is serving 25 years to life for murder, was assisting a wheelchair-bound inmate who needed to see a doctor. Sometimes, he writes letters for inmates, or helps them to communicate.

HOSPICE CARE

Older inmates’ needs have led the state to build a large dialysis center, stock hundreds of wheelchairs and offer assistance with hearing and declining vision. Stockton’s medical facility has a physical therapy center, and a palliative care unit is set to open in the next few weeks.

The California Medical Facility in Vacaville set up a hospice decades ago during the AIDS crisis, which now houses more inmates dying of old age diseases, officials said. The state expects to spend about $ 26,000 per inmate on health care next year.

Once a dementia unit is set up, California would follow New York, which opened one for its much smaller prison population in 2006. New York spends about $ 2.7 million annually to care for 29 patients in the unit, the state corrections department said.

California officials say it is too soon to know how much the unit they hope to create will cost, but it would not be difficult to re-purpose an existing ward for use by dementia patients.

Such patients wake up in the middle of the night not knowing where they are, requiring trained staff to comfort them. Others behave in ways that normally get an inmate in trouble, such as batting away a doctor’s hand during an injection.

In a normal prison ward, that is considered assault, said Captain Paul Vasquez, whose job includes reviewing behavioral issues at the Stockton facility.

Inmates can be handcuffed, lose privileges and even be sent to the Security Housing Unit, where prisoners are kept in near-isolation, he said.

“We need to learn to respond to them a different way – and not in a regular mainline type of prison,” Vasquez said.

For photo essay please click on: reut.rs/2lhHvs5

(For a graphic on ‘At the end of the sentence’ click tmsnrt.rs/2JY2D1d)

Slideshow (31 Images)

Reporting by Sharon Bernstein; Additional reporting by Jane Ross; Editing by Bill Tarrant and Diane Craft

Trump administration puts skimpy health insurance plans in place

NEW YORK (Reuters) – The Trump administration on Tuesday issued a finalized rule that will enable millions of Americans to buy skimpy health insurance plans that do not comply with key Obamacare coverage requirements, marking its latest effort to chip away at the healthcare law. 

U.S. President Donald Trump, next to ‪Vice President Mike Pence‬, delivers remarks at a meeting of the National Space Council at the White House in Washington, U.S. June 18, 2018. REUTERS/Jonathan Ernst

The rule, which the U.S. Department of Labor will post Tuesday, allows small businesses and those who are self-employed to band together and buy lower-cost health insurance policies, similar to large employers. 

But these insurance plans would not be subject to requirements under the Affordable Care Act (ACA), commonly called Obamacare, which included mandatory coverage for a set of 10 essential health benefits, such as maternity and newborn care, prescription drug costs and mental health treatment. They are expected to be far less expensive than Obamacare plans. 

Health providers, insurers and medical groups have warned that the plans could drive up premiums and make insurance unaffordable for some people by siphoning off healthy consumers who want cheaper coverage, leaving behind a sicker patient pool with higher medical costs in Obamacare plans.

The finalized rule is the Trump administration’s most recent effort to provide consumers with alternatives to Obamacare, former Democratic President Barack Obama’s signature domestic policy achievement. Republicans, who control both chambers of Congress and the White House, repeatedly failed last year to repeal and replace the law, a top presidential campaign promise of President Donald Trump.

Democrats blasted the rule as the latest effort by Republicans to sabotage Americans’ healthcare.

“The Republicans agenda is to inflict higher costs on sick Americans just to hand tax breaks to big corporations and billionaires,” House Minority Leader Nancy Pelosi said in a statement.  

Republicans repealed the ACA’s so-called individual mandate, the requirement that most Americans purchase health insurance or else pay a fine, in an overhaul of the U.S. tax code last year. Trump last year also ended billions of dollars of insurance subsidies under the law. Both were aimed at keeping ACA insurance plans more affordable for millions of Americans.

Republicans have praised the new rule as providing cheaper health insurance options to those who cannot afford Obamacare plans or who do not want them.

Additional reporting by Caroline Humer; Editing by Bill Berkrot