Category: Health

Oct. 26, 2022 – Trapper Haskins, a 45-year-old musician with type 1 diabetes, says the price of insulin is a constant stressor in his life. The Nashville resident takes two types of insulin daily and sometimes must ration the medicine because his insurance plan caps how much of the pricey drug he can receive each month. Insulin “isn’t like a high blood pressure medication,” he says. “Some days you need more, and then you get to the end of the month and you’re afraid you’ll run out.” 

Research shows that among people with type 1 and type 2 diabetes, about one in four must ration their supplies due to cost. In general, most people with diabetes need two or three vials of insulin a month. Each vial can cost hundreds of dollars, meaning patients’ costs could easily reach $1,000 a month.  

“The price of insulin has tripled in the last 10 years, and it’s creating a national crisis,” says Lizheng Shi, PhD, a professor of health policy at Tulane University in New Orleans.          .

There are 1.5 million people with type 1 diabetes in the U.S. who can’t buy their own insulin and are entirely dependent on it to keep their blood sugar in a safe range. The vast majority of people with diabetes, some 37 million, have type 2 diabetes, which usually results in the use of blood sugar-reducing medications until insulin is introduced later on because the body no longer responds to its own. 

The high cost of insulin is largely due to a lack of competition and too few makers of the current products, says Shi. One of the best hopes for more affordable insulin is to increase market competition and drive down prices with the introduction of so-called biosimilar drugs, which are highly similar versions of the original biologic medications – and typically far less expensive. 

Creating Competition in the Market 

In July 2021, the FDA approved the first biosimilar product that could be used interchangeably with current insulin products. Called Semglee, it’s a long-acting insulin analog and the generic form of Lantus, the world’s leading basal insulin, whose patent expired in 2016. Semglee, which is made by the drug company Mylan, is now available under some 2022 insurance plans and is approved for patients with type 1 and type 2 diabetes. But Semglee isn’t inexpensive – it’s around $133 per vial without insurance. Some versions of Lantus retail for more than $300. 

The introduction of insulin biosimilars won’t bring major price cuts anytime soon,  says Jing Luo, MD, an assistant professor of medicine at the University of Pittsburgh. One reason, he says, is that it takes years for drugmakers to develop  the expertise and capacity to scale up production of biosimilars. Still, Luo is optimistic that we’ll get there in the next 2-3 years, and once we do, it could mean insulin would cost 10 times less. 

Luo cites  the work of the nonprofit Civica Rx. In March, the organization announced it would produce large-scale generic insulin in an effort to drive down cost. 

The company will produce three forms of insulin to be used interchangeably with Lantus, Humalog, and Novolog. The products will be sold for no more than $30 a vial. They’ve already started building their manufacturing plant in Petersburg, VA, and will have products available for purchase by 2024, pending FDA approval.

Additionally, the state of California plans to produce its own generic insulin. The state is investing $50 million to make biosimilar insulin products and another $50 million to build a manufacturing facility. 

Not Soon Enough

But for many, price cuts aren’t happening fast enough. Allison Bailey of Ames, IA, who has type 1 diabetes, says that it can feel daunting sometimes to find a way to pay, but she couldn’t survive without the life-saving medication. At times, it’s cost her up to $500 to fill her prescription. Bailey was eventually able to adjust her prescription to a less expensive insulin, but the 35-year-old graphic designer says her insurance coverage still takes up a sizable chunk of her monthly expenses.

The introduction of biosimilars has not driven down the price of insulin fast enough for patients like Bailey, says Robert A. Gabbay, MD, PhD, chief science and medical officer at the American Diabetes Association. That’s why the association is pushing legislation to bring down insulin prices. It lobbied hard to establish a $35-per-month Medicare price cap that will go into effect in 2023. Now it’s focused its efforts on expanding the caps to private insurers, a move that was voted down by Republicans in Congress as part of the Inflation Reduction Act. 

“We want to see some transparency in pricing; right now, everyone just points fingers at each other and we don’t know who’s to blame,” Gabbay says. 

But people with diabetes like Haskins and Bailey agree that competition from biosimilars and price caps could help bring down what they view as the exorbitant prices for medications they need. “I’m lucky I have insurance, but for those who don’t, it’s often a life-or-death situation,” says Haskins

Oct. 26, 2022 – “We eat first with our eyes.” 

The Roman foodie Apicius is thought to have uttered those words in the 1st century AD. Now, some 2,000 years later, scientists may be proving him right. 

Massachusetts Institute of Technology researchers have discovered a previously unknown part of the brain that lights up when we see food. Dubbed the “ventral food component,” this part resides in the brain’s visual cortex, in a region known to play a role in identifying faces, scenes, and words. 

The study, published in the journal Current Biology, involved using artificial intelligence (AI) technology to build a computer model of this part of the brain. Similar models are emerging across fields of research to simulate and study complex systems of the body. A computer model of the digestive system was recently used to determine the best body position for taking a pill. 

“The research is still cutting-edge,” says study author Meenakshi Khosla, PhD. “There’s a lot more to be done to understand whether this region is the same or different in different individuals, and how it is modulated by experience or familiarity with different kinds of foods.”

Pinpointing those differences could provide insights into how people choose what they eat, or even help us learn what drives eating disorders, Khosla says. 

Part of what makes this study unique was the researchers’ approach, dubbed “hypothesis neutral.” Instead of setting out to prove or disprove a firm hypothesis, they simply started exploring the data to see what they could find. The goal: To go beyond “the idiosyncratic hypotheses scientists have already thought to test,” the paper says. So, they began sifting through a public database called the Natural Scenes Dataset, an inventory of brain scans from eight volunteers viewing 56,720 images. 

As expected, the software analyzing the dataset spotted brain regions already known to be triggered by images of faces, bodies, words, and scenes. But to the researchers’ surprise, the analysis also revealed a previously unknown part of the brain that seemed to be responding to images of food. 

“Our first reaction was, ‘That’s cute and all, but it can’t possibly be true,’” Khosla says. 

To confirm their discovery, the researchers used the data to train a computer model of this part of the brain, a process that takes less than an hour. Then they fed the model more than 1.2 million new images. 

Sure enough, the model lit up in response to food. Color didn’t matter – even black-and-white food images triggered it, though not as strongly as color ones. And the model could tell the difference between food and objects that looked like food: a banana versus a crescent moon, or a blueberry muffin versus a puppy with a muffin-like face. 

From the human data, the researchers found that some people responded slightly more to processed foods like pizza than unprocessed foods like apples. They hope to explore how other things, such as liking or disliking a food, may impact a person’s response to that food. 

This technology could open up other areas of research as well. Khosla hopes to use it to explore how the brain responds to social cues like body language and facial expressions. 

For now, Khosla has already begun to verify the computer model in real people by scanning the brains of a new set of volunteers. “We collected pilot data in a few subjects recently and were able to localize this component,” she says. 

Everyone has stress – even when you’re pregnant.

“Experiencing the whole range of human emotions while pregnant is to be expected,” says Elizabeth Werner, PhD, a researcher and assistant professor of behavioral medicine in obstetrics and gynecology and psychiatry at Columbia University Medical Center. “That’s normal and healthy, and what we should be doing.”

Don’t worry that everyday pressures, like working and taking care of other kids, will hurt your baby or your pregnancy, she says.

“There is no expectation that anyone lives a stress-free life,” Werner says. “That’s just not possible. Some stress in our lives, which we all have, is totally to be expected, and we’re not concerned about it being seriously detrimental to the fetal environment.”

Stress can describe many things, from daily worries to traumatic events like floods and earthquakes, or the complex impact of living in poverty, says Christine Dunkel Schetter, PhD, a researcher and professor of psychology and psychiatry at UCLA. Different types of stress will have different effects. 

“When you take stress in that context, there is no one answer,” Dunkel Schetter says. “There is considerable evidence that some forms of stress pose risk for the mother and the baby and the birth itself.”

What Does the Research Say?

Studies have shown that anxiety during pregnancy is a risk factor for earlier birth. A 2022 study led by Dunkel Schetter found that pregnant people who said they were anxious about their pregnancy, their baby, and giving birth were more likely to have shorter pregnancies. These results show anxiety is physiologically important and can affect when a person gives birth, she says.

Other studies have found that a birthing parent with serious anxiety during pregnancy can increase the risk of problems for the child later on – such as developmental delays, emotional reactivity, or behavior issues.

The takeaway: It’s important to get help to reduce anxiety, Dunkel Schetter says.

“What I want is for [pregnant people] to consider at the beginning of their pregnancy whether they might be anxious, or predisposed to anxiety, or worried about this particular pregnancy, and if any of those are true, seek the advice of their provider and look for online resources,” she says.

Discrimination and racism cause major stress for people of color. That stress can impact pregnancy – a 2008 study found that African American pregnant women who experienced more racism in their lives and their families’ lives were more likely to have babies with low birth weight.

Serious emotional distress and the impact it has on your lifestyle – like nutrition and sleep – can change the environment in your uterus, Werner says. Those changes are complicated and still being studied, but distress can alter how the placenta works, and affect your hormones that respond to stress.

“We’re seeing hints, but we have a long way to go to really understanding mechanistically the complex relationship with how all those things happen, also keeping in mind that the postpartum environment is hugely important, and the brain is tremendously plastic, especially the infant brain,” Werner says.

Even if a baby’s parent had extreme stress during pregnancy, later problems aren’t inevitable. “You may be more at risk, but a really healthy and nurturing postpartum environment can really change that,” Werner says.

When to Get Help for Stress

Taking care of your mental health during pregnancy is a positive step for you and your future baby.

“If you are really struggling with anxiety or with a mood disorder, it’s a really great time to engage in treatment,” Werner says. “Maybe you’ve felt really overwhelmed by it, or it’s been something you’re avoiding. Sometimes this can be a great period where you feel motivated in a new way.”

Though having worries is normal, if it feels like they are stopping you from living a full life, think about getting treatment, she says.

“The degree to which it’s influencing your ability to do other things is probably a good indicator,” Werner says. “If you’re just so consumed with worry all the time that it’s really getting in the way of other things, that’s probably a really good time to reach out and get help.”

Many OB/GYN offices screen all pregnant patients for anxiety and depression with a questionnaire about how you’re feeling; ask your doctor to be screened if you haven’t been.

If your anxiety is making it hard for you to leave the house, or if you feel unable to get out of bed, find help. Pay attention to changes in your eating and your moods, Werner says. Friends, family, or your partner might also notice changes in your mental health.

“There are a variety of ways that anxiety and depression manifest, in both the way we’re thinking and our behavior,” Werner says. “Sometimes we think it’s just part of life, this level of suffering, but sometimes there are ways in which mental health professionals can help to reduce that and lead to a life that feels less painful.”

How to Find Help

Talk therapy can be very helpful for dealing with stress and anxiety during pregnancy, Werner says. Ask your OB/GYN or regular doctor if they can recommend mental health professionals in your area. You can also check with your insurance company to find services.

It can take work to find a therapist, so keep looking if you run into problems finding someone available and affordable, Werner says.

Cognitive behavioral therapy, which teaches techniques to manage anxiety, can be effective for coping with prenatal anxiety, Dunkel Schetter says. Mindfulness meditation can also help you live in the present and let go of distressing feelings, she says.

Everyday ways of taking care of yourself can relieve some stress, too. Find social support from friends and family, Dunkel Schetter says. Exercise – moderately, as your doctor recommends – and eat nourishing foods.

“All these things are part of a healthy pregnancy and can be helpful for stress management,” she says.

There are many tools to treat atopic dermatitis (AD), both over-the-counter and prescription. You can try ointments and creams, or your doctor might suggest light therapy, or medications you take by mouth or get as a shot.

“There are constantly new treatments arising for atopic dermatitis that help lessen the burden and make treatment more effective,” says Geeta Patel, DO, founder of River Oaks Dermatology in Houston.

“Topical steroids are currently the mainstay of treatment, but they’re not always the most effective,” she says. What works well for one person doesn’t always work well for another. It may take time to find the right treatment.

Your doctor will make recommendations based on how severe your AD is and what areas of your body it are affects.

Best Treatments for Mild AD

“Mild atopic dermatitis usually involves topical therapy,” Patel says. If you have mild AD, your doctor may recommend one of these topical treatments:

Topical steroids. These creams or ointments relieve itch and ease inflammation. You put them on red or inflamed skin.

Topical steroids come in different strengths. Prescription steroids are usually more effective than over-the-counter products. The stronger it is, the more effective it may be to control inflamed skin. But it may have more side effects, like thinning your skin. Never use high-strength steroids on your face, armpits, or groin. For long-term use, get the lowest strength you can.

Topical calcineurin inhibitors. These creams and ointments have drugs that target your immune system to suppress inflammation and ease symptoms of itching in mild to moderate AD. They’re safe to use long-term. You put them on after you moisturize your skin, but some have rules about how soon you can use them afterward, so check the prescribing info. Examples are pimecrolimus (Elidel) and tacrolimus (Protopic).

Topical PDE4 inhibitors. These topical medications put the brakes on inflammation by blocking PDE4, an enzyme that triggers it. They reduce itching, redness, thickened skin, and oozing in mild to moderate AD. Right now there’s only one FDA-approved PDE4 inhibitor. It’s called crisaborole (Eucrisa). It’s approved for people ages 3 months and older, and you can use it long-term on all body parts.

If you have mild AD, your doctor may also tell you to:

• Avoid triggers
• Moisturize after bathing
• Eat well
• Manage stress
• Sleep well

Best Treatments for Moderate to Severe AD

If you have moderate or severe AD, your doctor may recommend:

Wet wrap therapy. With this treatment, you wrap the affected skin with wet bandages after you apply moisturizers or topical corticosteroids. “Wet dressings help relieve itching, heal your skin, and help your creams or ointments to be more effective,” Patel says.

Your doctor will tell you how to do it and how often.

Oral medications. If creams don’t work, your doctor may recommend oral medication. “These work by slowing your immune system response, which can help to reduce the severity of symptoms,” Patel says.

Ultraviolet light or phototherapy. “Light therapy is often used to treat severe eczema that doesn’t respond to creams,” Patel says. The treatment exposes your skin to a controlled amount of natural sunlight, UVA, or UVB light to help with symptoms.

It usually involves going to your dermatologist’s office 2-3 times a week. Try to be patient. “It can sometimes take 1-2 months to take effect,” Patel says.

Dupilumab (Dupixent). This new lab-made medication can lessen inflammation, itching, how severe the disease is, and how far it has spread. You get it as a shot. Your doctor may recommend it if other treatments don’t work or if you can’t use products you rub onto your skin.

Complementary Treatments for AD

These treatments may help ease your symptoms:

Mind-body practices. “Stress can worsen atopic dermatitis,” Patel says. Managing it can help cut down on flares. Try mindfulness meditation, yoga, tai chi, acupressure, hypnosis, or biofeedback, where you learn how to control things your body does, like your heart rate, to help you relax. These practices may also help if you scratch a lot.

Massage therapy. Massage is known to relieve stress, so it may cut back on flares. Choose a therapist who’s accredited and has experience working with people who have similar skin conditions. Make sure they don’t use oils or lotions that might trigger your AD or make it worse.

Coconut oil. Studies suggest applying coconut oil to your skin may lower staph bacteria and help prevent infection. “Apply it once or twice a day to damp skin,” Patel says. Choose virgin or cold-pressed oils, which don’t have chemicals.

Sunflower oil. “Sunflower oil boosts the skin’s barrier function, helping it retain moisture. It also has anti-inflammatory properties,” Patel says. Put it on twice a day, once after bathing so your skin is wet.

You may have heard that vitamins, supplements, and probiotics help with AD. But there’s not enough research to support taking them, and they may be harmful if you’re taking certain medications.

Lifestyle Tips for AD

Take these steps to help your treatments work better and relieve symptoms:

Take a lukewarm bath. Keep it to 10-15 minutes. Then pat your skin dry and apply moisturizer while it’s still damp.

Moisturize twice a day. Apply moisturizing cream at least twice a day to strengthen your skin’s barrier.

Prevent scratching. If your skin is itchy, try pressing it instead of scratching. “Covering the itchy area also helps stop you from scratching it,” Patel says.

Use a humidifier. “Hot, dry indoor air can dry out sensitive skin and worsen itching and flaking. A portable home humidifier or one attached to your furnace adds moisture to the air inside your home,” Patel says.

Avoid irritants. Choose mild soaps and detergents without dyes or perfumes. Avoid fragrances and cosmetics with chemicals, wool and synthetic clothes, and smoke. Keep your home clear of dust mites. Avoid foods that might trigger a flare.

Take allergy medication. Over-the-counter antihistamines like cetirizine (Zyrtec) and fexofenadine (Allegra) may help with itching. If your itch is severe, you can try diphenhydramine (Benadryl). It may make you drowsy, so take it at bedtime.