Publisher Health

By studying a disease caused by a close cousin of the virus behind COVID-19, a team of scientists has identified a compound that shows potential in easing the symptoms of coronavirus infections.
The team, from the Department of Energy’s Pacific Northwest National Laboratory and the University of North Carolina at Chapel Hill, studied the virus that causes Middle East Respiratory Syndrome, which is caused by a coronavirus. MERS is much less common, but much more lethal, than COVID-19.
The team set out to learn more about how the virus that causes MERS damages the lungs and harms patients. In laboratory studies, the team analyzed tens of thousands of measurements of proteins, molecular messengers and other signals that occur after infection. They pinpointed a molecular process, part of the body’s quality-control machinery, that plays a central role in causing damage from a coronavirus infection.
Then, the team searched a vast database of compounds and identified one — known as AMG PERK 44 — that put a halt to virus replication in human tissue in the laboratory. They also found the compound has a strong effect in mice infected with the virus. The compound boosted lung function and reduced lung damage and weight loss in the mice, particularly in male mice.
The broad fight against respiratory diseases
Battelle, which operates PNNL, and UNC have filed for a patent on the use of a PERK inhibitor to treat coronavirus infections. But the scientists emphasize that it’s far too soon to know whether the compound could help patients. It’s not currently used as a drug.

The $1.85 trillion social policy bill would provide free private health insurance for more than two million adults locked out of coverage, but only for four years.ALBANY, Ga. — After giving up on their goal of creating a new Medicaid program to cover two million poor adults, Democrats are aiming to provide them with free private coverage as part of the party’s social policy bill. But there is a catch: The benefits would last only four years.Even with that expiration date, the legislation cannot come fast enough for people like Evelyn Davis, who suffered two heart attacks and has high blood pressure and diabetes. A former home health care aide, she lost coverage when she got divorced two years ago. She has chest pains and heart palpitations but said she cannot afford to see a cardiologist.“If I can’t get any medicine, I just get Tylenol PM when I sleep,” Ms. Davis, 63, said, “and just pray to God when I wake up that I won’t be in pain.”She is among an estimated 2.2 million American adults who lack insurance because they live in one of the 12 states where Republicans have refused to expand Medicaid, which is jointly financed by the federal government and states, under the Affordable Care Act. Too poor to qualify for subsidized private insurance through the Obamacare exchanges yet not poor enough for Medicaid, they navigate a byzantine system of charity care — and often skip care altogether.Now these patients may get what many have hoped for since the Affordable Care Act’s passage more than a decade ago — albeit with no guarantee that the new benefits are here to stay. The framework announced last week by President Biden for the $1.85 trillion social policy bill includes the biggest expansion of health care since the Obama-era health law, patching holes in the landmark law that had long seemed impossible to fix. Still, the framework is tenuous. On Monday, Senator Joe Manchin III, Democrat of West Virginia, dashed hopes for a quick Senate vote by refusing to endorse the measure, whose health care provisions had already been pared back under pressure from Mr. Manchin and other centriststo keep the price down. The “public option,” promoted by Mr. Biden during his presidential campaign as a way for people to buy into a Medicare-like plan, was never even considered. Language authorizing the government to negotiate prices with drug companies was scrapped. A plan to give dental, vision and hearing coverage to Medicare recipients has been whittled down to just hearing.And in the end, negotiators dropped the idea of a new Medicaid plan financed entirely by the federal government for people in the 12 holdout states, which would have been complicated to create, in favor of fully subsidized private coverage — but only through 2025. The free plans would be comparable to Medicaid coverage, with minimal fees for doctor visits and enhanced benefits like transportation to medical appointments. All told, an estimated 4.4 million people — including the uninsured and other low-income adults — would be able to take advantage of them.For Democrats, who took back the House in 2018 and this year gained control of the Senate in part by vowing to expand access to affordable heath care, the bill is a political necessity. And perhaps no Democrat needs it more than Senator Raphael Warnock, Georgia’s first Black senator, who won a special election in January on a promise of expanding Medicaid.Mr. Warnock will be on the ballot again in 2022, a year that is widely expected to be grim for his party, and the contest could determine control of the Senate. In Washington, closing the coverage gap remains Mr. Warnock’s signature issue.“I believe that health care is a human right, and if you believe it’s a human right, you don’t believe it’s a human right for 38 states,” Mr. Warnock said in an interview in September.But some Democrats, notably Mr. Manchin, view solving the problem solely with federal dollars as unfair to states that did expand Medicaid and continue to pay 10 percent of the cost; why, they ask, should Republicans be rewarded for resisting? Republicans oppose the social policy plan in its entirety, calling it a “tax and spending spree.” A rural hospital treating Covid-19 patients in Rio Grande City, Texas. The state accounts for more than a third of people in the Medicaid coverage gap.Christopher Lee for The New York TimesThe profile of those who fall in the gap is much the same as the profile of those hardest hit by the coronavirus pandemic: poor people of color. Most are in the South; Texas alone accounts for more than a third of people in the gap, according to the Kaiser Family Foundation.Della Young, 49, a kidney transplant patient with lupus, was doing fine when she lived in New York. As an end-stage renal disease patient, she is covered by Medicare, which paid 80 percent of her medical expenses. Medicaid picked up the rest.But when Ms. Young moved to McDonough, Ga., in 2015, she lost her Medicaid coverage and was unable to pay for drugs to prevent her body from rejecting her donated organ. Her transplant failed in 2016, and she has been waiting for a new kidney ever since, while undergoing dialysis three times a week. She sends the dialysis center a check for $5 a month — a small offering toward a much larger bill.Because out-of-pocket expenses associated with transplants are so high, Emory Transplant Center, where Ms. Young is a patient, advised her to raise money on her own. She started a GoFundMe account, hoping to raise $100,000. She has raised $5,077 so far.“This whole fund-raising thing is crazy,” she said. “Health care should be the same across the board, regardless of what state you live in.”In Albany, a small city about three hours south of Atlanta, patients like Ms. Davis are eager for any help they can get. She and about a dozen other uninsured people shared their stories in the bare-bones waiting room of the Samaritan Clinic, founded 15 years ago by the Rev. Daniel Simmons, the senior pastor of Mount Zion Baptist Church, who said he had followed the will of God.“People were suffering, dying right in our backyard,” he said. “I said, ‘Lord, what do you want me to do?’ ”Lisa Jones, 59, lost her employer-sponsored insurance when she gave up her job at a chicken processing plant to care for her ailing husband. He put her on his plan, but when he died she fell into the coverage gap.Nicole Craine for The New York TimesStill, the clinic can only do so much. Lisa Jones, 59, lost her employer-sponsored insurance when she gave up her job at a chicken processing plant to care for her ailing husband. He put her on his plan, but when he died she fell into the coverage gap. She gets blood pressure and cholesterol drugs through the clinic, which works with companies that offer free medicines.But when Ms. Jones sought care for Covid-19, she got a bill for $150. “That went to collections because I didn’t have the money to pay it,” she said.Volunteer doctors provide primary care at the clinic, but Nedra Fortson, a nurse practitioner and the clinic’s executive director, said it was difficult to refer patients to specialists because so many refuse to offer free care. Georgia is one of a dozen states that have not expanded Medicaid under the Affordable Care Act. Addressing the coverage gap has been a priority for the state’s two Democratic senators, Raphael Warnock, center, and Jon Ossoff, right. J. Scott Applewhite/Associated PressSome patients, she said, can afford to go to the community health center, which has a low co-payment of $25. “But oftentimes, once they get in to see a provider and they have to run labs, the patient ends up having a bill,” Ms. Fortson said. “And once they can’t pay that bill, they are unable to get appointments, and so they come to us to get help.”The question of Medicaid expansion has percolated through Georgia politics for much of the past decade. The Affordable Care Act intended for states to expand Medicaid to cover adults with incomes up to 138 percent of the federal poverty line — currently about $17,800 a year for an individual. Republican states sued, and in 2012 the Supreme Court upheld the law but made Medicaid expansion optional.Nedra Fortson, a nurse practitioner and the clinic’s executive director, said it was difficult to refer patients to specialists because so many refuse to offer free care.Nicole Craine for The New York TimesIn 2014, Georgia Republicans went one step further. Fearful that a Democrat would win the governorship, they passed a law requiring the legislature to approve any expansion plan. In 2018, Stacey Abrams, the Democratic candidate for governor, hit Republicans hard on health care. The next year, the state sought to partially expand Medicaid, with requirements for recipients to work.The Trump administration approved the plan, which would have covered only a fraction of the state’s uninsured low-income adults, just days before Mr. Trump lost the 2020 election. The Biden administration, opposed to work requirements, has put it on hold.In the meantime, people in the coverage gap are trying to make do — now with new hope that the social policy bill will become law. Ms. Davis, the former home health care aide, pays $90 out of pocket to see a primary care doctor once a year and gets annual mammograms from the county health department, where they are free. Her children help, but she does not like to accept it.The Democrats’ plan to fully subsidize four years of coverage would tide Ms. Davis over until she turns 65 in two years and becomes eligible for Medicare. She sought Social Security disability benefits, hoping to qualify for Medicare that way, but was unsuccessful.“I filed for disability and they denied me,” she said, “and I’m like, ‘Oh Lord, it ain’t so much about the check.’ If I could just get some insurance so I could see my doctors, that’s all I want.” She added, “If I could get four years, it would be great.”

In a pilot human study, researchers from the University of Minnesota Medical School and Massachusetts General Hospital show it is possible to improve specific human brain functions related to self-control and mental flexibility by merging artificial intelligence with targeted electrical brain stimulation.
Alik Widge, MD, PhD, an assistant professor of psychiatry and member of the Medical Discovery Team on Addiction at the U of M Medical School, is the senior author of the research published in Nature Biomedical Engineering. The findings come from a human study conducted at Massachusetts General Hospital in Boston among 12 patients undergoing brain surgery for epilepsy — a procedure that places hundreds of tiny electrodes throughout the brain to record its activity and identify where seizures originate.
In this study, Widge collaborated with Massachusetts General Hospital’s Sydney Cash, MD, PhD, an expert in epilepsy research; and Darin Dougherty, MD, an expert in clinical brain stimulation. Together, they identified a brain region — the internal capsule — that improved patients’ mental function when stimulated with small amounts of electrical energy. That part of the brain is responsible for cognitive control — the process of shifting from one thought pattern or behavior to another, which is impaired in most mental illnesses.
“An example might include a person with depression who just can’t get out of a ‘stuck’ negative thought. Because it is so central to mental illness, finding a way to improve it could be a powerful new way to treat those illnesses,” Widge said.
The team developed algorithms, so that after stimulation, they could track patients’ cognitive control abilities, both from their actions and directly from their brain activity. The controller method provided boosts of stimulation whenever the patients were doing worse on a laboratory test of cognitive control.
“This system can read brain activity, ‘decode’ from that when a patient is having difficulty, and apply a small burst of electrical stimulation to the brain to boost them past that difficulty,” Widge said. “The analogy I often use is an electric bike. When someone’s pedaling but having difficulty, the bike senses it and augments it. We’ve made the equivalent of that for human mental function.”
The study is the first to show that: A specific human mental function linked to mental illness can be reliably enhanced using precisely targeted electrical stimulation; There are specific sub-parts of the internal capsule brain structure that are particularly effective for cognitive enhancement; and A closed-loop algorithm used as a controller was twice as effective than stimulating at random times.Some of the patients had significant anxiety in addition to their epilepsy. When given the cognitive-enhancing stimulation, they reported that their anxiety got better, because they were more able to shift their thoughts away from their distress and focus on what they wanted. Widge says that this suggests this method could be used to treat patients with severe and medication-resistant anxiety, depression or other disorders.
“This could be a totally new approach in treating mental illness. Instead of trying to suppress symptoms, we could give patients a tool that lets them take control of their own minds,” Widge said. “We could put them back in the driver’s seat and let them feel a new sense of agency.”
The research team is now preparing for clinical trials. Because the target for improving cognitive control is already approved by the Food and Drug Administration for deep brain stimulation, Widge says this research can be done with existing tools and devices — once a trial is formally approved — and the translation of this care to current medical practice could be rapid.
“The wonderful thing about these findings is that we are now in a position to conduct clinical trials to further demonstrate effectiveness and then hopefully move to helping treatment-resistant patients who are in desperate need for additional interventions to treat their illnesses,” Dougherty said.
This work was supported by grants from the Defense Advanced Research Projects Agency (DARPA) under Cooperative Agreement Number W911NF-14-2-0045 issued by the Army Research Organization (ARO) contracting office in support of DARPA’s SUBNETS Program, the National Institutes of Health, Ellison Foundation, Tiny Blue Dot Foundation, MGH Executive Council on Research, OneMind Institute and the MnDRIVE and Medical Discovery Team on Addiction initiatives at the University of Minnesota Medical School.

Monoclonal antibodies protected aged, diabetic rhesus macaque monkeys from disease due to SARS-CoV-2 and reduced signs of inflammation, including in cerebrospinal fluid, according to a new study from researchers at the University of California, Davis. The work is published Oct. 18 in the journal Cell Reports.
The data show that neutralizing antibodies prevent the adverse inflammatory consequences of SARS-CoV-2 infection, the authors said. The results help explain how antibodies, whether induced by vaccines or after infection, or given as a treatment, can affect the course of disease. They also suggest that antibodies could be given as a preventative treatment to people at high risk, such as elderly residents during an outbreak in a nursing home.
“COVID-19 is more severe in elderly people and those with pre-existing conditions,” said Smita Iyer, associate professor of pathology, microbiology and immunology at the UC Davis School of Veterinary Medicine and Center for Immunology and Infectious Disease, and a core investigator at the California National Primate Research Center.
“The elderly and diabetics tend to be immunosuppressed, but if you can get antibody levels high enough, you can prevent severe infection,” she said. Immune responses induced by vaccines are very effective at preventing severe disease and death. But an overwhelming inflammatory immune response could also be responsible for much of the damage of severe infections.
Immune responses induced by vaccines are very effective at preventing severe disease and death. But an overwhelming inflammatory immune response could also be responsible for much of the damage of severe infections.
“We want to know, what are the immune determinants of disease,” Iyer said.

Researchers at the University of British Columbia (UBC) and BC Cancer, in partnership with BC Children’s Hospital Research Institute (BCCHR), have developed a new test to more easily diagnose medulloblastoma, the most common malignant childhood brain tumour.
The test — which can distinguish between extremely high-risk medulloblastoma cases that need radiation therapy from those that are lower-risk and do not need radiation — could help pave the way for personalized treatment options for children suffering from the disease.
“With this new test, more doctors may one day be able to identify children with the most aggressive forms of medulloblastoma and better tailor treatment,” says the study’s senior author, Dr. Poul Sorensen, professor of pathology and laboratory medicine at UBC’s faculty of medicine, distinguished scientist at BC Cancer, and associate member at BCCHR.
According to the researchers, right now only sophisticated and expensive tests conducted in a handful of labs around the world can identify children with the most aggressive forms of the disease, which forms in the cerebellum, the posterior part of the brain.
Given current testing limitations, all children with medulloblastoma receive the same type of treatment, meaning children with less-aggressive forms are unnecessarily exposed to toxic side effects of brain radio- and chemotherapies, often leading to permanent learning, physical and emotional disabilities. Meanwhile, children with the most aggressive forms of the disease may not receive treatments sufficient to cure the disease.
The new test — developed in Dr. Poul Sorensen’s laboratory at the BC Cancer Research Institute — relies on an antibody-based technique called immunohistochemistry, which is widely available in clinical laboratories around the world.
“By using a technique that is available in virtually all clinical labs, our new test has the potential to improve the diagnosis and future treatment of medulloblastoma for children in almost every corner of the planet,” says the study’s lead author Dr. Alberto Delaidelli, MD and UBC PhD candidate in Dr. Sorensen’s lab.
To develop the test, the researchers analyzed various data sets, including proteomics (which measures overall protein expression in tumour tissues) and transcriptomics (which measures overall gene expression in tumour tissues). Using this strategy, they found a protein called TPD52 that is highly expressed in the most aggressive medulloblastoma.
They then screened for the expression of this protein in approximately 400 medulloblastoma samples and found that tumours where this protein was readily detectable were significantly more likely to display aggressive behavior and to relapse.
“These days, researchers often go from simpler techniques to extremely complicated ‘omics’ techniques as part of their research efforts to make clinically-relevant observations,” says Dr. Delaidelli. “Instead, we used a bit of ‘reverse engineering,’ working backwards by analyzing very complicated data sets to develop a technique that can be performed in virtually all clinical labs worldwide.”
The study, recently published in Clinical Cancer Research, is the result of a collaboration between researchers in Vancouver, Toronto, Philadelphia, Heidelberg and Moscow.
The research groups are now testing the performance of the test in a clinical trial, working in collaboration with colleagues in Germany and other parts of the world.
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Materials provided by University of British Columbia. Original written by Kerry Blackadar. Note: Content may be edited for style and length.

A new study reveals how sperm change their swimming patterns to navigate to the egg, shifting from a symmetrical motion that moves the sperm in a straight path to an asymmetrical one that promotes more circular swimming.
This change in behavior, called hyperactivation, enables the sperm to sweep the area once in the egg’s proximity, which improves the sperm’s chances of finding it.
For the in vitro study, the researchers designed microfluidic chips with micron-sized channels so they could observe bovine sperm with a microscope and a high-speed camera.
By exposing the mechanisms involved, the study not only unravels a mystery of how the sperm navigates to the egg, but it also has implications for human in-vitro fertilization and dairy cow reproduction and provides new information for engineers to design robotic micro swimmers.
“By understanding what determines the navigational mechanism and the biophysical and biochemical cues for a sperm to get to the egg, we may be able to use those cues to treat couples with infertility issues and select the best strategy for in vitro fertilization,” said Alireza Abbaspourrad, the paper’s senior author and the Youngkeun Joh Assistant Professor of Food Chemistry and Ingredient Technology in the Department of Food Science in the College of Agriculture and Life Sciences.
The study, “Mammalian Sperm Hyperactivation Regulates Navigation Via Physical Boundaries and promotes Pseudo-Chemotaxis,” was published online Oct. 29 in the Proceedings of the National Academy of Sciences.
The paper clarifies how millions of sperm travel through the female mammal’s reproductive tract, with only a handful eventually reaching the fertilization site. The sperm stay close to the side walls and swim in a straight line against a small amount of fluid that flows from the upper to lower part of the reproductive tract. But once sperm reach the uterine junctional zone, enter the fallopian tubes and move towards the egg, an influx of calcium ions into their flagellum triggers hyperactivation and circular swimming. More study is needed to understand exactly what triggers the calcium influx in the flagellum.
The microfluidic chips allowed the researchers to manipulate the environment. The team recorded the sperm swimming alongside the chamber’s walls. They then tested compounds, including caffeine, which increase calcium ions in a cell’s cytoplasm. They recorded the sperm’s behavioral switch in the presence of calcium from symmetrical, direct swimming to hyperactivated circular swimming that meant the sperm no longer hugged close to the walls. Without this shift, sperm could run into dead ends where they get stuck.
“It’s been shown that this [swimming] state is required for fertilization,” Abbaspourrad said. Though the observations occurred in a lab in vitro, it provides a sense of what might be happening in vivo, he said.
“We think that hyperactivation modulates sperm’s swimming behavior as it ascends towards the fertilization site, depending on the functional region within the tract, and as sperm responds to the biochemical factors present in the environment,” said Meisam Zaferani, the paper’s first author and a graduate student in Abbaspourrad’s lab.
Susan Suarez, emeritus professor of biomedical sciences, is a coauthor.
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Materials provided by Cornell University. Original written by Krishna Ramanujan, courtesy of the Cornell Chronicle. Note: Content may be edited for style and length.

University of Ottawa. “Mother’s weight before – not gained during – pregnancy has impact on development of allergic diseases.” ScienceDaily. ScienceDaily, 1 November 2021. .
University of Ottawa. (2021, November 1). Mother’s weight before – not gained during – pregnancy has impact on development of allergic diseases. ScienceDaily. Retrieved November 3, 2021 from www.sciencedaily.com/releases/2021/11/211101141457.htm
University of Ottawa. “Mother’s weight before – not gained during – pregnancy has impact on development of allergic diseases.” ScienceDaily. www.sciencedaily.com/releases/2021/11/211101141457.htm (accessed November 3, 2021).

It was an answer to Freudian analysis: a pragmatic, thought-monitoring approach to treating anxiety, depression and other mental disorders, and it changed psychiatry.Dr. Aaron T. Beck, whose brand of pragmatic, thought-monitoring psychotherapy became the centerpiece of a scientific transformation in the treatment of depression, anxiety and many related mental disorders, died on Monday at his home in Philadelphia. He was 100.His death was confirmed by Alex Shortall, an executive assistant at the Beck Institute for Cognitive Behavior Therapy in Bala Cynwyd, Pa., outside Philadelphia. Dr. Beck’s daughter Dr. Judith Beck is its president.Dr. Beck was a young psychiatrist trained in Freudian analysis when, in the late 1950s, he began prompting patients to focus on distortions in their day-to-day thinking, rather than on conflicts buried in childhood, as therapists typically did. He discovered that many people generated what he called “automatic thoughts,” unexamined assumptions like “I’m just unlucky in love” or “I’ve always been socially inept,” which can give rise to self-criticism, despair and self-defeating attempts to compensate, like promiscuity or heavy drinking.Dr. Beck found that he could undermine those assumptions by prompting people to test them out in the world — say, by socializing without alcohol to observe what happens — and to gather countervailing evidence from their own experience, like memories of healthy relationships. Practicing these techniques, in therapy sessions and in homework exercises, fostered an internal dialogue that gradually improved people’s mood, he showed.Dr. Beck’s work, along with that of Albert Ellis, a psychologist working independently, provided the architecture for what is known as cognitive behavior therapy, or C.B.T. Over the past several decades, C.B.T. has become by far the world’s most extensively studied form of psychotherapy. In England, it forms the basis for a nationwide treatment program offering a number of related talk therapies.“There is more to the surface than meets the eye,” Dr. Beck was fond of saying.The influence of C.B.T. on the treatment of mental disorders is hard to exaggerate. Researchers have adapted the approach — originally developed for depression — to manage panic attacks, addictions, eating disorders, social anxiety, insomnia and obsessive-compulsive disorder. Therapists teach a variation to help parents manage children’s outbursts at home, and some have used it, in combination with medication, to manage the delusions and hallucinations of schizophrenia. Sports psychologists have made use of the principles for performance anxiety.Dr. Beck, who spent his career at the University of Pennsylvania, led the way.“One by one, he took each condition in psychiatry and laid out his thinking about how it should be addressed — and others followed up,” said David Clark, a professor of psychology at Oxford University, who designed and helped institute England’s talk therapy program. “I’m not sure that that’s ever been done, in quite that way.”Steven Hollon, a psychologist at Vanderbilt University, said of Dr. Beck: “He took a hundred years of dogma, found that it didn’t hold up, and invented something brief, lasting and effective to put in its place. He basically saved psychotherapy from itself.”Aaron Temkin Beck, known to friends and colleagues as Tim, was born in Providence, R.I., on July 17, 1921, the youngest of four children of Russian Jewish immigrants. His father was a printer who had socialist leanings and wrote poetry; his mother ran the household. As a child, Aaron was in perpetual motion. He was a Boy Scout who played basketball and football with friends until age 8, when he developed a serious infection after surgery for a broken arm. The month he spent in the hospital became a pivotal experience, turning him toward more intellectual pursuits, like reading and writing.After high school, he entered Brown University, finishing summa cum laude in 1942. He went on to get a medical degree from Yale University and did his residency in psychiatry at the Cushing Veterans Administration Hospital in Framingham, Mass.He was still in training at the Philadelphia Psychoanalytic Institute (now the Psychoanalytic Center of Philadelphia) when he began to have doubts about the scientific basis of Freud’s open-ended talk therapy, which was then the gold standard of treatment in American psychiatry. Though Freudian analysts agreed that there were “deep factors at work” in many cases of mental distress, Dr. Beck told The New York Times in 2000, no one could agree on what they were.After searching in vain to find some empirical basis for Freud’s ideas, he began to focus on patients’ thinking in the here and now. For years he worked in relative obscurity, unsure of his footing and supported primarily by his wife, Phyllis, whom he called his “reality tester.” (He and Phyllis Whitman married in 1950.) Judge Phyllis W. Beck, who is now retired and survives him, was the first woman to serve on the Pennsylvania Superior Court.In addition to her and his daughter Judith, Dr. Beck is survived by another daughter, Alice Beck Dubow, a judge in the Pennsylvania courts; two sons, Roy and Daniel; 10 grandchildren; and 10 great-grandchildren.Dr. Beck openly cited the influence of other thinkers, like the German psychoanalyst Karen Horney (1885-1952), the American psychoanalyst George Kelly (1905-1967) and Dr. Ellis, in developing his ideas. Dr. Ellis’s “rational emotive behavior therapy,” as Dr. Ellis called it, shared many common-sense principles with Dr. Beck’s approach.In contrast with Dr. Ellis, a flamboyant, tough-love father figure who died in 2007, Dr. Beck came across as an affectionate paterfamilias. Smiling softly beneath a rich sweep of white hair, wearing a bright bow tie and tailored suit, he engaged patients gently, chipping away at defeating beliefs with Socratic questions: Would you agree it is against your interests to have this belief? Do you think it’s possible to ignore these thoughts?He had a different effect, however, on many of his contemporaries. When he first described his approach, Freudian analysts ventured that he “had not been well analyzed,” the ultimate insider’s put-down, implying that he was unequipped to understand others because he had not fully understood himself in his training therapy.Later, in the 1980s, Dr. Beck was hit from the other side: So-called biological psychiatrists, who focused on drug treatments, questioned the strength of C.B.T. studies, saying that they were unimpressive compared with drug trials. To the extent that the therapy worked, argued Dr. Donald Klein, then director of the New York State Psychiatric Institute, it was because of a general morale-boosting effect rather than a specific, targeted treatment. Dr. Beck hardened with a blunt New England edge when challenged. But he typically responded with a pile of new data, and avoided being drawn into intellectual blood feuds with other theorists.Cognitive therapy spread worldwide, in part because therapists found it useful and in part because its techniques could be summarized simply in manuals, making it easy to standardize, teach and use in research studies. Dr. Beck, patient, plain-spoken and persuasive, was its most effective ambassador.In the first chapter of his classic 1967 book, “Depression: Causes and Treatment,” he observed: “There is an astonishing contrast between the depressed person’s image of himself and the objective facts. A wealthy man moans that he doesn’t have the financial resources to feed his children. A widely acclaimed beauty begs for plastic surgery in the belief that she is ugly. An eminent physicist berates himself ‘for being stupid.’”He wrote or co-wrote 22 books in all, on technical psychiatric topics as well as love, anger and chronic pain, including three with his daughter Judith.In his last years Dr. Beck applied cognitive techniques to help largely forgotten groups of people, like destitute drug addicts and people with late-stage schizophrenia. “These people have some capacity to do better, but they have all these defeatist attitudes and expectations; they assume they’re going to fail,” he said in an interview with The Times in 2009 in Bala Cynwyd.He was also advising a friend who had terminal cancer. “He’s having mood problems, and who wouldn’t?” Dr. Beck said. “I’m having him spend 30 minutes every day, at the beginning of the day, to think about how important this day is — that it may be the most important day of his life, or one of richest.”

Novavax, a Maryland-based company that received $1.75 billion from the United States government to develop a protein-based Covid-19 vaccine, announced Monday it had won emergency authorization for its vaccine in Indonesia.After months of production delays, this is the first authorization for Novavax and its manufacturing partner, the Serum Institute of India. They have also applied for clearance in India and the Philippines, and Novavax has applied on its own to other countries, including Britain and Canada.In its Monday announcement, Novavax said it would be submitting an application to the U.S. Food and Drug Administration by the end of the year.In a statement, Stanley C. Erck, Novavax’s president and chief executive, said that the green light from Indonesia “is the first of many authorizations that Novavax expects in the coming weeks and months for our vaccine globally.”Novavax’s vaccine is fundamentally different from the Covid-19 vaccines now authorized in the United States from Johnson & Johnson, Moderna and Pfizer-BioNTech. It consists of microscopic particles studded with viral proteins, mixed with an immune-boosting compound called an adjuvant.In clinical trials in the United States and elsewhere, Novavax’s vaccine proved highly effective. But the company has struggled to ramp up its manufacturing and demonstrate the purity of its vaccines to regulators.As a result, Novavax fell behind other vaccine developers supported by Operation Warp Speed, the Trump administration’s program to expedite Covid vaccines, missing the first wave of vaccinations in the United States. If authorized in the United States, Novavax might potentially serve as a booster for people who have gotten other vaccines as their primary doses.Since last year, Novavax was also expected to make up a large portion of the vaccines that would be distributed globally. In February, it announced an agreement to supply 1.1 billion doses to Covax, an initiative to deliver vaccines to low and middle-income countries. In September, Covax had to cut its projected delivery of doses in 2021 by a quarter, in part because Novavax had yet to win authorization for its vaccine.Indonesia initially began vaccinating its citizens with vaccines from China, but a bout of breakthrough infections among health care workers raised concerns that their immunity had waned quickly. The country subsequently made deals to secure doses from Novavax, as well as Pfizer-BioNTech, AstraZeneca and Moderna.Indonesia has secured 320 million total doses through these deals, including 50 million from Novavax. Once those vaccines are delivered, they will be enough for 160 million people in a country of 237 million.So far, only 43 percent of people in Indonesia have received at least one dose, while almost 27 percent are fully vaccinated.Winning authorization in Indonesia will not on its own enable Novavax to live up to its promises to Covax. Covax accepts vaccines that have won authorization from the World Health Organization or a country that it recognizes as having stringent regulations. Indonesia is not on that list.

Many men and women with “failing kidneys” may not have anything more than a normal age-related decline in kidney function.If the public has learned anything about medicine during the Covid-19 pandemic, it is that science is constantly evolving. New findings can change how experts define a given illness, as well as how they diagnose, prevent and treat it.Such is the case, a new study suggests, with chronic kidney disease. A growing cadre of physicians are combating what they call an over-diagnosis of this condition in the elderly. According to these doctors, many older adults who’ve been told their kidneys are on the road to failure may not have anything more than a normal age-related decline in kidney function. For many, their kidney disease is unlikely to become a medical problem during their remaining years of life.This, in fact, is exactly what happened to a friend’s mother who was told she had kidney disease in her late 70s. She received drug treatment for the disorder and recently died at 92 of a combination of old age, malnutrition and bedsores, but with kidneys that still worked perfectly.Yet being told that organs as important as one’s kidneys are functioning poorly may cause older people needless emotional distress. In addition, doctors may too readily prescribe medications, including drugs that lower blood pressure, that have financial costs and side effects.Life-sustaining filtrationMost people are born with two kidneys, which work as the body’s filtration system. Each bean-shaped organ has about a million units called nephrons. And each nephron contains a glomerulus, a tuft of tiny vessels that filters the blood as it passes through, and a tubule that sends cleansed blood and essential nutrients back into circulation. In the course of a day, some 150 quarts of blood normally pass through the kidneys, with only a quart or two of liquid waste leaving the body as urine.Health care workers typically assess how well someone’s kidneys work by starting with a blood test for the glomerular filtration rate, or G.F.R., an estimate of how much blood passes through the glomeruli every minute. If the estimated G.F.R. is abnormally low, the patient’s urine is analyzed for the level of protein, or albumin, being excreted. If that is high, it could indicate poorly functioning kidneys.According to current guidelines, an estimated G.F.R. below 60 for three months or longer is considered an indication of chronic kidney disease. While a rate below 60 would indeed be worrisome for a 50-year-old, for people in their 70s and 80s it may simply reflect the normal slowing of a bodily function with age, the new research suggests. What the study found The new research, published in JAMA Internal Medicine in August, found that many people over 65 with a low estimated G.F.R. and no elevated protein in their urine did not have increased health risks. For the study, Dr. Pietro Ravani, a nephrologist at the Cumming School of Medicine at the University of Calgary in Alberta, and his co-authors analyzed health data collected from 127,132 men and women in Canada. They compared the risk of kidney disease and death over five years based on their G.F.R. The fate of those with a G.F.R. of less than 60 — which would result in a diagnosis of chronic kidney disease using current guidelines — was then assessed according to two different criteria. One was based on the fixed rate of 60, and the other with a sliding G.F.R. that was adjusted for age, ranging from younger than 40 to older than 65.The researchers found that in younger adults, a G.F.R. of 45 to 59 would indicate declining kidney function that warrants careful monitoring and treatment. But in older adults, particularly those in their 80s and beyond, the risk of kidney failure associated with such a low G.F.R. was essentially the same as those with a G.F.R. of 60 or above. In fact, the risk of death from kidney failure up to and beyond age 100 was no different at any age over 65.“When old patients come to the clinic all worried about kidney disease, I most often tell them their kidneys will not die before they do,” Dr. Ravani said.Evolving guidelinesDebate about the over-diagnosis of kidney disease is not new. Thirteen years ago, two nephrologists debunked the supposed “epidemic” of chronic kidney disease that stemmed from diagnostic guidelines issued in 2002. Although revised guidelines in 2012 further narrowed the definition of who has chronic kidney disease, the new study suggests those guidelines still result in far too many older adults being told they have the condition. The new research demonstrated that the commonly used benchmark for defining kidney disease — a glomerular filtration rate of less than 60 milliliters per minute — often results in older adults receiving a diagnosis and treatment for a condition that will never cause symptoms or hasten their death.The findings suggest that the diagnostic guidelines for chronic kidney disease needs yet another refinement that would significantly “reduce the burden of kidney disease” in the elderly, Dr. Ravani said. Competing interestsIn an editorial accompanying the new report, Dr. Ann M. O’Hare, a nephrologist at the University of Washington and the VA Puget Sound Health Care System in Seattle, noted that there is ongoing resistance to changing current diagnostic guidelines. Much of this resistance, she argued, is based less on science than on the financial, personal and professional stakes many decision makers have in maintaining the status quo.She explained that various groups — including pharmaceutical and biotechnology companies, health systems, professional organizations that develop medical guidelines, and even patient advocacy groups — benefit directly or indirectly from the current definition of disease that unnecessarily labels hundreds of thousands of older adults with a diagnosis of chronic kidney disease.The forces driving over-diagnosis can be subtle and not always financial, Dr. O’Hare said in an interview. Some groups believe strongly that everything possible should be done to avoid kidney failure down the road, no matter how unlikely it may be in an elderly person. But the new study showed that the current diagnostic cutoff “labels a large number of people with having a disease when they have nothing more than a natural decline in kidney function with age,” she said.Too often, Dr. Ravani said, doctors give credit for the patient’s survival to the medication that was prescribed, when in fact it really made no difference. Before agreeing to take a medication, he suggested that patients ask what effect it is likely to have on their lives.