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A 1980 Letter on the Risk of Opioid Addiction N Engl J Med 2017

A 1980 Letter on the Risk of Opioid Addiction
N Engl J Med 2017; 376:2194-2195June 1, 2017DOI: 10.1056/NEJMc1700150

To the Editor:

The prescribing of strong opioids such as oxycodone has increased dramatically in the United States and Canada over the past two decades.1 From 1999 through 2015, more than 183,000 deaths from prescription opioids were reported in the United States,2 and millions of Americans are now addicted to opioids. The crisis arose in part because physicians were told that the risk of addiction was low when opioids were prescribed for chronic pain. A one-paragraph letter that was published in the Journal in 19803 was widely invoked in support of this claim, even though no evidence was provided by the correspondents (see Section 1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org).
We performed a bibliometric analysis of this correspondence from its publication until March 30, 2017. For each citation, two reviewers independently evaluated the portrayal of the article’s conclusions, using an adaptation of an established taxonomy of citation behavior4 along with other aspects of generalizability (Section 2 in the Supplementary Appendix). For context, we also ascertained the number of citations of other stand-alone letters that were published in nine contemporaneous issues of the Journal (in the index issue and in the four issues that preceded and followed it).
We identified 608 citations of the index publication and noted a sizable increase after the introduction of OxyContin (a long-acting formulation of oxycodone) in 1995 (Figure 1FIGURE 1
Number and Type of Citations of the 1980 Letter, According to Year.). Of the articles that included a reference to the 1980 letter, the authors of 439 (72.2%) cited it as evidence that addiction was rare in patients treated with opioids. Of the 608 articles, the authors of 491 articles (80.8%) did not note that the patients who were described in the letter were hospitalized at the time they received the prescription, whereas some authors grossly misrepresented the conclusions of the letter (Section 3 in the Supplementary Appendix). Of note, affirmational citations have become much less common in recent years. In contrast to the 1980 correspondence, 11 stand-alone letters that were published contemporaneously by the Journal were cited a median of 11 times.
In conclusion, we found that a five-sentence letter published in the Journal in 1980 was heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy. We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy. In 2007, the manufacturer of OxyContin and three senior executives pleaded guilty to federal criminal charges that they misled regulators, doctors, and patients about the risk of addiction associated with the drug.5 Our findings highlight the potential consequences of inaccurate citation and underscore the need for diligence when citing previously published studies.

Pamela T.M. Leung, B.Sc. Pharm.
University of Toronto, Toronto, ON, Canada
Erin M. Macdonald, M.Sc.
Matthew B. Stanbrook, M.D., Ph.D.
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
Irfan A. Dhalla, M.D.
Li Ka Shing Knowledge Institute, Toronto, ON, Canada
David N. Juurlink, M.D., Ph.D.
Sunnybrook Research Institute, Toronto, ON, Canada


CRISPR Can Cause Hundreds of Unintended Mutations

CRISPR Can Cause Hundreds of Unintended Mutations
Wed, 05/31/2017 - 8:05am
by Columbia University Medical Center

As CRISPR-Cas9 starts to move into clinical trials, a new study published in Nature Methods has found that the gene-editing technology can introduce hundreds of unintended mutations into the genome.

"We feel it's critical that the scientific community consider the potential hazards of all off-target mutations caused by CRISPR, including single nucleotide mutations and mutations in non-coding regions of the genome," says co-author Stephen Tsang, MD, PhD, the Laszlo T. Bito Associate Professor of Ophthalmology and associate professor of pathology and cell biology at Columbia University Medical Center and in Columbia's Institute of Genomic Medicine and the Institute of Human Nutrition.


The researchers determined that CRISPR had successfully corrected a gene that causes blindness, but Kellie Schaefer, a PhD student in the lab of Vinit Mahajan, MD, PhD, associate professor of ophthalmology at Stanford University, and co-author of the study, found that the genomes of two independent gene therapy recipients had sustained more than 1,500 single-nucleotide mutations and more than 100 larger deletions and insertions. None of these DNA mutations were predicted by computer algorithms that are widely used by researchers to look for off-target effects.

"Researchers who aren't using whole genome sequencing to find off-target effects may be missing potentially important mutations," Dr. Tsang says. "Even a single nucleotide change can have a huge impact."

More at https://www.biosciencetechnology.com/news/2017/05/crispr-can-cause-hundreds-unintended-mutations

These companies are racing to develop a Breathalyzer for pot

These companies are racing to develop a Breathalyzer for pot
POSTED 10:00 PM, MAY 28, 2017, BY CNN WIRE


...Hound Labs announced on Tuesday that it has raised $8.1 million from the venture capital company Benchmark, which funded Uber and Tinder, and has started clinical trials in conjunction with the University of California, San Francisco.

The Hound device is designed to detect both marijuana and alcohol in human breath. Dr. Michael Lynn, the CEO, said his company is planning to sell it by the end of the year.

“We tested on so many people now that we’re quite confident,” he told CNNMoney.

He said his company’s device will cost $600 to $800 and will be sold to police departments — and employers, too. In the eight states where recreational pot is legal, companies might not care whether their workers smoked weed the night before, but would definitely care if they are driving trucks or school buses while stoned....


Nuclear industry prices itself out of power market, demands taxpayers keep it afloat

Nuclear industry prices itself out of power market, demands taxpayers keep it afloat

Nuclear power is so expensive even some conservatives are turning on it

The nuclear industry is so uncompetitive that half of U.S. nuclear power plants are no longer profitable. And if existing nukes are uneconomic, it’s no surprise that new nuclear plants are wildly unaffordable.
New York and Illinois have already agreed to more than $700 million a year in subsidies, and if all northeast and mid-Atlantic nukes got similar subsidies, it would cost U.S. consumers $3.9 billion a year. Things are so bad for the nuclear industry that, recently, even conservatives have started to publicly oppose the subsidies the industry needs to survive.
“Ever since the completion of the first wave of nuclear reactors in 1970, and continuing with the ongoing construction of new reactors in Europe, nuclear power seems to be doomed with the curse of cost escalation,” explained one 2015 journal article, “Revisiting the Cost Escalation Curse of Nuclear Power.”
At the same time, nuclear’s main competition — natural gas, energy efficiency, and renewables — have gotten much cheaper.
Last week, the Atlanta Journal-Constitution reported on the umpteenth cost overruns in Georgia Power’s effort to built two new reactors, with the headline, “Plant Vogtle: Georgia’s nuclear ‘renaissance’ now a financial quagmire.” The Westinghouse plants, originally priced at a whopping $14 billion are “currently $3.6 billion over budget and almost four years behind the original schedule.” Westinghouse filed for bankruptcy in March.
The Georgia debacle should not shock anyone...


As 100 Percent Renewables Become the New Norm, a New Role for Utilities Emerges

As 100 Percent Renewables Become the New Norm, a New Role for Utilities Emerges
May 22, 2017
By Indran Ratnathicam

Portland, Ore., is one of the most recent municipalities to join dozens of cities and states across the U.S. in pledges to run on 100 percent renewable energy in the coming decades. Portland is taking a two-step approach toward its goal: first, the city and county in which it’s located have committed to work with energy utilities Portland General Electric (PGE) and Pacific Power to shift the electricity portfolio to renewable sources by 2035; second, it will eliminate all direct fossil fuel use, such as vehicle fuels, natural gas and home heating oil.

While Portland prides itself on being environmentally conscious, more and more government leaders across the country are introducing similarly aggressive measures — from Midwestern cities such as Chicago and Madison, Wis., to San Diego and the state of Hawaii.

A similar movement is happening at the corporate level. Leaders of some of the nation’s biggest companies are adopting 100 percent renewable purchasing initiatives. Leaders include Walmart, Nike, Nestle, Salesforce, Microsoft and Facebook, among many others, and are all part of the global Renewable Energy 100 Initiative. Per RE100’s 2016 annual report, the 90 companies in the program were, on average, already halfway to reaching their goal. Salesforce even accomplished its aim to achieve net zero carbon emissions across its global footprint by 2050, a whopping 33 years earlier than anticipated. Now that’s some serious momentum.

Wind and solar are among the most popular renewable energy sources, and companies are putting significant dollars behind adopting and expanding these programs. Wind has blown its way to the top of the list of renewables with record growth in 2016, according to the American Wind Energy Association (AWEA). The growth is due in part to large-scale corporate initiatives such as General Motor’s (GM) wind-powered Arlington, TX assembly plant and 7-Eleven’s plan to power most of its Texas stores with wind energy beginning in 2018. Joining the likes of GM and 7-Eleven, as well as Facebook and Home Depot in wind energy investments, Apple recently announced that a soon-to-be-built wind farm in Oregon will power one of its data centers, which is located about 130 miles away. This is Apple’s largest renewable energy investment to date.

Given government organizations and corporations make up most of a utility’s customer base...


Physicians for a National Health Program support single-payer national health insurance.

Who is PNHP
Physicians for a National Health Program is a non-profit research and education organization of 20,000 physicians, medical students and health professionals who support single-payer national health insurance.


Q: Should Hillary return to the Senate in 2018?

If so, in what type of state should she make her run?

Stacked value: Combine distributed energy resources and goals to dramatically raise ROI

Stacked value: Combine distributed energy resources and goals to dramatically raise ROI
May 17, 2017

When it comes to achieving the best possible ROI from battery storage investments, a lot of potential value is being left on the table. This is mostly because many energy storage purchasers use only a fraction of their storage capacity. Worse, many target only one use with their storage systems, even though batteries can provide multiple uses and value streams.

The Rocky Mountain Institute’s report titled The Economics of Battery Energy Storage notes that an energy storage system dispatched solely for demand charge reduction is utilized for only 5–50% of its useful life, whereas dispatching batteries for a primary application and then re-dispatching them to provide multiple, stacked services make the economics of storage much greater.

In fact, a holistic approach that combines battery storage with other distributed energy resources (DERs) such as controllable loads can increase value streams dramatically and can, in fact, cut battery project payback times in half.

Enbala recently quantified the economics of storage alone versus storage plus load for a large energy service provider (ESP) seeking to control battery storage on C&I accounts so it could engage in a power purchase agreement (PPA) with a west coast utility. The primary goal was to provide capacity to the regional ISO (CAISO) using behind-the-meter storage. If the network could maintain its commitment level to the ISO, additional services and revenue streams could be stacked on, with the ESP retaining the rights to this additional value...


Tucson Electric signs solar + storage PPA for 'less than 4.5/kWh'

Tucson Electric signs solar + storage PPA for 'less than 4.5¢/kWh'
Gavin Bade

May 23, 2017
Dive Brief:

Tucson Electric Power has signed a power purchase agreement for a solar-plus-storage system at "an all-in cost significantly less than $0.045/kWh over 20 years," according to a company official. Exact prices are confidential, but a release pegged the PPA for the solar portion of the project at below $0.03/kWh.

The project, being developed by an affiliate of NextEra Energy Resources, calls for a 100 MW solar array combined with a 30 MW, 120 MWh energy storage system. If the pricing proves accurate, it would represent a major cost reduction for combined storage facilities since the signing of the last significant PPA — a $0.11/kWh Hawaii contract in January.

The PPA would confirm a forecast in Arizona's proposed "Clean Peak Standard" that solar-plus-storage facilities could compete with gas peakers on price. But TEP does not support the proposal, now on hold with regulators, and Energy Supply Director Carmine Tilghman said batteries do not provide the same capabilities as peaker plants.


See also
Plant Vogtle: Georgia’s nuclear ‘renaissance’ now a financial quagmire

BUSINESS By Russell Grantham and Johnny Edwards - The Atlanta Journal-Constitution

Southern Company’s chief executive has said more than once that the giant utility’s project to build two more nuclear reactors at Plant Vogtle would be history-making.
He may be right, but not in the way he meant.

Years behind schedule, billions over budget, and with a key contractor’s bankruptcy clouding its future, the troubled Vogtle project near Augusta is fast becoming Exhibit A for why no U.S. utility before Atlanta-based Southern had tried building a new reactor in 30-plus years....


Syrian refugees in Jordan's desert get solar power

Syrian refugees in Jordan's desert get solar power
Karin Laub, Associated Press 10:06 p.m. ET May 19, 2017

AMMAN, Jordan — Syrian refugees in Jordan's remote desert were connected to solar power on Wednesday, making their community the world's first refugee camp to be powered by renewable energy.

The $4.5-million plant was funded by a foundation established by Ikea, the global home furnishings retailer. In the first phase, it will serve 20,000 of 35,000 people in Azraq camp.

The plant's capacity is to be more than doubled to provide power to all residents, for an eventual cost of $9.7 million, the United Nations refugee agency said...

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