Category Archives: Alternative Medicine

Early-stage research suggests that cannabis-derived medicines could be effective in treating various cancers. Recent experimental treatments and small-scale clinical trials have shown the importance of showing the efficacy of these medicinal cannabis formulations and will be a crucial and necessary path leading the way for medical cannabis to enter mainstream treatment for cancer patients.

For centuries, the plant Cannabis sativa L., has been used across the world as a herbal remedy. After ending its 50-year prohibition, medical cannabis was legalised in 2018 in the UK sparking renewed interest and research into the plants properties.

In cancer treatment, cannabinoids, the group of molecules, including CBD and THC, which constitute the active compounds in cannabis, have been primarily used as a part of palliative care to alleviate pain, relieve nausea and stimulate appetite. However, early-stage research and testing have suggested that medical cannabis may also be a highly effective treatment for killing cancer cells itself.

Several pre-clinical laboratory studies have shown that cannabinoids may reduce cancer cell growth and could disrupt the blood supply to cancerous cells, including brain tumours [1], breast cancers [2,3] and prostate cancer [4], among others.

As medicinal cannabis moves away from the novel and into the mainstream, pharmaceutical companies will need to ensure that these medical formulations comply with current pharmaceutical gold standards with respect to consistent dosing, routes of administration, stability, clinical efficacy and safety. The new medicines will need rigorous protected intellectual property via defendable international patents, with actual clinical efficacy in patient data.

Understanding how cannabis can treat cancer depends on the cannabinoids and the type of cancer in question, thus complicating the matter.

Results have shown that different cannabinoids can cause cell death (apoptosis), block cell growth through various inhibitors, stop the development of blood vessels (mTOR inhibitors) which are needed for tumours to grow, reduce inflammation through induction of apoptosis, inhibition of cell proliferation, suppression of cytokine production and induction of T-regulatory cells [5], and reduce the ability of cancers to spread (cell migration and metastasis).

With over 100 naturally occurring cannabinoids, there is no one size fits all for medical cannabis in cancer treatment. Cutting edge work using artificial intelligence (AI) is being carried out to analyse cannabis plant genetics and phenotypes, to determine the best combination of cannabinoids, terpenes and flavonoids to target and optimise the treatment of various cancers.

Numerous scientific papers looking at cannabinoids and cancer have been published to date. However, due to years of prohibition, cannabis and its role in oncology currently lack the robust scientific evidence gained through extensive clinical trials.

Before authorising human trials, potential cancer treatments can be tested through 2D or 3D cell culture testing. 3D cell culture models allow researchers to recreate specific pathophysiological environments and tumorigenic processes to identify potential biomarkers for therapeutic targeting or assessing cell response to therapies and drug efficacy.

The improvement in 3D cell culture technology has led to the generation of in vitro models that can encompass more physiological and tissue-specific microenvironments, with the aim to overcome the drawbacks observed in other pre-clinical models and have better predictive value for clinical outcomes.[6]

Despite the advancements in pre-clinical testing, the key to gaining cannabis full acceptance in the scientific community is real human data from clinical trials.

In the UK, researchers at the University of Birmingham are looking at the efficacy of Sativex commonly associated with the treatment of Multiple Sclerosis in treating Glioblastomas, the most common and most aggressive form of brain cancer. The second phase of human testing will assess whether adding Sativex to chemotherapy could extend the life of those diagnosed with Glioblastoma, which sadly has an average survival of less than 10 months [7].

Over in Europe, the University Medical Centre Groningen, in the Netherlands, is in phase II of testing the effect of cannabis oil on 20 liver cancer patients who have exhausted all other treatment options [8]. The trial, which launched in 2021, will run for three years and uses Transvamix which contains 10% THC and 5% CBD [9].

These small scale clinical trials need to be licenced and expedited globally. Knowledge sharing in the scientific community will help remediate the years of lost research through prohibition.

As our understanding of medical cannabis and its potential in oncology continues to grow, scientists are assessing the role of personalised medicines. As mentioned, with over 100 naturally occurring cannabinoids and many different types of cancer, there is no one size fits all for treatment.

Personalised medicine recognises that we are all physiologically unique and uses individual DNA sequencing to target treatment according to human microbiomes. As all cancers have a genetic base, personalised medicine is already commonly used in the traditional treatment of cancer. When combined with the powers of AI, personalised medicine presents a huge opportunity for medical cannabis and the treatment of cancer. It is estimated that one in two of us will get cancer within our lifetime [10] and in 2019, cancer caused more than one in four of all deaths in the UK [11]. By researching new alternative treatments, such as medical cannabis, we stand a real chance at improving survival rates and extending lives.

References

(1) Rocha, F. C. M., dos Santos Jnior, J. G., Stefano, S. C., & Da Silveira, D. X. (2014). Systematic review of the literature on clinical and experimental trials on the antitumor effects of cannabinoids in gliomas. Journal of neuro-oncology, 116 (1), 11-24.

(2) Apollon Formularies plc, https://polaris.brighterir.com/public/apollon_formularies/news/rns/story/r726zjw, Accessed January 2022

(3) Apollon Formularies plc, https://polaris.brighterir.com/public/apollon_formularies/news/rns/story/xq749kw, Accessed January 2022

(4) Apollon Formularies plc, https://polaris.brighterir.com/public/apollon_formularies/news/rns/story/x8ql8jx, Accessed January 2022

(5) Nagarkatti P, Pandey R, Rieder SA, Hegde VL, Nagarkatti M. Cannabinoids as novel anti-inflammatory drugs. Future Med Chem. 2009;1(7):1333-1349. doi:10.4155/fmc.09.93

(6) Law, A. M., Grundy, T. J., Fang, G., Valdes-Mora, F., & Gallego-Ortega, D. (2021). Advancements in 3D Cell Culture Systems for Personalizing Anti-Cancer Therapies. Frontiers in Oncology, 11, 782766-782766.

(7) The University of Birmingham, https://www.birmingham.ac.uk/news/latest/2021/08/cannabis-brain-tumour-clinical-trial.aspx, Accessed January 2022

(8) The University of Groningen, https://www.rug.nl/about-ug/latest-news/news/archief2021/nieuwsberichten/umcg-studies-cannabis-oil-for-liver-cancer-patients-with-no-further-treatment-options?lang=en, Accessed January 2022

(9) Bedrocan, https://bedrocan.com/umcg-starts-scientific-research-into-cannabis-oil-and-liver-cancer/, Accessed January 2022

(10) Ahmad, A. S., Ormiston-Smith, N., & Sasieni, P. D. (2015). Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960. British journal of cancer, 112(5), 943-947.

(11) Cancer Research UK, https://www.cancerresearchuk.org/health-professional/cancer-statistics/mortality/all-cancers-combined, Accessed January 2022

Please note: This is a commercial profile

2019. This work is licensed underCC-BY-NC-ND.

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Medical cannabis & the future of cancer treatments - Open Access Government

People who smoke e-cigarettes and hookahs may be at a higher risk of inflammation and cancers of the nose, sinuses, and throat because of the way they exhale when using these devices, according to a new study.

Researchers found that vapers and hookah users are more than twice as likely to exhale particles through their nose than people who smoke cigarettes, who typically exhale the emissions from their mouth.

This matters because the way vapers and hookah smokers use their devices may expose the nose and sinuses to far more emissions than cigarettes, which may in turn increase their risk of upper respiratory diseases, says the study's lead author,Emma Karey, PhD, a postdoctoral research fellow in the department of environmental medicine at NYU Langone Health in New York City. The findings were published on February 28 in Tobacco Use Insights journal.

Electronic cigarettes (e-cigarettes), electronic hookahs (e-hookahs), and vape pens allow the user to inhale a vapor that may contain nicotine as well as flavorings, solvents, and other chemicals. E-cigarettes and e-hookahs come in many shapes, including cigarettes, pipes, pens, USB sticks, cartridges, and refillable tanks, pods, and mods.

Cigarette smoking remains more popular than vaping; 16 percent of U.S. adults smoke, compared with 6 percent who report they have vaped (including the use of e-cigarettes) within the past week, according to a July 2021 Gallup poll.

Vaping is more popular among some groups:

To investigate how people used e-cigarettes, vaping devices, and hookahs, researchers discreetly observed 122 cigarette smokers and 123 vapers on the streets of New York City between March 2018 and February 2019. They also monitored 96 people smoking inside two Manhattan hookah bars.

They found 63 percent of vapers and 50 percent of hookah users exhaled through their nose, while only 22 percent of e-cigarette users did.

Investigators found that more than 70 percent of those who used pod-like devices exhaled through their nose at some point during the observation period, while 50 percent of modular tankstyle users did the same.

Dr. Karey points out that users may exhale through the nose because vaping products come in a variety of flavors, such as pineapple, bubblegum, and blue raspberry. Vapers may be more likely to exhale through their nose because scent enhances taste, she says.

In an earlier, related study, the researchers found increased damage in the nasal passages of vapers and hookah users. The device users had as much as 10 times higher inflammation than those who smoked traditional cigarettes.

This type of sustained inflammation is where we start to become concerned with pathologies and diseases; it suggests there may be sustained injury to that tissue, says Karey.

The link between how people smoke and their potential health risks has been seen before, says the study's senior author,Terry Gordon, PhD, a professor in the department of environmental medicine at NYC Langone Health. For example, when people smoke cigars, they dont inhale as deeply, and they get more oral cancers compared with cigarette smokers, who inhale more deeply, he says.

These findings are in line with what is already known about the risks these products bring, says Adam Goldstein, MD, MPH, a professor in the UNC department of family medicine and the director of tobacco intervention programs at the UNC School of Medicine in Chapel Hill, North Carolina. Dr. Goldstein was not involved in the new research.

We have already known for a long time that combustible tobacco products, like cigarettes, water pipes, and cigars, cause multiple cancers in multiple different organs of the body, including elevated risks for cancers related to nasal sinuses. These cancer-causing agents enter the bloodstream and tissues of most every organ, says Goldstein.

Although vaping is likely safer than combustible tobacco, at least in laboratory studies, that doesnt mean its safe, he says. Vaping exposes users to many toxic chemicals. Regardless of how they're smoked, smoking products like hookah are deadly to the user as well as those exposed to secondhand hookah smoke, says Goldstein.

E-cigarettes, vaping pens, and hookahs all may carry a different type of risk depending on how they are used, says Karey. The most important health endpoints may no longer be a one-size-fits-all for these new and emerging alternative products how people are using them may change where the risk ends up, she says.

Diseases of both the nose and lungs should be considered when evaluating different smoking methods before judging whether one is riskier than another, adds Dr. Gordon.

Goldstein questions whether further research on different tobacco products or potential differences in risks based on subtle changes in smoking behavior is whats needed. For instance, we spent two decades believing that filters on cigarettes made them safer. This belief was entirely false, and it distracted from our need to understand much better how people can attempt to and stay quit, he says.

E-cigarettes and vape pens have not been approved by the U.S. Food and Drug Administration (FDA) as a smoking cessation method, but some people use them that way. E-cigarettes have not been shown to be a safe or effective way to quit smoking, according to MedlinePlus.

Theres a divide in the health community about e-cigarettes and vaping, says Karey. These could be a harm-reducing tool if a person is going to either do this or smoke cigarettes. However, if adolescents are starting to smoke e-cigarettes and they never would have smoked cigarettes, youre introducing potential harm where there would have otherwise been no risk, she says.

The use of e-cigarettes may actually increase the likelihood of later cigarette smoking. A study published in February 2021 in Pediatricsfound that young people ages 12 to 24 who used e-cigarettes were three times more likely to eventually become daily cigarette smokers.

A few things to keep in mind when considering e-cigarettes, according to MedlinePlus:

Both the authors and Goldstein agree that the take-home message of the study should not be that vapers or hookah users should change the way they exhale. Instead, people should focus on the free resources that are available in every state to help people quit smoking for good, says Goldstein.

If you want to quit smoking, the CDC offers information and materials on how to get started.

Excerpt from:

Vapers and Hookah Users May Have Increased Risk of Diseases of the Nose - Everyday Health

They say a healthy outside starts with a healthy inside, but in this busy world, it can sometimes be difficult to connect with our bodies and hear what theyre trying to tell us.

Naturopaths are known for their ability to observe symptoms and treat patients using an individualistic and holistic approach. In doing so, naturopaths offer an alternative for people who find that traditional medicine hasnt been able to heal them the way they need.

Thanks to recommendations and votes from readers like you, we have compiled a list of the best naturopaths in Kamloops, presented to you by Valley First, a division of First West Credit Union.

Raised in Kamloops, Dr. Melissa Bradwell attended Thompson Rivers University and graduated with a Bachelor of Science degree. Because she had a passion for alternative medicine and health care, she continued her studies at the Canadian College of Naturopathic Medicine in Toronto, and later returned to Kamloops to become a local practitioner in 2006.

Dr. Melissa thinks that the patient should be in the driver's seat when it comes to their health. Her approach is helping people find a healthy balance within their mind, body, and spirit in order to achieve their best overall health. She believes in getting to the root cause of an ailment rather than suppressing the symptoms.

Practicing out of Total Health Clinic, Dr. Melissa works to create personalized health plans focused on prevention and education for each one of her patients.

Dr. Melissa is currently accepting new patients, so if you would like to book an appointment with her, please call 250-374-9700.

You can read more about Dr. Melissa Bradwell by clicking here.

Dr. Tamzin Morley was born in South Africa, but was raised on this side of the world in British Columbia's capital city, Victoria. After she completed her undergraduate degree at the University of Victoria, she was accepted into the Boucher Institute of Naturopathic Medicine where she received her doctorate in Naturopathic Medicine.

Having a passion for the health and wellbeing of others, Dr. Tamzin focuses on creating comprehensive and individualistic treatment plans for her patients. She always wants her patients to feel encouraged and supported along their journey to better health.

Dr. Tamzin combines traditional and conventional medicine together in order to design the perfect treatment plan for each oneof her patients. Utilizing a combination of methods such as diagnostic lab testing, intravenous nutrient therapies, acupuncture, and herbal medicine, Dr. Tamzin is able to create a plan personalized for everyone she treats.

To book an in-person or online appointment with Dr. Tamzin Morley, click here!

Kamloops born and raised, Dr. Tara Drummond says she feels humbled and grateful to be a part of such an amazing profession. Dr. Tara is currently practicing at Thompson Rivers Chiropractic in downtown Kamloops.

Believing in preventative medicine and living a balanced lifestyle, Dr. Tara helps patients regain optimal health through a variety of methods. Having dedicated many years on education and building on her expertise, Dr. Tara has garnered acclaim and appreciation from the patients she has helped feel healthier and more joyful throughout the years.

Dr. Tara continues to enjoy learning new techniques and disciplines while also hosting her podcast Walking Together Fiercely, and preparing delicious and healthy meals for herself and her family.

To book an appointment with Dr. Tara Drummond, click here.

If you would like to learn more about Thompson Rivers Chiropractic, then click here!

Go here to read the rest:

Best naturopaths in Kamloops, as voted by you! - KamloopsBCNow

Over 25,000 Canadians have died from opioid overdose since 2016 with 6,306 people dying in 2020 alone.

The overdose crisis is driven by an unregulated drug supply made up mostly of fentanyl, increasingly potent fentanyl analogues such as carfentanil, and more recently, unregulated benzodiazepines. Early in the COVID-19 pandemic, fentanyl directly contributed to 89 per cent of all overdose deaths in Ontario.

The volatility and toxicity in the unregulated drug supply continues to lead to more deaths. The British Columbia coroners report shows that more people died in 2021 from suspected illicit toxic drugs than ever before. In 2021, there was a 26 per cent increase in overdose deaths compared to 2020.

The Public Health Agency of Canada recently estimated that without new interventions, another 8,000 overdose deaths will occur in 2022. Addressing this devastating crisis requires bold action that includes expanding current evidence-based harm reduction and treatment services, alongside new interventions to prevent overdose deaths.

Safer supply, the practice of providing a medical prescription for pharmaceutical drugs of known quality, is one of those new interventions. In Ontario, safer supply programs are run mostly by community health centres that specialize in providing care to our most marginalized community members. These small pilot programs are a low-barrier first step alternative to the toxic drug supply.

There are several research studies funded across Canada to evaluate different parts of these pilot safer supply programs. We are public health researchers involved in some of these studies, and initial results are promising.

At Londons Intercommunity Health Centre, close to 250 clients are prescribed pharmaceutical opioids as a daily-dispensed prescription that they take home and use at their discretion. A recent evaluation of this program reported decreased use of fentanyl and other street-acquired drugs, reduced hospitalizations and a dramatic decrease in overdoses among clients.

Importantly, clients reported that the program was saving their life and helped them to take steps to improve their health.

Unfortunately, there has been opposition to safer supply programs from some in the addiction treatment community. Such opposition has the potential to undermine public support for people who use drugs and the expansion of lifesaving interventions that are urgently needed.

Current interventions to respond to opioid use dont work for everyone. Opioid agonist treatments (OAT) like methadone and buprenorphine, are intended to reduce cravings for opioids and manage withdrawal symptoms, but they do not produce euphoria or the high associated with other opioids.

There are issues with both access and retention in OAT. Fewer than 70 per cent of people who are diagnosed with an opioid use disorder ever start OAT. And although retention rates vary, an Ontario study found that after one year, less than half of people who do start are still using OAT. Although there isnt a set rule for how long someone should stay on OAT, generally longer treatment is associated with better outcomes.

Despite low retention rates, addiction medicine has been reluctant to address the barriers to care that people who use drugs have been attempting to call attention to for years.

People who use drugs have highlighted for a long time how restrictions around take-home doses reduce peoples ability to stay in methadone programs. And they are right when restrictions on taking home doses of methadone were loosened during the COVID-19 pandemic to facilitate physical distancing, retention to methadone improved without increased negative outcomes like overdose.

To address the toxic drug poisonings that are killing Canadians at such an alarming rate, we need to start listening to people who use drugs when they tell us whats not working with the current system.

The war on drugs has so demonized people who use drugs that they are mostly dismissed by addiction medicine experts when they have tried to say what will help their communities.

Groundbreaking grassroots work being done by organizations such as the Drug User Liberation Front (DULF) in Vancouver has highlighted the demand for a non-medicalized model for a safer supply of drugs.

DULF has organized in its community to distribute tested drugs to keep people alive during a crisis; contrast this to prominent members of the addiction medicine community attempting to use their social power to deliberately undermine their efforts.

Opposition to safer supply often misrepresents both the aim and benefits of safer supply. Safer supply is intended to keep people alive and it works.

We need new options. Both for people for whom current addiction treatment models have not worked and for those who simply dont need or want treatment.

People are dying from using a toxic drug supply. Building models of care that listen to the voices of people who use drugs and centre their needs is critical and should not be dismissed based on the fears of doctors who act as gatekeepers of the status quo. The status quo did not prevent, and it will not address, the overdose crisis.

Urgent actions like decriminalization and access to a regulated drug supply are part of the policy changes needed to address the toxic drug crisis in Canada. But for the people at risk of drug poisoning today, and for their friends, families and loved ones, safer supply represents a real chance at preventing more tragedy.

Read more:

Safer supply of opioids saves lives: Providing alternatives to toxic street drugs - The Conversation

The Charity Commission has issued a warning to quack medical charities as it bans a group which claimed to treat cancer with juice drinks.

Gerson Support Group, registered as a charity since 1997, promoted its own nutritional therapy for patients with life-threatening illnesses. This included an organic vegetarian diet, nutritional supplements and enemas. Freshly made juices were also advocated as part of the programme to help restore your health.

However, its charitable status has now been revoked after the Charity Commission said it must provide objective scientific evidence to support its medical claims.

The decision comes after the regulator tightened up its rules for charities offering complementary and alternative medicine (CAM) therapies.

In 2018, a review by the Charity Commission concluded that to satisfy the public benefit requirement and qualify for charitable status, organisations must provide evidence that the therapy being offered is capable of delivering the claimed benefits.

This is the first time that a CAM charity has been removed from the register following the review.

The Charity Commission said it is investigating a number of other similar cases and has warned CAM charities to consider the public benefit requirement and ensure that their own activities deliver clear public benefit.

Helen Earner, director of regulatory services, said: I welcome the decision by the trustees of Gerson Support Group to wind it up, having recognised our concerns regarding its claims to cure people from life-threatening diseases.

Charitable status is a special status that comes with clear expectations and responsibilities. The law is clear that all organisations which wish to hold that status must demonstrate public benefit.

It is right that, following the commissions intervention, the organisation has been removed from the register of charities.

The Prince of Wales mentioned Gerson Support Group in a 2004 speech on complementary therapies and cancer care.

He said: I know of one patient who turned to Gerson Therapy having been told that she was suffering from terminal cancer, and would not survive another course of chemotherapy. Happily, seven years later she is alive and well. So it is therefore vital that, rather than dismissing such experiences, we should further investigate the beneficial nature of these treatments.

Representatives for the Prince of Wales declined to comment.

The Charity Commission began its investigation into Gerson Support Group in September 2019, questioning its trustees and reviewing its nutritional therapy programme.

The organisation agreed that its claims about treating cancer and its symptoms would not now meet the regulators tougher new registration criteria.

A Charity Commission spokesperson declined to say how many CAM charities it was investigating.

Some cases being investigated could be resolved through dialogue with trustees rather than organisations losing their charitable status, it said.

It conceded that organisations promoting therapies offering comfort and relief, rather than cures for illnesses, may be able to rely on more subjective evidence, including patient testimonials, to demonstrate a tangible public benefit.

Read this article:

Alternative health group offering juice drinks to treat cancer stripped of charity status - The Telegraph

Ive been writing about quackery and the antivaccine movement for over two decades, having blogged about these topics for well over 14 years here on SBM and 17 years at my not-so-secret other blog. During that unbelievablyto melong time, Ive learned a few things, not the least of which is, as readers no doubt get tired of me repeating since COVID-19 hit, that there is nothing new under the sun with respect to antivax quackery. To put it another way, everything old is new again. I have, of course, written about this in general and in specifics going back to even before the pandemic was officially declared a pandemic, but also in the context of individual antivax claims that have been resurrected, recycled, and given a fresh coat of COVID-19 paint in order to appear shiny and new. Examples include misuse of the VAERS database by antivaxxers to portray COVID-19 vaccines as deadly, as well as claims that vaccines sterilize our womenfolk (or even our girls before they go through puberty). So I suppose I shouldnt have been surprised to see the resurrection of a form of antivaccine quackery commonly used to treat vaccine-induced autism back in the day. A decade or so ago, it was all the rage in antivax circles and was featured prominently across multiple years during the yearly antivaccine quackfest known as AutismOne, which was usually held at a hotel near OHare International Airport in Chicago. True, there are some seemingly new wrinkles based on the fact that the technology used in the first approved vaccines hadnt been approved for use in vaccines before, but even the claim that the mRNA-based vaccines can permanently alter your DNA was not new (and seemingly wont die).

In light of this history, I suppose I shouldnt be surprised that antivaxxers are now touting bleachexcuse me, Miracle Mineral Solution (MMS) or chlorine dioxideas a cure for COVID-19, and Im not. I am, however, still amazed at how advocates of unscientific medicine can persuade people that a chemical bleach used in water disinfection and purification can cure so many things. MMS is what some refer to as a zombie treatment in that it always rises from the dead even when killed. I tend to prefer the term slasher quackery, though, because MMS is more like Jason Voorhees or Michael Myers, two iconic slashers featured in innumerable horror movies since the 1980s. No matter how many times the slasher appears to have been killed at the end of one installment in the movie franchise, he always returns to kill more hapless college students.

Enter Mark Sircus and an article published a few weeks ago, Chlorine Dioxide Cure For COVID? Of course, quacks began touting MMS as a cure for COVID-19 very early in the pandemic, but, even so and even at this late date in the pandemic, I thought it worth discussing the claims made by Mr. Sircus, who is an acupuncturist and practitioner of traditional Chinese medicine who insists on calling himself doctor even though he most definitely is not a physician. After all, if grifters can sell magic dirt from a special peat bog in Canada as a cure-all for COVID-19, why not bleach?

Sircus, as is typical in these sorts of pitches, starts out with a conspiracy theory about how they dont want you to know about cures for COVID-19 (links to Bitchute pages removed):

When discussing any cure for COVID, the first thing to note is that neither health officials nor politicians are interested in a cure. Therefore, to expect any kind of medical sanity or truth from the FDA about what is and is not safe and effective to treat or cure COVID is a bad idea. Trusting the FDA about anything is like trusting a thief or pathological liar.

There is a massive, yawning gulf between what pharmaceutical companies want us to believe about health and medical treatments and reality. Decades of pharmaceutical propaganda have distorted peoples perception of reality so severely that at least half the population has slept [sic] walked into taking experimental vaccines so dangerous that if you die from them, life insurance companies will rule suicide.

They did it. No guns or concentration camps were needed. We have seen two years of them making the world their concentration camp. Pretty impressive. Lockdowns included. Hospitals were one of their primary weapons. There is no doubt that pharmaceutical terrorism is fully operational. However, people are starting to wake up and get smart. A video shot this past weekend in Paris, France, shows thousands of protesters surrounding the headquarters of Pfizer in the nations capital and chanting assassins!

As we approach the second anniversary of the World Health Organization officially declaring COVID-19 a pandemic, I must admit that before I encountered this post I had not encountered the conspiracy theory that if someone dies from a COVID-19 vaccine insurance companies wont pay off a life insurance policy because they will rule the death a suicide. I might have to investigate that one further on my not-so-super-secret other blog, but right now doing so would be too much of a diversion. So Ill just say one word: Wow. Also, sometimes even I can be surprised.

And, of course, Sircus thinks that the vaccines dont work:

Just about everyone alive today is starting to understand that COVID genetic vaccines are not a cure; they do not stop infection, though perhaps they do provide, at best, temporary protection from the most severe forms of COVID, hospitalization, and death. However, I seriously doubt even that. The most obvious evidence of them not working is the need for boosters and the worldwide sky-high infection rates experienced by the vaccinated. Moreover, with millions of reported adverse reactions and uncountable vaccine deaths, even thinking of COVID vaccines as a cure is a disgusting medical perversion.

Of course, no one claimed that COVID-19 vaccines are a cure, although I will admit that they have often been oversold as the be-all and end-all to stop the pandemic, probably because, comparatively speaking and as difficult as even a mass vaccination program is, maintaining policies and mitigations to slow the spread of disease is so much more difficult, particularly given the flood of disinformation about masks and lockdownsseriously, is there anywhere in the US or Europe where theres anything even resembling a lockdown any more?and the pandemic weariness of the public, vaccination is easy. Similarly, the emergence of variants like Delta and Omicron doesnt mean that the vaccines dont work. They were a not-unexpected and feared result of letting the virus circulate so widely, where the selective pressure on the virus has always been to develop the capability to spread more easily and quickly, vaccines or not. Similarly, what Sircus neglects to point out is that these variants, particularly Omicron, have shown as remarkable an ability to evade natural (more properly, infection-induced) immunity as they have to evade vaccine-induced immunity. Moreover, the need for vaccine boosters is not an indication that the vaccines dont work, just that immunity from them can wane, just as natural immunity (again, more properly called infection-induced immunity or postinfection immunity) wanes as well. And dont get me started on Sircus parroting of the antivaccine misuse of the VAERS database to misattribute reports there as definitely having been caused by the vaccine and thereby portray a vaccine Holocaust.

Similarly, it is just not true that early treatment has been ignored by big pharma and the medical profession (presumably in favor of the evil vaccine). Early in the pandemic, it was determined, for instance, that the steroid dexamethasone could decrease mortality from COVID-19, and physicians were so desperate that they repurposed the antimalarial drug hydroxychloroquine as a treatment, even in the absence of good evidence that it actually worked. Moreover, the development of drugs like Paxlovid and molnupiravir, both of which were intended to be early treatments for COVID-19 that could prevent its progression to severe disease, shows that finding effective antiviral treatments for COVID-19 has been a strategy to combat the pandemic since the beginning, a strategy that is only recently starting to bear fruit because drug development takes time. Of course, antivaccine conspiracy theorists like to refer to Paxlovid, for instance, as Pfizermectin based the mechanism of Paxlovid being protease inhibition, a mechanism supposedly shared by ivermectin, antivaxxers favorite repurposed drug that doesnt work against COVID-19,.

But what about MMS?

Given the setup about how early treatment and cures for COVID-19 are supposedly being suppressed, all, apparently, to allow for tyrannical governments to impose lockdowns and mask mandates, while killing their citizens with a vaccine that doesnt workbecause depopulation?Sircus gets into the meat of his claims for MMS, starting first with the observation thatwell, lets just look:

So what is chlorine dioxide, and why should everyone have some ready at home? Dr. Stephanie Seneff, writing for the Weston Price organization, says, Chlorine dioxide (CD) is a strong oxidizing agent that has found many applications in wastewater treatment and food disinfection. It is popular among campers as a way to disinfect water taken from a lake or stream prior to using it as drinking water. In recent years, it has become a popular treatment choice among alternative medicine specialists for various diseases and conditions, despite the fact that the mainstream medical establishment has come down very hard against it. To say that it is controversial would be an understatement.

Of course, its not really controversial; that is, unless youre a believer. Physicians know that drinking a bleaching chemical most commonly used as a surface disinfectant and water purification chemical is incredibly unlikely to produce a therapeutic effect on a viral disease, just based on mechanism alone. It is interesting, however, to look at what the reference cited by Sircus also says about MMS:

Kerri Rivera is the mother of an autistic child. Like many other parents of autistic children, she was desperate to find a way to improve her childs autistic symptoms. She spent over a million dollars trying to find a treatment that would work to heal her son. She was sufficiently impressed with the improvements she witnessed following CD treatment that she decided to become actively involved in promoting the idea that it might be useful for autism.

Kerri has developed a protocol to treat autism that includes various nutritional supplements (such as chondroitin sulfate and vitamin D) and a modified ketogenic diet that eliminates gluten and casein. Although the protocol can also include a number of other components anti-parasitic medications, humic and fulvic acid, black seed oil, digestive enzymes, binders, thyroid supplements, ionic foot baths and hyperbaric oxygenshe believes that an essential aspect is the idea of frequent tiny doses of CD throughout the day.

Before I briefly revisit Kerri Riveras claims, Ill just remind readers that MMS is 28% sodium chlorite in distilled water. Proponents recommend diluting MMS in either water or a food acid, such as lemon juice, a process that results in the formation of chlorine dioxide. In essence, MMS is equivalent to an industrial-strength bleach and disinfectant. Ill briefly revisit its history, as well, for those not familiar with it. MMS was originally sold by a man named Jim Humble, who has long claimed that MMS can be used to successfully treat AIDS, hepatitis A, B, and C, malaria, herpes, TB, most cancer and many more of mankinds worse diseases. He even goes so far as to claim that 5,000,000 people have used MMS and that hundreds of thousands of lives have been saved. Unfortunately, it appears that for this function Jim Humble uses more concentrated MMSa lot more concentrated. More horrifically, Humble bestows his blessings on poor people in less developed countries like Haiti.

Of course, Rivera has been featured on this blog before, beginning a decade ago when I wrote about how she was bleaching away what ails you, specifically in her case, autism. Perhaps the most horrific part of Riveras MMS protocol for autism was the method of use of MMS. She not only recommended feeding autistic children bleach until they started showing signs of becoming ill from it, but also advocated bleach enemas. What horrified me the most about this quackery is how MMS advocates misinterpreted the strings and rope-like things they fish out of their childrens stools as parasites dying from the MMS when in fact any surgeon or gastroenterologist would recognize them as sloughed pieces of the lining of the colon. At least Sircus doesnt appear to recommend MMS enemas, but its likely because adults, unlike autistic children, would not be likely to stand for the discomfort that bleach enemas would cause.

Lets return to Sircus claims. His logic (such as it is) is very much like the logic used by believers in colloidal silver, namely that if a substance is an effective antibacterial and antiviral agent for surfaces and water, then it will be a cure for bacterial and viral infections when taken internally:

Once dissolved in water, this gas releases free oxygen much in the same way as hydrogen peroxide will. The magic happens when oxygen & chlorine are bound in one molecule; there are VERY few pathogens found in water that can survive coming into contact with this compound! This is why this compound has become the chemical of choice for water sanitation the world over!

Dr. Puya Yazdi states firmly, Chlorine dioxide is an antiviral. It destroys the proteins on the outside of viruses and degrades the virus.

Chlorine dioxide gas is effective against:

Chlorine dioxide solution also inactivated human and monkey rotaviruses (that cause diarrhea) and hepatitis A.

Again, it is important to emphasize that a chemical that can kill bacteria and inactivate viruses on surfaces and in water will rarely be effective doing the same thing in the body, usually because of the required concentrations involved. Colloidal silver, for instance, is used as a topical antibacterial agent to treat wounds, particularly burn wounds. It works because it is possible to get a high enough concentration of silver on the surface of a wound for it to work without too much of it being absorbed into the bloodstream at toxic levels. (Unsurprisingly, colloidal silver has been touted as a cure for COVID-19 as well.) Even at nontoxic doses, prolonged use of colloidal silver can produce argyria and turn you blue. As infectious disease specialist and former SBM blogger Mark Crislip once noted as well, its not even clear that colloidal silver is that great a medicine for burn wounds.

None of this stops Mr. Sircus from referring to MMS as the Tiger tank of modern medicine:

It is hard to dispute; once you get to know chlorine dioxide like millions already do, that it is the Tiger Tank of medicine, the point of the spear, an essential treatment that the FDA will never accept. It really is too good to be true, but it is true, as campers and water treatment systems have known for decades.

Being the World War II buff that I amsince junior high!I cant help but interject here the Tiger was a German heavy tank that was feared for its destructiveness and heavy armor that made it difficult to destroy or disable. I also cant resist pointing out that the Tiger was also very expensive (costing twice as much per tank as a Panzer), difficult to manufacture, and very fuel inefficient, even for a tank. I thus suggest that Mr. Sircus analogy might not quite be the one he was looking for.

Sircus continues:

Chlorine dioxide empowers the immune system giving it a massive assist in its battle against pathogens and diseases. Though it is not the only oxygen therapy that can and should be employed, it is best if near-instant results are required, which is crucial if you come down with a COVID and suffer from a severe drop in oxygen.

Elsewhere, Mr. Sircus claims:

There are other ways to ram oxygen down our mitochondrias throats. However, one of the best and least expensive ways is chlorine dioxide. Chlorine dioxide is a substance that provides oxygen to tissues and all body fluids, activating the mitochondria of cells, which in turn generate more energy that allows the body to recover.

Dr. Andreas Klacher says, Many debilitating secondary infections with their toxins will be neutralized, thus relieving the liver and kidneys. In addition, there is much more oxygen and thus much more energy in the body. Chlorine dioxide thus provides more quality of life and lifetime in the short term.

While it is true that immune cells generate oxygen free radicals to attack and destroy pathogens, it does not follow from this physiological function of the immune system that ingesting an oxidizing agent will help the immune system generate this oxygen. For one thing, these cells generate high concentrations of these free radical in a hyperlocal fashion, releasing them when they are in close contact with the pathogen being attacked. For another thing, the low oxygen levels in the blood are different problem in that they are due to poor gas exchange in the lungs as a result of the inflammation caused by the virus and the immune response to it. Conceivably, adding more free radical to the mixture (if that were even possible using MMS) could just as likely make the clinical situation worse by increasing the inflammation in the lungs due to the immune system attacking the virus as make it betterprobably more likely. Indeed, even if MMS did ram oxygen down our mitochondrias throats that would not necessarily be a good thing if it generated too many free radicals, which can damage DNA and proteins, potentially even killing cells (which could increase inflammation) and even be carcinogenic.

That reminds me. Mr. Sircus repeats the false antivax claim that COVID-19 vaccines can cause cancer, touting MMS asyou guessed it!the cure for vaccine-induced cancer. Whom does he cite to support this claim? Andreas Kalcher, who, shockingly, appears to have been featured on this blog only one time before, in the context of a discussion of how Jim Humble and his Genesis II Church have been one of the primary promoters of MMS quackery around the world. Kalcker, it turns out, is quite the quack. Hes a true believer in MMS and has used it to treat autism, even using intravenous MMS to treat COVID-19. You heard that right, intravenous bleach! In addition to recommending the ingestion of bleach, bleach enemas, and bathing in bleach, there are quacks using intravenous bleach to treat COVID-19.

Also, why is Mr. Sircus referencing campers and water treatment systems? It is true that chlorine dioxide is used as a water treatment, both in water treatment systems and as water purification tablets for campers. It works mainly through oxidation to kill bacteria and inactivate viruses. It has some advantages over traditional chlorine, but is more expensive and is often used with chlorine to disinfect pools and water. Also:

Acute exposure of the skin to chlorine that originates from the decomposition of chlorine dioxide causes irritations and burns. Eye exposure eyes to chlorine dioxide causes irritations, watering eyes and a blurry sight. Chlorine dioxide gas can be absorbed by the skin, where it damages tissue and blood cells. Inhalation of chlorine dioxide gas causes coughing, a sore throat, severe headaches, lung oedema and bronchio spasma. The symptoms can begin to show long after the exposure has taken place and can remain for a long time. Chronical exposure to chlorine dioxide causes bronchitis. The health standard for chlorine dioxide is 0,1 ppm.

I would also note that the concentration used to disinfect water is generally on the order of 1-5 ppm, which is a very high concentration to try to achieve in the body. Of course, Ive done the math before regarding the claimed use of MMS to treat children and found that the amount recommended in, for example, Kerri Riveras protocol is easily much more than 120 times the amount of chlorine dioxide a child would get from just drinking tap water.

Mr. Sircus even goes beyond this and claims that MMS is so miraculous that it can dissolve blood clots caused by COVID-19 spike protein. It is, of course, true that clotting is a major complication of COVID-19 resulting in cardiac and pulmonary complications that can (and often do) lead to death. Referencing Kalcker again, Sircus exults:

Chlorine dioxide works on the central damaging aspect of COVID vaccines, which is coagulation in the blood. Normally doctors prescribe an anticoagulant, such as warfarin, which is a substance equal to rat poison, which in the long term, will cause strokes, etc. So its not a solution at all. However, chlorine dioxide is a solution because we have seen that it directly dissolves mini clots before they get bigger, says Dr. Andreas Kalcker.

Oxygen deprivation is the cause of death for most covid-19 victims. Chlorine dioxide floods the blood with oxygen, immediately enriching the hemoglobin molecules on red blood cells and allowing patients to breathe again, continues Kalcker.

Notably, many sick and dying have red blood cells clumping together and are not moving freely. Severely clumped red blood cells (Rouleau) affect proper oxygenation because the red blood cells do not circulate well enough to deliver oxygen where it is needed. Early in the pandemic, New York physicians noted that it seemed COVID patients had been transported to 30,000 feet in altitude and were starving for oxygen. This video shows that after taking chlorine dioxide, the red blood cells regain proper size and shape and move freely through the blood.

Note first how Sircus blames COVID-19 vaccines for blood clots. While its true that certain COVID-19 vaccines have been associated with (rare) clotting issues, he doesnt mention that COVID-19 itself is so much more likely to cause blood clots that are one of the consequences of the infection that endanger life than even the highest risk from the vaccine ginned up by the most hysterical antivaxxers that it is far, far safer to be vaccinated than it is to get COVID-19. That is not the narrative that quacks like Sircus like to promote, however.

I must admit that that video issomething else. Whoever made it claims to have had a person drink 280 ml of a 114 ppm solution of chlorine dioxide, touted as 3x the therapeutic dose and having had a blood draw before and after. The claim is that the red blood cells go from clumped to freely moving, indicating that they can now deliver oxygen appropriately. Of course any hematopathologist or hematologist will tell you that the appearance of red blood cells under the microscope is highly dependent on a number of factors, in particular how long the sample has been sitting after being drawn and how it was prepared (anticoagulant included or not?). This exercise in microscopy is nothing more than glorified live blood analysis that tells us nothing informative. Moreover, even if you take this video at face value, its one person. Unless one can show effects in a large number of people and correlate them to actual functional changes that improve the ability of the red blood cells to transport oxygeninstead of just alleged changes in appearanceyouve shown nothing.

I like to think of it as a Rorschach test, only using red blood cells instead of inkblots. Interestingly, even if you take this test at face valuewhich you definitely should notit shows the effect of chlorine dioxide wearing off at two hours, which would imply that youd better keep drinking bleach to maintain a steady state level. Of note, thats not how even MMS advocates recommend using it.

When COVID-19 first hit, those of us who had been deconstructing various forms of quackery and antivaccine misinformation fully expected that pretty much every quackery under the sun would be recommended for the new coronavirus disease. Even now, more than a decade after I first learned that autism biomed quacks were using bleach (MMS) to treat autism, which they (of course) believed to be caused by vaccines, I still shake my head that anyone could think that ingesting (or injecting) a strong oxidizing agent can treat a viral disease based on its properties disinfecting surfaces and water. Yet they do, and here we are. I suppose that I shouldnt be so surprised, given that homeopaths think that they can also treat COVID-19.

Unfortunately, the latest installment in the MMS horror franchise is COVID-19.

Which of these iconic horror movie slashers is MMS?

Link:

It rises again! Bleach as an early treatment alternative to vaccines and a cure for COVID-19 - Science Based Medicine

Patients who start physical therapy for the first time might have questions about the process. Whether they are referred by a physician or choose to go to physical therapy on their own, there are some common questions that come up at the first appointment.

Megan Day, DPT, works at WNY Geneva Physical Therapy and shares her knowledge with those who might want to know more about the process.

When I was young, I was involved in a car crash and ended up needing physical therapy for several months. Through that time, I became very familiar about what to expect and the process people go through at physical therapy.

When the time came for me to choose what I wanted to do after high school, I thought about what my own physical therapist had been able to do for me. That was something I wanted to do for others, so I chose to go into the field. I dont know if I would have thought about becoming a physical therapist had I not had that personal experience.

There is a variety of conditions that we work on with our patients to help them improve and reach their goals. Some of those include:

Our staff is trained and certified in an array of various methods of physical therapy. Treatments may differ depending on the reason why you are doing physical therapy.

Treatment options we offer are both provider-directed and patient-directed, such as:

We also have methods to assist with pain management, including:

An initial evaluation will last approximately 60 minutes. Beginning with a one-on-one interview, a member of our staff will get to know the patient and their primary concerns.

After discussing the patients medical history and their need for physical therapy, the provider will create the best treatment plan with the patient. Together, they will determine goals, ensure their expectations align with the physical therapists expectations, and talk about what comes next.

Depending on the patient, treatment may start during the first session.

Currently, Dr. Day is the sole physical therapist at the practice.

All physical therapists will have at least a Bachelor of Science. Many have masters, and most have a doctorate level degree in physical therapy (DPT). Most DPT programs last six years.

Some clinics have Physical Therapy Assistants (PTA) on staff, similar to a Physician Assistant. PTAs are able to provide nearly all the same treatments as a physical therapist, but do not conduct the initial consultation or send progress reporters to primary care providers.

Chiropractors and physical therapists can have similar treatment strategies and will even work in conjunction with one another for some patients.

Where the practices diverge are in two main areas: traditional vs. alternative medicine, and timeframe.

Chiropractors practice a form of alternative medicine that focuses on properly aligning the body, usually the spine, with health benefits and pain relief resulting from regular maintenance. They may also have regularly scheduled appointments with patients, along with acute care visits as needed.

Physical therapists practice traditional medicine and specifically focus on functionality and movement. Their ultimate goal is to guide a patient to return to the level of function they had before they started physical therapy so they no longer require follow-up visits often within a set amount of time.

Most of our patients are being treated for general orthopedic and chronic pain issues. We do have special training for vertigo treatment.

We see both pediatric and adult patients with orthopedic conditions. Currently we are not treating infants or toddlers, but we are happy to assist families in finding appropriate centers for children who may require early intervention services.

Primary care providers are a good resource as to whether a patient should do physical therapy or not. We keep open lines ofcommunication with all providers, and keep them up to date on the progress of our patients, as well as any concerns that may arise if patients are not meeting their goals as expected.

No pain, no gain is not our motto.

We work to keep our patients as comfortable as possible while keeping them on track to meet their goals. Throughout the therapy process, our providers communicate with their patients with the knowledge that some things might be difficult to get through at first, but to keep focusing on their end goal.

Hands-on treatments and other methods of therapy treatments help with pain management. We teach our patients strategies they can use to cope between visits, as well.

At WNY Geneva Physical Therapy, yes. However, staffing may vary depending on the clinic and their practices.

Keeping the same provider-patient relationship is good for everyone involved. The provider develops a good rapport with the patient and understands their case more thoroughly. The same is true for the patient understanding what the provider needs.

With this in mind, physical therapists work closely with one another to communicate the needs of their patients in the event of someone being unavailable for a patients appointment.

In New York, yes. Patients are allowed to undergo physical therapy through direct access. Most insurance policies cover physical therapy with the exception of workers compensation, no fault, and Medicare/Medicaid.

If a patient wants to come in for physical therapy before visiting a doctors office for a prescription, they can attend for 10 visits or 30 days before they need to obtain a prescription.

To determine your level of coverage, check with your health insurance to be sure.

Here is the original post:

The Most Common Questions We Receive about Physical Therapy | Health Hive - Health Hive

John Mascarenhas, MD, hosts a panel of experts who discusses current strategies used to stratify risk patients with myelofibrosis and their preferences for sequencing therapy.

At an Around the Practice presentation hosted by CancerNetwork, experts discussed recent advancements in the treatment of patients with myelofibrosis. The panel was led by John Mascarenhas, MD, professor of medicine at the Icahn School of Medicine, director of the Center of Excellence for Blood Cancers and Myeloid Disorders, and a member of the Tisch Cancer Institute at Mount Sinai in New York.

The expert panel also included Aaron Gerds, MD, MS, a physician at the Cleveland Clinic as well as assistant professor in the School of Medicine and member of the Developmental Therapeutics Program of Case Comprehensive Cancer Center at Case Western Reserve University in Cleveland, Ohio; Raajit Rampal, MD, PhD, a hematologic oncologist at Memorial Sloan Kettering Cancer Center in New York; and Srdan Verstovsek, MD, PhD, director of the Hanns A. Pielenz Clinical Research Center for Myeloproliferative Neoplasms, chief of the Section for Myeloproliferative Neoplasms, and professor in the Department of Leukemia, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center in Houston.

Mascarenhas: Can you explain what myelofibrosis is? How do you distinguish between primary and secondary disease?

Gerd: The hallmark [of myelofibrosis] is scar tissue in the bone marrow, which is the common pathologic finding that we see. Mutations that occur in the JAK-STAT signaling pathway lead to this proliferation and growth and the ultimate scarring of tissue in the marrow. Over time, that scar tissue can lead to dysfunction in the hematopoietic process, and you see low blood counts in patients. As for primary vs secondary myelofibrosis, those words are tricky [because] primary myelofibrosis refers to [the] disease of bone marrow cancer. Secondary can mean either inflammatory scar tissue in the bone marrow vs a rheumatological disorder, for example, and it can also indicate myelofibrosis that has evolved out of a preexisting polycythemia vera (PV) or essential thrombocythemia (ET).

Mascarenhas: What are some examples of nonmyeloproliferative neoplasm [MPN] secondary myelofibrosis? In what other settings could you see a myelofibrotic marrow?

Rampal: Fibrosis in the marrow is nonspecific, in many cases. Can you see it in other myeloid diseases? The answer is yes. Rarely, you see it in MDS [myelodysplastic syndrome]. A rare MDS subtype [exists], known as MDS with fibrosis, but beyond hematologic cancers, you can certainly see it in autoimmune conditions.

Mascarenhas: How do signaling pathway mutations and genetic and epigenetic alterations contribute to the pathophysiology of myelofibrosis?Rampal: The hallmark of MPN pathogenesis [consists of] activations in the JAK-STAT pathway, which is a pathway that is involved in both inflammation and hematopoiesis. The disease is principally driven by unregulated JAK-STAT signaling. Other mutations can occur in the disease as well, and its very clear to us from both patient data and laboratory data that those mutations can alter the biology of the disease and, in many cases, advance it or cause it to be more aggressive. In addition, other pathways are activated by the JAK-STAT pathway, which we think plays a role in the pathogenesis of the disease. [Those mechanisms] are currently targets of inhibitors in clinical trials.

Mascarenhas: What are the biomarkers of interest?

Verstovsek: The prognostication in myelofibrosis has become complicated because we have identified multiple different biomarkers. Fifteen years ago, we started with the biomarkers that would be easy to understand, [such as] the number of white blood cells, blasts in the blood, or a clinical finding like symptoms or age. Since then, the other biomarkers we have identified [include] different driver mutations that activate the JAK-STAT pathway, like JAK2, CALR, or MPL mutations. [Patients who have] none of the 3 biomarkers are called triple negative, which we can test for by NGS [next-generation sequencing] panels in academic centers.

Mascarenhas: Are you doing tests like NGS in a serial fashion?

Verstovsek: We do repeat the testing automatically when clinical progression [occurs]. Ideally, [you would] test patients periodically, even when theyre stable, to predict a progression by acquisition of certain molecular abnormalities or cytogenetic abnormalities, but that is not a standard practice [because its] not feasible. This is [also] not being done because you cant do much [with that information]. You do something when things change clinically, so the information [would be] applicable to or [would] influence the management. Then, its justifiable to test.

In a polling question, the audience indicated that fatigue was the most common symptom they saw in their patients with myelofibrosis (poll question 1).

Mascarenhas: What drives fatigue in myelofibrosis?

Rampal: Often, we need to figure it out. For example, if a patient has anemia, its [important to consider if its the] anemia driving the fatigue, or the disease, or both. Commonly, the answer is both, but its hard to tease out that answer. Aside from that, we have a lot of hypotheses about what drives fatigue. We blame cytokines, [for instance]. There may be truth to that because we do see a correlation between improvements in cytokine profiles in patients treated with JAK inhibitors and improvements in symptom burden. Fatigue improves despite patients developing some degree of anemia, so the answer is that [the reason behind fatigue] is often multifactorial.

Mascarenhas: How do you formulate your treatment plan based on symptoms?

Verstovsek: [National Comprehensive Cancer Network] guidance suggests using MPN 10 [MPN Symptom Assessment Form Total Symptom Score], a questionnaire that would cover the 10 most common symptoms. We use that questionnaire as a guide for discussion and it becomes a part of the medical record. If symptoms are affecting the patients quality of life [QOL], that is a trigger to [work with them] to improve QOL.

Mascarenhas: How are you generally classifying myelofibrosis?

Verstovsek: Many [classifications] are fixed on the grade of fibrosis in the bone marrow, [which] may have some significance on the outcome of the patients, but there are many other factors. Prognostication in terms of life expectancy does not depend solely on the degree of fibrosis. We look at patient, genetic, and chromosomal characteristics, as well as comorbidities, in deciding when to intervene. The factors would be assessment of QOL, to see whether we can control that, as well as bone marrow failure and anemia, to see whether the patient should be referred for bone marrow transplant.

Mascarenhas: Can treatment be distinguished for primary and secondary myelofibrosis, or is it broad for all subtypes?

Verstovsek: Apart from the prognostication that we discussed, I do not apply risk of dying to decide whether I should treat the patient for anemia, for [symptoms in the] spleen, or for their QOL. The trigger is recognition of poor QOL. If the spleen is big and the patient is not in pain, I would ask a few more questions. Unless you ask questions and engage with the patients, youre not going to recognize those problems. That applies to post-ET, post-PV, or primary myelofibrosis to the same degree, although [there are differences related to the] application of different therapies.

Mascarenhas: Where do clinical trials fit in terms of assessing patients for novel therapies?

Verstovsek: In a frontline setting, if platelets are above 50 109/L, you have 2 drugs: ruxolitinib [Jakafi] or fedratinib [Inrebic]. But neither is supposed to be given to patients with platelets below [that level], [which includes] about 10% to 15% of patients. [Patients with those low levels] typically have a low red blood cell count, and their spleen is not as big. This is a cytopenic patient in the frontline setting who needs something new. JAK inhibitors cover the spleen and symptoms, but they may worsen the anemia. In the frontline setting, anemia compromises the delivery of JAK inhibitors, so you need a drug for anemia. Drugs have been developed, like luspatercept [Rebozyl], to be combined with JAK inhibitors in the frontline setting. You want a combination that would enhance the JAK inhibitors, [and lead to] more spleen and symptoms control and other biological effects on the disease. Then, the durability of the response is much longer.

Mascarenhas: If you saw this patient, what would be your first-line therapy?

Verstovsek: I would not watch and wait. Age 67 [years] is still good for transplant. Further assessment with an NGS panel may push me to recommend the transplant even faster. We want to eventually cure the patient; that would be the goal. In between today and when the patient has the transplant, I treat for the symptoms and the spleen. If the anemia worsens through therapy with JAK inhibitors, you may add an anemia drug on top of it to help the patient get to their transplant in the best possible shape.

Gerds: What do you do to measure response?

Rampal: Thats a great question, and weve got to separate out what we do in clinical trials vs what we do practically speaking. It depends to some degree on what the treatment goals are. One of the treatment goals we would all agree with is to make the patient feel better, for which you can use the total symptom score. On the other hand, just talking to the patient and getting that assessment makes a difference. Lets say the patient goes to stem cell transplant; making them functionally feel better makes a difference, but [so does] spleen size. On a high level, if we have a patient who is not a transplant candidate and their spleen shrinks enough that they feel comfortable and their symptoms are improved, that [can be considered] a response.

Gerds: What are some things you look for when you consider changing therapy?

Verstovsek: I talk to the patient to understand whether there is a benefit [of the current therapy], I palpate the spleen, and I look at their weight. Then my goal would be to maintain that benefit, even if its slowly going away, by adding another agent to the JAK inhibitor. Use of pacritinib is coming as an investigational agent for patients with low platelets. That would be my first choice if I had it today. I dont have it yet, but hopefully [I will soon]. I would expand on that first line for as long as possible before I would change. In the second-line setting, we have agents that are being tested and we also have fedratinib, which is being used in the second-line setting as a JAK inhibitor. Momelotinib is [being examined in clinical trials as well], which [represents] a very interesting concept.

Rampal: One of the striking things with [momelotinib] is that [we saw] an anemia benefit, described by increases in hemoglobin and changes in theproportion of patients getting transfused. Of course, we know with JAK inhibitors that anemia is a nontarget effect. With the mechanisms of action of momelotinib hitting other pathways, we think that is probably the mechanism by which it is contributing to an anemia response. This is a profile of a JAK inhibitor, and its not one-size-fit-all. For our cytopenic patients, weve been talking about pacritinib and the hopeful approval of that drug, which clearly has a benefit for patients with cytopenia. It doesnt require dose modification based on platelet count, so that becomes an important tool in the arsenal. Then, coming to momelotinib, some patients may need something beyond just a drug for anemia. The patient who has symptomatic splenomegaly and who has anemia wont benefit from single-agent daratumumab or other related drugs. But momelotinib [may lead to] spleen size reduction and potentially anemia benefit. Were beginning to see niches for these different drugs that will greatly benefit the patients.

Verstovsek: What is the alternative pathway that the pacritinib affects in addition to the JAK pathway?

Mascarenhas: Pacritinib is interesting. There are differentiating factors [compared with] JAK inhibitors in late-stage testing. Pacritinib inhibits IRAK1, beyond JAK, and in doing so it likely affects a signaling pathway through the toll-like receptor, myosin complex, and then downstream to NF- B [nuclear factor light chain enhancer of activated B cells]. Hitting this alternative but relevant pathway in addition to JAK likely explains why this drug is less myelosuppressive [vs ruxolitinib/infigratinib]. You can give a full dose and enjoy symptom and spleen benefits with less myelosuppression. Some of the differences that well see with these JAK inhibitors are likely due to their kinome profile and some of the other targets that they hit.

In a polling question, most of the audience indicated that that they would treat this patient with pacritinib (poll question 3).

Rampal: I would not increase the dose of ruxolitinib. However, if someone is having a benefit, we must be careful. Of course, going by the FDA label, we need to attenuate, if not stop, ruxolitinib, [but] we cannot do that suddenly and risk withdrawal syndrome. In a practical sense, one could attenuate the dose of ruxolitinib and see if the platelets get betterDo they improve?and then maybe rechallenge. That is not an unreasonable option. Another clear option would be to consider switching to pacritinib, which will hopefully be approved soon. In this scenario, we have a highly symptomatic patient. They need JAK inhibition and in this circumstance, pacritinib wouldnt require dose modification due to the thrombocytopenia. It may be a fit for this patient.

Mascarenhas: From a safety standpoint, do these drugs have differences among their toxicity profiles?

Verstovsek: There are some, but they dont affect the management too much. Fedratinib has some mild [gastrointestinal] toxicities such as nausea, vomiting, and diarrhea; you can prophylactically treat them easily with medications. Pacritinib could possibly be considered first in a patient who has platelets of 81 109/L because the intensity matters. There is no need for dose adjustments. This is the area where we expect new developments, [so we can understand] what the best approach is in the frontline setting [among] those 3 drugs for patients with low platelets. When the platelets go down to 37 109/L, it is certainly not easy to manage with the currently available medications, so we welcome the new development of pacritinib.

NCCN. Clinical Practice Guidelines in Oncology. Myeloproliferative neoplasms, version 2.2021. Accessed February 10, 2022. https://www.nccn.org/professionals/physician_gls/pdf/mpn.pdf

Read more:

Advances in the Treatment of Myelofibrosis - Cancer Network

Most people spend about a third of their entire life asleep but for many, the activity isnt as natural or comforting as it could be.

Up to 70 million adults in the US have a disorder that disrupts their sleep, according to the American Sleep Association, resulting in about $16 billion in medical costs each year. Insomnia is the most common problem, affecting 1 in 3 adults at some point in their lives, and 1 in 10 chronically. Poor sleep has been linked to a variety of health problems, including type 2 diabetes, heart failure, high blood pressure, depression, obesity, a compromised immune system, and low sex drive.

If you can relate to the struggle, you might want to consider trying one medication-free approach: listening to music.

Decades of research suggest that many kinds of music can help people fall asleep faster and improve overall sleep quality. A 2018 online survey of 615 adults published in the journal PLOS One found that 62% reported occasionally listening to music at night to help them sleep, 35% used it at least once a week, and 4% used it every night. (The researchers noted their sample may not be representative of the general population.)

We tried our own (decidedly unscientific) Twitter poll to see how many people use music to help them snooze. Overall, 28% (among 218 respondents) use it regularly, while about 12% said they tried it but it didnt work for them.

If listening to music before bed sounds like an appealing way to doze off, there are professionals music therapists who can help you use this technique successfully.

Music therapy and its research in sleep is gaining traction as a novel, culturally sensitive, cost-effective, and safe intervention, Joanne Loewy, a music therapist and founding director of the Louis Armstrong Center of Music and Medicine at Mount Sinai Beth Israel in New York, told BuzzFeed News. Our brain likes predictability and thrives on patterning. So, with music and music therapy, we have special ways of addressing sleep by helping people induce a relaxation response.

While music probably wont replace doctor-prescribed medication or therapies for sleep problems, you dont need to have a sleep disorder or be musically inclined to try it for better sleep.

Listening to music throughout the day can often help people feel good and distract them from stressors that can contribute to anxiety or depression. Turns out, the same is true at nighttime, and music can help some people fall asleep faster and have better-quality sleep.

According to one 2012 study published in the International Journal of Nursing Studies, 25 adults with chronic insomnia who tuned into soothing music for 45 minutes before bed over four days had improved overall rest, shortened stage two sleep (a lighter stage in non-REM sleep), and prolonged REM sleep compared to a control group who didnt listen to music. REM sleep is associated with dreams and deeper slumber, which is critical for cognitive function, memory, emotional processing, and learning.

A 2014 study published in the Journal of Alternative and Complementary Medicine had a similar finding among young adults with long sleep latency, meaning they took an average of 10 minutes or longer to fall asleep.

Part of the reason listening to music can help you sleep is that it can lower the stress hormone cortisol, release pleasure and satisfaction neurotransmitters such as dopamine, and nudge your nervous system from fight or flight to rest and digest mode, according to Dr. Michael Jaffee, director of the Neurology Sleep Clinic at the University of Florida.

Whats more, your breathing and heart rates can synchronize to music over time. This phenomenon, called entrainment, encourages relaxation. Jaffee told BuzzFeed News that much of the music that improves sleep quality generally plays at about 60 to 80 beats per minute, which is close to an adult's normal resting heart rate of about 60 to 100 beats per minute. (Music has also been shown to have this effect on premature infants, improving their feeding behaviors and sucking patterns.)

Listening to music before bed can distract you from other noises like outside traffic, too, similar to white noise machines. Unlike music, however, white noise (think whirring fans or radio static) emits consistent and simultaneous sounds at the same frequencies that can drown out more intermittent and distracting background noises. Sleep researchers often consider nature sounds like rain or waterfalls to be white noise, as well.

White noise is not as well studied as music for sleep, but the former can be more beneficial for some people because its consistency may be less of a distraction than music, according to Thomas Dickson, a musicologist who works in the Empirical Musicology Laboratory at the University of New South Wales in Australia. However, white noise could be less of a helpful sleeping tool for people who find it boring, he added.

The genres of music that help people sleep vary widely. (Dickson said his research has found anything from classical to ambient music to pop and folk songs can work.) You should try whatever type of music you think works for you, but it may be best to choose tunes that have a lower pitch, dont encourage dancing, have a smooth sound, and don't have lyrics.

And youll want to avoid wearing headphones while you sleep, Jaffee said, because they could cause hearing damage or headaches; they could also prevent you from hearing any safety alarms or problems in your home.

Instead, experts recommend playing music on a speaker with an automatic timer so it doesnt play all night long. With that said, tuning into your music might be difficult if you share a bed with someone who finds it annoying. Some negotiating with your partner may be necessary.

Just remember you have to be patient, Dickson warns. Generally, studies show it takes about three to four weeks of consistent listening at bedtime, at the same time every night, for music to improve sleep quality.

Jaffee recommends first listening to music during the day to see if it sparks relaxation and joy that might help you sleep at night. (Avoid music that triggers strong emotional reactions, which can be counterproductive to relaxation.)

Volume matters too. Aim for anything under 50 decibels (about as loud as a quiet refrigerator or moderate rainfall), Dickson said, or just start with a volume thats as quietly as comfortably possible.

Here are some general healthy sleep habits you should follow:

Keep in mind that any random music may or may not do the trick for you. Popular sleep and relaxation apps like Calm, Headspace, and BetterSleep may be a better option; they offer prerecorded music or allow you to create your own sound clips.

For an even more custom approach, music therapists can select or create tunes and protocols that meet your specific needs.

Music therapists are trained in psychology, medicine, and music and work as independent clinicians alongside doctors, psychologists, audiologists, social workers, and behavioral health specialists, to name a few.

For years, they have used music in places like hospitals and nursing homes to soothe adults with dementia, improve communication abilities in children with autism, and reduce pain among hospitalized patients.

Music therapists also treat people who still have trouble sleeping despite medication or cognitive behavioral therapy, which helps people change how they think about sleep and develop healthy bedtime habits.

Anyone can call and make an appointment with a music therapist to address sleep problems, but people are most often referred to the professionals by other doctors such as psychiatrists, said Loewy, the New Yorkbased music therapist.

In the beginning, a music therapist will prescribe helpful sleep habits, Loewy said, like avoiding food at least a couple of hours before bed. Other sessions address why you cant sleep, your childhood, lifetime traumas, bedtime habits, and general likes and dislikes when it comes to different sounds and instruments. The result: They can create custom-made tunes or playlists just for you.

Using a sleep music sedation protocol she developed, Loewy starts by playing music or songs that are familiar or induce feelings of safety in people. Next, she removes any lyrics, if patients want, and changes the meter (beats and bars). Then she may implement instrumental sounds and rework pitch, harmony, and melody to match and enhance the persons breathing.

The final composition is a unique yet simple collection of sounds thats predictable, repetitive, and comforting, which is what the brain is looking for to relax, Loewy said. After several real-time listening sessions in a clinical setting to see how patients react to the music, she then may prescribe playlists for at-home listening beginning half an hour before sleep.

For some, these playlists may last 15 to 20 minutes, but for others with severe anxiety, for example, they may last about 40 minutes, Loewy said.

Still, there is no formula for music therapy sessions or treatments, including how long each visit lasts; treatment plans can range from three months to five years. It just depends on a persons unique circumstances, she said. A 60-year-old whos worried because her son recently lost a job, for instance, may need longer sessions than a 25-year-old dealing with a noisy upstairs neighbor.

While sleep apps can help some people, Loewy is not a fan.

I believe in individual assessment because apps assume that people like a certain kind of music, which tends to be generic and misses culture and transition of tempo. I don't find them very relaxing, Loewy said. Compared to what music therapists provide, its like the difference between going to a diner and going to a real French restaurant.

There are currently 9,712 board-certified music therapists, a spokesperson for the Certification Board for Music Therapists told BuzzFeed News. Of that number, 9,129 work in the US.

A 2019 survey conducted by the American Music Therapy Association found more than 1 million people received music therapy services in 2018, according to responses from nearly 3,000 professionals. However, its unclear how many people receive music therapy for sleep issues, specifically.

The survey also found the average rate for individual music therapy sessions across the US is $77 per hour; group sessions are about $88 per hour.

Depending on where you live, music therapy is a reimbursable service through Medicare or Medicaid. Some private insurance companies like Blue Cross Blue Shield, United Healthcare, Cigna, and Aetna will pay for the service, the AMTA says. Generally, music therapy, like other types, is reimbursable when its preapproved and deemed medically or behaviorally necessary to reach the individual patient's treatment goals, according to the association.

The service can also be reimbursed via other sources, including grants, private pay, workers compensation, and state departments.

About 31% of AMTAs survey respondents said their music therapy sessions were covered by either government funding or a third-party health insurance. You can find a music therapist through the AMTA or CBMT.

Music at night isnt everyones groove and thats OK.

BuzzFeeds own Twitter poll found about 61% of respondents said they cant listen to music at night. Some said they run their TV on a timer, listen to the radio instead, or scroll on social media until they doze off.

Its probably because music can be both beneficially and detrimentally distractive, Dickson said. Anecdotally, I've heard from some musicians that they find music too distracting for sleep, and maybe this is because they intellectualize the music instead of relaxing to it.

A 2021 study published in the journal Psychological Science found that people who listen to music more often (particularly popular or catchy songs, either during the day or before bed) are more likely to catch earworms when a song or tune plays over and over in your mind at night. This was associated with greater difficulty falling asleep, more nighttime awakenings, and more time spent in lighter stages of sleep among the approximately 250 study participants who either answered survey questions or slept in a sleep clinic.

The researchers from Baylor University in Texas said their results suggest our brains process music while we sleep, and that listening to familiar music before bed may not be in our best interest.

But fear not, Loewy said. Theres really no specific person or group of people that should avoid using music as a sleep aid. If youre interested, she suggests seeking a professionals help if you feel you need it. And if it doesnt work, there are other treatment options.

Here's a technique that could help a lot of people, but in many cases needs to be individualized or tailored to the individual based on their unique tastes and preferences, Jaffee said. Music as a sleep aid shares commonality, but at the same time with that individuality, speaks to who we are as people.

See the article here:

Music Can Improve Your Sleep, And There Are Therapists Who Can Guide You - BuzzFeed News

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