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Sometimes numbers tell a story, but sometimes they obscure one. According to the latest figures from the National Cancer Institute, the death rate for people diagnosed with bladder cancer has hardly budged during the past 30 years. But experts who treat the disease tell a different and more hopeful tale—and they credit a surge in clinical trials for much of it. “In just the last five or six years, there has been quite a bit of work looking at new therapies for patients with bladder cancer, and we’re seeing unprecedented responses with some of these new drugs,” says Dr. Stephen A. Boorjian, professor and chair of the department of urology at Mayo Clinic in Rochester, Minn.

Some of the greatest advancements in bladder cancer treatment have involved a class of drugs called immune checkpoint inhibitors. They shift a person’s immune system activity in ways that help it fight cancer cells. “These have been paradigm-changing,” Boorjian says. “The way we treat bladder cancer is different than it was just five years ago.”

Others in his field tell a similar story. For people with both metastatic and nonmetastatic bladder cancers, the past half-decade has witnessed the introduction of dozens of promising new treatments. Some have been revolutionary, whereas others have led to incremental but important improvements in care. In every case, these advancements have depended on clinical trials and the people who take part in them.

“Clinical trials are how we got here,” says Dr. Guru Sonpavde, director of the bladder cancer program at Dana-Farber Cancer Institute and associate professor of medicine at Harvard Medical School in Boston. “All the new drugs we have coming out that have changed the outcomes for patients with bladder cancer—all of this has come from clinical trials.”

Clinical trials are carefully designed research studies, conducted in a medical setting, that help experts identify new or better ways to prevent, diagnose, or treat a disease. “Participating in a trial is often the only way to get access to new and promising drugs, or to therapeutic alternatives that may be better than standard of care,” Sonpavde explains.

Although pretty much every type of cancer is the subject of ongoing research, he says bladder cancer may be one of the hottest areas for clinical-trial work. Part of that is because of the prevalence of the cancer; bladder cancer is the sixth most common cancer in the U.S., with more than 80,000 new cases being diagnosed annually. But another factor is that, until recently, decades had passed without major breakthroughs in bladder cancer treatment. “We had some chemotherapies, but this was a cancer where we hadn’t seen many advances until about five years ago,” Sonpavde says.

Like Boorjian, he highlights the game-changing effect that immune checkpoint inhibitors have had on the treatment of bladder cancer. This and other advancements have led to an explosion in new research—and with it, a need for more people to participate in clinical trials.

Unfortunately, this need is not being met. “There are so many drugs and therapies being explored in this space that in some cases there hasn’t been enough patient participation to validate study results,” says Dr. Ashish Kamat, an endowed professor of urologic oncology and director of bladder cancer research at MD Anderson Cancer Center in Houston. “To obtain reliable results, trials need lots of patients, and until we have greater participation it’s going to be hard to move the needle as much as we’d like.”

How to find clinical trials

Part of the problem, Kamat says, is that a lot of people with bladder cancer may not be aware that they are eligible to take part in a clinical trial. Cancer doctors—especially those not affiliated with major research institutions—often fail to bring up these opportunities with their patients. “I’ve given educational talks to patient groups, and people have come up to me and said they had no idea this option existed,” he says. “In some cases they’ve ended up coming to Houston and participating.”

He recommends that patients broach the topic themselves; simply asking your doctor if clinical trials are worth exploring could be enough to get the ball rolling. Also, websites like ClinicalTrials.gov, which is maintained by the U.S. National Library of Medicine, provide up-to-date information about current research trials. You can easily search for clinical trials that are actively recruiting participants in your home state or city. Meanwhile, most major health systems and research institutions maintain their own patient-facing sites featuring clinical-trial information. For example, MD Anderson, Dana-Farber, and Mayo Clinic provide these online resources.

Not everyone with bladder cancer will be a good candidate for a clinical trial. For some, the current standard of care may provide the most effective treatment for the disease. “For a patient that has low-grade bladder cancer, a resection”—that is, surgical removal of the tumor—“has a very high cure rate,” Kamat says. “For this -patient, it may not be advisable to participate [in a trial] because the standard of care is so effective.”

On the other hand, the prognosis for those with metastatic bladder cancer—that is, a cancer that has spread to other parts of the body—may make the prospect of a trial more appealing. “Unfortunately for patients in this space, existing therapies aren’t providing durable long-term survival,” he says. Clinical trials may provide their best opportunity to beat the averages. They may also provide alternatives to invasive procedures. Kamat says that among those with non-muscle-invasive bladder cancer—a group that makes up about 75% to 80% of new bladder cancer -patients—some don’t respond well to the current drugs. These patients normally must have their bladders surgically removed. “This is a life-changing invasive procedure, and clinical trials may provide another option,” he says. Of course, every case is different and needs to be evaluated by a patient’s physician.

Some may be hesitant to sign up for what is essentially an experiment. But clinical trials are tightly regulated to ensure that those who participate are not exposed to undue risks. Dana-Farber’s Sonpavde says clinical trials are always built on a foundation of prior work that suggests the intervention—that is, the new treatment or other thing being studied—is at the very least not excessively risky compared with the current standard of care, and that there is evidence it may be beneficial. “Once a trial happens, you already have basic research showing the intervention is promising,” he says. There is always some element of risk. But with this risk comes the potential reward of gaining access to new and better cancer care, he says.

Read More: The Latest Breakthroughs That Could Help Bladder Cancer Patients

What it’s like to participate in a clinical trial

Let’s say you and your care team have identified a clinical trial that could be a good fit. You’ll next meet with someone affiliated with the trial who will make sure that you understand exactly what the experiment entails. You’ll get a thorough explanation of the study’s design, as well as any potential risks or drawbacks.

If you decide you want to proceed—that is, if you give your informed consent—you’ll likely undergo some type of screening process to ensure you meet the trial’s criteria. It may involve additional testing—scans, biopsies, blood tests—as well as an examination of your medical records. “Sometimes we start doing these evaluations and something comes out that renders the patient ineligible,” Sonpavde says. For example, the genetic makeup of your cancer may ultimately not fit the study guidelines, or you may be taking medications that would interfere with the treatment. But if screening goes well, you will likely begin the study soon—usually within one to three weeks.

It’s important to highlight that, in many clinical trials, some people do not get the new drug or novel treatment. In other words, they’re part of a “control” group that will help the study team assess whether the new intervention provides a benefit. “Generally, the trial will be comparing the new treatment to the standard-of-care treatment,” Sonpavde explains. In other words, even if you don’t get the new treatment, you’ll generally be no worse off than if you hadn’t enrolled.

Another benefit of participating in clinical research is that in some cases—whether you’re getting the new intervention or the control intervention—the cost of your treatment will be covered by the trial. Outside of a clinical-trial setting, some cutting-edge drugs would cost thousands of dollars—or they may not be accessible at all.

On the other hand, clinical trials usually will not cover the cost of lodging or transportation for those who participate. This can be a major barrier for those who don’t live in cities or near research institutions. Also, participants are typically not compensated.

Read More: Changing Cancer Care, So Patients No Longer Feel Like a Number

What’s happening now

Almost every facet of bladder cancer is now the focus of clinical research. But several areas are the subject of particularly intense interest.

Boorjian says novel treatments for non-muscle-invasive bladder cancer are one of the most active areas of research. He recently led a trial that looked at something called adenoviral vector therapy. “This involves instilling the novel medication into the bladder to stimulate the immune system to attack the bladder cancer,” he says. His trial found promising results, and his group is now recruiting participants for some related trials. Meanwhile, Boorjian says a lot of current research is looking at new and improved ways to deliver effective treatments. For example, some trials are examining time-released delivery mechanisms for drugs, which may offer advantages over standard intravenous injections. “We’re looking at better ways to administer medications to minimize the risk of toxicity,” he says.

Another hot area of bladder cancer research is focusing on personalized therapies for metastatic cancers. These precision medicines can be directed at specific targets identified on tumors. Boorjian mentions some new classes of therapies that are designed to target specific genetic mutations within a person’s cancer cells. “We’re starting to target therapies to those tumors, and this is another move-the-field-forward change,” he says.

Changing the story

The National Cancer Institute estimates that this year alone, more than 80,000 people will be newly diagnosed with bladder cancer. More than 17,000 people with bladder cancer right now will not live to see 2023. Improving these figures will depend on clinical trials and the people who participate in them.

“The only way we make further advances is for patients to take part in this work,” Sonpavde says. Again, not everyone will be a good fit, and participating in a trial may present some risks. But you lose very little—and stand to gain a lot—by exploring your options with your care team.

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Climate change has caused more intense wildfires, heat waves, floods and hurricanes, lengthened allergy seasons and inflicted other forms of tangible harm. But an oft-overlooked consequence — one that warrants urgent attention and creative problem-solving — is worsening mental health.

The COVID pandemic has been a time of enormous suffering. According to the World Health Organization, the prevalence of depression and anxiety increased 25% globally during the first year of the pandemic. We are bruised and vulnerable, struggling to right ourselves after a tumultuous two and a half years.

But the daily reminders of global warming, including extreme heat, water rationing and parched landscapes, are threatening to worsen the situation, and we don’t have medications or vaccines to save us.

Climate change has direct effects on mood

Heat itself is associated with mental illness. Mood disorders, anxiety and aggressive behavior have been linked to higher temperatures. A 2019 study published by the National Bureau of Economic Research, found that violent crime in Los Angeles increased by 5.7% on days when temperatures rose above 85 F compared to cooler days.

Authors of a 2018 study in the journal Nature predicted warmer temperatures could lead to as many as 40,000 additional suicides in the U.S. and Mexico by 2050.

“There is a direct link, and mental health and psychosocial well-being will decline as climate change pressures increase,” said Kerry Wangen, a psychiatrist in private practice in Southern California.

People who face climate-related natural disasters frequently struggle with mental health problems. Hurricanes and wildfires lead to deaths and property destruction in the short-term. But they also contribute to depression, anxiety, post-traumatic stress disorder and suicidal thoughts.

Droughts can disrupt food and water supplies and lead to loss of livelihood, which can push families and whole communities into poverty, a risk factor for mental illness. According to a Washington Post analysis, more than 40% of Americans live in a county that experienced an extreme weather event in 2021.

Climate change also leads to the displacement of populations, as parts of the globe become uninhabitable due to sea-level rise, drought and other weather events. The result is more conflict and stress, both of which increase the odds of mental health problems.

Grappling with pervasive fears

The existential fear of climate change is a more pervasive concern, even if it is more subtle and less disabling than mental illnesses triggered by acute events. Fear of global warming leaves many of us feeling hopeless and powerless, dreading what is to come and sensing it is inevitable.

“Although I’ve never had a patient present primarily for climate-related anxiety, it’s common to discover that it’s there alongside other social and societal fears,” said Daniel Hochman, an Austin-based psychiatrist.

A 2020 poll by the American Psychiatric Association found that 67% of Americans are somewhat or extremely anxious about the effects of climate change, and 55% are worried about its impact on their mental health.

According to Hochman, climate anxiety — also referred to as “climate distress,” “climate grief” or “eco-anxiety”— can manifest as dysthymia, in which people are sad for the state of the world, and contribute to generalized anxiety disorder major depressive disorder, panic disorder and insomnia.

For children and young adults, aware that they have the most to lose, the climate crisis is a common source of distress. In a global survey, published in The Lancet in December, nearly 60% of the 16- to 25-year-old respondents reported they were “very” or “extremely” worried about climate change. An additional 25% admitted feeling “moderately” worried. Over 45% said climate change has a negative impact on their daily lives.

What you can do about it

During this summer of record-breaking heat, efforts to combat climate change have seen failure and triumph. On June 30, the U.S. Supreme Court undercut the Environmental Protection Agency’s ability to regulate carbon emissions. Last week, however, Congress passed legislation that will provide nearly $400 billion in tax credits for clean-energy projects to slow global warming.

As we move to address the palpable effects of climate change, we’d do well to follow the WHO’s recommendations to include mental-health and psychosocial support. We also need to boost funding for mental health and climate-change mitigation.

Bob Doppelt, coordinator of the International Transformational Resilience Coalition and author of the forthcoming book Preventing and Healing Climate Traumas: A Guide to Building Resilience and Hope in Communities, laments the inadequacies of our “crisis- and illness-focused” mental health, social service and disaster-response systems.

To address the “climate mega-emergency,” he calls for a public health approach to prevent and heal trauma and is working on federal legislation to support community mental health and resilience.

For those, like me, who often stare at the weather forecast with a sense of doom, Wangen recommends channeling our concern into positive change. Here are a few ideas:

1) Get involved locally

“Find ways to do something, however small, to make an impact locally and/or on a bigger scale,” Wangen said. Increase stress-reduction practices, such as meditation and prayer, and focus “on the present day to keep perspective in the here and now where change can be made, and life can be lived.”

2) Focus on small signs of progress

Doppelt encourages people to “get engaged in an existing neighborhood or community-based coalition or join with friends and colleagues to form a new one that strengthens the entire population’s capacity for mental wellness and transformational resilience for accumulating adversities.” Small signs of progress, he said, help create a sense of hope.

3) Join the conversation

Other innovative strategies for addressing personal eco-anxiety include attending a Climate Café, which encourages climate conversations and political engagement. The Good Grief Network is another option that seeks to build resilience and encourages meaningful action.

4) Keep things in perspective

Hochman also reminds us to get some perspective. Compared to 30 years ago, extreme poverty and famine are lower, he points out. Prior to the pandemic, life expectancy hit an all-time high. Energy and clean water are more accessible.

“Despite climate change, this is by far the safest and best time to live,” he said.

This story was produced by Public Health Watch.

Lisa Doggett, an Austin physician and senior medical director of HGS AxisPoint Health, is a columnist for Public Health Watch, a nonprofit investigative news organization. The views expressed in her column do not necessarily reflect the official policy or position of HGS AxisPoint Health or Public Health Watch.

The Food and Drug Administation authorized reformulated versions of the Moderna and Pfizer-BioNTech vaccines that aim to protect against the omicron variant.

The new shots target both the original strain of the coronavirus and the omicron BA.4/BA.5 subvariants that most people are catching now. This double-barreled vaccine is called a bivalent vaccine.

“The FDA has been planning for the possibility that the composition of the COVID-19 vaccines would need to be modified to address circulating variants. … We have worked closely with the vaccine manufacturers to ensure the development of these updated boosters was done safely and efficiently,” said Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, in an agency statement. “The FDA has extensive experience with strain changes for annual influenza vaccines. We are confident in the evidence supporting these authorizations.”

The Moderna COVID-19 vaccine is authorized for use as a single booster dose in people 18 and older. The Pfizer-BioNTech booster is authorized for people 12 years and up. People are eligible for the new boosters two months after completing their initial vaccination or their last booster shot.

The federal government plans to make the boosters available starting next week. In advance of the FDA’s decision, Dr. Ashish Jha, the White House COVID-19 Response Coordinator told NPR that the new boosters represented “a really important moment in this pandemic.”

Public health officials hope they will help contain a possible fall and winter surge.

But there is also skepticism about how big a difference the boosters can make. “It could be problematic if the public thinks that the new bivalent boosters are a super-strong shield against infection, and hence increased their behavioral risk and exposed themselves to more virus,” John Moore, an immunologist at Weill Cornell Medicine in New York, told NPR before the FDA decision.

The Centers for Disease Control and Prevention has endorsed the first updated COVID-19 booster shots.

The decision came just hours after advisers to the CDC voted to recommend reformulated versions of the Moderna and Pfizer-BioNTech COVID-19 vaccines. The vote was 13 in favor and one no vote.

“The updated COVID-19 boosters are formulated to better protect against the most recently circulating COVID-19 variant,” Walensky said in a written statement announcing the recommendation.

“If you are eligible, there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it,” Walensky said.

The booster shots target both the original strain of the coronavirus and the omicron BA.4 and BA.5 subvariants that most people are catching now. This double-barreled vaccine is called a bivalent vaccine.

The CDC advisers recommended that anyone age 12 and older get the new Pfizer-BioNTech boosters as authorized by the Food and Drug Administration. The updated Moderna COVID-19 vaccine is authorized for anyone 18 and older.

In both cases people would have to wait two months after completing their initial vaccination or their last booster shot. But many vaccine experts say it would be better to wait at least four months since the last shot or COVID infection, or the boosters won’t work as well.

This is the first time the FDA has authorized COVID vaccines without requiring they get tested in people. To keep up with the rapidly evolving virus, the FDA relied on how well the shots stimulated the immune systems of mice. They also looked at how well similar shots targeted at earlier variants worked on people.

The companies and federal officials say there’s no question the shots are safe and they argue the evidence indicates the reformulated boosters will help reduce the chances people will catch the virus and spread it.

But some people wonder if it would be better to wait for the results from human studies that are already underway.

“It certainly looks very promising,” said CDC advisor Dr. Pablo Sanchez from The Ohio State University at Thursday’s hearing. “I understand the constant shift of these variants but studies with the BA.4 and BA.5 are ongoing in humans and I just wonder if it’s a little premature,” he said. Sanchez was the only adviser to vote no. “I voted no because I feel we really need the human data,” he explained. “There’s a lot of vaccine hesitancy already. We need human data.”

But other advisers were more comfortable, pointing out that flu vaccines are updated every year without being tested in people.

“This is the future that we’re heading for,” says Dr. Jamie Loehr of Cayuga Family Medicine. “We’re going to have more variants and we should be treating this like the flu, where we can use new strain variants every year.” Loehr says he’s comfortable recommending the updated boosters, “even if we don’t have human data.”

Committee chair, Dr. Grace Lee, professor of pediatric infectious diseases at Stanford Medicine recognized there is some uncertainty, “I want to acknowledge it,” she said. “And I just want to say that despite that I think we hopefully made a huge impact in our ability to weather this pandemic together.”

Between 400 and 500 people are still dying every day in the U.S. from COVID-19 and public health officials are worried another surge could hit this fall or winter. The administration hopes the reformulated boosters will help contain a surge and protect people from serious disease or death.

The federal government plans to make the boosters available quickly. In advance of the FDA’s decision, Dr. Ashish Jha, the White House COVID-19 response coordinator told NPR that the new boosters represented “a really important moment in this pandemic.”

Now the CDC has signed off, few shots could be available as early as Friday, with a wider rollout next week.

Receiving opioid use disorder-related telehealth care during the COVID-19 pandemic was associated with lower odds of medically treated overdose and better retention using medications like methadone and buprenorphine, according to a study published in JAMA Psychiatry. 

The research used data from Medicare fee-for-service beneficiaries ages 18 and older who had received a diagnosis for opioid use disorder based on ICD-10 codes. It was divided into two groups: a prepandemic cohort of 105, 240 beneficiaries and a pandemic cohort of 70, 538. 

Researchers found 19.6% of beneficiaries in the pandemic group received OUD-related telehealth services during the study period, compared with only 0.6% of patients in the prepandemic cohort. They were also more likely to access behavioral health-related virtual care at 41%, compared with 1.9% in the prepandemic group. Additionally, 12.6% of pandemic beneficiaries accessed medications for OUD, like methadone, buprenorphine and extended-release naltrexone, compared with 10.8% of the prepandemic beneficiaries. 

Though the percentage who experienced a medically treated overdose was similar in both groups, the study found receiving OUD-related telehealth was associated with increased odds of continuing to use medications for OUD and lowered odds of overdose. 

“Use of telehealth during the pandemic was associated with improved retention in care and reduced odds of medically treated overdose, providing support for permanent adoption,” the study’s authors wrote. “Strategies to expand provision of MOUD [medications for opioid use disorder], increase retention in care and address co-occurring physical and behavioral health conditions are urgently needed in the context of an escalating overdose crisis.”

WHY IT MATTERS

Though telehealth did increase access to medications for OUD, the researchers noted that only a small portion of patients received medications on 80% or more of eligible days. 

They also found racial inequities in access to care. Non-Hispanic African American beneficiaries had lower odds of receiving OUD or behavioral health-related telehealth services and lower odds for medication retention. The study also found higher odds of overdose among patients who were non-Hispanic African American, American Indian or Alaska Native, and Asian or Pacific Islander.

However, researchers said their study demonstrates telehealth could be an important way to deliver care to people struggling with opioid use disorder. 

“The expansion of telehealth services for people with substance use disorders during the pandemic has helped to address barriers to accessing medical care for addiction throughout the country that have long existed,” Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse and senior author of the study, said in a statement. “Telehealth is a valuable service and, when coupled with medications for opioid use disorder, can be lifesaving. This study adds to the evidence showing that expanded access to these services could have a longer-term positive impact if continued.”

THE LARGER TREND

The opioid epidemic continues to be a major challenge for public health. According to the CDC, overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021.

At the beginning of the COVID-19 pandemic, the Drug Enforcement Administration loosened regulations to allow providers to prescribe controlled substances, like medications for opioid use disorder, without meeting with patients in person during the public health emergency.

The PHE was extended again earlier this summer. Health and Human Services Secretary Xavier Becerra has promised to give providers 60 days’ notice before it expires. 

GoodRx, a company best known for its prescription price transparency tools, will lay off approximately 140 employees, making up about 16% of its workforce.

According to a filing with the Securities and Exchange Commission, the reduction will primarily affect its technology-focused and marketing segments.

“The company is focused on efficiently growing its core prescriptions business, accelerating its pharma manufacturer solutions business and doubling down on consumer engagement,” Karsten Voermann, GoodRx’s chief financial officer, wrote in the SEC filing. “As the company focuses on these goals, it is consolidating functions and eliminating or reducing investment in areas of lower focus.”

THE LARGER TREND

GoodRx posted a $1.4 million net loss during the second quarter, compared with $31.1 million in income during the prior-year quarter. It reported revenue of $191.8 million, a 9% increase from $176.6 million in the second quarter last year. 

The company also said it had resolved an issue with an unnamed national grocery chain – which analysts suspected was Kroger – that had affected the acceptance of pharmacy benefit discounts for some drugs. 

During its second quarter earnings call, GoodRx said it was focusing on developing new services and incentives to ensure users would create accounts on their platform, which it doesn’t require to provide a “frictionless” experience. 

“We believe the benefits of deeper relationships with our consumers will allow us to help them better navigate their healthcare journey with even more compelling GoodRx value proposition and user experience,” cofounder and co-CEO Trevor Bezdek said. 

“We also believe that allowing users to provide us more information will increase the LTV [lifetime value] of each user in prescription transactions and other areas of the business over time as we leverage it to create new tools and products for our users in quarters and years to come.” 

GoodRx’s announcement marks the latest in a line of digital health and health tech companies that have laid off workers this summer. Insider recently reported that telehealth services vendor Wheel cut 17% of its workforce in mid-August. 

AI-backed genomic and clinical data company Sema4 announced it had laid off around 250 workers, about 13% of its workforce, last month. Its founder Eric Schadt also stepped down from his roles at the company. Meditation app Calm also recently let go of 20% of its staffers. 

Others announcing layoffs over the past few months include Pear Therapeutics, Included Health, Olive, Cedar, Ro and Carbon Health.