John Otrompke, Medicine and Science Journalist: 2018

Patients with Parkinson’s Disease (PD) miss medical appointments less frequently than other neurology patients, according to a poster presented at this year’s annual meeting of the American Academy of Neurology (AAN) in Los Angeles.

Neurologists previously hypothesized that PD is associated with personality traits such as increased conscientiousness and punctuality, but prior evidence was based on subjective questionnaires. Poster 60, “A Real-World Inquiry of the So-Called Parkinsonian Personality -- Comparing No-Show Rates of the Neurology Outpatients with and without Parkinson's disease (PD),” supplemented the existing data with real world evidence.

In the study, researchers from Virginia Tech's Carilion Clinic examined data from medical records for all neurology appointments between January of 2010 and June of 2016. Of 19,501 patients, 400 had a diagnosis of PD, for whom the no-show rate was 3%, compared to 7.4% (p<0.001) among other neurology patients, according to the abstract.

In addition to punctuality, PD is associated with other characteristics thought to illustrate reduced novelty seeking, which in turn is thought to arise from a dopamine-deficient state. Examples of such personality characteristics include smoking and gambling (and maybe erectile dysfunction, as well- see below).

“Multiple studies show tobacco use is inversely associated with developing PD,” said Joseph Ferrara, MD, assistant professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia, who presented the poster.

“People have associated lower smoking rates with reduced novelty-seeking, hypothesizing that the lower dopamine state makes it less likely people will begin smoking, and easier for them to quit. Gambling has also been looked at, because of problematic gambling that occurs in a minority of patients treated with dopamine agonists,” added Ferrara.

Another poster presented at AAN looked at another characteristic in some PD patients which may be associated with dopamine deficiency: erectile dysfunction.

Traumatic brain injury was not associated with an increased risk for alpha-synucleinopathy (including PD), but erectile dysfunction was, according to poster 63, “Traumatic brain injury and erectile dysfunction preceding clinically diagnosed alpha-synucleinopathies: a case – control study in Olmsted County, MN (1991-2010).”

In the study, researchers from The Mayo Clinic examined data from all cases of alpha-synucleinopathies in Olmsted County, Minnesota from 1991 to 2010. Erectile dysfunction was found to be more common in patients later diagnosed with PD. The odds ration was 1.48 (p=0.051).

Sunday, May 6, 2018

The Lancet has published my article from the American Academy of Neurology in LA

Here is my article for The Lancet's United States of Health blog from the American Academy of Neurology, on new guidelines for the treatment of multiple sclerosis in adults- a fascinating development in an increasingly complex field.

http://usa.thelancet.com/blog/2018-04-30-aan-issues-new-guidelines-disease-modifying-therapies-ms-including-switching

Wednesday, April 11, 2018

Now registered for the American Academy of Neurology

Hello readers,

I am now registered for another very important meeting, the American Academy of Neurology in Los Angeles.

American Academy of Neurology’s Annual Meeting

April 21-27, Los Angeles

http://aanmeeting.org

Monday, April 9, 2018

En route to AACR, and Points Beyond (And Offering Freelance Coverage)

Dear readers,

I will soon make my arrival at the annual meeting of the American Association for Cancer Research in my home town of Chicago.

AACR

April 14-18, Chicago,

http://www.aacr.org/MEETINGS/PAGES/MEETINGDETAIL.ASPX?EVENTITEMID=136#.WibhmBSTUb0

I am very excited, because although I have written frequently about cancer in the past, I have never before attended AACR. Plus, it's always great to be back in Chicago (I just hope the weather holds up!)

Look forward to lots of great news opportunities on melanoma, lung cancer, targeted therapies, epidemiology, and maybe even a feature on the Cancer Moonshot Initiative!

Please feel free to contact me if you have any questions, or just to start a conversation.

~John
John_Otrompke@yahoo.com
847-766-4352

Other Medical Meetings I am Registered for Between Now and ASCO

Here is a list of other events for which I am registered, including the National Kidney Foundation, SCAI, and the American Society for Microbiology's Clinical Virology Symposium.

Contact info at the bottom. Don't hesitate to get in touch!

National Kidney Foundation Spring Clinical Meetings

April 10- 14, Austin

https://www.kidney.org/spring-clinical

Society for Cardiovascular Angiography and Interventions Scientific Sessions

April 25-28, San Diego

http://www.scai.org/SCAI2018/default.aspx

American Society for Aesthetic Plastic Surgery Annual Meeting

April 26-May 1, New York City

https://www.surgery.org/downloads/microsite/meeting2018/index.php

The American Society of Breast Surgeons

May 2-6, Orlando

https://www.breastsurgeons.org/new_layout/index.php

ASM’s Clinical Virology Symposium

May 6–9, West Palm Beach

https://www.asm.org/index.php/2018-clinical-virology-symposium

Cannabis World Congress and Business Expo

May 31-June 2, NYC

http://www.cwcbexpo.com

John_Otrompke@yahoo.com

847-766-4352

Tuesday, March 27, 2018

A wonderful, busy month on the medical conference trail

Hello readers, I've had a wonderfully busy month with freelance appearances on the freelance medical conference trail, with appearances at AHIP in Washington, DC, the scientific sessions of the American College of Cardiology in Orlando, and the annual meeting of the Endocrine Society in Chicago.

And hopefully more to come with an appearance next month in Chicago at one of the biggest medical meetings of the year- the American Association for Cancer Research only three weeks away!

Join me in welcoming my newest client, The Lancet's United States of Health blog!

My recent article on a single payer session for The Lancet's USA blog

Hello readers,

Here is a link to an article I recently wrote for The Lancet's blog, The United States of Health.

http://usa.thelancet.com/blog/2018-03-13-single-payer-healthcare-debate-takes-stage-managed-care-0

This is based on reportage from a fascinating debate on single payer health care at the annual National Health Policy Forum, put on by America's Health Insurance Plans (a health insurance forum), in which Sir Donald Berwick, MD (an American and former head of CMS who was knighted for his role in reforming the British National Health Service) discussed the matter with two other thinkers, Douglas Holtz-Eakin, PhD and Larry Leavitt.

Neat!

Coverage from ACC for my new client- The Lancet!

Hello readers,

As mentioned, I've had a very busy and fulfilling month.

Let me take this opportunity to thank my newest client for their interest in my work-

And it's one of the most important medical journals on the planet- THE LANCET !

http://usa.thelancet.com/blog/2018-03-16-onco-cardiology—targeting-double-heart-break

That's right, I am writing articles from clinical medical conferences in the US for The Lancet's blog, The United States of Health, which is wonderful news.

Above is a link to one of my recent articles for the prestigious journal's publishing outlets. It is an article I wrote based on reportage I did from the recent meeting of the American College of Cardiology.

Thank you for your interest in my work.

Saturday, March 3, 2018

All contents (c) John J. Otrompke, JD

All contents (c) John J. Otrompke, JD, 2018

Thursday, February 8, 2018

An Image of the Artist and her Work

Woman Giving Birth with Fire and Suitcase, by Jordan Maclachlan

Other People, Other Lives

Enterprise Reporting from The Outsider Art Fair

An Extensive Series of Miniature Sculptures Explores the Dramas of Quasi-Alternate Realities

by John Otrompke

“What would it be like if all of us lost our housing all once? I mean everybody- what would that look like?”

A sculpture series by self-taught Toronto-based artist Jordan Maclachlan tries to answer that question, mixing horrifying scenes like a man being attached by a pack of domesticated-breed dogs with scenes of survivors who have no choice but to become stronger by the experience.

“But there are also just normal moments, too, like somebody reading a book,

getting a haircut, or somebody knitting,” said Maclachlan, who was interviewed by phone for this article.

The series of miniatures, called “Unexpected Subway Living,” currently numbers about 100 sculptures, 80 of which were on display at last month’s Outside Art Fair in New York.

“Then there are moments where people are needing privacy, but not getting privacy, and it’s just all right there. Like there’s a woman giving birth leaning against a subway chair, and she’s got a raccoon walking across the back of the chair,” said Maclachlan. “And I have a small surgery area in my series, where a girl is getting heart surgery, and a guy is getting brain surgery.”

However, while many of the scenes in the series are set in subway cars, the trains don’t move. “They’re all ruined. They’re all just sitting there,” explained Maclachlan, who began the series some seven years ago.

Alternatives and Antecedents

Maclachlan never attended art school, but has also loved dioramas. “Since I was a little kid, I was fascinated with them, such as French terra cotta models from the 16th and 17th century at the New York Met.

“None of them are fired, and sometimes they are really engaging, sometimes horrifying, and sometimes not. Sometimes a bar scene, or a husband and wife fighting over a baby,” she explained.

The artist also has other installations in progress, including a series called ‘Condo Living’ and another called ‘Zoo Living.’

“They’re all about how to live, and living in different ways. ‘Condo Living’ is much more civilized. There’s a party in a living room, where people are playing cards, and people are drinking champagne. The condo also has some things that are not so civilized going on behind closed doors, and private moments we get to peek at. There are balconies where people can jump off them, or throw garbage off of them and spy from them.

“And in ‘Zoo Living,’ I wonder what it would be like living in a zoo. There are a

lot of human-animal interactions. Then we get into circuses, and there’s a bearded lady. Baby elephants are taken and wrapped in ropes and chains, and some of them break their legs. There are animals in cages that are depressed. Then they have these huge cryobanks, so they can revive a species that might be endangered,” MacLachlan added.

“I’m a news junkie, more of an observer and reporter than a participant,” she explained. “I like unaffected art that comes from a really sweet place.”

The series is curated by Marion Harris in New York.

Wednesday, February 7, 2018

Interest in Safaris Growing Amidst Environmental Concerns, Adventure Trade Group Says

Enterprise Reporting from the New York Times Travel Show

by John Otrompke

Interest in safaris by “adventure travelers” is growing by double digits amidst concerns about over-tourism(1), according to speakers at last month’s New York Time’s Travel Show.

According to a 2016 survey(2), only 13% of respondents had gone on a “safari,” but 44% planned to do one in the future, according to Casey Hanisko, president for business services and events at the Adventure Travel Trade Association (ATTA), a Seattle-based membership organization of tour operators.

The ATTA has more than 1,300 members in 100 countries, said Hanisko, who spoke at a forum called “Focus on Adventure Tourism” on Friday, January 26.

But the organization doesn’t vet the tour operators individually for participation in canned hunts or hunting safaris. “We don’t screen them because of the time it would take, but we do have all of our members sign a value statement,” Hanisko explained. The association is also part of the US Wildlife Trafficking Alliance, she noted.

Money Spent on Travel Growing at Double Digit Rates

The growing interest in ‘safaris’ is accompanied by other measures indicating increased growth in adventure travel. The same study predicted that the “adventure travel” industry is growing at the rate of 17% per year, and would be worth $674 billion by 2017. “We think that’s a conservative estimate, compared to the figure of $953 billion reached by Euromonitor,” Hanisko said.

In some quarters, the economic sector is growing even more rapidly. “REI Adventures’ growth rate is in excess of 20% per year, and growth for 2018 for safari is definitely in excess of 30%,” said Justin Wood, manager of program development and operations at REI Adventures. The company, a member of the ATTA with over 100 retail outlets, began offering trips in 1987, he added.

REI’s safaris are an educational experience, and no aspect of them involves hunting animals, explained Wood, unlike other tour operators.

“We just sent out the survey for our 2018 snapshot, and we fully expect it to trend positively,” noted Hanisko, who said that large members of the association are expanding women-focused trips and conservation elements, such as the elimination of plastic water bottles.

¹ “Coping with Success: Managing overcrowding in tourism destinations.” World Travel and Tourism Council and McKinsey & Co. Dec. 2017.https://www.wttc.org/research/policy-research/managing-overcrowding-in-tourism-destinations/

² “North American Adventure Travelers: Seeking Personal Growth, New Destinations, and Immersive Culture: October 2017 Update,” Viren P, Murray A, Brown T. (research director, Outside Magazine), Beckmann C. (ATTA).

Saturday, February 3, 2018

Prevailing Nosology Insufficient to Identify Violent Children for Whom Psychiatric Medication Might be Considered, according to AACAP Presentation

(Enterprise Reporting from the AACAP Institute)

by John Otrompke

Current categories used to describe children who engage in dysfunctional aggression are insufficiently precise to determine when they should be treated with psychiatric medication, according to a presentation at last week’s Pediatric Psychopharmacology Update Institute in New York.

“Historically, we’d put them under the rubric of child-onset conduct disorder,” said Robert Findling, MD, MBA, vice president of psychiatric services and research at the Kennedy Krieger Institute at Johns Hopkins University in Baltimore.

Findling noted that oppositional defiance disorder is also sometimes used to characterize pediatric patients.

“But I want to make clear that while these diagnoses are suitable for many youngsters, the presence for either of these diagnoses should never be a reason for necessarily prescribing a medicine,” said Findling, who gave the presentation, entitled “Disruptive Behavior Disorders and Dysfunctional Aggression: When Might Pharmacotherapy be Considered?” at the AACAP event on Friday, January 26. “We’d like to be find a means by which to characterize these youngsters more efficiently,” he added, during an exclusive phone interview for this blog.

Analyze Violent Children as Individuals, Expert Says

Aggression is either predatory (in other words, goal-directed) or affective (or impulsive), according to the presentation. “There is no pharmacological approach for the treatment of predatory aggression,” noted Findling, who pointed out that all of the research discussed in his presentation was off-label. (Findling also disclosed a number of commercial relationships between himself or his institution and ventures such as pharmaceutical companies).

The problem is that some children diagnosed with either disorder are impulsively aggressive, while others are predatory.

“We don’t have a good label for this group of kids who often have bad outcomes,” said Findling.

Some of the characteristic acts of children who engage in dysfunctional aggression include physical cruelty to animals or people, forced sex, and possessing weapons.

Conduct disorder, which has been validated in children four or five years old, is present in 2.5% of children, and half of children w ADHD. Twenty-five percent of those with ADHD remain impulsively aggressive even if their pharmacological therapy is optimized, according to the presentation.

“We know what happens with these kids long-term: substance abuse, jail, depression, and premature death. It’s heart-breaking to see them as they get older, start scarring over and get tougher. The take-home message is that every youngster needs to be considered as an individual,” added Findling, who recommended that researchers review the CERT guidelines for thoughts on alternative nosology.(1)

Updated Results from TOSCA Study Analyzed

Findling recently co-authored an extended follow-up analysis from the TOSCA (Treatment of Severe Childhood Aggression) study.(2)

TOSCA, as originally described in a 2014 article in JAACAP(3), randomized 168 children between six and 12 years old into two arms: one group received a stimulant plus parental training along with a placebo, while the second group received the same, but with risperidone added.

In the follow-up, Findling and colleagues analyzed data from 103 of the 168 subjects in the original 9-week trial for an additional 12 weeks, using a ‘last analysis carried forward’ technique, in which researchers took the last observations from subjects who did not complete the entire study, and “simply extended them for the rest of the study,” according to Findling.

“What got you better kept you better,” he added, noting that the participants were never re-randomized.

Both groups in the initial TOSCA trial experienced improvements. “Parent ratings of problem behavior showed minimal worsening of behavior from the end of the 9-week acute trial,” however, according to the abstract.

“We found in our extension study that those who did well, stayed well, regardless of what their initial treatment was,” Findling explained.

In addition, when those who did not respond were included in the intent-to-treat analysis, subjects who received risperidone showed more improvement than those who did not, according to certain measures, such as the Antisocial Behavior Scale Reactive Aggression subscale (p = 0.03).

¹ Rosato N, Correll C, Pappadopulos E, et al. Treatment of Maladaptive Aggression in Youth: CERT Guidelines II. Treatments and Ongoing Management. Pediatrics, May 2012.

http://pediatrics.aappublications.org/content/early/2012/05/23/peds.2010-1361

² Findling R, Townsend L, Brown N, et al. “The Treatment of Severe Childhood Aggression Study: 12 Weeks of Extended, Blinded Treatment in Clinical Responders.” Journal of Child and Adolescent Psychopharmacology. February 2017, 27(1): 52-65. https://doi.org/10.1089/cap.2016.0081

³ Aman MG, Bukstein OG, Gadow KD, et al. What does risperidone add to parent training and stimulant for severe aggression in child attention-deficit/hyperactivity disorder? J Am Acad Child Adolesc Psychiatry. 2014;53:47-60.