The long taper

There’s a hidden danger in tapering someone off opioids.

These days (for obvious reasons), prescribers are trying to cut back on painkillers, even for patients who have chronic pain.

What they think: Tapering is tough at first, but after a few months of struggle patients adapt to a lower dose and the danger of a rebound overdose is gone.

The reality: “[F]or most tapering patients, elevated risks of overdose and mental health crisis persist for up to two years after taper initiation.” (Emphasis ours.) This comes from a study out of UC Davis, that also found the higher the initial dose, the greater the risk of tapering.

The options, they say, are either to skip tapering altogether, or to monitor patients closely — over the long term.

Why do dentists overuse antibiotics?

Blame the patients (says a Swedish researcher) — too many of them think they have a penicillin allergy (which are rare), so dentists go broad-spectrum instead. Now you know.

Picking the pneumonia

Is the pneumonia viral or bacterial? Half the time you can’t easily tell — antibiotics could help, or they could just be wasted (along with the patient’s time).

Enter MIT engineers who’ve designed a sensor that can distinguish between viral and bacterial pneumonia infections … in mice, at least. The trick is not trying to identify the pathogen, but to pinpoint the body’s response.

Viral and bacterial infections provoke distinctive types of immune responses, which include the activation of enzymes called proteases, which break down proteins. The MIT team found that the pattern of activity of those enzymes can serve as a signature of bacterial or viral infection.

They have a collection of 20 sensors (yes, yes, of course they use nanotechnology) and which one ‘lights up’ tells them what’s doing the infecting. Right now the sensors are injected, but they hope to create a home-test strip at some point, once they know it works on humans.

The eyes might have it (a new disease, that is)

Is your vision getting worse? Good news! It might not be because you’re getting older — it might be a whole new disease!

It’s so new it doesn’t even have a name yet; it was just discovered by researchers at the NIH’s National Eye Institute. It’s a new kind of macular dystrophy caused by a gene mutation, and (because it affects the macula) it leads to blurrier central vision.

So if someone’s giving you the side-eye, you can say, “Did I do something wrong, or do you have a newly discovered variant of the TIMP3 gene?”

Dragonlord Placidusax isn’t going to defeat himself

“Sleep is not a priority for men: many losing sleep to play video games and drink alcohol” — per the American Academy of Sleep Medicine.

Electronic adherence

Controlling asthma means taking your medication. But adherence can be a problem. There are tools to help, from apps and alarms to (if you have the means) hiring Judge Judy to crack you over the head if you forget.

But what tools work best? British researchers wanted to find out by reviewing previous studies. They didn’t get a definitive conclusion, but they got an overall picture.

The tools: smart inhalers, electronic adherence monitors (which rat you out to your provider), mobile apps, text-message reminders, and game-based approaches.

What works: smart inhalers and text messages work best, although digital “interventions” in general can improve adherence by about 15%, and they can cut asthma attacks in half (well, 32% to 91%).

* Judge Judy™ and Judge Judy’s Gavel of Pain™ are trademarks of Judge Judy Enterprises International.

D is for dementia

The latest condition that enough vitamin D can help prevent: dementia. So say Aussie researchers in what they call a “world-first study” — it found that “low levels of vitamin D were associated with lower brain volumes and an increased risk of dementia and stroke” and that there’s “a causal effect of vitamin D deficiency and dementia.”

And the correlation is a strong one, too:

in some populations as much as 17 per cent of dementia cases might be prevented by increasing everyone to normal levels of vitamin D.

The Long Read: This Is Your Brain on Addiction edition

When someone addicted to nicotine has a stroke, sometimes that addiction disappears. Learning why is teaching us a lot about how addiction — and the brain — work.

“They Were Cigarette Smokers. Then a Stroke Vanquished Their Addiction.”