(CNN)So the recent report from the Midwest Medical Examiner’s Office made it official — Prince Rogers Nelson died in his residence April 21, 2016, from an accidental overdose of the prescribed opioid, fentanyl. He was 57.
In the aftermath of the death of such an iconic figure we are experiencing a flurry of political activity as our elected leaders, both Republican and Democrat, hurry to pass some form of legislation that will help stem the tide of opioid-related death that claimed the lives of some 165,000 Americans from 2000-2014.
Medications such as Suboxone (buprenorphine) are proven effective in helping those who are addicted to opioids avoid relapse. Narcan, the opiate reversal agent, can save the life of someone who is acutely overdosing and needs to be in the hands of first responders everywhere.
Improving affordability and access to these and other proven treatments is a must and I am in full support of those measures.
But that alone will not stop this epidemic nor turn back this tide of misery.
All the authors said was that among the many hospitalized patients who were given a dose of opioid for their acute injury, very few developed addiction. That is all it said. It said nothing about what happens to patients who take these medicines indefinitely.
Yet those few sentences got transformed by relentless marketing into “opiates are not addictive.” Which was as crazy as saying “tobacco is not addictive,” if someone smoked four cigarettes and did not become a chain-smoker. It was blatantly irresponsible medicine. But it worked. Prescriptions soared.
By now, you know that the U.S. consumes 80% of the world’s opioid painkillers while comprising just 5% of the world’s population. And as the sales have increased, so, too, have the overdose deaths and the rates of admission to addiction treatment centers. In 1999, 4,030 Americans lost their lives to accidental opiate overdose. In 2014, that number had increased to 18,893. That is more than six World Trade Centers.
Some of you no doubt are asking: Where have the good doctors been in all this? Aren’t they supposed to be watching out for our safety? The answer to that question is very discouraging, but I can reach no other conclusion after studying and fighting this problem for the last 10 years. The answer is we are right where we have always been — minding the register.
The values currently prioritized by medicine were made explicit to me several years ago. During my annual performance review, my medical director told me: “You know, we are so proud of you for all the work you are doing fighting the opiate prescription problem. But it is such a fine line between increasing the risk of addiction and HCAHPS scores.”
Wow. Every health care professional reading this knows exactly what I am talking about. HCAHPS stands for Hospital Consumer Assessment of Healthcare Providers and Systems. These are “patient satisfaction” surveys and they talk about pain management specifically. Hospitals are required to participate in these surveys and reimbursement is tied to how well they do. Hence, every hospital administrator and department chair is acutely aware of their “score.”
If this sounds too fuzzy and “Kumbaya” for you, I would point out that this exact sentiment is expressed in the Hippocratic oath. The 1964 version (which I recited in medical school) admonishes us to remember “that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug.”
In America, we are far too heavy on the knives and drugs, and far too light on the warmth and sympathy.
I realize that making these fundamental changes to our health care delivery system will be very difficult. There are a lot of powerful interests with very little to gain by changing the current system. But change must happen. Because the yearly body count due to the opiate epidemic is simply not acceptable.
I believe we can do better. For the memory of Prince and the thousands of others whom we have lost too soon.
Research claims multivitamins and minerals do not improve mothers or babies health and are an unnecessary expense
Most pregnant women who take multivitamin and mineral supplements are wasting their time and money because such tablets do not improve their or their babys health, new research says.
Mothers should not be seduced by marketing that makes claims that cannot be backed up, according to a review of the available evidence on the subject in the journal Drug and Therapeutics Bulletin.
For most women who are planning to become pregnant or who are pregnant, complex multivitamin and mineral preparations promoted for use during pregnancy are unlikely to be needed and are an unnecessary expense, the study concludes.
The marketing of such products does not appear to be supported by evidence of improvement in child or maternal outcomes. Pregnant women may be vulnerable to messages about giving their baby the best start in life, regardless of cost, the review adds.
An unknown number of women take supplements during their pregnancy that typically contain more than 20 vitamins and minerals, including vitamins B1, B2, B3, B6, B12, C, D, E, K, folic acid, iodine, magnesium, iron, copper, zinc and selenium. They cost about 15 a month.
They are popular because, as the study says: Maternal deficiency in key nutrients has been linked to pre-eclampsia, restricted foetal growth, neural tube defects, skeletal deformity and low birth weight.
However, it adds: We found no evidence to recommend that all pregnant women should take prenatal multi-nutrient supplements beyond the nationally advised folic acid and vitamin D supplements, generic versions of which can be purchased relatively inexpensively.
The study led to a row with the supplements industry, which condemned its findings as confusing and unhelpful for pregnant women.
The review confirms the existing official advice that all mothers to be should have enough folic acid and vitamin D but cautions against the others.
Expectant mothers are encouraged to take 5mg of folic acid daily until they are 12 weeks into their pregnancy in order to lower the risk of their baby suffering from any neural tube defects, which can affect the brain and spine.
The new review of the evidence found little data from clinical trials that taking vitamin D can lower the risk of a woman experiencing complications during either her pregnancy or birth. But it advised expectant mothers to keep taking it daily throughout pregnancy and breastfeeding anyway.
In a direct challenge to the evidence behind the supplement industrys claims, the report says: Many nutritional supplements containing vitamins, minerals and other micronutrients are heavily marketed to women for all stages of pregnancy. However, much of the evidence for vitamin supplementation in pregnancy comes from studies carried out in low-income countries, where women are more likely to be undernourished or malnourished than within the UK population.
The authors of this study claim that vitamin and mineral supplements must produce clinical effects before pregnant women are encouraged to take them. This is absolute nonsense. Except for folic acid, which does have a therapeutic role by actively preventing neural tube disorders, the role of food supplements is simply to combat dietary gaps.
Ruxton said supplements could help women who do not eat the foods recommended, or in the right quantities, during pregnancy. Evidence from the national diet and nutrition survey shows that few women eat the right diet.
For example, only 30% of women eat five portions of fruit and vegetables daily and just 11% of women eat oily fish, which contains omega-3 fatty acids proven in EU law to contribute to the normal development of a foetuss brain and eye, she added.
Image copyrightGetty Images Image caption RAF Hawker Hart crews practising their formation flying for a 1930s air display
Farnborough: a small town in southern England; the birthplace of aviation in the UK and home for almost 70 years of arguably the world’s most important air show.
It’s an event that regularly sees a torrent of corporate deals, and has played a key role as a marketplace for Britain’s aerospace and defence firms.
It is a showcase for a sector worth 55bn a year, the fifth-largest industry in the UK that employs 340,000 people.
Indeed, the last show in 2014 saw a record $204bn (157bn) worth of orders being placed.
“Farnborough is a global shop window for the UK and Europe, for the entire world,” Shaun Omerod, chief executive of Farnborough International, said ahead of this year’s show, which starts on Monday.
“It connects UK small and medium-sized companies – who ordinarily wouldn’t get this access – to the global market.”
Image copyrightGetty Images Image caption Displays like this, by a US F-22 Raptor fighter back in 2008…. Image copyrightGetty Images Image caption …are guaranteed to get cameras clicking. This year the F-35 will take centre-stage
If Farnborough’s own connection with flying starts in 1904 with the Army Balloon Factory and the first flight of an aeroplane in the UK (by the showman Samuel Cody in 1908), then the history of today’s air show actually begins in suburban London.
In a bid to sell their wares the Society of British Aircraft Constructors (SBAC) organised a one-day exhibition at the annual RAF flying display at Hendon in 1932.
Image copyrightGetty Images Image caption The air pageants at Hendon led to today’s international show at Farnborough
It was small by today’s standards, with just 35 aircraft on display and only 16 companies taking part; this year there will be some 1,500 exhibitors.
After the Second World War the event was initially held at Radlett, moving in 1948 to Farnborough, the home of the Royal Aircraft Establishment – responsible for researching and testing experimental designs.
Image copyrightFlightGlobal Image caption Airliners on display at the first show held at Farnborough in 1948
The show has been the stage for many of the high points of post-war aviation, from the wonderful to the whimsical, such as the Saunders Roe A1 flying boat jet fighter.
First flown in 1947 at the show it was an heroic but ultimately flawed attempt to marry a long-range fighter with a flying boat.
The idea was it wouldn’t need to land on aircraft carriers as the Allies fought Japan across the Pacific Ocean, but the end of the war put paid to any use it might have had.
Image copyrightGetty Images Image caption Is it a bird, is it a plane? The Saunders Roe jet flying boat fighter came too late to see service
The 1949 show saw the truly massive Bristol Brabazon, then the world’s biggest airliner. It was designed to conquer the transatlantic air routes for Britain’s aircraft industry.
Driven by eight propellers it was so big that its construction was delayed while the runway at Bristol’s Filton factory was extended so it could take off. Yet despite its size it only carried 100 passengers, and airlines thought it too big and expensive. Only one was ever built.
Image copyrightGetty Images Image caption The Bristol Brabazon, an airliner so big they had to build a new runway for it
The same event also saw the UK introduce the world’s first jet airliner – the DH Comet.
The Comet’s pressurised cabin meant people could travel in comfort. It was a commercial success at first, yet the design hid a serious weakness.
Its square window frames contributed to metal fatigue, which led to a series of fatal crashes within a couple of years. The entire fleet was grounded for four years while the flaws were ironed out and the aircraft strengthened.
Image copyrightGetty Images Image caption The Comet was the world’s first jet airliner but the airlines bought its American rivals instead
Later Comet models flew well – indeed the RAF used the Nimrod, a version of the Comet, until 2011 – but they were not as cost-effective as their American competitors. Many airlines switched to buying Boeing’s new 707 and Douglas’s DC8 passenger aircraft instead.
1952 was marked by the worst ever accident at a UK air show. A prototype de Havilland DH110 broke up in mid-air, killing the two crew and 29 spectators.
The tragedy led to changes in safety rules at such shows.
Image copyrightGetty Images Image caption Aerobatics have always been a key part of the show, whether with the 1950s Black Arrows… Image copyrightGetty Images Image caption …or today’s Red Arrows
If the commercial crown was gradually passing to the US in the mid-1950s, spectators could still expect to be entertained by a host of British hardware.
It was a time of experimentation and exploration.
Media captionJet fighters and drones: some of the UK’s key combat aircraft
Witness the delta-wing Gloster Javelin; the Fairey Rotodyne, a helicopter with jets on its rotor-blades; the Fairey Delta, the first plane to fly faster than 1,000mph; and the jet and rocket-powered SR53 fighter.
1953 saw Britain’s nuclear triumvirate, the Valiant, Vulcan and Victor V-Bombers, at the show for the first time – alongside a scarlet painted Hawker Hunter jet fighter that Neville Duke had flown to regain the world speed record for the UK.
Image copyrightGetty Images Image caption The Vulcan, along with the Valiant and Victor, made up Britain’s nuclear-capable V-Bombers
Vertical takeoff and landing was one of the next milestones, with 1962 seeing two Hawker Siddeley P1127 prototype vertical/short takeoff and landing (V/STOL) aircraft at the event.
The aircraft would later become the Harrier, which is still in service with the US Marine Corps.
Image copyrightGetty Images Image caption Hawker Siddeley’s prototype “jump jet” was a resounding success… Image copyrightGetty Images Image caption …but the revolutionary TSR-2 was controversially scrapped before it could enter service
Perhaps the greatest aircraft never to make Farnborough was the revolutionary TSR-2, which first flew just after 1964’s show in September that year – and was controversially cancelled by a Labour government just a few months later because of rising costs.
As aircraft designer Sir Sydney Camm famously said: “All modern aircraft have four dimensions: span, length, height and politics; TSR-2 simply got the first three right.”
Image copyrightEPA Image caption Prize for the lowest “flying” craft at the show goes to the SRN1 hovercraft – complete with Royal Marines
By the 1960s things were changing. The show itself became biennial in 1962, taking turns with Paris. And the rapidly escalating cost of aircraft development and increasing international competition led to consolidation in the UK’s own aerospace sector.
With the merger of once proud rivals, just two big aircraft manufacturers remained – British Aircraft Corporation (BAC) and Hawker Siddeley. In 1977 these would join Scottish Aviation to form British Aerospace, now BAE Systems.
Farnborough was becoming more international, allowing in foreign aeroplanes so long as they had a British engine or components in 1966, and then by 1974 fully opening the doors to international aircraft.
Image copyrightGetty Images Image caption A visitor looks at a Rolls Royce Trent jet engine, used on the Airbus A380 Image copyrightGetty Images Image caption A Swedish Gripen fighter puts on an aerial display during 2004’s show
1974 saw US firm Lockheed bring the biggest and the fastest aircraft to the show: the C5 Galaxy military transport plane and the high-flying SR-71 spy plane.
Britain’s own Concorde made its first appearance at the show in 1970, and then at subsequent shows that decade; it was a brilliant technical Franco-British achievement, but one which failed to win orders from the world’s airlines.
Media captionBritish airliners: From Brabazon and Comet, to Concorde and Airbus
The Cold War may have reached a new intensity in the 1980s, but the decade also saw the first appearance of Soviet combat aircraft in the West, with two Mig-29 fighters at Farnborough in 1986 as well as the gigantic Antonov An-124 transporter.
Another memorable show for aerobatics fans came in 1990, when two Soviet SU-27 fighters performed the “cobra” manoeuvre.
This involves raising the noses of the aircraft to beyond the vertical position before dropping it back to normal flight, emulating the strike of the snake.
Image copyrightGetty Images Image caption A Sukhoi SU-27 demonstrates the “cobra” – the aircraft’s nose is vertical, but it’s still moving forward Image copyrightGetty Images Image caption Half-helicopter, half-conventional aeroplane: the tilt-rotor Bell/Boeing V22 Osprey
In recent years Farnborough has become a key marketing battleground for the world’s two largest passenger aircraft manufacturers, Airbus and Boeing, allowing them to display their latest offerings and to announce new orders.
Airbus showed off its A380 double-decker airliner in 2006, an aircraft designed for mass market long-haul routes; while 2010 saw Boeing’s 787 Dreamliner, promoted as the world’s most fuel-efficient airliner.
Image copyrightGetty Images Image caption Airbus’s A380 has been a popular sight at recent shows… Image copyrightGetty Images Image caption …as has Boeing’s 787 Dreamliner
So where now for Farnborough as it approaches its own 70th anniversary in 2018? Brexit may have clouded the immediate future, but many are robustly confident of their ability to ride out the changes.
“We may not be the manufacturing guru that existed in the days of the empire,” says Phil Seymour of leading independent aviation consultancy IBA.
“But we still produce significant parts for aircraft – we have a huge service sector – and London remains the foremost centre of aviation finance and insurance. So the event attracts many thousands of people.”
Image copyrightGetty Images Image caption Richard Branson came to showcase a replica of Virgin Galactic in 2012, planned as the world’s first commercial space liner Image copyrightGetty Images Image caption Drones are now a major attraction for many visitors, with increasing numbers of civilian and military UAVs on display
“Farnborough is one of the very few international trade events which is left on UK soil,” says the show’s chief executive Shaun Omerod.
“Many of the traditional ones have disappeared or moved to mainland Europe over the years.
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