10 hours agoHugh PymHealth editor

The middle-aged patient seemed to embody all the twists and contradictions of the opioid crisis. A white-collar professional with a history of addiction, he had become hooked on prescription painkillers again after a knee operation. When doctors would no longer prescribe the opioids, he returned to heroin. But recently he had developed an abscess at an injection site on his leg. Now he was in Highland Hospital, in Oakland, Calif., claiming to have been bitten by a spider.Listen to this article, read by Robert PetkoffAndrew Herring, a specialist in emergency medicine at the hospital, vividly remembers this man, the first person he would ever treat with the drug buprenorphine. The patient was hoping to receive a few opioid pills to help with his “spider bite.” But he had also caught wind of a trial program Herring was just then starting in the emergency department. He and his colleagues were interested in buprenorphine — itself an opioid — as a way to treat addiction to more powerful opioids like heroin. The patient wanted to try that instead of attempting to finagle pills. Struck by his forthrightness and honesty, and by his evident desire to escape the downward spiral of addiction, Herring sent him home with a prescription.This was in 2016. The previous year, doctors at the Yale School of Medicine published what would come to be seen as a seminal study in the field of addiction medicine. Their study subjects, primarily people who were using heroin or prescription opioids, had been divided into three groups. One received a referral to addiction-treatment services outside the hospital. Another group received a similar referral, along with a brief counseling session at the hospital. And a third group received both the referral and the counseling while also starting on buprenorphine, taken daily as a tablet. After a month, this last cohort was about twice as likely as the other two groups to remain in treatment. This one medicine doubled these patients’ likelihood of staying the course and greatly improved their odds of avoiding a fatal overdose.An unusual aspect of the study was its setting: the emergency room. Addiction treatment usually didn’t happen in the emergency department, a place generally seen as reserved for acute medical issues, not disorders like drug addiction that require long-term treatment. Yet Herring couldn’t stop thinking about the implications of the Yale research — about how many lives might be saved if E.R. doctors embraced this approach.And there was already evidence of buprenorphine’s effectiveness, at the population level, in combating overdose deaths. Although the United States government had partly funded buprenorphine’s development as a treatment for opioid addiction, France was one of the first countries to most fully exploit the drug’s potential. In the 1990s, French health authorities began allowing any doctor to prescribe buprenorphine. By the early 2000s, overdose deaths there from heroin and other opioids had declined by nearly 80 percent.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Soon, Irene Mekel will need to pick the day she dies.She’s not in any hurry: She quite likes her life, in a trim, airy house in Castricum, a Dutch village by the sea. She has flowers growing in her back garden, and there is a street market nearby where vendors greet villagers by name. But if her life is going to end the way she wants, she will have to pick a date, sooner than she might like.Listen to this article with reporter commentary“It’s a tragedy,” she said.Ms. Mekel, 82, has Alzheimer’s disease. It was diagnosed a year ago. She knows her cognitive function is slowly declining, and she knows what is coming. She spent years working as a nurse, and she cared for her sister, who had vascular dementia. For now, she is managing, with help from her three children and a big screen in the corner of the living room that they update remotely to remind her of the date and any appointments.In the not-so-distant future, it will no longer be safe for her to stay at home alone. She had a bad fall and broke her elbow in August. She does not feel she can live with her children, who are busy with careers and children of their own. She is determined that she will never move to a nursing home, which she considers an intolerable loss of dignity. As a Dutch citizen, she is entitled by law to request that a doctor help her end her life when she reaches a point of unbearable suffering. And so she has applied for a medically assisted death.In 2023, shortly before her diagnosis, Ms. Mekel joined a workshop organized by the Dutch Association for Voluntary End of Life. There, she learned how to draft an advance request document that would lay out her wishes, including the conditions under which she would request what is called euthanasia in the Netherlands. She decided it would be when she could not recognize her children and grandchildren, hold a conversation or live in her own home.But when Ms. Mekel’s family doctor read the advance directive, she said that while she supported euthanasia, she could not provide it. She will not do it for someone who has by definition lost the capacity to consent.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Hannah KarpelBBC News, health reporter

Heart disease is more common in people over 65, but treatments are better than ever. That can complicate decision-making for older heart patients.It turns out that the Isley Brothers, who sang that 1966 Motown hit “This Old Heart of Mine (Is Weak for You),” were onto something when they linked age to an aching and flagging heart.Heart disease, the nation’s leading cause of death and disability, has been diagnosed in about 6 percent of Americans ages 45 to 64, but in more than 18 percent of those over 65, according to the Centers for Disease Control and Prevention.Old hearts are physiologically different. “The heart gets stiffer as we age,” said Dr. John Dodson, director of the geriatric cardiology program at NYU Langone Health. “It doesn’t fill with blood as easily. The muscles don’t relax as well.”Age also changes the blood vessels, which can grow rigid and cause hypertension, and the nerve fibers that send electrical impulses to the heart. It affects other organs and systems that play a role in cardiovascular health, too. “After age 75 is when things accelerate,” Dr. Dodson said.But in recent years, dramatic improvements in treatments for many kinds of cardiovascular conditions have helped reduce both heart attacks and cardiac deaths.“Cardiology has been blessed with a lot of progress and research and drug development,” said Dr. Karen Alexander, who teaches geriatric cardiology at Duke University. “The medications are better than ever, and we know how to use them better.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

This month, Vishvaa Rajakumar won the Memory League World Championship, which tests memorization skills. He shared some of his techniques with The Times.In early February, Vishvaa Rajakumar, a 20-year-old Indian college student, won the Memory League World Championship, an online competition pitting people against one another with challenges like memorizing the order of 80 random numbers faster than most people can tie a shoelace.The renowned neuroscientist Eleanor Maguire, who died in January, studied mental athletes like Mr. Rajakumar and found that many of them used the ancient Roman “method of loci,” a memorization trick also known as the “memory palace.”The technique takes several forms, but it generally involves visualizing a large house and assigning memories to rooms. Mentally walking through the house fires up the hippocampus, the seahorse-shaped engine of memory deep in the brain that consumed Dr. Maguire’s career.Vishvaa Rajakumar, a 20-year-old Indian college student, suggests staying hydrated as a way to keep your mind clear.via Vishvaa RajakumarWe asked Mr. Rajakumar about his strategies of memorization. His answers, lightly edited and condensed for clarity, are below.Q. How do you prepare for the Memory League World Championship?Hydration is very important because it helps your brain. When you memorize things, you usually sub-vocalize, and it helps to have a clear throat. Let’s say you’re reading a book. You’re not reading it out loud, but you are vocalizing within yourself. If you don’t drink a lot of water, your speed will be a bit low. If you drink a lot of water, it will be more and more clear and you can read it faster.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

By watching the brain process information, she discovered that a specific region plays a key role in spatial navigation — and that it can be strengthened like a muscle.Eleanor Maguire, a cognitive neuroscientist whose research on the human hippocampus — especially those belonging to London taxi drivers — transformed the understanding of memory, revealing that a key structure in the brain can be strengthened like a muscle, died on Jan. 4 in London. She was 54.Her death, at a hospice facility, was confirmed by Cathy Price, her colleague at the U.C.L. Queen Square Institute of Neurology. Dr. Maguire was diagnosed with spinal cancer in 2022 and had recently developed pneumonia.Working for 30 years in a small, tight-knit lab, Dr. Maguire obsessed over the hippocampus — a seahorse-shaped engine of memory deep in the brain — like a meticulous, relentless detective trying to solve a cold case.An early pioneer of using functional magnetic resonance imaging (f.M.R.I.) on living subjects, Dr. Maguire was able to look inside human brains as they processed information. Her studies revealed that the hippocampus can grow, and that memory is not a replay of the past but rather an active reconstructive process that shapes how people imagine the future.“She was absolutely one of the leading researchers of her generation in the world on memory,” Chris Frith, an emeritus professor of neuropsychology at University College London, said in an interview. “She changed our understanding of memory, and I think she also gave us important new ways of studying it.”In 1995, while she was a postdoctoral fellow in Dr. Frith’s lab, she was watching television one evening when she stumbled on “The Knowledge,” a quirky film about prospective London taxi drivers memorizing the city’s 25,000 streets to prepare for a three-year-long series of licensing tests.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

President Trump ordered on Friday that federal funding be withheld from schools and universities that require students to be vaccinated against Covid, White House officials said, another step in the administration’s campaign against coronavirus vaccine requirements.It was not clear how widely impactful the order would be. No states require K-12 students to be vaccinated against Covid. Only 15 colleges still required Covid vaccines for students as of late last year, according to No College Mandates, an advocacy group.Riding the same wave of anti-vaccine sentiment, 21 states had already moved to outlaw student Covid vaccine mandates, the National Academy for State Health Policy, a nonpartisan research group, has said. And Republican elected officials across the country have pursued a tide of anti-vaccine measures, including a proposed ban in Montana on administering mRNA vaccines, which include some Covid shots, and a ban on a local health department in Idaho offering any Covid vaccines.The Centers for Disease Control and Prevention has said that monitoring has shown that Covid vaccines are safe for children.Younger people are much less likely to be severely sickened by the coronavirus, but doctors have said that the virus has still harmed many children.For Mr. Trump, whose first administration accelerated the development and rollout of Covid shots, saving some 140,000 lives in their early months of availability, the latest executive order was a turn toward reining in efforts to promote the vaccines.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

After weeks of disruption to scientific federal grants, the National Institutes of Health has fallen behind in funding research into treatments for deadly diseases.Federal research funding to tackle areas like cancer, diabetes and heart disease is lagging by about $1 billion behind the levels of recent years, reflecting the chaotic start of the Trump administration and the dictates that froze an array of grants, meetings and communications.The slowdown in awards from the National Institutes of Health has been occurring while a legal challenge plays out over the administration’s sudden policy change last week to slash payments for administrative and facilities costs related to medical research. A federal judge in Massachusetts has temporarily blocked the cutbacks, pending hearings later this month.Federally funded research has driven major advances in cutting-edge gene therapies and immune-system-boosting treatments for certain cancers, cystic fibrosis and sickle cell disease.The broader lag in funding is being felt at universities and medical centers from Baton Rouge to Boston, according to congressional lawmakers who are tracking it. Federal spending records show the allocations are about $1 billion lower than last year’s disbursements were at this time.N.I.H. funding has ground to a halt in the past 10 days, according to Senator Tammy Baldwin, Democrat of Wisconsin.“The president has completely stopped funding for research that discovers cures for diseases that devastate families across the country, like cancer and Alzheimer’s disease, all so he can give tax breaks to billionaires and big corporations,” Ms. Baldwin said in a statement on Friday. “Make no mistake, their efforts to rob Peter to pay Paul means crushing families’ hopes and dreams of having cures.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A specialist surgeon has been suspended from a world-renowned NHS hospital after nine children under their care were left with lasting injuries.