From Medicine and Health

Planned Parenthood Braces For Fallout From Title X Decision With Fundraisers, New Fees And Warnings

Clinics across the country are expecting to lose millions in federal funding after Planned Parenthood rejected money that came with a condition the organization deemed a “gag rule.” The women’s reproductive health care provider plans to lean heavily on donors to make up the funding gap while staff members assess how they’ll cope. Other news on abortion comes out of Ohio and Tennessee, as well.

Lung Illnesses Among Vapers Is Growing: FDA Joins CDC’s Investigation As 153 Cases In 16 States Are Identified

Federal and state officials say it does not appear that an infectious disease is responsible for the illnesses, while noting numerous ingredients in e-cigarette aerosol could harm the lungs. News on e-cigarettes also looks at bans against vaping in public places, a new industry probe over health concerns and more.

Feds Pave The Way To Expand Home Dialysis — But Patients Hit Roadblocks

Home dialysis for older adults will become more common in the years ahead, experts predict — but not without overcoming significant challenges.

By 2025, the Trump administration wants 80% of people newly diagnosed with kidney failure to receive home dialysis or kidney transplants, according to an executive order issued in July. Currently, more than 85% of such patients are treated at dialysis centers.

In a notable move, retail health giant CVS Health has said it will enter the dialysis business, while the companies that dominate this market — Fresenius Medical Care and DaVita — have confirmed plans to expand their home dialysis offerings.

“We think there’s definitely an opportunity to get more of our patients home,” said Dr. Dinesh Chatoth, associate chief medical officer at Fresenius, which this year bought NxStage Medical, a leading provider of home dialysis technology. (About 12% of Fresenius’ 208,000 U.S. dialysis patients are on home therapies.)

“I think it’s realistic to expect 40% to 50% of patients to be able to do home dialysis,” said Dr. Martin Schreiber, chief medical officer for DaVita home modalities. (About 13% of DaVita’s 203,000 U.S. dialysis patients now receive home therapies.)

Other experts think that’s optimistic. “I think 25% to 30% of patients is more realistic,” said Dr. Thomas Golper, a professor of medicine at Vanderbilt University, whose home dialysis program is among the largest in country.

Home dialysis has several advantages over dialysis in treatment centers: Patients can get therapy more frequently, which puts less stress on their bodies; it’s more convenient; it’s less expensive; and patients’ quality of life is generally better, according to numerous studies. On the downside, doing this therapy at home can be isolating, fraught with anxiety, technologically challenging and burdensome for patients and caregivers.

What changes are needed to bring home dialysis to more patients — especially older adults, the fastest-growing group of patients with serious, irreversible kidney disease? We asked nephrologists, patient advocates and dialysis company officials for their thoughts.

Better patient education. Medicare pays for “pre-dialysis education” that informs patients about treatment options before their kidneys fail. Yet, fewer than 2% of Medicare members with advanced kidney disease receive this benefit, according to a U.S. Government Accountability Office report.

“We need to improve the education of patients regarding their [dialysis] modality choices,” said Schreiber of DaVita. Patients who attend that company’s Kidney Smart education classes are six times more likely to select home dialysis as a treatment option, according to materials supplied by DaVita.

Ongoing education about how to handle issues that arise during home dialysis is also needed. In a recent survey of caregivers providing complex care at home, 60% of caregivers assisting with home dialysis said they needed “more/better instruction” while 18% called for “more help from others.”

“Right now, patients are educated on the mechanics of the treatment,” said Nieltje Gedney, treasurer of Home Dialyzors United, a patient group that has been testing an education curriculum. “But in order to be successful at home, patients also have to learn much more about how to manage their treatment.”

More personal assistance. In Canada, Australia and other countries where home dialysis is much more common than in the U.S., patients can get assistance from health workers who help them set up for a dialysis treatment and wind things down when treatment is over. On each end, tasks required can take half an hour or longer.

Medicare doesn’t pay for this kind of assistance, but it should — especially for older adults, several experts suggest.

“Imagine trying to move someone 75 or older who’s socioeconomically disadvantaged onto home dialysis,” said Dr. Holly Mattix-Kramer, president of the National Kidney Foundation and a professor of medicine at Loyola University Medical Center in Chicago. “Maybe they feel insecure and kind of afraid. Maybe they need some extra time going over skills. Maybe they need some extra support the first few months before they feel comfortable with the routine.”

Home health aides or community health workers could provide help of this kind. Dori Schatell, executive director of the Medical Education Institute, which specializes in serving people with kidney disease, called for a demonstration project of paid home dialysis helpers.

“Assisted dialysis in the home would have tremendous advantages, I believe, especially for the elderly,” Schreiber said, and DaVita has been talking to the Centers for Medicare & Medicaid Services about how this might work.

New technologies. In the next several years, Chatoth of Fresenius envisions that new technologies will allow people on home dialysis to be monitored much more closely, day by day. Two-way portals would allow data to flow back and forth between patients and clinicians. Telehealth would allow physicians, nurses, social workers and dietitians to interact with patients remotely and provide more ongoing support.

This kind of connectivity is especially important for older adults with multiple medical conditions who need extra oversight and may have difficulty traveling to a dialysis center.

Fresenius is doing a telehealth pilot, and “we think by the end of the year we should have this rolled out across most of our [home dialysis] programs,” Chatoth said.

Dr. Eric Wallace, an associate professor of nephrology at the University of Alabama at Birmingham and a pioneer in the use of telehealth for home dialysis, thinks telehealth has considerable potential but voiced concerns.

For instance, poor patients and patients in rural areas often don’t have enough internet bandwidth to support videoconferencing. While physicians rely on laboratory tests to evaluate dialysis patients, “there aren’t mechanisms in place to do labs inside a patient’s home,” Wallace said. And some older patients may become even more isolated without regular face-to-face visits to medical providers.

“Telehealth is going to open up new ways to connect with patients,” he said. “But I don’t think it’s quite as easy as people want to make it sound.”

Also, several companies are developing technologies that could make home dialysis safer and easier, including NxStage, CVS, Outset Medical of San Jose, Calif., Quanta Dialysis Technologies of the United Kingdom, and Physidia, out of France.

“They each have their own specific angle, but the general theme with all of them is the ‘Apple-fication’ of dialysis machines,” said Dr. Frank Liu, director of home hemodialysis at the Rogosin Institute in New York City.

Altering physician practices. A precondition for change is educating physicians about home dialysis and persuading them to offer it to more patients, experts suggest.

Only one-third of patients who need to start dialysis are told peritoneal dialysis at home is an option, while only 12% are offered home hemodialysis, research has shown.

Dr. Matthew Rivara, a nephrologist and investigator at the University of Washington Kidney Research Institute, faults “inadequate training in home dialysis” in nephrology fellowship programs, as do several other leading nephrologists.

“There’s almost nothing on board examinations that tests physicians’ knowledge about home dialysis; nephrologists can pass with flying colors and know very little about these therapies,” said Golper of Vanderbilt who’s helped launch a training program for physicians, Home Dialysis University.

Easing transitions. When patients learn they have potentially fatal kidney disease, “you’re literally blinded with fear. There’s no way you can think about your options until you get past that,” said Gedney of Shepherdstown, W.Va., who has relied on home hemodialysis since 2014.

Transitional programs that help people adjust to the need for dialysis and understand what it entails should become more widely available, she said.

Fresenius has nearly 40 programs of this kind across the U.S., and more are starting up. Over four to six weeks, people start receiving dialysis at a center and learn about specifics such as what they can eat, who’s going to pay for dialysis, how their lives might change and how much support they’ll need.

The goal is to help patients “cope with the diagnosis,” Chatoth said. After going through transitional programs, he added, more than half of patients choose home dialysis.

 

Shopping Abroad For Cheaper Medication? Here’s What You Need To Know

In its effort to temper the sky-high prices Americans pay for many vital medications, the Trump administration last month unveiled a plan that would legalize the importation of selected prescription drugs from countries where they sell for far less. But the plan addresses imports only at the wholesale level; it is silent about the transactions by millions of Americans who already buy their medications outside the United States.

Americans routinely skirt federal law by crossing into Canada and Mexico or tapping online pharmacies abroad to buy prescription medications at a fraction of the price they would pay at home.

In some cases, they do it out of desperation. It’s the only way they can afford the drugs they need to stay healthy — or alive. And they do it despite warnings from the Food and Drug Administration, echoed by the pharmaceutical industry, about the risk of contaminated or counterfeit products.

“The reality is that literally millions of people get their medications this way each year, and they are either saving a lot of money or they are getting a drug they wouldn’t have been able to get because prices are too high here,” says Gabriel Levitt, president of PharmacyChecker.com, an online company that allows people to compare prescription drug prices among international and U.S. pharmacies.

For people with diabetes, the inability to pay U.S. prices for insulin can be a matter of life and death, which is why so many families look to Canada or Mexico to meet their needs.

Robin Cressman, who was diagnosed with Type 1 diabetes in 2012 and has become a vocal advocate for lower drug prices, says that even with insurance she was paying $7,000 a year out-of-pocket for the two insulin drugs she needs: Lantus and Humalog. At one point, her credit card debt hit $30,000, says Cressman, 34, of Thousand Oaks, Calif.

While on an outing in Tijuana, Mexico, last year, she popped into a few pharmacies to see if they stocked her medications. With little fanfare, she says, she was able to buy both drugs over the counter for less than 10% of what they cost her north of the border.

“I left Tijuana that day absolutely trembling because I could not believe how easy it was for me to get my insulin,” she says, “but also how little money it cost and how badly I was being extorted in the U.S.”

If you are planning to cross the border for your medications, or get them through an online pharmacy abroad, here are two things you should know. First: It is technically illegal. Second: It is unlikely you will be prosecuted.

Despite the official prohibition, FDA guidelines allow federal agents to refrain from enforcement “when the quantity and purpose are clearly for personal use, and the product does not present an unreasonable risk to the user.”

Personal use generally means no more than a 90-day supply. You should think twice before bringing in quantities larger than that, because if authorities suspect you have commercial intentions, you could land in legal jeopardy — and lose the drugs.

People familiar with the practice say you generally can pass through customs without much hassle if you have no more than three months’ worth of a medication, you declare it to customs agents and you show them a doctor’s prescription or a personal note attesting it is for personal use, along with contact information for your physician.

Even in the worst-case scenario, an unsympathetic agent might confiscate the drugs — but not arrest you.

Ordering drugs online from foreign pharmacies also tends to go largely unchallenged. Legally, the FDA can refuse entry of the package at an international mail facility. “That does happen from time to time,” but not often, says Levitt.

It is more common for shipments that do get through to be detained for several days pending FDA inspection. So, if you need to take your medication every day, be sure to build in a sufficient margin for potential delays.

A far bigger risk if you’re shopping abroad for medications is that you might not get what you paid for — and it might not be safe. “There’s a lot of junk in the pharmaceutical world,” says Dr. Ken Croen, a primary care physician at the Scarsdale Medical Group in Westchester County, N.Y., who advises many of his patients on how to buy drugs safely in Canada.

And there are plenty of rogue operators, especially in the world of online pharmacies. You will need to do a little vetting.

Before doing business with an online pharmacy, confirm it is licensed in its country of origin and that the country has strong pharmacy regulations, says Dr. Aaron S. Kesselheim, a professor of medicine at Brigham & Women’s Hospital and Harvard Medical School. (Read below for websites that can help with that.)

Countries with well-regulated pharmacies include Canada, New Zealand, Australia, much of Western Europe and Turkey.

Also, check to make sure the pharmacy posts an address and phone number on its website. Experts advise against using online pharmacies that don’t require a doctor’s prescription: They are more likely to cut other corners, as well.

A couple of websites do the vetting for you, using these and other criteria.

The Canadian International Pharmacy Association runs a site (cipa.com) that allows you to compare drug prices among dozens of pharmacies whose legitimacy it has certified. Its customers “tend to be people who live in the U.S., are on fixed income or low income and can’t afford the medications where they live,” says Tim Smith, the association’s general manager.

To buy through one of CIPA’s certified pharmacies, you must have a valid prescription and submit a medical profile to help guard against adverse drug interactions. The site also maintains a list of “rogue” online pharmacies.

PharmacyChecker.com offers a similar service, linking customers to a broader range of online pharmacies abroad and in the U.S.

Levitt, its president, notes that while importing drugs from overseas is a “critical lifeline” for many people, it is still possible to buy many medications affordably in the U.S. He and others suggest you take the time to comparison shop in the U.S. because prices can vary significantly from pharmacy to pharmacy.

Santa Monica, Calif.-based GoodRx tracks prescription drug prices at over 70,000 pharmacies across the U.S. and offers coupons.

Levitt also recommends asking your doctor if there is a viable therapeutic alternative or a lower-cost generic drug. Recent research from PharmacyChecker shows that 88% of the most commonly prescribed generic drugs can be purchased more cheaply in the U.S. than from Canadian pharmacies.

“Many times there is no reason to go international,” Levitt says. “The drug will actually be cheaper here.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Texas Touch Football Group Requires All Players Wear Soft-Shell Helmets After Serious Head Injuries Occur

Researchers have found that flag football players receive many smaller hits to the head than those playing contact football, and they’re falling down on nearly every play. “This idea that there is no contact at all is fairly naïve,” said Robert C. Lynall, co-author of a study done at Georgia. Public health stories focus on artificial intelligence, vaping, PTSD treatments, a dehydration patch, e-cig TV ads, state fairs and cannabis research, as well.

Former FDA Chief Urges Agency To Loosen Restrictions On Drugs To End Early Pregnancy

Former FDA Commissioner Dr. Jane Henney says Mifepristone is still heavily regulated despite having been proven safe and effective. “I think the FDA has shown a willingness to … take action,” Henney said. “I believe it’s important for them to do another review in light of the safety information we know about this drug.” In other news, clinics react to the Planned Parenthood’s decision to forgo Title X funds and ousted Planned Parenthood head Leana Wen announces her new job.

FDA Officials: Stakes Were Too High In Novartis Data Manipulation Case To Do Anything But Publicly Drop The Hammer

The FDA came down hard on Novartis, subjecting the company to a public flogging over the data manipulation that, at the end of the day, didn’t effect patients’ safety. But the issue is too important to give anyone a pass, officials say. “It may sound like we’re kind of bureaucratic paper-pushers, but it’s more than that,” said FDA’s Dr. Peter Marks. “It’s making sure that the whole ecosystem understands that when people are working on these things that are highly technically complex, that they have to work truthfully and accurately.”

Alaska Governor Vetoes Bill To Restore Sharp Medicaid Cuts

Following the move by Gov. Mike Dunleavy and earlier action by the Alaska’s legislature, the state’s Medicaid program is expected to be cut by about 22%. Those state spending cuts mean Alaska will receive at least $127 million less in federal Medicaid matching funds. Medicaid news comes out of Oklahoma and Ohio, as well.

Cigna Explores Sale Of Its Group Benefits Insurance Business In Sign Insurer Intends To Focus On Health Care

Reuters reports that the division Cigna is looking to shed involves disability and life insurance. The move echoes ones made by other insurers looking to focus on health care. In other health industry news: a slew of departures from Apple’s health team, price transparency, hospital chains and purchases, and more.

Government Was On Cusp Of Alerting Public About Opioid Crisis 13 Years Ago. Why It Didn’t Remains A Mystery.

Top government officials flagged “disturbing” data around opioids and addiction back in 2006 and requested urgent action be taken. Then-U.S. Surgeon General Richard Carmona agreed to issue a call to action. But then the momentum fizzled after a new surgeon general came on and 13 years later, the crisis continues to grip the country.

Joe Camel Was Forced Out Of Ads. So Why Is Juul Allowed On TV?

Why does e-cigarette maker Juul advertise its product on TV when cigarette ads are banned? The short answer: Because it can.

For nearly 50 years, cigarette advertising has been banned from TV and radio. But electronic cigarettes — those battery-operated devices that often resemble oversized USB flash drives with flavored nicotine “pods” that clip in on the end — aren’t addressed in the law.

Since launching its product in 2015, Juul Labs, based in San Francisco, has taken the e-cigarette market by storm, and now accounts for roughly 75% of e-cigarette sales at convenience stores and mass retail outlets. Until recently, TV ads haven’t played a role in Juul’s marketing, which relied primarily on social media.

But this year, the company launched a $10 million TV advertising campaign, “Make the Switch,” that it said was aimed at helping adults find a healthier alternative to smoking cigarettes. The campaign also features print and radio ads.

Many public health advocates are skeptical of the company’s repeated assertions that adult smokers are its target audience. When the company launched its sleek e-cigarette four years ago, it relied on social media outlets such as Facebook, Instagram and Twitter to promote its product in ads that, especially at the beginning, featured playful, partying 20-somethings.

As the product caught on, young people helped spread the word to other young people using hashtags like #juul. Social media influencers who posted content praising Juul amplified the message.

“There’s overwhelming evidence that the behavior of Juul contributed to the product being sold to youth,” said Dr. Robert Jackler, a professor and the principal investigator at Stanford Research Into the Impact of Tobacco Advertising (SRITA) at the university’s medical school.

Juul said it is not targeting children and teens and supports efforts to limit tobacco products to people under age 21. “We recognize that youth use of vapor products is a problem that requires an effective and appropriate response from industry and regulatory bodies,” said Ted Kwong, a Juul Labs spokesman. “We strongly support restrictions on social media marketing of vapor products.”

In recent years, the number of high schoolers and even younger kids who say they’ve used e-cigarettes has grown rapidly, alarming parents and public health advocates.

Last year, almost 21% of high school students reported using e-cigarettes in the previous 30 days, according to an analysis of National Youth Tobacco Survey data published by the federal Centers for Disease Control and Prevention. In 2011, the proportion was just 1.5%. Between 2017 and 2018 alone, the number of high school students who said they were current e-cigarette users grew by 78%, to more than 3 million students overall. The CDC said 1 in 20 middle school students, those in grades 6 through 8, reported vaping in the previous 30 days.

In contrast, 3% of adults said they used e-cigarettes in 2017, according to the CDC.

E-cigarettes, also called vapes, were introduced in the United States in the mid-2000s. Some early versions resembled actual cigarettes. Juul’s product can be plugged into a USB port to recharge and fits inconspicuously into the palm, often frustrating parents and teachers seeking to stop teens from using it.

There’s evidence that smoking e-cigarettes may act as a “gateway” that leads young people to try cigarette smoking. And cigarette smoking remains the leading cause of preventable death, killing more than 480,000 people in the United States every year.

E-cigarettes don’t produce tar, in which most of the cancer-causing and other harmful chemicals from tobacco smoke are found. But both products contain nicotine, which is highly addictive and can harm the developing brains of adolescents.

In addition, the vapor that people inhale when the liquid nicotine in e-cigarettes is heated may contain cancer-causing chemicals, heavy metals and other dangerous substances.

Nevertheless, e-cigarettes are often touted as a healthier alternative to cigarette smoking, and that’s the premise of Juul’s “Make the Switch” campaign. The testimonial ads feature adults describing the positive changes in their lives after they gave up smoking cigarettes to use Juul.

“We want adult smokers to hear directly from former adult smokers that Juul Labs provides a true alternative to combustible cigarettes and is showing unprecedented success, with studies showing 40 to 56 percent of adult smokers fully switching within 90 days of use,” said Kwong.

Although adolescents may be more likely to see ads in social media than traditional broadcast and print ads, the Juul TV ads probably have an impact on them, said Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University School of Medicine who developed a tobacco prevention toolkit for teachers.

“When you say that a product is for an adult, the message is not ‘Don’t use,’ it’s ‘Use these products and you’ll appear to be adult or mature,’” Halpern-Felsher said.

Anti-smoking advocates would like to see the same marketing limits applied to e-cigarettes that apply to so-called combustible cigarettes, including banning them from advertising on TV and radio.

They would also like to see the changes that were put in place under the Master Settlement Agreement in 1998 between the largest cigarette manufacturers and the attorneys general of 46 states applied to e-cigarettes. The states had sued the cigarette makers to recover their costs for treating sick and dying smokers. Among other things, the agreement banned most transit and billboard advertising of cigarettes, branded merchandise, free product samples and sponsorships of events, such as concerts and sporting events.

E-cigarette makers, such as Juul, have used some of those advertising methods over the years.

Last year, after the federal Food and Drug Administration said it was cracking down on an “epidemic” of teen vaping, Juul announced changes to its marketing activities.

The company shut down its Facebook and Instagram accounts and limited Twitter communications to non-promotional posts, Kwong said.

That’s like closing the door to the barn after the horse has left, said public health advocates. Young people, they added, are continuing to post about Juul on those sites.

“It’s too late,” said Dave Dobbins, chief operating officer at the Truth Initiative, an anti-tobacco advocacy group. “The kids are doing their work for them.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

MDMA, Or Ecstasy, Shows Promise As A PTSD Treatment

The first time Lori Tipton tried MDMA, she was skeptical it would make a difference.

“I really was, at the beginning, very nervous,” Tipton said.

MDMA is the main ingredient in the club drug known as ecstasy or molly. But Tipton wasn’t taking pills sold on the street to get high. She was trying to treat her post-traumatic stress disorder by participating in a clinical trial.

After taking a dose of pure MDMA, Tipton lay in a quiet room with two specially trained psychotherapists. They sat next to her as she recalled some of her deepest traumas, such as discovering her mother’s body after Tipton’s mother killed two people and then herself in a murder-suicide.

“In the embrace of MDMA,” Tipton said, she could revisit that moment without the usual terror and panic. “I was able to find such empathy for myself.”

Scientists are testing how pharmaceutical-grade MDMA can be used in combination with psychotherapy to help patients with a severe form of PTSD that has not responded to other treatments. Unlike street drugs, which may be adulterated and unsafe, researchers use a pure, precisely dosed form of the drug.

MDMA is not yet available as a treatment for PTSD outside of clinical trials. But proponents are aiming for approval by the Food and Drug Administration, which granted breakthrough therapy status to MDMA-assisted psychotherapy in 2017.

Researchers are conducting Phase 3 clinical trials at more than a dozen sites. Clinicians who treat PTSD are hopeful the next round of trials will show that MDMA treatment is an effective option to relieve patient suffering.

“The problem is we haven’t had a new drug to treat PTSD in over 17 years,” said Dr. Sue Sisley, a physician and president of the Scottsdale Research Institute, based in Arizona. “There are certain illnesses that are just intractable and not responsive to traditional therapy, and we need to start thinking more broadly.”

But MDMA is a Schedule I controlled substance, which means it currently has no accepted medical use and has a “high potential for abuse” (something that MDMA’s therapeutic proponents dispute). Because of that designation, the current research trials are privately funded by the Multidisciplinary Association for Psychedelic Studies, or MAPS.

‘Anywhere I Would Feel Unsafe’

Tipton struggled for years with PTSD before she was treated with MDMA. She said life with PTSD was like “seeing the world through dirty goggles.”

“Anywhere I would feel unsafe,” the 40-year-old from New Orleans said. “I would feel like I had to always be vigilant because if I didn’t, something bad was going to happen.”

Tipton described her 20s as a catalog of tragedy and trauma. It began when her brother fatally overdosed in her home. After his death, she began caring for her mother, who struggled with mental illness. In 2005, Tipton’s mother killed two people and then herself. Tipton discovered their bodies.

“I completely just disassociated. I couldn’t believe what I was seeing,” Tipton said.

“When you have PTSD, you are living in this constantly triggered environment,” says patient Lori Tipton. More than a year after getting MDMA-assisted psychotherapy in a clinical trial, Tipton no longer qualifies as having PTSD.(Will Stone)

The traumas continued to pile up. The place she lived was destroyed when Hurricane Katrina hit New Orleans, and the following year, she was raped.

As the years went by, Tipton had panic attacks and terrible anxiety. She tried everything to treat her symptoms: talk therapy, antidepressants, hypnotherapy, meditation and yoga. Nothing worked. She went through life exhausted and apathetic, constantly triggered and struggling to be intimate with people close to her.

Then Tipton enrolled in the Phase 2 clinical trials for MDMA-assisted psychotherapy.

MDMA And Therapy Together

MDMA was first synthesized in 1912, and its therapeutic benefits were studied in the 1970s. But those efforts stalled when the U.S. federal government — in light of the growing popularity of ecstasy as a recreational drug — designated it a Schedule I drug in 1985.

In recent years, research has resumed, funded by private sponsors such as MAPS.

The treatment protocol in the current trial calls for a 12-week course of psychotherapy with specially trained therapists. During that time, there are two or three daylong sessions, which begin with the patient taking a calibrated dose of MDMA in pill form.

The treatment begins with patients swallowing a calibrated dose of MDMA in pill form.(Courtesy of the Multidisciplinary Association for Psychedelic Studies)

A team of two therapists, generally one man and one woman, then guide the patient through the eight-hour MDMA “session.” Later, there’s follow-up talk therapy, without the drug, to help the patient process feelings, thoughts or impressions that came up while under the influence of the drug.

“MDMA allows you to contact feelings and sensations in a much more direct way,” said Saj Razvi, a Colorado-based psychotherapist who was a clinical investigator in the Phase 2 trials.

How MDMA works in the brain is not completely understood. The psychoactive drug boosts chemicals like serotonin and oxytocin. It also tamps down activity in the amygdala, a part of the brain that processes fear. This may lead to a state characterized by heightened feelings of safety and social connection.

“Trauma happens in isolation,” Razvi said. “One of the things that MDMA does is, really, lets you know that you are not alone.”

PTSD In Remission

After the Phase 2 trials of MDMA-assisted treatments concluded in 2017, researchers found that 54% of the 72 patients who took MDMA had improved to the point that they no longer fit the diagnosis for PTSD (compared with 23% in the control group).

And the beneficial effects of the treatment appeared to increase over time. A year later, the number who no longer had PTSD had risen to 68%.

“That was astonishing,” Sisley said. “Even with the best pharmaceutical regimen, you rarely ever see patients go into remission.”

Dr. Sue Sisley, president of the Scottsdale Research Institute, has spent much of her career working with people who have severe PTSD.(Will Stone)

She said she hopes to offer her patients MDMA-assisted psychotherapy as soon as possible, maybe before the drug receives full FDA approval.

Brad Burge, a spokesman for MAPS, said that, beyond sponsoring the MDMA trial, the organization is working to get the FDA to include the drug in its expanded access program, which can allow individual patients to be approved to use drugs that are still being studied.

Burge said the goal is to make MDMA-assisted psychotherapy available as a prescription treatment in a specialty clinic to anyone with PTSD.

And MAPS is working to persuade public and private insurance plans to cover the treatment, Burge said. He estimates that for patients paying entirely out-of-pocket, a 12-week course of treatment would cost between $5,000 and $10,000.

Most of the cost is for the guided therapy, not the actual drug.

Transformative Treatment

Tipton describes her treatment with MDMA as transformative.

She was able to let go of the troubling feelings surrounding her mother’s death. And, she unearthed other memories, too, feelings of joy that had been sealed away.

By her last MDMA session, Tipton was even able to talk about her sexual assault.

A year later, she was reassessed and no longer qualified as having PTSD. Tipton said she believes the treatment saved her life.

“Everything is at my fingertips for me in a way that it never was before,” she said. “I want that for everybody.”

This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News.

Watch: Trump-Pence Policy Shift Makes Birth Control Harder To Get

KHN correspondent Sarah Varney talks with PBS NewsHour‘s Yamiche Alcindor on Monday about how the Trump administration’s policy shift on Title X family planning funds is likely to make birth control harder to get and more expensive for low-income women. It will also shift funds from organizations like Planned Parenthood to the Obria Group, which provides women’s health care that does not include hormonal contraceptives or condoms. On Tuesday, Varney discusses  the decisions by Planned Parenthood and several states to forgo Title X funds with MSNBC’s Ali Velshi.

Democrats’ Different Takes On Tackling Health Care

Kaiser Health News reporter Emmarie Huetteman joined Connecticut Public Radio’s Lucy Nalpathanchil on the “Where We Live” program Tuesday to talk about Democratic presidential candidates’ health care plans.

She discussed how the current Medicare program works and how some candidates, including Sens. Bernie Sanders of Vermont and Kamala Harris of California, have offered plans that would build a national health care program using Medicare as a guide. And she contrasted that with the plan pitched by former Vice President Joe Biden that would include a health plan offered by the government that consumers could opt into. She also took questions from listeners.

The program is available here.

Missouri Lawmaker Attributes Massive Medicaid Enrollment Cuts To Software That More Accurately Assesses Income

Missouri Speaker of the House Elijah Haahr said the software found that a significant number of people weren’t eligible based on income. However, critics remain skeptical. “Most of those kids probably should be eligible for Medicaid unless their parents’ income doubled or tripled,” said Washington University Health Economics Professor Tim McBride. Medicaid news comes out of Louisiana, as well.

Long-Sought Safety Changes In Car Seats For Side Impact Crashes Hit Multiple Road Bumps. Federal Agency, Industry Can’t Agree On New Rules.

While car crashes are a leading killer of children, seats have only been tested for head-on crashes. Since the early 2000s, the National Highway Traffic Safety Administration has pushed for new seats that also protect children from side-impact crashes as well. ProPublica reports on what’s taking so long and how the industry is dragging its heals. Public health news looks at dementia, measles, vaccines, diets and telemedicine, as well.