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Canada should delay MAID for people with mental disorders: psychiatrists

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Canada is not ready to expand medical assistance in dying for people with a mental disorder, leaving psychiatrists across the country “incredibly concerned” about patients needing better access to care, including for addiction services, says a group representing the specialists across the country.

The Association of Chairs of Psychiatry in Canada, which includes heads of psychiatry departments at all 17 medical schools, issued a statement Thursday calling for a delay to the change set to be implemented in mid-March.

Lack of public education on suicide prevention as well as an agreed-upon definition of irremediability, or at what point someone will not be able to recover, are also important, unresolved issues, the statement says.

“As a collective organization, we recognize that a lot of work is being done in Canada on this issue,” Dr. Valerie Taylor, who heads the group, said in the statement.

“Further time is required to increase awareness of this change and establish guidelines and standards to which clinicians, patients and the public can turn for more education and information,” said Taylor, who is also chair of the psychiatry department at the University of Calgary.

A statement from the office of federal Health Minister Jean-Yves Duclos says Canada is committed to implementing MAID for those with a mental disorder by keeping their safety and security at the forefront.

“We will continue to listen to the experts, including those at the front lines and those with lived experience, and collaborate with our provincial and territorial counterparts to ensure that a strong framework is in place to guide MAID assessors and providers before MAID becomes available to those for whom mental disorders are the sole underlying condition.”

The office did not say whether the implementation expected on March 17 would be delayed.

Dr. Jitender Sareen, head of the psychiatry department at the University of Manitoba, said many controversial issues were discussed at the group’s annual meeting in October regarding which patients with a mental disorder could be eligible for MAID, seven years after the practice was legalized in Canada for those with a physical ailment.

“If a person wants MAID solely for mental health conditions, we don’t have the clear standards around definitions of who’s eligible. How many assessments and what kinds of assessment would they actually need?” he said.

Sareen also called for training for health providers doing the assessments to begin sooner than its expected rollout next fall. Psychiatrists want clarity on what could be a request for suicide compared with MAID, leaving them to determine a path toward treatment or providing euthanasia, he added.

“There is still controversy around that between providers. Some people believe suicide is impulsive and self-destructive. But that’s not necessarily the case. People can have thoughts about suicide without a mental health condition, an active condition like depression or schizophrenia.”

Patients in rural communities may lack access to mental health care, and those struggling with addiction who have little to no access to harm-reduction services like supervised injection sites could also be left suffering until they try to seek MAID as a way out, said Sareen, who specializes in addiction services.

“We’re in the middle of an opioid epidemic. And we’re in the middle of a mental health pandemic. Post-COVID, wait times for access to treatment are the highest ever,” he said.

“As a group of department heads in the country who are responsible for medical education both for psychiatrists and residents, we’re saying, ‘Look, let’s put things aside as far as whether we agree with this law change or not.’ We’re just concerned we’re not ready for March.”

The federal parliamentary committee reviewing the law to expand MAID to those with a mental disorder issued an interim report in June and is expected to publish a final report in October. However, it has been delayed until February.

The final report of an expert panel was released in May with 19 recommendations, including training for doctors and nurse practitioners assessing MAID requests to address topics like the impact of race, socioeconomic status and cultural sensitivity.

The report also said the expansion of MAID raises additional challenges involving those who are elderly, have neurodevelopmental or intellectual disabilities and people who are in prison, where the prevalence of mental disorders is high compared with the general population.

The panel relied on evidence from Belgium and the Netherlands, which it said have the most extensive set of safeguards, protocols and guidance overall.

Dr. Derryck Smith, a psychiatrist in Vancouver and a past board member of Dying With Dignity, said that while there is no doubt that MAID is a divisive topic among his peers across Canada, he believes there’s a need to wait for the special parliamentary committee’s final report “before we try to slow the process down.”

Smith said lack of access to care for mental health is no different than that for physical ailments so any delay in implementing the new law is a basis for discrimination.

“The healthcare system is crumbling around us but that’s a different matter altogether,” he said. “What concerns me as well is what is so special about psychiatric illness. Why are we putting stigma around psychiatric illness?”

The Canadian Mental Health Association said it is focused on ensuring Canadians have access to universal mental health care with supports that are fully integrated into the public system and available for free.

“This includes recognizing the social determinants that are prerequisites for good mental health by providing housing and income and food supports that help keeps people well, safe and out of poverty, and which create conditions that may mitigate requests for MAID,” it said in a statement.

This report by The Canadian Press was first published Dec. 1, 2022.

This story was produced with financial assistance from the Canadian Medical Association.

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STD epidemic slows as new syphilis and gonorrhea cases fall in US

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NEW YORK (AP) — The U.S. syphilis epidemic slowed dramatically last year, gonorrhea cases fell and chlamydia cases remained below prepandemic levels, according to federal data released Tuesday.

The numbers represented some good news about sexually transmitted diseases, which experienced some alarming increases in past years due to declining condom use, inadequate sex education, and reduced testing and treatment when the COVID-19 pandemic hit.

Last year, cases of the most infectious stages of syphilis fell 10% from the year before — the first substantial decline in more than two decades. Gonorrhea cases dropped 7%, marking a second straight year of decline and bringing the number below what it was in 2019.

“I’m encouraged, and it’s been a long time since I felt that way” about the nation’s epidemic of sexually transmitted infections, said the CDC’s Dr. Jonathan Mermin. “Something is working.”

More than 2.4 million cases of syphilis, gonorrhea and chlamydia were diagnosed and reported last year — 1.6 million cases of chlamydia, 600,000 of gonorrhea, and more than 209,000 of syphilis.

Syphilis is a particular concern. For centuries, it was a common but feared infection that could deform the body and end in death. New cases plummeted in the U.S. starting in the 1940s when infection-fighting antibiotics became widely available, and they trended down for a half century after that. By 2002, however, cases began rising again, with men who have sex with other men being disproportionately affected.

The new report found cases of syphilis in their early, most infectious stages dropped 13% among gay and bisexual men. It was the first such drop since the agency began reporting data for that group in the mid-2000s.

However, there was a 12% increase in the rate of cases of unknown- or later-stage syphilis — a reflection of people infected years ago.

Cases of syphilis in newborns, passed on from infected mothers, also rose. There were nearly 4,000 cases, including 279 stillbirths and infant deaths.

“This means pregnant women are not being tested often enough,” said Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California.

What caused some of the STD trends to improve? Several experts say one contributor is the growing use of an antibiotic as a “morning-after pill.” Studies have shown that taking doxycycline within 72 hours of unprotected sex cuts the risk of developing syphilis, gonorrhea and chlamydia.

In June, the CDC started recommending doxycycline as a morning-after pill, specifically for gay and bisexual men and transgender women who recently had an STD diagnosis. But health departments and organizations in some cities had been giving the pills to people for a couple years.

Some experts believe that the 2022 mpox outbreak — which mainly hit gay and bisexual men — may have had a lingering effect on sexual behavior in 2023, or at least on people’s willingness to get tested when strange sores appeared.

Another factor may have been an increase in the number of health workers testing people for infections, doing contact tracing and connecting people to treatment. Congress gave $1.2 billion to expand the workforce over five years, including $600 million to states, cities and territories that get STD prevention funding from CDC.

Last year had the “most activity with that funding throughout the U.S.,” said David Harvey, executive director of the National Coalition of STD Directors.

However, Congress ended the funds early as a part of last year’s debt ceiling deal, cutting off $400 million. Some people already have lost their jobs, said a spokeswoman for Harvey’s organization.

Still, Harvey said he had reasons for optimism, including the growing use of doxycycline and a push for at-home STD test kits.

Also, there are reasons to think the next presidential administration could get behind STD prevention. In 2019, then-President Donald Trump announced a campaign to “eliminate” the U.S. HIV epidemic by 2030. (Federal health officials later clarified that the actual goal was a huge reduction in new infections — fewer than 3,000 a year.)

There were nearly 32,000 new HIV infections in 2022, the CDC estimates. But a boost in public health funding for HIV could also also help bring down other sexually transmitted infections, experts said.

“When the government puts in resources, puts in money, we see declines in STDs,” Klausner said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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World’s largest active volcano Mauna Loa showed telltale warning signs before erupting in 2022

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WASHINGTON (AP) — Scientists can’t know precisely when a volcano is about to erupt, but they can sometimes pick up telltale signs.

That happened two years ago with the world’s largest active volcano. About two months before Mauna Loa spewed rivers of glowing orange molten lava, geologists detected small earthquakes nearby and other signs, and they warned residents on Hawaii‘s Big Island.

Now a study of the volcano’s lava confirms their timeline for when the molten rock below was on the move.

“Volcanoes are tricky because we don’t get to watch directly what’s happening inside – we have to look for other signs,” said Erik Klemetti Gonzalez, a volcano expert at Denison University, who was not involved in the study.

Upswelling ground and increased earthquake activity near the volcano resulted from magma rising from lower levels of Earth’s crust to fill chambers beneath the volcano, said Kendra Lynn, a research geologist at the Hawaiian Volcano Observatory and co-author of a new study in Nature Communications.

When pressure was high enough, the magma broke through brittle surface rock and became lava – and the eruption began in late November 2022. Later, researchers collected samples of volcanic rock for analysis.

The chemical makeup of certain crystals within the lava indicated that around 70 days before the eruption, large quantities of molten rock had moved from around 1.9 miles (3 kilometers) to 3 miles (5 kilometers) under the summit to a mile (2 kilometers) or less beneath, the study found. This matched the timeline the geologists had observed with other signs.

The last time Mauna Loa erupted was in 1984. Most of the U.S. volcanoes that scientists consider to be active are found in Hawaii, Alaska and the West Coast.

Worldwide, around 585 volcanoes are considered active.

Scientists can’t predict eruptions, but they can make a “forecast,” said Ben Andrews, who heads the global volcano program at the Smithsonian Institution and who was not involved in the study.

Andrews compared volcano forecasts to weather forecasts – informed “probabilities” that an event will occur. And better data about the past behavior of specific volcanos can help researchers finetune forecasts of future activity, experts say.

(asterisk)We can look for similar patterns in the future and expect that there’s a higher probability of conditions for an eruption happening,” said Klemetti Gonzalez.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Waymo’s robotaxis now open to anyone who wants a driverless ride in Los Angeles

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Waymo on Tuesday opened its robotaxi service to anyone who wants a ride around Los Angeles, marking another milestone in the evolution of self-driving car technology since the company began as a secret project at Google 15 years ago.

The expansion comes eight months after Waymo began offering rides in Los Angeles to a limited group of passengers chosen from a waiting list that had ballooned to more than 300,000 people. Now, anyone with the Waymo One smartphone app will be able to request a ride around an 80-square-mile (129-square-kilometer) territory spanning the second largest U.S. city.

After Waymo received approval from California regulators to charge for rides 15 months ago, the company initially chose to launch its operations in San Francisco before offering a limited service in Los Angeles.

Before deciding to compete against conventional ride-hailing pioneers Uber and Lyft in California, Waymo unleashed its robotaxis in Phoenix in 2020 and has been steadily extending the reach of its service in that Arizona city ever since.

Driverless rides are proving to be more than just a novelty. Waymo says it now transports more than 50,000 weekly passengers in its robotaxis, a volume of business numbers that helped the company recently raise $5.6 billion from its corporate parent Alphabet and a list of other investors that included venture capital firm Andreesen Horowitz and financial management firm T. Rowe Price.

“Our service has matured quickly and our riders are embracing the many benefits of fully autonomous driving,” Waymo co-CEO Tekedra Mawakana said in a blog post.

Despite its inroads, Waymo is still believed to be losing money. Although Alphabet doesn’t disclose Waymo’s financial results, the robotaxi is a major part of an “Other Bets” division that had suffered an operating loss of $3.3 billion through the first nine months of this year, down from a setback of $4.2 billion at the same time last year.

But Waymo has come a long way since Google began working on self-driving cars in 2009 as part of project “Chauffeur.” Since its 2016 spinoff from Google, Waymo has established itself as the clear leader in a robotaxi industry that’s getting more congested.

Electric auto pioneer Tesla is aiming to launch a rival “Cybercab” service by 2026, although its CEO Elon Musk said he hopes the company can get the required regulatory clearances to operate in Texas and California by next year.

Tesla’s projected timeline for competing against Waymo has been met with skepticism because Musk has made unfulfilled promises about the company’s self-driving car technology for nearly a decade.

Meanwhile, Waymo’s robotaxis have driven more than 20 million fully autonomous miles and provided more than 2 million rides to passengers without encountering a serious accident that resulted in its operations being sidelined.

That safety record is a stark contrast to one of its early rivals, Cruise, a robotaxi service owned by General Motors. Cruise’s California license was suspended last year after one of its driverless cars in San Francisco dragged a jaywalking pedestrian who had been struck by a different car driven by a human.

Cruise is now trying to rebound by joining forces with Uber to make some of its services available next year in U.S. cities that still haven’t been announced. But Waymo also has forged a similar alliance with Uber to dispatch its robotaxi in Atlanta and Austin, Texas next year.

Another robotaxi service, Amazon’s Zoox, is hoping to begin offering driverless rides to the general public in Las Vegas at some point next year before also launching in San Francisco.

The Canadian Press. All rights reserved.

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